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9&OHIO  STATE 


OWNED  AND  PUBLISHED  MONTHLY  BY 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 

AS  A MEDIUM  OF  SERVICE  TO  ITS  MEMBERS 


JANUARY  1,  1933 


VOLUME  XXIX 
Number  - - - 1 


Have  you  paid  YOUR  1933  MEMBERSHIP  DUES  in  the 
Ohio  State  Medical  Association  ? 

If  not,  you  should  do  so  immediately  to  the  Secretary-Treasurer  of  your  county 
medical  society  or  academy  of  medicine. 

Your  continuous  good  standing  in  medical  organization  is  based  on  the  payment 
of  your  membership  dues  ON  OR  BEFORE  JANUARY  1.  Moreover,  payment  of  your 
1933  dues  now  will  insure  your  receiving  THE  JOURNAL,  the  annual  subscription  for 
which  is  included  in  your  membership  dues. 

Don’t  neglect  this  important  matter.  You  need  the  numerous  benefits  which 
membership  in  organized  medicine  affords.  Medical  organization  needs  your  active 
interest  and  cooperation. 


eh 


ontents 


lummary  of  Qq 

ORIGINAL  ARTICLES 

Abdominal  Surgery  in  Children.  Norris  W.  Gillette,  A.B.,  M.D.,  F.A.C.S.,  Toledo, 
Ohio  _ 


Migraine-Like  Headache  Due  to  Allergy.  Jonathan  Forman,  B.A.,  M.D.,  Colum- 
bus, Ohio  „ . 1 

Ophthalmic  Manifestations  of  Otic  Disease.  M.  F.  McCarthy,  M.D.,  Cincinnati, 

Ohio  | 

Tularemia.  A Summary  of  Recent  Researches,  with  a Consideration  of  103  Dayton 
Cases.  Walter  M.  Simpson,  M.S.,  M.D.,  F.A.C.P.,  Dayton,  Ohio. 


The  Intracapsular  Operation  of  Cataract:  A Survey  of  Fifty  Years’  Experience. 

J.  W.  Wright,  M.D.,  Columbus,  Ohio 1_ . _ 

The  President’s  Page.  H.  M.  Platter,  M.D.,  Columbus,  Ohio-..: L 


23 

28 

31 

35 

41 

43 


EDITORIAL 

Important  Legisative  Issues  Affecting  Public 
Health  and  Medical  Practice  Anticipated 

in  90th  General  Assembly 

Socialization  of  Medicine  Advocated  in  Ma- 
jority Report  of  National  Committee  on 

the  Costs  of  Medical  Care 

Harmonious  Coordination  is  Necessary 

STATE  NEWS 

Numerous  Important  Policy  and  Organization 
Problems  Considered  by  the  Council  at 
its  Last  Meeting  for  1932 : Preparations 
Made  for  1933 


Official  Statement  Issued  by  the  Council  of 
The  Ohio  State  Medical  Association  od 


17 

19 

of  Medical  Care  . „ 

Important  Public  Health  Questions  Discussed 
at  Well-Attended  Annual  Conference  of 
Ohio  Health  Commissioners  and  Public 
Health  Nurses  

22 

Mid-Winter  Examinations  by 
Board  

State  Medical 

News  Notes  from  County 
Academies  

Societies  and 

Deaths  in  Ohio . . ... 

News  Notes  of  Ohio 

44 

Classified  Advertisements  ... 

SO 

61 


66 

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66 

68 


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INSTITUTIONS 


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qpar\Pi  Tavet  Streptococcus  j^W-OXAn 


SCARLET 

FEVER 

prevention 


, , ^msiKAV  Hiinamrara  wire 


Scarlet  Fever  immunization  is  es- 
pecially important  in  institutions. 

It  eliminates  the  ever-present  dan- 
ger of  contagion. 

An  instance  of  the  effectiveness 
of  this  protection  is  given  in  the 
September,  1932,  issue  of  the  American 
Journal  Diseases  of  Children.  Of  258  adults 
examined  in  the  Children’s  Memorial  Hos- 
pital of  Chicago,  186  gave  negative  reac- 
tions to  the  Dick  Test  and  none  of  these 
contracted  Scarlet  Fever  during  an  epi- 
demic. Forty  of  the  forty-five  who  gave 
positive  reactions  were  immunized  with 
Squibb  Scarlet  Fever  Toxin  to  the  point 
of  negative  skin  reactions.  Only  two  of 
these  contracted  Scarlet  Fever  and  they 
contracted  mild  cases  before  the  immuni- 
zation was  completed.  Two  of  the  five  who 
were  not  immunized  contracted  severe 
attacks  of  the  disease. 

Equally  effective  results  have  been  noted 
in  the  control  of  a number  of  epidemics 
throughout  the  country.  It  has  been  proved 


without  doubt  that  with  proper  measures 
of  immunization  no  susceptible  person 
need  have  Scarlet  Fever. 

Squibb  Scarlet  Fever  Products  are  made 
under  license  from  the  Scarlet  Fever  Com- 
mittee, Incorporated.  A triple  control  of 
the  Squibb  Scarlet  Fever  Products  assures 
potency.  This  control  includes  laboratory 
tests  and  clinical  trials,  approval  of  the 
National  Institute  of  Health  at  Washing- 
ton, D.  C.,  and  tests  by  the  Scarlet  Fever 
Committee,  Incorporated. 

Squibb  Authorized  Scarlet  Fever  Prod- 
ucts include  Scarlet  Fever  Toxin  for  Dick 
test  and  immunization,  and  Squibb  Scarlet 
Fever  Antitoxin  for  temporary  prophylaxis 
and  treatment. 


For  literature,  write  Professional  Service 
Department,  745  Fifth  Ave.,  New  York  City 


SQUIBB 


authorized 

SCARLET  FEVER  PRODUCTS 


% \~6  f 


January,  1933 


Advertisements 


1 


The  SAWYER  SANATORIUM 

White  Oaks  Farm,  Marion,  Ohio 

f RE  ATS  NERVOUS  AND  MENTAL  DISEASES 


Provides  Thorough  Diagnosis,  Scientific  Treatment,  Homelike  Surroundings,  Complete 
Equipment,  Individual  and  Personal  Professional  Attention,  Splendid  Cuisine,  all  the 
modern  conveniences  of  the  best  private  homes.  Located  on  an  130-acre  farm. 
Presided  over  by  men  and  women  devoting  all  their  time  to  the  work. 

Send  for  Booklet,  Address 

SAWYER  SANATORIUM  WHITE  OAKS  FARM  MARION,  OHIO 


THE  PATIO 


The  Ohio  State  Medical  Association 


Officers  1932-1933 

PRESIDENT 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year;  single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 

Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1933) Cleveland 

Gilbert  Micklethwaite,  M.D.  (1936) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager  | 


H.  M.  Platter,  M.D Columbus 

PRESIDENT-ELECT 

C.  L.  Cummer,  M.D Cleveland 

TREASURER 

James  A.  Beer,  M.D Columbus 

EXECUTIVE  SECRETARY 
Don  K.  Martin Columbus 


State  Council 

First  District 

John  A.  Caldwell,  M.D Cincinnati 

Second  District 

E.  M.  Huston,  M.D Dayton 

Third  District 

0.  P.  Klotz,  M.D Findlay 

Fourth  District 

B.  J.  Hein,  M.D. Toledo 

Fifth  District 

H.  V.  Paryzek,  M.D Cleveland 

Sixth  District 

H.  S.  Davidson,  M.D . Akron 

Seventh  District 

E.  B.  Shanley,  M.D New  Philadelphia 

Eighth  District 

E.  R.  Brush,  M.D. Zanesville 

Ninth  District 

1.  P.  Seiler,  M.D Piketon 

Tenth  District 

S.  J.  Goodman,  M.D Columbus 

Ex-Officio,  The  Ex-President 
D.  C.  Houser,  M.D Urbana 


2 


The  Ohio  State  Medical  Journal 


January,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies  President 


Secretary 


First  District 


Adams R.  L.  Lawwell,  Seaman O.  T.  Sproull,  West  Union 

Brown R.  B.  Hannah,  Georgetown Geo.  P.  Tyler,  Jr.,  Ripley. 

Butler H.  O.  Lund,  Middletown Walter  Roehl,  Middletown 

Clermont J.  K.  Ashburn,  Batavia Allan  B.  Rapp,  Owensville 

Clinton F.  A.  Peele,  Wilmington Wm.  L.  Regan,  Wilmington 

Fayette S.  E.  Boggs,  Washington  C.  H. J.  F.  Wilson,  Washington  C.  H. . 

Hamilton Parke  G.  Smith,  Cincinnati Geo.  B.  Topmoeller,  Cincinnati  — 

Highland J.  C.  Bohl,  Hillsboro W.  B.  Roads,  Hillsboro 


3d  Wednesday  in  April,  June,  Aug. 

Oct. 

4th  Wednesday  in  Feb.,  May  and 
Nov. 

2d  Wednesday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Monday  evening  of  each  week. 

1st  Wednesday,  monthly. 


Warren J.  E.  Witham,  Waynesville James  Arnold,  Lebanon 1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 


Cyril  Hussey,  Sidney H.  R.  Huston,  Dayton 

E.  D.  Buhrer,  Urbana L.  A.  Woodburn,  Urbana 

-E.  H.  Long,  So.  Vienna E.  C.  Nehls,  So.  Charleston 


Second  District 

Champaign  

Clark 

Darke C.  F.  Frankman,  Greenville 

Greene 


_.W.  D.  Bishop,  Greenville 

- L.  L.  Taylor,  Yellow  Springs H.  C.  Schick,  Xenia 

Miami F.  D.  Kiser,  Tippecanoe  City G.  A.  Woodhouse,  Pleasant  Hill — 

Montgomery A.  F.  Kuhl,  Dayton Miss  M.  E.  Jeffrey,  Dayton 

Preble J.  I.  Nisbet,  Eaton C.  E.  Newbold,  Eaton 

Shelby A.  B.  Gudenkauf,  Sidney B.  A.  Welch,  Sidney 


2d  Thursday,  monthly. 

2d  and  4th  Wednesday  noon. 

1st  Friday,  monthly. 

1st  Thursday,  monthly. 

1st  Friday,  monthly,  except  Jnly 
and  August. 

1st  and  3d  Friday  each  month. 

3d  Thursday,  monthly. 

1st  Friday,  monthly. 


Third  District V.  H.  Hay,  Lima C.  E.  Hufford,  Toledo 

Allen E.  C.  Yingling,  Lima H.  L.  Stelzer,  Lima 

Auglaize E.  F.  Heffner,  Wapakoneta C.  C.  Berlin,  Wapakoneta 

Hancock A.  E.  King,  Mt.  Cory H.  O.  Crosby,  Findlay 

Hardin F.  M.  Elliott,  Ada W.  N.  Mundy,  Forest 

Logan O.  C.  Amstutz,  Bellefontaine W.  H.  Carey,  Bellefontaine 

Marion E.  L.  Brady,  Marion Kenneth  D.  Smith,  • Marion 

Mercer M.  B.  Fishbaugh,  Celina F.  E.  Ayers,  Celina 

Seneca E.  H.  Porter,  Tiffin R.  E.  Hershberger,  Tiffin 

Van  Wert A.  T.  Rank,  Van  Wert R.  H.  Good,  Van  Wert 

Wyandot B.  A.  Moloney,  Upper  Sandusky J.  Craig  Bowman,  Up.  Sandusky 

Fourth  District — (With  Third  District  in  Northwestern  Ohio  District) 

Defiance E.  E.  DeMuth,  Hicksville D.  J.  Slosser,  Defiance 

Fulton P.  S.  Bishop,  Delta Geo.  McGuffin,  Pettisville 

Henry T.  P.  Delventhal,  Napoleon F.  M.  Harrison,  Napoleon 

Lucas E.  B.  Gillette,  Toledo A.  P.  Hancuff,  Toledo 

Ottawa R.  A.  Willett,  Elmore Cyrus  R.  Wood,  Port  Clinton 

Paulding L.  R.  Fast,  Paulding Gaile  L.  Doster,  Paulding 

Putnam E.  Blackburn,  Kalida W.  B.  Light,  Ottawa 

Sandusky C.  L.  Smith,  Fremont L.  N.  Bates,  Fremont 

Williams A.  Hathaway,  Edon B.  C.  Bly,  Bryan 

Wood O.  S.  Canright,  Haskins F.  V.  Boyle,  Bowling  Green 


Lima,  1932. 

3d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 
1st  Wednesday,  monthly. 
1st  Thursday,  monthly. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Tuesday,  monthly. 

3rd  Thursday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


3d  Thursday,  monthly. 
2nd  Thursday  monthly. 
2nd  Wednesday,  monthly. 
Friday,  each  week. 

2d  Thursday,  monthly. 

3d  Wednesday,  monthly. 
1st  Tuesday,  monthly. 
Last  Thursday,  monthly. 
3d  Thursday,  monthly. 

3d  Thursday,  monthly. 


I1  if tli  District  .11.  V.  Paryzek,  Councilor.. -Chrm.  Com.  on  Arrangements 

Ashtabula P.  J.  Collander,  Ashtabula E.  H.  Merrell,  Geneva 

Cuyahoga El.  G.  Sloan,  Cleveland Clarence  H.  Heyman,  Cleveland 

Erie H.  W.  Lehrer,  Sandusky G.  A.  Stimson,  Sandusky 

Geauga H.  E.  Shafer,  Middlefield Isa  Teed-Cramton,  Burton 

Huron W.  W.  Lawrence,  Norwalk Geo.  F.  Linn,  Norwalk 

Lake W.  P.  Ellis,  Painesville B.  T.  Church,  Painesville 

Lorain David  Thomas,  Lorain W.  E.  Hart,  Elyria 

Medina Harry  Street,  Litchfield _.J.  K.  Durling,  Wadsworth 

Trumbull Frank  La  Camera,  Warren R.  H.  McCaughtry,  Warren 


_ Cleveland. 

_ 2nd  Tuesday,  monthly. 

3d  Fri.  March,  May,  Sept., 

Nov.,  Dec. 

_ Last  Wednesday,  monthly,  except 
July,  Aug.,  Sept. 

_ Last  Wednesday,  Apr.  to  Dac 

3d  Tuesday,  Feb.,  May, 

August,  Nov. 

--  4th  Tuesday,  monthly. 

— 2d  Tuesday,  monthly. 

1st  Thursday. 


3d  Thursday,  monthly.  axcapv 
June,  July,  August. 


January.  1933 


The  Ohio  State  Medical  Journal 


3 


Societies 

President 

Secretary 

C. 

j. 

w. 

Paul  E.  Kellogg.  Ashland.. 

L. 

c. 

T.  Bahier,  Walnut  Creek- 

A. 

W. 

M.  Skipp,  Youngstown.. 

E. 

J.  Widdecombe,  Kent ..  ..  __ 

W. 

P. 

Stark 

J. 

F. 

Summit 

F! 

A. 

S.  McCormick,  Akron 

Wnvne 

E. 

H.  McKinney.  Doylestown 

R. 

C.  Paul,  Wooster.. 

2d  Wed.,  Jan.,  April  & Oct. 
2nd  Friday,  Sept,  to  May. 

1st  Tuesday,  quarterly,  Jan., 
July,  October. 

3d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  monthly. 

2d  Tuesday,  monthly. 

1st  Tuesday,  monthly. 

2d  Tuesday,  monthly. 


April. 


Se.ditli  District  — 


Balmont G.  L.  Ramsey,  Powhatan  Point 

Carroll (With  Stark  Co.  Society) 

Columbiana G.  E.  Byers,  Salem 


Coshocton R.  E.  Hopkins,  Coshocton 


_A.  C.  Grove,  Jewett_ 


Harrison 

Jefferson  

Monroe 

Tuscarawas C.  J.  Miller,  New  Phila 


Victor  Biddle,  Steubenville 

G.  W.  Steward.  Woodsfield- 


C.  W.  Kirkland,  Bellaire 

_T.  T.  Church,  Salem 

J.  D.  Lower,  Coshocton 

W.  C.  Wallace,  Hopedale 

_John  Y.  Bevan,  Steubenville 

A.  R.  Burkhart,  Woodsfield 

G.  L.  Sackett,  New  Phila 


2d  Wednesday,  monthly  at  1 :45  p.m 

2d  Tuesday,  monthly. 

4th  Thursday,  April,  June,  Sept.. 
December. 

3d  Wednesday,  monthly. 

Last  Thursday,  monthly. 

2d  Wednesday,  monthly. 

2d  Thursday,  monthly. 


Eighth  District 


Athens C.  E.  Welsh,  Nelsonville T.  A.  Copeland,  Athens 

Fairfield W.  B.  Taylor,  Pickerington C.  W.  Brown,  Lancaster 

Guernsey M.  S.  Lawrence,  Quaker  City C.  C.  Headley,  Cambridge . 

Licking H.  A.  Campbell,  Newark G.  A.  Gressle,  Newark 

Morgan D.  G.  Ralston,  McConnelsville C.  E.  Northrup,  MeConnelsville — 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 


1st  Monday,  monthly. 

2d  Tuesday,  monthly. 

1st  and  3rd  Thursday  each  month 
Last  Friday,  monthly. 

3d  Wednesday,  monthly. 

1st  Wednesday,  monthly. 


Noble 


Perry Joseph  Clouse,  Somerset F.  J.  Crosbie,  New  Lexington 3d  Monday,  monthly. 

Washington S.  E.  Edwards,  Marietta E.  W.  Hill,  Jr.,  Marietta 2d  Wednesday,  monthli 


Ninth  District 


Gallia O.  A.  Vornholt,  Gallipolig Milo  Wilson,  Gallipolis 

Socking . H.  M.  Booeks,  Logan . M.  H.  Cherrington,  Logan . 

Jackson J.  S.  Hunter,  Jackson J.  J.  MeClung,  Jackson 

Lawrence Cosper  Burton,  Ironton V.  V.  Smith.  Ironton 

Meigs P.  A.  Jividen,  Rutland Byron  Bing,  Pomeroy 

Pike Paul  Jones,  Stockdale L.  E.  Wills,  Waverly 

Scioto C.  M.  Fitch,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 

Vinton O.  S.  Cox,  McArthur H.  S.  James.  McArthur 


1st  Wed.,  Feb.,  May,  Sept,  and  Dec. 
Quarterly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 

1st  Thursday,  April,  July  and  Oct 
1st  Monday,  monthly. 

2d  Monday,  monthly. 

3d  Wednesday,  monthly 


tenth  District 


Crawford E.  C.  Brandt,  Crestline R.  L.  Solt,  Bucyrus 

Delaware A.  R.  Callander,  Delaware E.  V.  Arnold,  Delaware 

Franklin James  H.  Warren,  Columbus John  H.  Mitchell,  Columbus 

Knox S.  O.  Gantt,  Centerburg R.  L.  Eastman,  Mt.  Vernon 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  JTeffersom 

Morrow W.  D.  Moccabee,  Cardington T.  Caris,  Mt.  Gilead 

Pickaway A.  F.  Kaler,  New  Holland Lloyd  Jonnes,  Circleville . 

Robs Glen  Nisley,  Chillicothe W.  C.  Breth,  Chill icothe 

Union E.  J.  Marsh,  Broadway Angns  Maclvor,  Marysville 


1st  Monday,  monthly. 

1st  Tuesday,  monthly. 

1st  four  Mondays. 

Last  Thursday,  monthly. 
4th  Wednesday,  monthly. 
1st  Wednesday,  monthly. 
1st  Friday,  monthly. 

1st  Thursday,  monthly. 

2d  Tuesday,  monthly. 


4 


Advertisements 


January,  1933 


A MODERN  ETHICAL  HOSPITAL 

Rates:  $25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alcohol,  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  Not  limited  as  to  the  quantity 
used  but  can  give  the  patient  as  much  whiskey  as  his  condition  requires. 

NERVOUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoseine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  that  their  own 
home  affords. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 

tal. Female  attendants  only ; absolute  privacy ; com- 
fortable, well-appointed  ladies’  lounge. 

Cherokee  Road  (Long  Distance  Phone  East  3488) 

THE  STOKES  SANATORIUM 

Louisville,  Ky. 


WHITING  MINERAL  SPRINGS 

Sanitarium  and  Baths 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and 
allied  diseases  together  with  cases  for  elimination  and  rest  cure. 

Medical  department  thoroughly  proficient  and  STRICTLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

DR.  U.  G.  WHITING,  Phy.  & Mgr.  MARTINSVILLE,  INDIANA 


THE  MERCER  SANITARIUM  - MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristown,  Pa.) 


Windsor 

Hospital 

T HE  Windsor  Hospital  and 
Sanitarium  is  completely  equip- 
ped with  all  the  best  apparatus 
for  giving  Hydrotherapy,  Oc- 
cupational Therapy,  and  other 
treatment  for  all  types  of  Nerv- 
ous diseases,  acute  and  chronic. 

Herbert  Sihler 

Director 

Phone  ENdicott  8882 
4415  Chester  Ave.,  N.E. 

(Formerly  4416  Windsor  Ave.,  N.E.) 

CLEVELAND,  OHIO 

ESTABLISHED  30  YEARS 


Service 
Exclusively 
Ethical 

Constant  research,  and  over 
Fifty  Years  experience  in 
manufacturing  pharmaceuti- 
cals for  physicians  is  the  basis 
of  our  honored  reputation. 

We  are  proud  and  appreciative 
of  the  confidence  reposed 


in  us. 


Write  for  our  complete  catalog. 

The  Columbus  PharmacalCo. 

330  OAK  ST.  , COLUMBUS,  OHIO. 


‘With  Editorial  Comment  by  D.K.M. 


Numerous  complicated  and  vital  social,  economic  and  political  problems  of  local, 
state  and  national  significance  confront  organized  medicine  in  Ohio  as  it  enters  a new 
calendar  year. 

The  era  of  unrest  and  agitation  for  a change  has  not  ended.  Events  and  de- 
velopments of  greater  importance  than  those  of  the  past  year  are  in  the  offing. 

The  medical  profession,  like  many  other  groups,  faces  serious  challenges  and  at- 
tacks. The  outcome  may  determine  the  future  course  of  medical  practice  in  this  coun- 
try and  the  destiny  of  the  profession  itself. 

Two  matters  in  particular  which  promise  to  put  the  resources  and  courage  of  the 
medical  profession  to  the  test  during  the  coming  year  are: 

1.  The  forthcoming  session  of  the  Ohio  General  Assembly,  scheduled  to  open  in 
Columbus  on  Monday,  January  2,  during  which  there  will  be  proposed  legislation  bear- 
ing, directly  or  indirectly,  on  public  health,  scientific  medicine  and  medical  practice. 

2.  The  movement  to  socialize  medical  practice  which  has  gained  impetus 
through  propaganda  based  on  the  final  report  of  the  majority  group  of  the  Commit- 
tee on  the  Costs  of  Medical  Care,  some  of  the  recommendations  of  which  are  incon- 
sistent with  sound  social  and  economic  principles,  good  medical  practice,  and  the 
fundamentals  of  competent  medical  care. 

The  matter  of  preparing  to  meet  the  problems  raised  by  these  two  developments 
should  be  of  vital  concern  to  every  physician  and  every  unit  of  organized  medicine. 


Important  Legislative  Issues  Affecting  Public  Health  and 
Medical  Practice  Anticipated  in  90th  General  Assembly 


It  has  been  predicted  by  well-informed  political 
observers  that  the  90th  regular  session  of  the 
State  Legislature  will  be  the  most  important 
legislative  gathering  in  the  history  of  Ohio. 

Moreover,  it  has  been  predicted  this  year’s 
legislative  session  will  be  more  complicated  and 
more  hectic  than  any  of  recent  years  and  may 
offer  greater  opportunities  for  the  enactment  of 
undesirable  and  unsound  legislation. 

These  conclusions  are  based  on  a number  of 
situations  which  should  be  seriously  considered 
by  those  interested  in  good  government  and  con- 
structive legislation : 

1.  The  fact  that  an  exceptionally  large  number 
of  members  of  the  90th  General  Assembly  will  be 
serving  their  first  terms  and  have  had  no  previous 
legislative  experience. 

2.  The  indication  that  a larger  number  of  in- 
dividuals and  groups  with  special  axes  to  grind 
and  sponsoring  special-interest  legislation  will  be 
actively  engaged  in  promoting  “pet”  measures 
and  in  exerting  considerable  pressure  on  members 
of  the  General  Assembly,  especially  on  members 
who  received  their  support  during  the  heated  pre- 
election contests. 


3.  The  certainty  that  a repercussion  of  the  pro- 
longed business  depression,  extensive  unemploy- 
ment, and  pressing  need  for  poor  relief  will  be 
felt  and  may  have  a tendency  to  influence  the 
Legislature  to  enact  legislative  palliatives  to  meet 
temporary  and  abnormal  conditions. 

4.  The  danger  that  radicals,  fanatics  and  de- 
structionists  will  take  advantage  of  the  prevailing 
spirit  of  unrest  and  uncertainty  to  arouse  support 
for  foolish  and  destructive  proposals. 

Sixty-three  members  of  the  House  and  13  mem- 
bers of  the  Senate,  out  of  a total  of  167  seats  in 
both  branches,  are  without  previous  legislative 
experience.  The  attitude  of  many  of  these  76  new 
members  toward  matters  of  vital  public  interest, 
including  health  and  medical  questions,  is  un- 
known. 

In  addition,  the  situation  has  been  complicated 
by  the  defeat  of  some  candidates  for  re-election 
whose  records  show  them  to  have  been  sincere, 
honest  and  conscientious  legislators;  entirely  in 
sympathy  with  sound  and  constructive  health  and 
medical  legislation,  and  opposed  to  legislation  of 
the  opposite  vintage. 

Moreover,  among  the  successful  candidates  for 


17 


18 


The  Ohio  State  Medical  Journal 


January,  1933 


re-election  are  a few  who  have  in  the  past  lent 
their  support  to  unsound  and  questionable  legis- 
lation of  all  types  and  who  have  indicated  little, 
if  any,  desire  to  cooperate  with  or  obtain  the 
counsel  of  the  medical  profession  on  health  and 
medical  matters. 

These  new  and  inexperienced  members,  espe- 
cially, will  be  beseiged  by  individuals  and  groups 
backing  questionable  legislation.  There  is  always 
the  danger  that  new  members  will  let  themselves 
be  tricked  into  supporting  fallacious  proposals, 
many  of  which  have  been  rejected,  and  properly 
so,  by  previous  legislatures.  Great  pressure  will 
be  brought  to  bear  on  candidates  who  “got  them- 
selves on  a limb”  through  ill-advised  pre-election 
promises. 

This  is  a danger  which  should  not  be  minimized. 
Unless  a majority  of  the  members  of  the  Legis- 
lature remain  open-minded  on  all  questions  until 
after  they  have  had  an  opportunity  to  analyze 
carefully  the  provisions  of  each  bill  and  to  seek 
competent  advice  regarding  all  measures,  foolish 
and  detrimental  legislation  may  be  enacted. 

Considerable  public  sentiment  has  been  aroused 
against  excessive  governmental  activities  and 
high  taxes.  An  organized  campaign  for  retrench- 
ment in  government  is  expected  during  the  ses- 
sion. 

On  the  other  hand,  attempts  probably  will  be 
made  by  some  groups  to  add  to  and  expand  the 
functions  and  activities  of  both  state  and  local 
governmental  units  with  resulting  increased  ex- 
penditure of  public  funds. 

PATERNALISM  OFFERED  AS  PANACEA 

The  latter  movement  has  the  support  of  theor- 
ists, reformers,  and  those  individuals  and  groups 
believe  that  the  ills  of  society  can  be  cured  by 
legislation  and  governmental  supervision.  They 
are  preaching  that  paternalism  and  socialization 
are  panaceas  for  present  temporary  social  and 
economic  imbalances.  Fundamental  economic  laws 
and  principles,  they  feel,  are  unscientific  and 
obsolete. 

The  anticipated  clash  between  these  two  fac- 
tions undoubtedly  will  add  to  the  complications 
and  difficulties  of  the  forthcoming  session.  Legis- 
lation supported  by  either  faction  undoubtedly 
would  include  important  questions  having  health 
and  medical  angles.  Unwise  legislation  might 
easily  result  unless  the  members  of  the  General 
Assembly  are  well-informed  and  careful  to  dis- 
criminate between  what  are  and  what  are  not 
necessary  and  proper  functions  of  government, 
and  realize  that  the  necessary  activities  of  gov- 
ernment cannot  be  carried  on  effectively  without 
adequate  finances. 

Too  much  emphasis  cannot  be  placed  on  the 
importance  of  some  of  the  questions  which  will  be 
considered  when  the  legislative  mill  begins  to 
grind.  They  include:  Changes  in  existing  tax 

laws  and  proposals  for  new  forms  of  taxation; 


problems  of  poor  relief;  unemployment;  social  in- 
surance; amendments  to  the  Workmen’s  Com- 
pensation Law;  welfare  legislation  of  various 
kinds;  attempts  to  change  the  medical  practice 
act;  revisions  and  modification  of  the  public 
health  laws;  hospital  legislation;  automobile  legis- 
lation, including  a drivers’  license  law  and  drivers’ 
financial  liability  law;  changes  in  the  criminal, 
probate,  election,  jury,  school  laws,  etc.;  pro- 
hibition repealers;  congressional  reapportion- 
ment; measures  setting  up  new  bureaus,  commis- 
sions, boards  and  departments;  salary  cuts  for 
state  and  local  elective  officials. 

Much  of  the  anticipated  legislation  would  be  of 
direct  interest  to  physicians,  as  leading  citizens, 
advocates  of  good  government,  and  professional 
men  interested  in  constructive  and  sound  public 
health  and  medical  legislation. 

In  particular,  physicians  should  be  vitally  con- 
cerned about  legislative  questions  involving  pub- 
lic health,  scientific  medicine,  medical  practice, 
and  medical  care.  The  attitude  of  medical  or- 
ganization toward  such  questions  always  has  been, 
and  should  continue  to  be,  determined  on  the  basis 
of  permanent  public  benefit. 

HEALTH  SAFEGUARDS  NECESSARY 

Statutory  provisions  in  Ohio  for  official  public 
health  activities  and  for  regulation  of  the  practice 
of  medicine  have  proved  themselves  of  immeas- 
urable benefit  to  the  public  at  large.  The  existing 
constructive  public  health  safeguards  and  the  pro- 
visions for  effective  and  efficient  regulation  of  the 
practice  of  medicine  in  Ohio  were  conceived,  pro- 
moted and  supported  by  the  medical  profession. 
The  attitude  of  the  profession  has  not  changed. 
No  backward  step  should  be  taken  to  curtail  or 
destroy  the  effectiveness  of  these  laws.  Any- 
changes  which  would  weaken  necessary  public 
health  administration  should  be  opposed  by  the 
medical  profession.  Moreover,  statutory  changes 
which  have  a tendency  to  place  public  health  ac- 
tivities under  the  dominance  of  group  politics  or 
subject  public  health  administration  to  the  dic- 
tation of  those  holding  unsound  and  impractical 
views  should  be  combated. 

Incidentally,  the  attention  of  members  of  the 
Legislature  should  be  called  to  the  fact  that 
necessary  and  beneficial  public  health  work  can- 
not be  carried  on  unless  adequate  funds  are  pro- 
vided. However,  it  should  be  made  clear  to  them 
that  this  does  not  necessarily  mean  that  public 
funds  should  be  expended  for  frivolous  and  fan- 
tastic activities,  masquerading  under  the  name  of 
public  health,  which  are  not  essential  functions  of 
official  health  departments. 

Attacks  which  may  be  made  on  scientific  medi- 
cine and  efforts  which  may  be  made  to  nullify  the 
safeguards  set  up  by  the  medical  practice  act 
should  be  opposed  vigorously  by  organized  medi- 
cine. 

Cultists  and  fanatics  who  belittle  the  good 


January,  1933 


Editorial 


19 


which  scientific  medicine  has  accomplished  and  in- 
dividuals seeking  entrance  into  the  practice  of 
medicine  through  the  “back  door”,  without  pos- 
sessing the  proper  qualifications,  education  and 
training,  undoubtedly  will  again  ask  the  Legisla- 
ture to  look  with  favor  on  their  self-interest  pro- 
posals. 

Ohio’s  present  laws  regulating  the  practice  of 
medicine  are  reasonable,  fair  and  just.  They  are 
constructive.  They  guarantee  the  maintenance  of 
high  standards  for  the  practice  of  medicine.  They 
safeguard  public  health  and  protect  the  public 
from  the  untrained  and  incompetent. 

Any  legislation  which  would  destroy  the  high 
standards  which  have  been  established  and  per- 
mit cultists  and  others  seeking  special  privileges 
to  advocate  their  own  interests  at  the  expense  of 
public  health  and  public  safety  should  be  actively 
opposed. 

workmen’s  compensation  proposals 

The  indication  that  some  attempts  may  be 
made  to  revise  certain  sections  of  the  Workmen’s 
Compensation  Law  raises  questions  of  vital  in- 
terest to  the  medical  profession. 

Revision  in  the  present  law  should  not  be  made 
unless  they  can  be  proved  to  be  for  the  best  in- 
terests of  the  public  and  the  beneficiaries  of  the 
act.  Obviously,  crippling  and  reactionary  pro- 
posals which  would  be  impractical  from  the  stand- 
point of  administration  and  would  react  adversely 
to  all  interested  in  the  efficient  and  just  adminis- 
tration of  the  act,  should  not  be  considered  by  the 
Legislature. 

The  foregoing  brief  summary  of  developments 
and  trends  incidental  to  the  coming  session  of  the 
General  Assembly  indicate  in  a general  way  why 
it  will  be  vitally  important  for  every  member  of 
organized  medicine  to  keep  himself  fully  informed 
on  legislative  happenings  and  pending  legislation. 
Moreover,  it  emphasizes  how  necessary  it  will  be 
for  the  profession,  individually  and  collectively,  to 
take  an  active  personal  interest  in  seeing  that 
members  of  the  General  Assembly  are  given  the 
concerted  medical  viewpoint  on  health  and  medical 
legislation. 

As  usual,  legislative  developments  at  Columbus 
will  be  watched  closely  by  the  Committee  on  Pub- 
lic Policy  and  headquarters  of  the  State  Asso- 
ciation. The  Committee  will  be  in  constant  com- 
munication with  the  legislative  chairman  of  each 
component  county  medical  society  and  academy  of 


medicine.  Measures  having  health  and  medical 
angles  will  be  analyzed  in  the  Committee’s  bul- 
letins. Policies  of  organized  medicine  regarding 
important  issues  will  be  summarized  and  inter- 
preted. 

However,  the  primary  responsibility  for  mold- 
ing public  opinion  and  impressing  on  members  of 
the  Legislature  the  correct  medical  viewpoint  on 
questions  in  which  the  medical  profession  is 
vitally  interested,  rests  with  the  local  members  of 
each  component  county  medical  society  and 
academy. 

Members  of  the  General  Assembly  will,  or 
should,  listen  to  and  respect  the  advice  of  their 
physician  constituents.  Physicians  are  the  best 
authorities  on  health  and  medical  questions  and 
have  a right  to  be  heard  on  such  questions.  More- 
over, they  have  a right  to  expect  their  counsel  to 
be  given  full  and  thorough  consideration  by  their 
respective  legislators. 

EVERY  PHYSICIAN  MUST  HELP 

Every  physician  should  feel  it  a personal  duty 
to  interest  himself  in  legislative  matters.  He 
should  assist  in  guiding  the  views  of  all  persons 
in  public  office.  He  should  take  an  active  and 
constructive  part  in  promoting  sound  legislation 
and  good  government.  Friendly  contact  with 
members  of  the  Legislature  and  other  public 
officials  should  be  established.  The  opportunity 
should  be  offered  them  to  talk  over  health  and 
medical  questions  with  the  physicians  of  their 
community. 

Medical  organization  in  Ohio  is,  and  should 
continue  to  be,  non-partisan  and  non-political  in 
make-up  and  purpose.  However,  this  does  not 
preclude  active  interest  on  the  part  of  physicians 
in  legislative  and  governmental  affairs.  As  in- 
dividuals, physicians  should  express  their  views 
on  all  questions  of  public  interest.  As  members 
of  the  medical  profession,  they  have  a right  to 
assume  leadership  in  health  and  medical  matters, 
including  legislation  and  governmental  adminis- 
tration. 

Unless  organized  medicine  continues  to  take  the 
lead  in  such  matters,  fatal  mistakes  in  adminis- 
trative and  legislative  functions  may  be  made. 

Unless  aggressive  tactics  are  pursued  during 
the  coming  months  by  every  member  of  medical 
organization,  laws  may  be  enacted  by  the  90th 
General  Assembly  which  will  prove  detrimental 
to  the  public  health  and  welfare,  the  medical  pro- 
fession, and  the  practice  of  medicine. 


Socialization  of  Medicine  Advocated  in  Majority  Report 
of  National  Committee  on  the  Costs  of  Medical  Care 


The  final  report  of  the  Committee  on  the  Costs 
of  Medical  Care,  following  five  years  of  activity 
and  the  expenditure  of  approximately  $1,000,000, 
most  of  which  was  contributed  by  several  large 
and  widely-publicized  foundations,  has  been 
greeted  by  the  majority  of  the  medical  profession 
with  an  attitude  of  mingled  doubt  and  anxiety. 


Thousands  of  physicians  who  have  followed 
closely  the  activities  of  the  committee  since  its 
formation  in  1927  and  were  familiar  with  the 
economic  and  social  views  of  those  comprising  the 
committee,  were,  in  all  probability,  prepared  for 
the  conclusions  reached  by  the  committee’s  ma- 
jority. 


20 


The  Ohio  State  Medical  Journal 


January,  1033 


The  committee,  as  indicated  by  the  majority 
report  and  four  minority  reports,  could  not  reach 
an  agreement  on  some  of  the  fundamental  issues 
involved  in  the  question  it  set  out  to  study.  In 
fact,  one  of  the  minority  reports  implies  that  the 
committee’s  studies  failed  to  include  several  of 
the  fundamental  economic  problems  which  the 
committee  was  expected  to  consider. 

A significant  minority  dissented  from  the  ma- 
jority report  and  presented  one  of  their  own.  This 
minority  report  was  supported  by  several  present 
and  former  officers  of  the  American  Medical  Asso- 
ciation and  a number  of  physicians  in  active 
private  practice. 

Comparison  of  the  two  principal  reports  serves 
the  purpose  of  revealing  the  alignment  of  the 
forces  in  the  campaign  to  change  the  administra- 
tion of  medical  care. 

On  one  side  are  those  who  favor  radical  re- 
organization of  medical  practice;  the  development 
of  various  socialized  forms  of  medical  service; 
various  sickness  insurance  plans,  and,  more  or 
less,  extensive  centralized  health  and  medical  ser- 
vices under  the  supervision  and  control  of  local 
or  state  governments. 

On  the  other  side,  represented  by  the  signers  of 
the  first  minority  repoii;,  are  those  who  recognize 
that  medical  practice  must  change  from  time  to 
time  to  meet  the  demands  of  social  evolution  but 
who,  at  the  same  time,  are  firmly  convinced  that 
the  fundamental  principles  and  ideals  which  are 
necessary  to  the  sound  practice  of  medicine  must 
be  preserved  and  become  the  basis  for  new  forms 
of  medical  practice  if  the  health  and  welfare  of 
society  are  to  be  safeguarded  and  the  advance- 
ment of  scientific  medicine  guaranteed. 

The  majority  report’s  major  premise  is  as  fol- 
lows : 

“The  Committee  recommends  that  medical  ser- 
vice, both  preventive  and  therapeutic,  should  be 
furnished  largely  by  organized  groups  of  physi- 
cians, dentists,  nurses,  pharmacists  and  other 
associated  personnel.  Such  groups  should  be  or- 
ganized, preferably  around  a hospital,  for  ren- 
dering complete  home,  office  and  hospital  care. 
The  form  of  organization  should  encourage  the 
maintenance  of  high  standards  and  the  develop- 
ment or  preservation  of  a personal  relation  be- 
tween patient  and  physician.” 

In  arguments  for  the  “medical  center”  plan,  the 
majority  report  endorses  industrial  medical  ser- 
vice provided  by  industrial  corporations  and  sug- 
gests the  expansion  of  student  health  services  at 
universities  to  include  members  of  the  faculty  and 
residents  of  the  city  or  town  in  which  the  uni- 
versity is  located,  pointing  out  that  these  two 
types  of  service  fit  into  the  whole  plan  of  de- 
veloping community  medical  centers. 

The  following  section  of  the  minority  report 
adequately  summarizes  objections  which  may  be 
raised  to  what  the  majority  report  terms  “the 
Committee’s  most  fundamental  specific  proposal”: 

“There  is  nothing  in  the  experience  of  the  medi- 
cal profession,”  the  minority  report  declares,  “to 


show  that  the  ‘Community  Medical  Center’  is  a 
workable  scheme  or  that  it  would  not  contain 
evils  of  its  own  which  might  be  worse  than  the 
evils  it  is  supposed  to  alleviate.  This  Medical 
Center  Plan  is  suggestive  of  the  great  mergers  in 
industry  in  which  mass  production  and  centralized 
control  are  the  principal  features.  It  apparently 
disregards  the  fundamentals  which  make  medi- 
cine a personal  service  and  which  require  that  the 
individual  patient  and  not  diseases  or  economic 
classes  or  groups  be  the  object  of  medical  care. 

“The  objections  to  the  Medical  Center  Plan  are 
summarized  as  follows: 

“1.  It  would  establish  a medical  hierarchy  in 
every  community  to  dictate  who  might  practice 
medicine  there. 

“2.  It  would  be  impossible  to  prevent  competi- 
tion among  the  many  such  centers  necessary  for 
large  cities;  cost  would  inevitably  be  increased  by 
the  organization  necessary  to  assign  patients  to 
the  various  centers.  This  would  add  to  the  evils 
of  medical  dictatorship  those  of  a new  bureau  in 
the  local  government  with  its  attendant  cost. 

“3.  Continuous  personal  relationship  of  phy- 
sician and  patient  would  be  difficult  if  not  impos- 
sible under  such  conditions. 

“Other  disadvantages  of  group  practice  are : 
Restriction  of  freedom  of  action  in  respect  to 
vacations,  study,  travel,  attendance  on  scientific 
meetings  and  even  publication  of  medical  articles 
to  all  members  except  the  heads  of  the  group; 
comparatively  static  income  of  members  of  a 
group  except  that  of  the  owner  or  owners;  salary 
cuts,  then  discharge  of  employes  to  reduce  over- 
head in  times  of  depression;  disruption  of  groups 
through  death  or  disability  of  some  able  man  or 
men  around  whom  the  group  has  been  built,  and 
the  difficulty  with  which  physicians  are  able  to 
find  employment  in  another  group  or  are  able  to 
enter  private  practice  when  a group  closes.” 

CLAIM  DATA  IS  INADEQUATE 

The  minority  report  points  out  that  the  estab- 
lishment of  group  clinics  may  be  in  line  of  prog- 
ress when  they  are  a natural  outgrowth  of  local 
conditions  but  that  the  studies  conducted  by  the 
Committee  were  “far  too  few  in  number  to  con- 
stitute a safe  base  on  which  to  erect  so  large  and 
revolutionary  a structure  as  is  proposed”. 

Similar  criticism  is  made  of  the  majority’s  en- 
dorsement of  industrial  medical  service.  It  is 
pointed  out.  in  the  minority  report  that  the  Com- 
mittee studied  only  “the  most  favorable  examples 
of  this  type  of  practice”  and  that  for  each  of 
these  plans  a score  of  the  opposite  kind  can  be 
found. 

The  second  major  recommendation  of  the  ma- 
jority report  is: 

“The  extension  of  all  basic  public  health  ser- 
vices— whether  provided  by  governmental  or  non- 
governmental agencies — so  that  they  will  be  avail- 
able to  the  entire  population  according  to  its 
needs.  This  extension  requires  increased  financial 
support  for  official  health  departments  and  full- 
time trained  health  officers  and  members  of  their 
staffs  whose  tenure  is  dependent  only  on  pro- 
fessional and  administrative  competence.” 

This  suggestion  may  be  interpreted  in  two 
ways.  The  medical  profession  is  in  full  accord 
with  the  promotion  of  properly  defined  public 
health  administration  for  the  protection  of  public 
health  and  safety.  Likewise,  it  agrees  that  public 


January,  1933 


Editorial 


21 


health  activities  should  be  financed  in  such  a way 
that  they  shall  be  efficient  and  effective.  How- 
ever, the  suggestion  of  the  committee  is  so  vague 
and  general  that  it  may  be  interpreted  to  imply 
that  the  further  invasion  of  government  into  the 
practice  of  medicine  is  advocated. 

The  menace  inherent  in  such  expansion  is 
readily  recognized  by  the  medical  profession  which 
can  point  to  innumerable  examples  of  unfair  com- 
petition by  governmental  agencies  with  private 
practitioners.  Doubtless,  most  physicians  will  en- 
dorse the  view  expressed  in  the  minority  report  to 
the  effect  that  governmental  competition  in  the 
practice  of  medicine  should  be  discontinued  and 
its  activities  in  this  field  restricted  to  proper  and 
recognized  public  health  functions. 

INSURANCE  PLAN  CRITICIZED 

Recommendation  No.  3 of  the  majority  report, 
and  one  which  is  certain  to  be  a subject  for  pro- 
longed discussion,  is: 

“That  the  costs  of  medical  care  be  placed  on  a 
group  payment  basis,  through  the  use  of  insur- 
ance, through  the  use  of  taxation,  or  through  the 
use  of  both  these  methods.  This  is  not  meant  to 
preclude  the  continuation  of  medical  service  pro- 
vided on  an  individual  fee  basis  for  those  who  pre- 
fer the  present  method.  Cash  benefits,  i.e.,  com- 
pensation for  wage-loss  due  to  illness,  if  and 
when  provided,  should  be  separate  and  distinct 
from  medical  services.” 

As  pointed  out  in  the  minority  report: 

“A  system  of  voluntary  health  insurance  tied  to 
the  visionary  medical  center  plan  which  is  offered 
as  the  ‘keystone’  of  all  medical  service,  would 
plunge  the  medical  profession  into  similar  or  more 
difficult  problems  than  have  been  experienced  by 
the  European  profession  in  its  struggle  against 
the  various  European  insurance  schemes.  In  the 
United  States,  contract  practice  is  essentially 
health  insurance  and  has  already  given  rise  to 
destructive  competition  among  professional 
groups,  inferior  medical  service,  loss  of  personal 
relationship  of  patient  and  physician,  and  de- 
moralization of  the  profession.  It  is  clear  that  all 
such  schemes  are  contrary  to  sound  public  policy 
and  that  the  shortest  road  to  commercialism  of 
the  practice  of  medicine  is  through  the  supposed- 
ly rosy  path  of  insurance.  The  objection  to  com- 
pulsory health  insurance  are  almost  as  compelling 
to  this  minority  group  as  are  those  to  voluntary 
insurance.” 

The  minority  report  states  that  no  effort  is 
made  in  that  report  to  list  all  the  facts  and  argu- 
ments that  can  be  used  against  health  insurance, 
both  voluntary  and  compulsory,  but  that  there 
are  great  dangers  and  evils  in  insurance  practice 
which  must  be  set  over  against  the  advantages  of 
distributing  the  costs  of  medical  care  by  this 
method.  Of  course,  this  should  not  be  taken  to 
mean  that  the  minority  report  is  opposed  to  any 
individual  carrying  insurance  against  the  occur- 
rence of  major  illness  or  operation  so  that  he 
might  receive  funds  sufficient  to  pay  the  hospital 
and  the  physician  of  his  own  choice. 

Continued  study  of  medical  economic  problems 
and  readjustments  in  the  field  of  professional  edu- 
cation are  recommended  in  Recommendations  4 


and  5 of  the  majority  report  which  are  as  fol- 
lows : 

“The  committee  recommends  that  the  study, 
evaluation  and  coordination  of  medical  service 
be  considered  important  functions  of  every  state 
and  local  community,  that  agencies  be  formed  to 
exercise  these  functions,  and  that  the  coordination 
of  rural  and  urban  services  receive  special  atten- 
tion.” 

“The  Committee  makes  the  following  recom- 
mendations in  the  field  of  professional  education: 
(A)  That  the  training  of  physicians  give  increas- 
ing emphasis  to  the  teaching  of  health  and  the 
prevention  of  disease;  that  more  effective  efforts 
be  made  to  provide  trained  health  officers;  that 
the  social  aspects  of  medical  practice  be  given 
greater  attention;  that  specialties  be  restricted  to 
those  specially  qualified;  and  that  postgraduate 
educational  opportunities  be  increased;  (B)  that 
dental  students  be  given  a broader  educational 
background;  (C)  that  pharmaceutical  education 
place  more  stress  on  the  pharmacist’s  responsi- 
bilities and  opportunities  for  public  service;  (D) 
that  nursing  education  be  thoroughly  remolded  to 
provide  well  educated  and  well  qualified  registered 
nurses;  (E)  that  less  thoroughly  trained  but  com- 
petent nursing  aides  and  attendants  be  provided; 
(F)  that  adequate  training  for  nurse  mid-wives 
be  provided,  and  (G)  that  opportunities  be  offered 
for  the  systematic  training  of  hospital  and  clinic 
administrators.” 

MINORITY  REPORT  RECOMMENDATIONS 

The  seven  recommendations  made  in  the  minor- 
ity report  are: 

“1.  The  minority  recommends  that  government 
competition  in  the  practice  of  medicine  be  discon- 
tinued and  that  its  activities  be  restricted  (a)  to 
the  care  of  the  indigent  and  of  those  patients  with 
diseases  which  can  be  cared  for  only  in  govern- 
mental institutions;  (b)  to  the  promotion  of  pub- 
lic health;  (c)  to  the  support  of  the  medical  de- 
partments of  the  Army  and  Navy,  Coast  and 
Geodetic  Survey,  and  other  government  services 
which  cannot  because  of  their  nature  or  location 
be  served  by  the  general  medical  profession;  and 
(d)  to  the  care  of  veterans  suffering  from  bona 
fide  service-connected  disabilities  and  diseases,  ex- 
cept in  the  case  of  tuberculosis  and  nervous  and 
mental  diseases. 

“2.  The  minority  recommends  that  government 
care  of  the  indigent  be  expanded  with  the  ultimate 
object  of  relieving  the  medical  profession  of  this 
burden. 

“3.  The  minority  joins  with  the  Committee  in 
recommending  that  the  study,  evaluation  and  co- 
ordination of  medical  service  be  considered  im- 
portant functions  for  every  state  and  local  com- 
munity, that  agencies  be  formed  to  exercise  these 
functions,  and  that  the  coordination  of  rural  with 
urban  services  receive  special  attention. 

“4.  The  minority  recommends  that  united  at- 
tempts be  made  to  restore  the  general  practi- 
tioner to  the  central  place  in  medical  practice. 

“5.  The  minority  recommends  that  the  cor- 
porate practice  of  medicine,  financed  through  in- 
termediary agencies,  be  vigorously  and  persis- 
tently opposed  as  being  economically  wasteful, 
inimical  to  a continued  and  sustained  high  quality 
of  medical  care,  or  unfair  exploitation  of  the 
medical  profession. 

“6.  The  minority  recommends  that  methods  be 
given  careful  trial  which  can  rightly  be  fitted 
into  our  present  institutions  and  agencies  without 
interfering  with  the  fundamentals  of  medical 
practice. 


22 


The  Ohio  State  Medical  Journal 


January,  1933 


“7.  The  minority  recommends  the  development 
by  state  or  county  medical  societies  of  plans  for 
medical  care.” 

Any  plan  for  the  distribution  of  medical  costs 
must  have  the  following  safeguards,  the  minority 
group  believes: 

1.  It  must  be  under  the  control  of  the  medical 
profession. 

2.  It  must  guarantee  not  only  nominal  but 
actual  free  choice  of  physician. 

3.  It  must  include  all,  or  a large  majority  of, 
the  members  of  the  county  medical  society. 

4.  The  funds  must  be  administered  on  a non- 
profit basis. 

5.  It  should  provide  for  direct  payment  by  the 
patient  of  a certain  minimum  amount,  the  com- 
mon fund  providing  only  that  portion  beyond  the 
patient’s  means. 

6.  It  should  make  adequate  provision  for  com- 
munity care  of  the  indigent. 

7.  It  must  be  entirely  separate  from  any  plan 
providing  for  cash  benefits. 

FUNDAMETAL  ISSUES  INVOLVED 

In  its  consideration  of  the  questions  raised  by 
the  reports  of  both  the  majority  and  minority 
groups  of  the  Committee  on  the  Costs  of  Medical 
Care,  the  medical  profession  must  resort  to  calm 
and  logical  discussion  of  the  fundamental  issues 
involved.  The  principles  on  which  medicine  must 
stand;  its  responsibilities  to  the  public;  and  the 
return  it  has  a right  to  expect  from  the  public 
are  clear-cut  and  definite. 

The  responsibility  of  deciding  which  program 
will  in  the  final  analysis  produce  the  greatest 
good  for  the  greatest  number  of  members  of  so- 
ciety and  of  choosing  which  they  will  support 
rests  with  the  individual  members  of  the  medical 
profession.  Judging  from  comments  which  have 
appeared  in  the  public  press,  which  may  be  pre- 
sumed to  voice  the  opinion  of  a large  portion  of 
the  public  at  large,  there  seems  little  reason  to 
doubt  what  the  reaction  of  the  public  will  be 
toward  any  proposal  which  would  ultimately 
mean  sovietizing  a profession  with  whom  the  indi- 
vidual has  his  most  intimate  relations  outside  the 
family  circle,  and  which  would  create  more  gov- 
ernment bureaus  and  greater  public  expense. 

One  writer,  in  analyzing  the  report,  makes  this 
pertinent  observation : 

“It  is  just  possible  that  the  real  cure  lies 
deeper  than  a mere  reorganization  of  the  medi- 
cal profession.  The  wage-earner’s  inability  to 
pay  for  the  care  he  needs,  and  the  doctor’s  ina- 
bility to  get  the  income  he  deserves — aren’t  these 
a part  of  a larger  problem  whose  solution  de- 
pends upon  a restoration  of  economic  health  to 
the  whole  community?  In  the  long  run,  what  we 
need  to  aim  at  is  a restoration  of  prosperity  on  a 
broader  and  firmer  base  than  we  have  ever  had 
it  before.” 

In  studying  the  report  of  the  Committee  on 
the  Costs  of  Medical  Care,  members  of  the  State 
Association  should  give  careful  consideration  to 
the  formal  and  official  statement  regarding  the 
report  adopted  by  The  Council  of  the  State  Asso- 


ciation at  its  meeting  in  Columbus,  December  11, 
and  published  elsewhere  in  this  issue  of  The 
Journal,  in  which  various  fundamental  questions 
involved  in  the  procedures  recommended  in  the 
report  are  summarized  and  discussed. 

Moreover,  every  physician  should  study  thor- 
oughly the  editorial  comments  and  articles  con- 
cerning the  Costs  of  Medical  Care  report,  pub- 
lished in  The  Journal  of  the  American  Medical 
Association  on  Pages  1950  to  1952  and  1954  to 
1958  of  the  December  3,  1932,  issue,  and  Pages 
2034  to  2036  and  2037  to  2039  of  the  December 
10,  1932,  issue. 


Harmonious 
Coordination 
Is  Necessary 


Pleading  with  the  medical  profession  of  British 
Columbia  to  present  a united  front  for  impending 
battles  and  to  wield  a greater  influence  in  the 
period  of  readjustment 
which  will  follow  the  pres- 
ent economic  crisis,  the  edi- 
tor of  the  Vancouver  Medi- 
cal Bulletin  declares : 

“Our  weakness  as  a pro- 
fession has  always  been  a lack  of  understanding 
of  the  most  elementary  principles  of  organization : 
rules  are  all  right  for  the  other  fellow,  but  do  not 
apply  to  us  personally.  Till  we  can  see  things  in 
a different  light  to  this,  medical  organization  is 
bound  to  be  weak.  Our  battles  in  the  past  have 
been  lost  through  a lack  of  loyalty  to  each  other 
and  to  our  leaders.  Always,  just  at  the  critical 
point  in  the  fight,  our  enemy  has  been  able  to 
divide  us  and  so  conquer  us.  It  was  the  fault  of 
the  rank  and  file,  not  only  of  those  who  were  try- 
ing to  lead.  As  individual  medical  men,  we  have 
a right  to  run  our  own  affairs:  as  members  of  an 
organization  our  first  duty  is  loyalty  to  that  or- 
ganization, that  is,  to  each  other,  and  a willing- 
ness to  submerge  our  own  individuality  for  the 
common  good.” 

Vital  problems  which  now  exist  and  others 
which  assuredly  will  arise  cannot  be  solved 
through  individual  effort  on  the  part  of  physi- 
cians. They  must  be  met  by  an  enlightened  pro- 
fession and  one  adequately  organized.  Organiza- 
tion machinery  has  been  established  and  has 
functioned  effectively  with  but  few  exceptions. 
However,  unless  the  rank  and  file  of  the  profes- 
sion continue  to  give  to  organized  medicine  the 
support  and  loyalty  which  they  have  given  in  the 
past,  results  will  be  disappointing  and  may  be  dis- 
astrous. The  great  majority  of  the  members  of 
the  medical  profession  individually  are  in  accord 
on  most  of  the  serious  problems  which  confront 
the  profession.  To  crystalize  this  unanimity  of 
thought  into  concerted  action  sometimes  is  diffi- 
cult. However,  it  has  been  done  in  the  past  and 
can  be  in  the  future,  providing  each  physician 
realizes  that  he  has  a very  important  part  to  per- 
form in  the  program  of  activities.  The  respon- 
sibility of  medical  organization — county,  state  and 
national — is  to  inspire  and  stimulate  this  interest. 


Abdominal  Surgery  In  Children 

Norris  W.  Gillette,  A.B.,  M.D.,  F.A.C.S.,  Toledo,  Ohio. 


THE  practice  of  surgery  of  the  abdomen  in 
children  follows  the  same  general  principles 
as  abdominal  surgery  in  adults,  but  is  com- 
plicated by  the  lesser  resistance  of  the  child  to 
surgical  intervention  and  by  certain  pathological 
conditions  that  are  peculiar  to  the  young. 

The  conditions  that  commonly  require  operative 
procedure  in  the  abdomen  are  appendicitis,  umbili- 
cal, diaphragmatic,  and  inguinal  hemiae,  intus- 
susception, congenital  pyloric  obstruction,  defects 
of  the  abdominal  wall,  undescended  testicle,  retro- 
peritoneal sarcoma,  adhesions,  foreign  bodies  in 
the  intestines,  extrophy  of  the  bladder,  anemia 
with  splenomegaly,  intestinal  malformations,  and 
volvulus. 

Appendicitis  is  the  commonest  of  all  surgical 
diseases  of  the  abdomen  in  the  young.  It  must 
be  ruled  out  of  every  case  evidencing  the  symp- 
toms of  nausea  and  vomiting,  hyperpyrhexia,  ab- 
dominal distention,  and  pain.  Children  are,  how- 
ever, much  more  susceptible  to  vomiting  than  are 
adults  and  will  vomit  from  that  alone  without  ab- 
dominal pathology.  This  should  be  borne  in  mind 
when  making  tho  diagnosis. 

It  is  not  necessary  to  wait  for  the  pain  to  local- 
ize in  the  right  lower  quadrant  before  making  a 
diagnosis  in  every  case.  A generalized  distention 
with  diffuse  pain  is  more  common  than  the  origi- 
nal McBurney’s  point  pain.  The  brunt  of  the 
diagnosis  must  be  borne  by  clinical  examination, 
inasmuch  as  the  blood  count  is  frequently  decep- 
tive. A moderate  concomitant  lung  infection  may 
increase  the  leucocyte  count  giving  a deceptive 
idea  of  the  severity  of  the  abdominal  infection,  or 
on  the  other  hand  the  white  blood  cell  count  may 
remain  normal,  or  there  may  even  be  a moderate 
leucopenia  in  very  severely  infected  cases. 

When  a moderately  inflamed  appendix  is  re- 
moved at  operation,  it  is  my  practice  to  instill  fifty 
to  one  hundred  c.c.  of  amniotic  fluid  and  close 
without  drainage.  In  the  presence  of  gangrene 
with  free  pus  unless  the  appendix  presents  itself 
in  the  opening  it  is  not  searched  for,  because  of  the 
danger  of  breaking  up  adhesions  and  tearing  down 
the  banders  of  resistance.  It  is  inadvisable  to 
tear  loose  a single  adhesion  in  this  type  of  case. 
Free  and  adequate  drainage  is  necessary  with  the 
tubes  placed  in  the  pelvis,  the  right  iliac  fossa,  and 
to  the  left  side  of  the  lower  abdomen.  The  less 
manipulation  that  can  be  done  the  better  the 
chance  the  patient  has  for  recovery.  I am  placing 
along  side  of  the  drains  a small  catheter  and  after 
the  abdomen  has  been  closed  around  the  drains, 
equal  parts  of  amniotic  fluid  and  sodium  ricino- 


Read  before  the  Surgical  Section,  Ohio  State  Medical 
Association  at  the  86th  Annual  Meeting,  Dayton,  May  3 and 
4,  1932. 


leate  are  instilled,  and  this  is  repeated  daily.  This 
solution  tends  to  keep  pyogenic  membrane  from 
forming  and  pockets  of  pus  from  being  walled  off 
between  the  loops  of  the  intestines.  If  drainage 
is  sufficient,  the  patient  has  a good  chance  of  re- 
covery. The  drains  must  not  be  removed  too  soon. 
It  takes  seven  days  for  a sinus  to  develop  walls 
that  will  not  collapse  when  the  drains  are  re- 
moved, and  if  the  sinus  collapses  an  abscess  may 
develop  at  the  end  of  the  drain  and  necessitate  a 
second  entrance  into  the  abdomen. 

Adhesions  will  develop  with  no  greater  or  less 
frequency  than  in  adults.  When  obstruction  oc- 
curs with  vomiting  and  distention,  the  earlier  the 
diagnosis  and  surgical  intervention  the  greater  is 
the  possibility  of  saving  life.  A flat  X-ray  plate 
is  made  at  the  first  sign  of  obstruction  to  deter- 
mine its  existence  and  location.  If  peristalsis  is 
present,  it  can  be  determined  by  a peculiar  clink- 
ing sound  heard  with  the  stethoscope.  There  is  no 
peristaltic  action  in  peritonitis,  but  it  is  always 
present  in  intestinal  obstruction  due  to  adhesions. 
There  is  an  attempt  to  force  intestinal  contents  by 
the  obstructed  point  and  the  peristalsis  is  usually 
strong.  The  immediate  opening  of  the  abdomen 
is  always  advisable  before  autointoxication  has 
devitalized  the  child.  Whenever  a distended  loop 
of  the  small  intestine  is  evidenced  on  the  plate  the 
abdomen  should  be  reopened.  I have  been  hearing 
of  paralytic  ileus  without  peritonitis  or  mechani- 
cal obstruction  for  many  years,  but  have  never 
seen  it.  Every  case  has  eventually  shown  either  a 
definite  peritonitis  or  obstruction  due  to  adhe- 
sions. 

Intussusception  is  the  invagination  of  the  bowel 
within  itself.  It  is  one  of  the  most  common  causes 
of  intestinal  obstruction  in  children  and  its  early 
recognition  is  of  extreme  importance.  The  me- 
chanics of  this  disease  consists  in  the  contraction 
of  a portion  of  the  intestine  through  which  the 
peristaltic  action  is  not  transmitted.  It  may  be 
that  irritation  from  some  cause  may  incite  the 
trouble  or  that  the  autonomic  nervous  system  is 
at  fault.  It  is  certain  that  castor  oil  and  other 
irritating  cathartics  have  not  infrequently  been 
followed  by  intussusception.  The  diagnosis  is 
made  by  the  onset  of  sudden  abdominal  cramps 
with  increasing  tenesmus  and  bloody  mucus  from 
the  rectum,  though  blood  is  not  always  present  if 
the  invagination  is  above  the  ileocecal  valve,  the 
presence  of  a sausage  shaped  tumor  about  one  inch 
in  diameter  and  of  varying  length,  generally  lo- 
cated in  the  left  flank,  the  absence  of  feces,  and 
the  marked  tenderness  on  examination. 

Spontaneous  cure  occurs  in  less  than  3 per  cent 
of  all  cases  either  by  the  development  of  a fecal 
fistula  to  the  surface  or  by  a reduction  of  the  in- 


23 


24 


The  Ohio  State  Medical  Journal 


January,  1933 


tussusception.  Operative  treatment  should  always 
be  advised.  A mid-line  incision  is  preferable, 
though  Fraser  recommends  a right  sided  gridiron 
opening.  The  tumor  mass  is  located  and  manipu- 
lated into  the  incision  and  reduction  attempted  by 
traction  at  both  ends.  Usually  this  will  open  up 
the  invagination,  particularly  if  the  intussuscep- 
tion is  in  the  ileum  or  large  bowel.  The  greatest 
difficulty  is  at  the  ileocecal  junction.  Pressure  on 
the  tumor  will  at  times  reduce  the  size  of  it  by 
squeezing  out  the  oedema  and  allow  reduction  to 
take  place.  If  reduction  is  impossible  by  these 
methods,  an  enterostomy  above  the  mass  can  be 
done  or  a removal  of  the  tumor  with  an  anastom- 
osis of  the  intestines  above  and  below  it  can  be 
performed.  In  certain  instances  it  may  be  advis- 
able to  implant  a catheter  into  the  intestines  above 
the  tumor  mass  and  leave  it  in  place.  This  will 
relieve  the  intestinal  obstruction  and  allow  the 
child  to  be  put  into  better  shape  for  resection  at 
a later  date.  Due  to  the  reduction  of  the  oedema 
it  may  even  be  possible  to  reduce  the  invagination 
at  the  second  operation. 

Obstruction  at  the  pylorus  due  to  a congenital 
hypertrophy  of  the  pyloric  musculature  is  not  in- 
frequent in  early  life.  The  incidence  of  the  disease 
is  about  ten  boys  to  one  girl.  There  is  a history 
of  a normal  appearing  child,  with  the  development 
of  vomiting  two  or  three  weeks  after  birth  which 
becomes  projectal  in  type  and  of  marked  severity. 
Peristaltic  action  of  the  stomach  can  be  traced 
during  these  periods.  The  tumor  at  the  pylorus 
can  almost  invariably  be  felt  if  enough  care  is 
taken.  In  untreated  cases  exhaustion  follows  in 
a short  time  and  the  child  succumbs. 

Medical  treatment  is  generally  advised  by  the 
pediatrician  for  a period  of  time.  A suitable  diet 
with  daily  washing  out  of  the  stomach  with  per- 
haps the  administration  of  atropine  is  the  regime 
followed.  Some  cases  undoubtedly  have  been 
cured  by  this  method,  but  generally  the  little  suf- 
ferer is  only  made  weaker  and  frequently  kept 
from  operation  until  the  risk  is  desperate  and 
then  turned  over  to  the  surgeon.  In  cases 
of  marked  severity  medical  treatment  is  in- 
advisable, and  if  the  weight  continues  to  fall 
during  medical  treatment  the  child  should  at  once 
be  operated  upon.  The  Rammsteadt  operation  is 
undoubtedly  the  method  of  choice,  though  Strauss’ 
modification  of  it  has  its  adherents.  An  incision 
is  made  from  one  and  one-half  to  two  inches  long 
to  the  right  of  the  mid-line,  through  the  rectus 
muscle  in  the  upper  abdomen.  The  pylorus  is 
picked  up  and  brought  into  the  incision  and  the 
pyloric  vein  is  located.  It  is  necessary  to  rotate 
the  pylorus  in  order  to  bring  the  bloodless  por- 
tion into  view.  A longitudinal  incision  is  then 
made  through  the  hypertrophic  musculature  down 
to  the  mucosa.  The  operator  must  proceed  cau- 
tiously on  nearing  the  mucosa  in  order  to  avoid 
penetrat'on  into  the  lumen.  The  mucosa  appears 


yellowish  white  in  color  and  may  bulge  when  com- 
pletely exposed.  Every  fiber  must  be  cut.  No 
attempt  is  made  to  close  this  opening.  The  ab- 
dominal wall  is  then  sutured. 

Strauss’  modification  consists  of  the  use  of  a 
flat  hook  with  which  to  deliver  the  pylorus  and  the 
covering  of  the  mucosa  with  a muscular  omental 
flap  and  the  mobilization  of  the  mucosa  by  blunt 
dissection,  and  when  properly  done  relief  is  im- 
mediate and  results  are  permanent.  The  mortality 
rate  increases  with  the  duration  of  the  disease. 
This  is  an  additional  reason  for  early  operation. 
The  diagnosis  is  entirely  clinical  and  the  recog- 
nition of  the  trouble  is  not  difficult  by  one  ex- 
perienced. 

Inguinal  hernia  in  children  is  practically  in- 
variably a congenital  defect  due  to  an  imperfect 
closure  of  the  processus  vaginalis.  The  sac  lies 
within  the  cord  and  is  dissected  free  with  some 
difficulty.  The  hernia  may  be  noticed  at  birth  or 
appear  within  the  next  few  years.  If  uncared  for 
it  has  a tendency  to  enlarge  and  generally  pro- 
trudes into  the  scrotum.  Usually  it  is  easily  re- 
ducable.  The  greatest  difficulty  in  diagnosis  is  in 
those  children  in  which  the  rupture  occurs  only 
occasionally  and  the  bulging  is  not  present  at  the 
time  of  the  examination.  Frequently  an  unde- 
scended testicle  is  mistaken  for  this  disease  or 
hydrocele  or  fat  may  produce  a swelling  that  is 
misleading.  A cure  without  treatment  has  often 
taken  place  and  the  conservative  treatment  of  the 
use  of  a yarn  truss  may  give  good  results.  The 
presence  of  a hernia,  however,  is  a great  factor  in 
producing  an  undernourished  child.  Feeding  is 
difficult  and  the  bowels  are  generally  sluggish. 
During  the  first  few  months  of  life,  or  in  a very 
feeble  infant,  it  is  not  wise  to  attempt  operation. 
With  a persistent  hernia,  however,  herniotomy 
should  always  be  performed,  except  in  a fretful 
child  during  the  teething  period.  After  the  first 
four  months  and  before  teething  begins  or  at  any 
time  after  the  first  teeth  have  erupted  are  the 
suitable  periods  for  operation. 

Inasmuch  as  the  walls  of  the  inguinal  canals 
are  not  weakened  as  they  are  in  the  adults,  it  is 
unnecessary  to  utilize  the  usual  technique  em- 
ployed in  acquired  hernia.  The  inguinal  canal  is 
opened  and  the  vessels  of  the  cord  are  separated 
in  order  to  find  the  sac  which  is  contained  within 
the  cord.  When  located,  it  is  separated  upward  as 
far  as  possible  toward  the  abdomen.  It  is  then 
clamped,  ligated  and  amputated,  and  the  stump 
retracts  into  the  abdomen.  Two  sutures  are  ap- 
plied to  close  the  external  ring  and  the  skin  is 
closed.  This  method  requires  little  time  and  is  en- 
tirely adequate.  Inasmuch  as  dressings  in  infants 
in  this  area  are  usually  wet  with  urine,  it  is  well 
to  apply  over  the  incision  a smear  of  Lassar’s  paste 
to  avoid  infection  as  often  as  the  dressing  is 
changed.  After  the  second  year  of  life  this  is  un- 
necessary. 


January,  1933 


Abdominal  Surgery  in  Children — Gillette 


25 


Strangulation  is  exceedingly  rare.  When  it 
does  occur,  it  seldom  causes  necrosis  of  the  bowel. 
The  same  operation  is  performed  as  in  inguinal 
hernia,  with  the  addition  of  dividing  the  fibrous 
cord  surrounding  the  sac,  which  releases  the 
strangulated  gut.  In  females  the  occurrence  of 
inguinal  hernia  is  rare  due  to  the  fact  that  the 
ovary  is  an  intra-abdominal  organ,  and  does  not 
pass  down  through  the  inguinal  canal.  The  opera- 
tion performed  is  the  same  as  that  in  males. 

Congenital  femoral  hernia  is  rare.  The  usual 
method  of  approaching  it  is  through  the  thigh, 
though  Seelig  has  described  an  admirable  in- 
guinal route.  The  sac  is  exposed,  amputated, 
ligated,  and  allowed  to  retract  and  a single  stitch 
is  placed  from  Gimbernat’s  ligament  to  Poupart’s 
ligament  to  close  the  opening. 

Umbilical  hernia  may  be  congenital  or  acquired. 
If  the  opening  is  not  large,  an  incision  may  be 
made  down  to  the  sac  wall.  The  sac  is  not  opened, 
but  the  contents  must  be  completely  reduced.  Cat- 
gut is  passed  around  the  sac  and  through  the 
fascia  from  three  directions  and  drawn  tight. 
After  a few  days,  adhesions  will  occur  which  will 
completely  and  permanently  close  the  opening. 
When  the  opening  is  large,  however,  the  standard 
Mayo  method  for  umbilical  hernia  is  performed. 
This  consists  in  making  a transverse  incision 
through  the  skin,  and  emptying  and  ligating  the 
sac.  The  fascia  is  likewise  cut  transversely  and 
the  lower  flap  brought  up  over  the  upper  layer 
of  fascia  and  sutured  in  place  with  mattress 
sutures.  This  completely  eradicates  the  umbilicus. 
This  method  in  children  produces  much  shock,  and 
may  be  followed  by  collapse  of  the  lung  and 
should  not  therefore  be  performed  on  infants,  ex- 
cept in  cases  of  strangulation. 

Diaphragmatic  hernia  is  rare,  but  should  be 
borne  in  mind  because  of  the  unusualness  of  the 
symptoms.  Frequently  cyanosis  develops  asso- 
ciated with  vomiting  and  shortness  of  breath.  The 
onset  is  sudden,  and  there  may  be  a cessation  of 
symptomatology  occurring  as  rapidly  as  the  onset. 
Inasmuch  as  the  stomach  is  almost  invariably 
displaced,  it  is  advisable  to  give  a barium  meal  to 
determine  its  position.  It  is  always  advisable  to 
attempt  to  close  the  opening  in  the  diaphragm 
because  of  the  danger  of  strangulation.  The 
easiest  method  of  approach  is  through  the  chest 
wall. 

A persistent  omphalomesenteric  duct  will  oc- 
casionally cause  trouble.  If  it  is  open  to  the 
umbilicus,  it  can  be  injected  with  opaque  oil  which 
will  be  detected  in  the  intestines  by  the  X-ray. 
Ordinarily  a Meckel’s  diverticulum  causes  no 
trouble  as  the  distal  end  atrophies  allowing  a 
separation  of  the  intestine  from  the  abdominal 
wall.  The  vitelline  duct  may  remain  as  a cord 
around  which  adhesions  may  form  to  the  intes- 
tines and  cause  obstruction,  or  it  may  become  in- 
flamed and  cause  symptoms  simulating  appendi- 


citis. Penberthy  has  had  cases  of  this  character 
in  which  the  abdomen  has  been  opened  and  in- 
testinal obstruction  demonstrated.  The  operative 
procedure  is  to  open  the  abdomen,  release  the  ob- 
struction, remove  the  remnants  of  the  duct  and 
close  the  opening  into  the  intestine  if  the  duct  is 
patent. 

Congenital  defects  of  the  abdominal  wall  are 
very  rare,  and  when  they  do  occur  are  of  little 
practical  importance  from  a surgical  standpoint, 
inasmuch  as  their  repair  requires  extensive  sur- 
gery at  a time  of  life  when  abdominal  surgery  is 
not  well  tolerated,  and  the  patient  almost  in- 
variably dies.  In  addition,  this  condition  is  gen- 
erally associated  with  other  malformations  which 
must  be  considered  before  any  operation  is  under- 
taken. Small  defects  can  be  closed  by  plastic  sur- 
gery, but  it  is  useless  to  attempt  the  closure  of 
large  openings  with  protrusion  of  the  intestine. 

Undescended  testis  is  associated  with  a defect 
in  the  gubernaculum.  The  gubernacular  tissue 
widens  and  extends  allowing  the  testis  to  leave 
the  abdomen  and  pass  down  through  the  inguinal 
canal.  When  imperfectly  formed  the  testicle  will 
not  descend.  There  is  generally  a partial  atrophy 
of  the  testicular  structure  in  this  condition,  more 
noticeable  in  those  that  have  been  allowed  to  go 
untreated  for  a number  of  years.  The  constant 
pressure  of  the  abdominal  musculature  and  the 
pressure  and  constant  irritation  causes  atrophy 
or  sarcomatous  degeneration.  It  is  not  uncommon 
for  atrophy  to  occur  in  those  cases  that  have  been 
operated  upon  in  the  first  three  years  of  life.  It 
is,  therefore,  best  to  wait  until  after  the  period  of 
time  when  a normal  testicle  would  have  completed 
its  descent  before  operation  should  be  performed. 
The  important  point  in  the  operation  is  the  com- 
plete separation  of  the  cord  from  the  surrounding 
structure.  The  inguinal  canal  is  opened,  and  the 
cord  is  freed  completely  from  adhesions  up  into 
the  abdominal  cavity.  The  testicle  is  then  brought 
down  and  placed  in  the  scrotum.  Some  operators 
complete  the  operation  at  this  point.  It  not  in- 
frequently happens,  however,  that  the  testicle  re- 
tracts somewhat  and  lies  just  outside  of  the  ex- 
ternal ring  when  this  method  is  used.  I,  there- 
fore, open  the  scrotum,  bring  the  testicle  through 
the  opening  and  implant  it  in  the  thigh  through 
a small  incision,  suturing  the  opening  in  the 
scrotum  to  the  opening  in  the  thigh.  At  the  end 
of  four  months,  the  cord  has  been  lengthened  and 
stretched  to  such  a degree  that  it  will  remain  low 
in  the  scrotum  when  it  is  replaced.  The  results 
of  this  operation  are  very  good  if  atrophy  has  not 
already  taken  place. 

Congenital  deformities  of  the  bladder  are  of 
two  types:  first  complete  and  second  incomplete. 
Complete  extrophy  occurs  with  no  urethra  present, 
and  is  frequently  associated  with  complete 
separation  of  the  pubic  bones.  Due  to  the  fact 
that  the  anterior  wall  of  the  bladder  is  absent,  it 


26 


The  Ohio  State  Medical  Journal 


January,  1933 


is  necessary  to  perform  either  a plastic  operation 
for  closure  or  a transplantation  of  the  ureters. 
The  plastic  operations  devised  have  not  been  suc- 
cessful, however,  in  the  absence  of  a urethra  and 
the  only  successful  method  of  repair  is  that  of 
transplantation  of  the  ureters  into  the  colon  ac- 
cording to  Coffee.  In  this  operation  the  cut  ends 
of  the  ureter  are  buried  under  the  serosa  the  dis- 
tance of  an  inch  before  emptying  into  the  lumen 
of  the  bowel  in  order  to  provide  a valve.  The  re- 
sults are  eminently  successful  when  properly  car- 
ried out. 

In  the  incomplete  type  in  which  a urethra  is 
present  and  enough  tissue  is  available  to  cover  the 
bladder,  it  may  be  closed  layer  by  layer.  If  suffi- 
cient is  not  present  plastic  skin  flaps  taken  from 
the  abdomen  or  scrotum  and  turned  to  make  an 
anterior  wall  are  used  as  a covering.  Fortunately 
this  condition  occurs  not  more  often  than  one  in 
thirty  thousand  births.  In  untreated  cases  at  least 
50  per  cent  die  before  the  age  of  ten  years.  It  is 
always  advisable,  therefore,  to  recommend  opera- 
tion. The  optimum  period  is  about  the  age  of 
two,  before  the  kidneys  are  infected  and  while  an 
operation  is  well  tolerated. 

Volvulus  is  a condition  of  rotation  of  the  in- 
testine upon  its  long  axis.  In  the  presence  of  a 
long  mesentery  some  unusual  effort  or  strain- 
ing may  be  followed  by  the  symptoms  of  this  con- 
dition. The  abdominal  musculature  becomes  rigid 
and  tense.  It  is  very  tender  over  the  area  of 
pathology.  A distinctive  sign  may  be  initial  re- 
traction of  the  abdominal  wall  followed  by  a dis- 
tention at  the  umbilicus  associated  with  intestinal 
obstruction.  Surgical  intervention  is  always  re- 
quired. 

On  opening  the  abdomen,  the  condition  present 
dictates  the  method  of  procedure.  If  gangrene  has 
not  set  in  a straightening  of  the  loop  is  sufficient. 
Where  gangrene  is  present  it  will  be  necessary  to 
perform  an  anastomosis  and  remove  the  infected 
portion  of  the  intestine.  An  attempt  to  repeat  the 
occurrence  should  be  made  by  freeing  the  ad- 
hesions or  shortening  the  mesentery  with  catgut 
sutures. 

It  is  not  within  the  province  of  this  paper  to 
describe  anemias  with  the  exception  of  splenic. 
Continued  anemia  with  splenomegaly  is  aided  by 
transfusion  and  repeated  cures  have  followed  the 
removal  of  the  spleen.  It  is  my  practice  to  intro- 
duce blood  directly  into  the  peritoneal  cavity.  It 
should  be  citrated  to  keep  it  in  a liquid  state  and 
prevent  the  formation  of  clots  and  non-absorption. 
An  immediate  improvement  in  the  hemoglobin  and 
erythrocyte  count  is  not  noted,  but  at  the  end  of 
twenty-four  hours  there  is  a definite  increase  in 
the  hemoglobin  and  number  of  red  blood  cells  in 
the  blood  stream,  showing  that  the  red  blood  cells 
and  hemoglobin  have  been  removed  from  the  ab- 
domen and  taken  into  the  blood. 

After  repeated  blood  transfusions  and  the  ab- 


domen is  opened  some  adhesions  may  be  present, 
but  these  are  fine  and  are  not  troublesome.  The 
removal  of  the  spleen  is  not  attended  with  great 
difficulty  if  it  is  delivered  outside  of  the  abdominal 
wall  before  the  pedicle  is  ligated.  An  attempt  to 
ligate  the  pedicle  without  delivering  the  spleen  is 
attended  with  hemorrhage  and  shock. 

Congenital  atresia  of  the  gastro-intestinal  tract 
may  be  single  or  multiple.  I have  recently 
operated  upon  a new  born  in  which  vomiting 
started  two  days  after  birth.  No  meconium  was 
present  due  to  the  fact  that  the  atresia  was  in  the 
large  bowel.  The  ascending  colon  from  the  ileo- 
cecal valve  to  the  hepatic  flexure  was  a fibrous 
cord.  The  transverse  colon  was  normal  in  size 
and  appearance  and  one  and  one-half  inches  of 
the  splenic  flexure  was  again  occluded.  The  small 
intestine  was  dilated  to  nearly  the  size  of  that  of 
an  adult.  The  terminal  ileum  was  brought  through 
the  intestinal  wall  and  a fistulous  opening  made. 
The  child  succumbed  to  inanition  in  a few  days. 
This  is  the  usual  course  following  the  intestinal 
defects,  though  there  are  records  that  some  of 
them  have  been  saved.  Operation,  of  course, 
offers  the  only  possible  chance  for  life  and  should 
be  performed  at  the  earliest  possible  moment  after 
diagnosis  has  been  made.  Occasionally  there  is  a 
complete  absence  of  some  part  of  the  intestine 
but  this  is  rare.  The  more  common  type  of  lesion 
is  that  in  which  there  is  a narrowing  of  the  gut 
which  is  persistent. 

Foreign  bodies  in  the  gastro-intestinal  tract 
can  usually  be  detected  by  the  X-ray.  Any  smooth 
circular  body  which  is  less  than  one  inch  in 
diameter  will  pass  without  trouble  or  obstruction. 
Its  progress  should  be  carefully  followed  in  order 
that  the  abdomen  may  be  opened  early  if  com- 
plete obstruction  develops.  Cathartics  should  not 
be  given  because  of  the  likelihood  of  injuring  the 
gut  by  the  active  peristalsis. 

Pins,  nails,  and  other  sharp  pointed  objects 
will  frequently  pass  if  left  alone  Open  safety 
pins  may  cause  no  trouble,  as  they  turn  in  the 
stomach  and  pass  on  downward  blunt  end  first. 
Unless  obstruction  occurs  the  procedure  of  watch- 
ful waiting  should  be  followed. 

Retroperitoneal  sarcoma,  originating  in  the  post 
peritoneal  glands,  pi-esents  a picture  of  a rapidly 
growing  tumor  mass  in  the  mid-line.  It  is  only 
moderately  painful,  but  with  the  progress  of  the 
disease  there  develops  a cachexia  and  marked  in- 
anition of  the  child.  Operative  procedure  is  only 
advisable  in  the  early  stages  of  the  disease,  and 
then  only  with  the  idea  of  delaying  the  growth,  as 
it  is  invariably  fatal.  It  is  to  be  distinguished 
from  sarcoma  of  the  kidney,  which  is  more  lat- 
terly placed,  and  from  hydronephrosis,  which  is 
slow  in  growing  and  in  which  the  children  present 
symptoms  similar  to  that  of  adults. 

The  selection  of  the  type  of  anesthetic  is  im- 
portant. Ether,  ethyl  chloride,  chloroform,  and 


January,  1933 


Abdominal  Surgery  in  Children — Gillette 


27 


nitrous  oxide  gas  are  used  as  inhalation  gases. 
Warmed  ether  is  the  best  of  these  because  of  its 
safety  and  good  relaxation.  Its  disadvantages  are 
the  nausea  following  operation  and  the  reduction 
of  body  temperature  following  its  use.  I have  been 
using  spinal  anesthetic  routinely  except  in  the 
very  young,  and  in  suitable  cases  local,  or  local 
preceded  by  avertin.  Avertin  is  perfectly  safe 
when  given  in  the  correct  dosage,  but  usually  the 
relaxation  is  not  sufficient  without  the  additional 
use  of  local  anesthesia  or  50  per  cent  nitrous 
oxide  gas.  With  this  mixture  relaxation  is  good,  and 
the  patient  is  not  sick  afterward.  In  the  very 
young  a little  ether  or  ethyl  chloride  is  preferable. 

The  diagnosis  of  abdominal  diseases  in  children 
is  frequently  misleading  and  misunderstood,  and 
there  is  often  a misconception  of  the  symptom- 
ology.  A painstaking  examination  is  essential  to 
a correct  valuation  of  the  condition.  A definite 
diagnosis  should  be  made  before  opening  the 
abdomen  instead  of  making  an  exploratory  lapar- 
otomy, as  it  may  mean  the  difference  between  suc- 
cess and  failure. 

320  Michigan  Street. 


discussion 

Joseph  L.  DeCourcy,  M.D.,  Cincinnati,  Ohio: 
It  has  been  said  that  many  an  adult  may  safely 
be  treated  as  a child,  but  conversely  to  treat  chil- 
dren as  though  they  were  adults  is  a dangerous 
procedure  when  surgery  is  contemplated.  Ab- 
dominal surgery  upon  children  is  no  exception  to 
this  rule,  as  Dr.  Gillette  has  ably  shown. 

Owing  to  the  increased  metabolic  rate  in  chil- 
dren incidental  to  normal  growth,  these  functions 
are  very  easily  upset  by  any  radical  changes  in 
regime  such  as  are  ordinarily  instituted  prepara- 
tory to  surgery  in  the  adult.  Acidosis  is  more 
easily  induced  and  it  is  more  intense  and  dis- 
astrous. 

Hence,  we  must  exercise  every  precaution  be- 
fore, during  and  after  operation  in  these  cases  to 
minimize  metabolic  upheaval  and  prevent  acidosis 
and  a possibly  fatal  collapse. 

Preoperative  starving  and  purgation  are  not  to 
be  countenanced  in  children.  On  the  contrary,  the 
injured  child  brought  in  from  the  street  for 
emergency  operation  often  makes  a good  operative 
risk. 

In  the  DeCourcy  Clinic  we  allow  food  up  to 
within  three  hours  of  operation,  and  frequent 
small  amounts  of  water  up  to  within  an  hour  or 
less  before  administering  the  anesthetic. 

We  do  not  purge,  nor  do  we  consider  pre- 
operative enemata  necessary  though  an  enema 
may  be  employed  a few  hours  before  operation. 

We  do  pay  some  attention  to  the  preoperative 
diet,  but  it  has  to  do  particularly  with  mainte- 
nance or  increase  of  the  carbohydrate  intake 
rather  than  curtailment  of  any  sort.  Starvation, 
with  its  danger  of  acetonuria,  especially  is  to  be 
avoided.  We  find  it  desirable  to  give  plenty  of 
orange  juice  and  increase  the  cereals. 

You  have  perhaps  heard  of  the  terse  dietary 
regime  which  calls  for  “plenty  of  lump  sugar 
and  no  castor  oil.”  Such  a regime  meets,  no  doubt, 


with  the  entire  approval  of  the  youngsters  them- 
selves. It  is  in  principle  a pretty  good  rule  to  fol- 
low from  the  surgical  viewpoint. 

We  give  subcutaneous  injections  of  glucose 
solution  preoperatively  as  a routine  when  the  con- 
dition of  the  child  is  precarious  and  operation 
cannot  be  delayed  for  a more  favorable  time.  In 
serious  cases,  it  may  be  necessary  to  resort  pre- 
operatively to  blood  transfusion.  In  general, 
however,  we  prefer  to  delay  operation  whenever 
possible  until  the  child  is  in  the  best  possible 
state  of  nutrition  and  with  the  least  evidence  of  a 
tendency  to  acetonuria  or  acidosis. 

For  the  anesthetic,  personally,  I prefer  a nit- 
rous oxide-ether  sequence  and  consider  this  the 
safest  method.  While  I realize  that  general 
anesthesia  in  these  children  has  a tendency  to 
increase  the  production  of  an  acidosis,  yet  I feel 
that  our  access  to  offsetting  measures  such  as 
glucose  administration  adequately  compensates 
for  the  potential  danger. 

I do  not  personally  resort  to  spinal  anesthesia 
or  rectal  anesthesia  with  avertin,  though  I have 
used  local  anesthesia  for  pyloric  obstruction  in 
extreme  cases. 

I often  find  it  essential  to  utilize  general  anes- 
thesia in  order  to  make  adequate  abdominal  ex- 
amination, as  well  as  preferable  for  surgery 
itself.  Certainly  the  psychological  element  of 
fright,  in  my  opinion,  offsets  the  advantages  of 
spinal  or  local  anesthesia,  and  I feel  that  method 
of  anesthesia  should  be  chosen  which  places  the 
child  most  completely  under  the  control  of  the 
operator  both  mentally  and  physically.  Whether 
the  patient  is  child  or  adult,  the  anesthetist  must 
know  what  he  is  about.  Expert  anesthetization 
should  be  a requisite  especially  in  children,  since 
there  is  a smaller  margin  between  the  anestheti- 
zing dose  and  the  asphyxiating  dose. 


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versity School  of  Medicine;  a compilation  of 
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MIgramedLike  Headache  Dime  to  Allergy* 

Jonathan  Forman,  B.A.,  M.D.,  Columbus,  Ohio 


THIS  paper  has  to  do  with  one  particular 
kind  of  suffering  found  only  in  approxi- 
mately one  family  in  ten.  Ninety  per  cent 
of  the  population  cannot  acquire  this  disease  in 
any  possible  manner.  It  comes  only  in  those  who 
have  inherited  the  necessary  background  or  con- 
stitution. For  centuries  the  common  folk  have 
known  that  certain  foodstuffs,  normally  harmless, 
acted  as  poisons  to  certain  individuals.  Hence  the 
axiom  arose  “what  is  one  man’s  food  is  another 
man’s  poison.”  With  this  generation  of  physi- 
cians has  come  the  understanding  that  these  per- 
sons who  show  an  altered,  or  different  from  the 
average,  reaction  to  substances  normally  harm- 
less, fall  into  one  group  comprising  approximately 
10  per  cent  of  the  population.  This  capacity  to- 
give  an  unusual  reaction  to  certain  specific  sub- 
stances is  strictly  subject  to  heredity  in  con- 
tradiction to  all  other  forms  of  hypersensitive- 
ness. This  distinguishing  characteristic  has  been 
shown  to  be  inherited  and  transmitted  as  a domi- 
nant Mendelian  character.  This  has  rightly  been 
named  Atopy  (a  strange  disease.) 

What  substance  it  is  that  the  person  with  this 
inherited  allergic  constitution,  or  altered  capacity 
to  react  differently  from  the  other  90  per  cent  of 
the  population  actually  becomes  specifically 
hypersensitive  to,  is  determined  by  the  degree  and 
manner  of  contacts  with  substances  capable  of 
so  acting.  Such  materials  are  usually,  if  not  al- 
ways, protein  in  character. 

The  kind  of  symptoms  that  such  persons  under 
such  conditions  will  manifest  depends  upon  the 
make-up  of  the  individual  and  his  inheritance. 
Recent  studies  indicate  that  these  patients  often 
inherit  a tendency  to  develop  a specific  type  of 
altered  reaction.  There  may  be,  for  instance,  the 
tendency  for  all  the  members  of  a certain  allergic 
family  to  all  develop  food  sensitizations  or  all  to 
develop  pollen  sensitizations.  There  is  also  the 
tendency  of  members  of  the  same  family  to  ex- 
hibit a specific  localization  as  well,  such  as  hay- 
fever,  asthma  or  sick  headaches.  The  second  fac- 
tor which  determines  what  kind  of  disturbances 
such  people  manifest  is  the  character  and  quali- 
ties of  the  particular  subtsances  to  which  this  in- 
dividual is  most  exposed  (allergens).  And  finally 
the  third  factor  is  the  mode  of  contact  and  entry 
for  the  most  commonly  encountered  and  most  ac- 
tive substance  (allergens). 

A glance  at  the  chart  will  show  you  that  an  in- 
dividual who  belongs  through  inheritance  in  this 
smaller  group  (10  per  cent  of  the  total  popula- 
tion) may  become  specifically  sensitive  to  some 
substance  by  direct  contact  or  absorption.  Fur- 
thermore, it  must  be  noted  that  in  addition  to  the 

*Read  before  the  Medical  Section,  Ohio  State  Medical  As- 
sociation, at  the  86th  Annual  Meeting,  Dayton,  May  3-4,  1932. 


specific  factor  there  is  non-specific  aggravating 
factor  or  factors  which  may  assume  a role  of 
major  importance  in  certain  individual  attacks. 
Of  these  non-specific  factors,  barometric  changes, 
emotional  upsets  and  infections  are  the  three 
most  important  ones  and  must  always  be  given 
consideration. 

Where  this  inherited  capacity  to  react  in  a dif- 
ferent but  specific  way  has  been  transmitted  from 
both  sides  of  the  house,  the  clinical  disturbances 
are  pretty  certain  to  make  themselves  manifest 
before  the  child  is  ten  years  old. 

Specific  sensitiveness  may  be  acquired  by  the 
infant  still  in  utero  as  a result  of  the  mother’s 
over-indulgence  in  certain  protein  foods.  These 
proteins  enter  into  the  circulation  unchanged 
from  the  mother’s  intestines  through  the  perme- 
able placenta.  After  birth,  an  infant  coming  in 
contact  with  this  food  for  the  first  time  may  react 
by  some  of  the  manifestations  in  our  chart  as 
local  allergic  reactions  such  as  eczema,  hives  or 
asthma. 

The  intestinal  wall  in  infants  is  extremely 
permeable  to  the  invasion  of  unchanged  proteins. 
In  the  vast  majority  of  infants  such  invasions 
never  make  the  slightest  disturbance,  but,  in  the 
group  of  individuals  which  we  have  under  con- 
sideration in  this  paper,  these  proteins  entering 
directly  into  the  circulation  will  sensitize  certain 
organs  to  the  future  ingestion  of  .such  proteins. 
It  may  be  the  protein  of  cow’s  milk  or  the  offend- 
ing substance  may  be  transmitted  through  the 
breast  milk  from  the  mother’s  blood,  and  so  repre- 
sent something  she  is  eating.  This  is  what  has 
usually  taken  place  in  those  cases  where  you  are 
told  that  the  child  became  sensitive  to  its  own 
mother’s  milk.  As  these  persons  grow  older  they 
are  more  apt  to  acquire  sensitization  to  things 
that  they  breathe  in  heavy  doses  at  certain  times 
rather  than  to  food  stuffs — such  things  as  pollen, 
orris  root,  house  dust,  etc. 

Before  this  section  on  May  10,  1927,  I read  a 
paper  on  “Chronic  Recurring  Headaches  From 
the  Viewpoint  of  the  Gastroenterologist.”  In  that 
paper  a working  classification  of  headaches  was 
presented.  From  the  160  or  more  types  of  head- 
ache those  of  the  greatest  importance  we  dis- 
cussed. We  placed  migraine  among  the  inde- 
pendent forms  of  headache  and  gave  the  following 
tentative  classification : 

INDPENDENT  FORMS  OF  HEADACHE 

A.  Migraine  (cephalic  and  ophthalmic  types) 

1.  Due  to  protein  sensitization 

2.  Due  to  carbohydrate  excess  (actual  or 
relative) 

3.  Due  to  disturbance  of  purin  metabolism. 

Our  experience  in  dealing  with  the  people  fall- 


28 


January,  1933 


Headache  Due  to  Allergy — Forman 


29 


mg'  in  the  group  of  those  who  have  inherited  a 
constitutional  capacity  to  react  in  an  unusual 
fashion  has  been  that  persons  with  migraine  as 
the  only  possible  marfifestation  of  allergy  in  the 
personal  history  have  a higher  percentage  of 
allergy  in  their  family  history,  than  do  non-aller- 
gic  persons  without  migraine;  likewise,  allergic 
individuals  who  present  other  manifestations  but 
not  migraine  show  a higher  percentage  of  mi- 
graine in  their  family  history  than  do  people 
without  migraine  or  any  other  manifestation  of 
allergy. 

It  has  been  well  established  now  that  chronic 
recurring  headaches  are  often  atopic  in  nature — 
an  expression  of  allergy.  We  must  not,  however, 
be  misled — not  every  recurring  headache  has  an 
allergic  background.  There  are  still  eight  score 
other  causes  of  this  condition.  Hence  every  such 
case  must  be  given  a complete  study.  This  can 
only  be  emphasized  here  but  it  was  given  in  de- 
tail in  our  other  paper. 

THE  DIAGNOSIS 

The  diagnostic  problem  then  after  a complete 
study  has  been  made,  and  it  seems  pretty  certain 
that  we  are  not  dealing  with  a headache  associ- 
ated with  organic  disease  but  rather  an  independ- 
ent form  of  headache  of  an  apparently  migrainous 
nature,  is: 

(I)  To  identify  an  allergic  constitution  in  our 
patient;  (II)  To  identify  the  particular  substance 
or  substances,  to  which  this  patient  is  specifically 
hypersensitive;  (III)  To  prove  which  of  these  spe- 
cific sensitizations  are  causing  the  headaches. 

The  allergic  nature  of  our  patient’s  constitution 
may  be  established  on  four  essential  criteria: 

1.  A family  history  which  reveals  the  presence 
of  asthma,  hay-fever,  vasomotor  rhinitis, 
hives,  angioneurotic  edema,  migraine,  epi- 
lepsy, mucous  colitis,  persistent  canker 
sores,  eczema,  drug,  shell-fish  and  berries 
idiosyncrasies. 

2.  A personal  history  showing  some  of  these 
allergic  manifestations. 

3.  An  eosinophilia,  local  or  general.  This  may 
not  be  found  because  it  is  not  looked  for  at 
the  proper  time  or  in  the  proper  place. 

4.  Positive  skin  tests — we  are  not  concerned 
here  with  their  interpretation — just  the  fact 
that  they  are  present. 

Having  confirmed  our  suspicion  that  we  are 
dealing  with  a type  of  chronic  headache  which  is 
independent  of  organic  disease,  and  that  this 
symptom  is  appearing  in  a person  with  an  allergic 
background  by  having  satisfied  the  criteria  set 
forth  in  the  preceding  paragraph,  we  must  proceed 
to  find  to  what  substance  or  substances  it  is  that 
our  patient  is  sensitive.  Our  first  consideration 
here  is  the  interpretation  of  a properly  performed, 
adequate  number  of  skin  tests.  While  there  is  a 
distinct  tendency  for  these  allergic  manifestations 


to  localize  themselves  in  different  parts  of  the 
human  body,  the  majority  of  these  commonly  rec- 
ognized symptoms  of  allergy  are  characterized  by 
a swelling  of  the  mucous  membrane  in  some  part 
of  the  body.  Now,  when  the  outer  or  protective 
layers  of  the  skin  are  removed,  a deeper,  second  or 
live  skin  is  exposed.  This  deeper  layer  resembles 
in  many  ways  and  is  similar  to  the  mucous  mem- 
branes which  line  the  nose,  the  bronchial  tubes, 
the  alimentary  and  urinary  tract.  Skin  tests  for 
protein  sensitization  makes  use  of  this  fact.  By 
the  scratch  technique  or  by  injecting  into  the  skin 
between  the  two  layers  of  skin  a test  exposure  is 
made  with  many  substances  which  is  comparable 
to  the  national  exposure  of  the  hypersensitive 
person  undergoing  the  diagnostic  study.  The 
various  pollen,  animal  dander,  foods  and  drug  are 
placed  and  rubbed  in  gently.  If  a hive  or  a red- 
dened area  is  produced,  this  indicates  that  the  test 
is  positive  and  its  bearer  is  sensitive  to  the  sub- 
stance which  has  been  applied. 

Finally,  skin  testing  is  done  by  the  injection  of 
small  quantities  of  the  protein  extracts  of  the  sub- 
stances to  be  tested  into  the  skin,  exercising 'great 
care  not  to  go  below  the  skin.  This  second  method 
in  order  to  be  a safe  procedure,  in  our  opinion, 
should  only  be  used  after  negative  tests  have  been 
obtained  for  the  same  substance  by  scratch 
method.  In  this  way  through  the  use  of  less  sen- 
sitive method  of  testing,  it  has  been  established 
that  the  patient  is  not  unusually  sensitive  to  cer- 
tain of  the  test  substances. 

The  cutaneous  tests  should  be  applied  only  after 
a cax-eful  analysis  of  the  clinical  history.  This 
analysis,  if  properly  made,  should  give  some  idea 
of  the  probable  offenders.  If  the  family  history 
is  positive  for  allergic  manifestations  in  blood  rel- 
atives; if  the  patient  presents  a symptom  or  set 
of  symptoms  which  may  well  be  allergic  in  char- 
acter; if  this  is  strengthened  by  the  routine  test 
and  the  demonstration  of  an  eosinophilia  in  the 
blood  or  nasal  secretions  of  the  patient,  one  of 
two  things  has  happened — - 

1.  The  offending  substances  have  been  detected 
in  a case  of  atophy. 

2.  The  allergic  state  has  been  discovered  to 
exist  in  the  patient  but  offending  substances 
are  still  to  be  found. 

If  the  second  state  of  affairs  exists  then  the 
next  step  is  to  apply  a rather  more  extensive 
group  of  proteins.lt  is  our  practice  toi  use  the  fol- 
lowing test  substance  arranged  in  the  order  of  the 
reported  frequency  with  which  they  have  pro- 
duced an  atopic  coryza. 

We  use  the  back  for  the  scratch  test — five  on 
each  side  of  the  spine,  ten|  in  a row.  For  the  in- 
tradermal  injections  we  use  the  outer  aspect  of 
the  arm. 

While  skin  tests  for  protein  sensitization  have 
a most  useful  place  in  the  study  of  the  various 
allergic  manifestations,  this  procedure  has  defi- 


A SPECIFIC 


30 


The  Ohio  State  Medical  Journal 


January,  1933 


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Manifestations  of  Otic  Disease — McCarthy 


31 


nite  limitations  and  serves  only  as  a guide  in  the 
management  of  the  case  to  facilitate  the  identifi- 
cation of  the  offending  substance  through  clinical 
trial. 

The  clinical  trial  is  given  by  adopting  a diet 
properly  balanced  and  adequate  in  all  particulars, 
but  from  which  have  been  eliminated  all  the  com- 
mon “offenders”  and  in  so  far  as  possible  the  prob- 
able offenders.  This  “elimination”  diet  then  is 
gradually  developed  by  the  addition  and  substitu- 
tion one-food  substance  at  a time  at  intervals  of 
three  or  four  days  until  the  patient  has  nearly  a 
normal  range  and  variety  of  diet  and  until  the  one 
or  more  offending  substances  are  thus  developed 
by  the  proper  application  of  the  rules  laid  down 
by  Warren  Taylor  Vaughan. 

1.  The  removal  of  the  suspected  food  relieves 
the  patient  of  the  allergic  manifestations. 

2.  The  exhibition  of  the  suspected  food  causes 
the  patient  to  develop  the  allergic  manifesta- 
tions. 

When  carefully  studied  and  properly  identified, 
these  allergic  individuals  who  come  complaining 
of  a chronic  recurring  migrainous  headache  re- 
spond very  well  to  non-allergic  elimination-sub- 
stitution-identification management  as  outlined  by 
Rowe.  They  respond  better  for  us  than  any  of 
the  other  clinical  manifestations  of  this  “strange 
disease”  (Atopy) . 

DISCUSSION 

Bernhard  Steinberg,  M.D.,  Toledo,  Ohio:  My 
only  qualification  to  discuss  this  paper  is  a sub- 
jective one.  Doctor  Forman  apparently  knew  that 
if  I could  not  add  facts  to  his  paper,  I could  at 


least  be  properly  appreciative  of  the  subject  since 
I have  headaches  myself  and  realize  that  there  is 
nothing  more  uncomfortable  than  a headache  ex- 
cept another  one.  We  should  be  indebted  to 
Doctor  Forman  for  bringing  before  the  section 
this  topic  long  before  the  expiration  of  the  usual 
twenty-year  period  that  it  requires  to  introduce 
a new  observation  to  the  practicing  profession. 

The  allergic  headache  usually  begins  in  the 
frontal  region  over  either  eye,  occasionally  in  the 
occipital  region  and  spreads  over  the  entire  head. 
The  severity  of  the  headache  is  commonly  pro- 
portional with  the  amount  of  the  offending  sub- 
stance. The  pathological  change  responsible  for 
the  headaches  is  probably  a cerebral  edema  since 
sodium  chloride  therapy  relieves  the  headache. 
The  common  allergen  is  food  but  inhalants  may 
also  be  responsible.  More  than  one  food  may  in- 
duce the  migraine.  One  should  not  rely  on  a 
negative  skin  reaction  in  ruling  out  allergy  as  a 
basis  for  the  headache,  since  negative  reactions 
by  no  means  exclude  the  possibility  of  the  in- 
dividual’s susceptibility  to  that  substance. 

Predisposing  factors  such  as  physical  and  men- 
tal exertion  may  precipitate  the  headache  in  sus- 
ceptible individuals  even  without  ingestion  or  in- 
halation of  the  sensitizing  substance.  In  an  in- 
dividual with  a definite  allergic  history,  the 
recognition  of  an  allergic  headache  is  not  diffi- 
cult. It  is  the  patient  with  a concealed  or  latent 
allergy  that  offers  difficulties  in  the  discovery  of 
the  basis  for  the  migraine.  It  may  be  said  that 
a patient  with  frequent  headaches  and  with  either 
a familial  or  personal  allergic  history,  with  or 
without  positive  skin  tests,  should  be  considered 
a subject  of  allergic  headaches  until  proved  other- 
wise. If  a patient’s  condition  is  intractable,  the 
practicing  physician  should  not  give  up,  but  refer 
the  patient  to  an  allergist  whose  equipment  al- 
lows him  an  opportunity  for  a more  thorough  in- 
vestigation. Lest  I be  suspected  of  ulterior 
motives  I will  declare  myself  as  merely  a patho- 
logist interested  in  allergy  and  not  a practicing 
allergist  interested  in  new  patients. 


of  Otic 


M.  F.  McCarthy,  M.D.,  Cincinnati,  Ohio 


IN  order  to  give  form  to  a discussion  of  the 
ophthalmic  manifestations  of  otic  disease,  it 
is  well  to  set  down  in  some  order  the  more 
important  otic  diseases  which  may  or  may  not 
have  eye  symptoms.  From  this  group  we  can 
then  place  in  more  significant  order  those  which 
may  have  ophthalmic  manifestations.  Since  there 
are  no  important  external  ear  diseases  which  have 
to  be  considered  as  presenting  eye  manifestations, 
our  classifications  can  be  under  the  heading  of 

DISEASES  OF  THE  MIDDLE  EAR  AND  INTERNAL  EAR 
HAVING  OPHTHALMIC  MANIFESTATIONS 

Group  1. 

Otitis  media  acute  catarrhal  with  catarrhal 
labyrinthitis 

Otitis  media  acute  purulent  and  purulent  mas- 
toditis 

Read  before  the  Eye,  Ear,  Nose  and  Throat  Section, 
Ohio  State  Medical  Association,  at  the  86th  Annual  Meeting, 
Dayton,  May  3 and  4,  1932. 


with  a)  catarrhal  labyrinthitis  acute 

b)  purulent  labyrinthitis  acute  or  latent 

c)  meningitis  in  its  various  forms 

d)  brain  abscess  acute  or  chronic 

e)  sinus  thrombosis 

Otitis  media  chronic  purulent  and  mastoiditis 
chronic  purulent  with  or  without  cholesteatome 
with  a)  catarrhal  labyrinthitis  acute 

b)  purulent  labyrinthitis  acute  or  latent 

c)  labyrinthine  fistula 

d)  meningitis  in  its  various  forms 

e)  brain  abscess  acute  or  chronic 

f)  sinus  thrombosis 

Meniere’s  disease  (hemorrhagic  labyrinthitis) 

Fractures  of  the  temporal  bone  extending  into 
the  internal  ear 

a)  without  meningitis 

b)  with  meningitis 

It  now  becomes  apparent  that  we  can  group  all 
otic  diseases  having  eye  manifestations  into  those 
affecting  the  labyrinth  and  those  resulting  in  in- 
tracranial change,  as  follows: 


32 


The  Ohio  State  Medical  Journal 


January,  1933 


Gi’oup  II. 

Labyrinthine  irritation  or  destruction  from 

1)  Catarrhal  labyrinthitis 

2)  Purulent  labyrinthitis  acute  or  latent 

3 ) Labyrinthine  fistula 

4)  Hemorrhage  into  the  internal  ear 

5)  Neuritis  of  eighth  nerve  from  toxins  or 
drugs 

Intracranial  changes  of  Otic  Origin 

1)  Meningitis  in  its  various  forms 

2)  Brain  abscess  acute  or  chronic 

3)  Sinus  thrombosis 

4)  Neoplasms  of  the  eighth  nerve 

Consideration  of  the  ocular  manifestations  of 

labyrinthine  irritation  or  destruction,  as  com- 
pared to  those  taking  place  as  the  result  of  intra- 
cranial changes  of  otic  origin,  makes  possible  the 
statement  to  follow. 

Ocular  manifestations  of  labyrinth  origin  are 
always  shown  by  the  presence  or  absence  of 
rhythmic  nystagmus  and  nothing  else. 

Ocular  manifestations  of  otic  intracranial  origin 
may  be  shown  by 

a)  Rhythmic  nystagmus 

b)  Paresis  or  paralysis  of  the  lid  muscles 

c)  Ocular  muscle  paresis  or  paralysis 

d)  Sensory  changes  in  cornea 

e)  Pupillary  changes 

f)  Fundus  changes 

g)  Visual  changes 

It  is  not  fitting  in  this  paper  to  enter  upon  a 
prolonged  discussion  of  the  normal  ocular  re- 
sponse to  labyrinthine  irritation  or  stimulation. 
However,  the  absence  of  the  normal  ocular  re- 
sponse to  labyrinth  irritation  or  stimulation  is  an 
important  observation  as  well  as  the  presence  or 
absence  of  spontaneous  rhythmic  nystagmus. 
Without  going  into  it  at  too  great  length,  this 
much  can  be  said: 


Nystagmus  is  either 

Spontaneous  or  Elicited 

(by  turning  (Barany 
tests)  by  douching  ears 
(caloric  tests)  water  at 
68  or  112  degrees  F. 

Rhythmic  or  Oscillating 

(Has  rapid  and  slow  (Note.  Oscillating  is 
component.  Direction  of  not  of  Otic  origin.) 
nystagmus  is  always 
given  as  that  of  rapid 
component.) 

f Horizontal 

Horizontal  Rotatory  or  Mixed  j and 

[ Rotatory 


Spontaneous  Rhythmic  Nystagmus  is 


Strong 

(May  mean  marked  ir- 
ritation to  or  beginning 
destruction  of  the  laby- 
rinth.) 

Persistent 

(If  continued  beyond  14 
to  16  days  is  not  due  to 
suppurative  labyrinthi- 
tis. If  continued  beyond 
this  period  may  be  due 
to  catarrhal  labyrinth- 
itis or  intracranial  diffi- 
culty.) 


Weak 

(Usually  means  irrita- 
tion of  the  labyrinth  is 
not  severe.) 

Transient 

(Is  usually  of  intra- 
cranial origin.) 


Normal  (in  direction)  or  Abnormal  (in  direction) 


(All  spontaneous  nys- 
tagmus of  labyrinthine 
origin  should  be  from 
side  to  side,  whether  it 
be  horizontal,  rotatory 
or  mixed.) 


(Any  spontaneous  nys- 
tagmus having  move- 
ments other  than  from 
side  to  side,  be  they 
oblique  or  vertical  is 
the  result  of  intra- 
cranial pathology.) 


Elicited  Nystagmus  By  Barany  turning  tests 

or  by  douching  ears  with  water  at  68  de- 
grees F.,  or  with  water  at  112  degrees  F. 


is  Present 

(When  present  the  most 
important  inference  is 
that  the  labyrinth  is  ac- 
tive and  probably  nor- 
mal. If  not  normal  it  is 
at  least  not  the  seat  of 
a suppurative  process.) 


or  Absent 

(Always  means  some 
organic  change,  either 
in  the  labyrinth  or  its 
associated  pathways.) 


Elicited  Nystagmus  if  Present  may  be 
Normal 

In  Type.  (Horizontal  canal  stimulation  should 
always  yield  horizontal  nystagmus.  Verti- 
cal canal  stimulation  should  always  yield 
rotatory  nystagmus.) 

In  Direction.  (Nystagmus  always  follows  the 
rule  that  it  is  opposite  to  the  direction  of 
the  intra-canalicular  fluid  flow,  whether 
from  or  toward  the  ampulla.) 

In  Intensity.  (A  weak  response  may  mean  that 
the  labyrinth  is  being  destroyed  slowly. 
Excessive  response  may  mean  irritation.) 
or  Abnormal 

Whatever  the  abnormality  of  the  response  may 
be,  it  must  mean  that  the  LABYRINTH  is  func- 
tioning. Abnomalities  of  TYPE  and  DIREC- 
TION are  always  due  to  organic  intracranial 
change  and  not  due  to  labyrinthine  dysfunction. 
Variations  in  the  intensity  of  elicited  nystagmus 
may  or  may  not  be  due  to  labyrinthine  dysfunc- 
tion but  in  most  instances  can  be  interpreted  as 
being  due  to  labyrinthine  changes. 

Abnormalities  are  a)  Inversion 

b)  Perversion 

c)  Weakness 

d)  Absence 

Since  the  only  ocular  manifestation  of  laby- 
rinthitis or  labyrinthine  disorders  is  nystagmus, 
we  can  confine  our  discussion  for  the  moment  to 
the  various  forms  of  that  phenomenon,  setting 
down  also  some  of  the  other  symptoms  aiding  in  a 
differential  diagnosis. 

CATARRHAL  LABYRINTHITIS 
Ocular  Symptoms 

Spontaneous  Nystagmus  (to  the  opposite  side) 
Mixed 

Usually  Weak 

More  often  transient  than  persistent 
Normal  in  direction. 

Other  Symptoms 

Hearing  usually  present  but  impaired 
Labyrinth  responds  to  caloric  or  turning  tests 
Vertigo 

Tends  to  fall  to  same  side  as  ear  lesion 
Past  Pointing  (if  present  spontaneously)  to 
same  side 

Tinnitus  usually  present  in  involved  ear. 


January,  1933 


Manifestations  of  Otic  Disease — McCarthy 


33 


PURULENT  LABYRINTHITIS 
Ocular  Symptoms 

Spontaneous  nystagmus  (to  the  opposite  side) 
Mixed 

Strong  (early) 

Persistent  (for  not  over  14  to  16  days  then 
stops) 

Normal  in  type  and  direction. 

Other  Symptoms 
No  hearing 

Dead  labyrinth  (no  response  to  turning  or 
caloric  tests 

Marked  vertigo  (early) 

Fall  to  same  side  as  ear  lesion 
Past  pointing,  spontaneous  to  the  same  side 
Tinnitus,  usually  marked 
Vomiting,  may  be  present. 

LABYRINTHINE  FISTULA 
Ocular  Symptoms 

May  have  spontaneous  nystagmus  to  opposite 
side.  Usually  horizontal. 

Nystagmus  present  when  air  is  forced  into  or 
withdrawn  from  the  ear 
Usually  Horizontal 

Note.  Horizontal  canal  usually  one  involved, 
due  to  exposed  position. 

Persistent  or  transient 

(present  only  when  positive  or  negative  air 
pressure  is  used  if  transient) 

Direction 

Varies  with  positive  or  negative  air  pressure. 
Other  Symptoms 

Usually  history  of  ear  suppuration  or  ear 
operations 

Obvious  permanent  tympanic  membrane  per- 
forations present 

May  or  may  not  have  spontaneous  falling,  past 
pointing  or  vertigo. 

HEMORRHAGE  INTO  THE  INTERNAL  EAR 
Ocular  Symptoms 

Spontaneous  Nystagmus  (to  opposite  side) 

Mixed 

Strong 

Persistent,  often  for  several  weeks 
Normal  in  type  and  direction. 

Other  Symptoms 
No  ear  suppuration 

May  be  history  of  fracture  or  concussion 
Absence  of  such  history  suggests  Meniere’s 
disease 

No  hearing  early.  Later  may  be  small  return 

Usually  no  labyrinth  response  early 

Later  may  respond  slightly 

Marked  vertigo 

Falls  to  same  side 

Past  points  same 

Tinnitus,  marked  and  prolonged. 

NEURITIS  OF  EIGHTH  NERVE 
Ocular  Symptoms 
If  one  ear  is  affected 
Spontaneous  Nystagmus  to  opposite  side 
Mixed 

Strong  or  weak 
Persistent  or  transient 
Normal  in  type  or  direction. 

Other  Symptoms 

Condition  seen  most  commonly  in  lues. 

May  also  follow  large  doses  of  arsenic,  mercury, 
salicylates  or  quinine,  etc. 

Occasionally  seen  following  use  of  methyl 
alcohol 

Always  some  transient  or  permanent  loss  of 
hearing. 


The  more  easily  interpreted  ocular  symptoms 
are  levator  or  orbicularis  weakness  or  paralysis, 
weakness  or  paralysis  of  the  muscles  having  to 
do  with  the  eye  motion,  corneal  sensitiveness, 
gross  visual  clarity  and  the  more  marked  changes 
in  the  optic  disc.  By  adding  to  these  observations 
a study  of  elicited  and  spontaneous  nystagmus, 
one  has  a reasonably  comprehensive  diagnostic 
picture,  which  is  often  of  great  help. 

It  is  not  the  desire  to  here  give  the  impression 
that  the  essayist  considers  that  these  fairly  gross 
findings  are  all  that  is  essential  for  every  diag- 
nosis. What  it  is  desired  to  have  understood  here 
is  that  the  above  list  of  observations  are  those 
which  the  average  otologist  can  make  and  inter- 
pret, and  that  in  a fairly  large  group  of  cases 
they  are  exceedingly  useful  to  him  and  lead  to 
the  correct  diagnosis.  The  exact  differentiations 
of  muscle  balance,  the  fields  of  vision,  the  finer 
details  of  the  study  of  the  fundus  and  the  like, 
belong  properly  to  the  ophthalmologist  and  where 
these  and  other  important  observations  are  neces- 
sary, he  should  be  called. 

Purulent  meningitis  of  otic  origin  results  more 
commonly  from  extension  or  absorption  from  the 
mastoid  cell  infection  than  from  purulent  laby- 
rinthitis. Since  the  ocular  findings  in  the  pres- 
ence of  purulent  meningitis  from  these  two 
sources  are  often  different,  they  are  here  set  down. 

OCULAR  FINDINGS  IN  PURULENT  MENINGITIS 
RESULTING  FROM  PURULENT  LABYRINTHITIS 
(Early) 

Nystagmus.  Always  strong,,  contralateral, 
normal,  mixed,  lasting  not  over  two  weeks  fol- 
lowing onset  of  purulent  labyrinthitis. 

When  the  labyrinth  operation  has  been  done 
and  thereafter  there  develops  a nystagmus  in  any 
other  direction,  meningitis  is  strongly  suggested. 
The  presence  of  any  abnormality  of  direction  or 
the  presence  of  nystagmus  upward  or  downward 
is  usually  a sign  of  marked  extension  of  the 
purulent  process.  Upward  or  downward  nystag- 
mus which  is  usually  interpreted  as  due  to  marked 
pontine  pressure  is  usually  the  result  of  the 
formation  of  pus  in  the  ventricles.  When  this 
type  of  spontaneous  nystagmus  is  present  a fatal 
prognosis  is  strongly  suggested. 

(Late) 

Other  Eye  Muscle  Symptoms 

May  or  may  not  be  weakness  or  paralysis  of 
the  lid  muscles  or  the  eye  muscles;  pupillary  in- 
equality, changes  in  the  corneal  sensitivity,  gross 
changes  in  the  venous  retinal  circulation,  or 
swelling  of  the  optic  disc.  The  multiplicity  and 
lack  of  coordination  of  the  symptoms  is  signifi- 
cant. 

With  one  exception  (which  will  be  noted  later) 
it  is  impossible  to  make  a differential  diagnosis  as 
to  the  type  of  meningitis  with  which  we  are  deal- 
ing from  the  eye  findings  alone.  Whether  the 


34 


The  Ohio  State  Medical  Journal 


January,  1933 


process  be  a serous  one  or  a purulent  one,  cannot 
usually  be  differentiated  except  by  spinal  tap. 
However,  in  the  presence  of  a strong  and  per- 
sistent contralateral  spontaneous  nystagmus,  with 
other  symptoms  suggesting  meningitis  as  being 
present  or  developing,  it  is  to  be  strongly  sus- 
pected that  the  meningitis  developing  is  the  result 
of  a purulent  labyrinthitis. 

Whether  the  result  of  this  extension  be  a serous 
or  a purulent  meningitis  and  whatever  the 
source  be,  the  ocular  findings  other  than  nystag- 
mus in  the  two  types  of  meningitis  are  in  the 
early  stages  approximately  the  same.  In  the 
serous  type  spinal  tap  with  withdrawal  of  fluid 
usually  results  in  almost  immediate  cessation  of 
symptoms  for  several  days,  whereas  spinal  tap 
and  fluid  withdrawal  in  the  presence  of  purulent 
meningitis,  particularly  where  there  are  organ- 
isms present  in  the  spinal  fluid,  is  often  followed 
by  only  slight  cessation  of  eye  symptoms  and  an 
early  return. 

In  the  presence  of  an  acute  otorrhea  the  ap- 
pearance of  homolateral,  partial  or  complete  sixth 
nerve  paralysis  as  evidenced  by  weakness  or 
paralysis  of  the  external  rectus  of  that  side,  is 
almost  pathognomonic  of  middle  fossa  pachy- 
meningitis of  a serous  type,  a part  of  the  so- 
called  Gradenego’s  Syndrome.  There  are  usually 
no  other  eye  findings.  It  is  of  interest  to  note 
here  that  the  appearance  of  sixth  nerve  paralysis 
on  the  contra  lateral  side  to  a purulent  otorrhea 
is  usually  significant  of  the  presence  of  a basilar 
meningitis  of  purulent  type  with  a fatal  prog- 
nosis strongly  suggested. 

Extradural  middle  fossa  brain  abscess  of  otic 
origin  may  exist  for  months  and  be  of  great  size 


without  any  ocular  manifestations  at  all  as  wit- 
ness the  one  here  shown. 

According  to  Ruttin  ektradural  abscess  of  the 
posterior  fossa  may  and  often  does,  show  spon- 
taneous nystagmus.  Neither  type  of  extradural 
abscess,  however,  shows  other  ocular  symptoms 
unless  the  process  extends  through  the  dura. 

Subdural  abscess  of  the  middle  fossa  is  usually 
in  the  temperosphenoidal  lobe  and  the  eye  findings 
are  not  characteristic.  One  significant  feature  is 
the  advance  and  recession  of  ocular  pressure 
symptoms.  In  this  type  of  case  a slightly  swollen 
optic  disc  today  may  be  almost  normal  in  appear- 
ance tomorrow.  For  this  reason  careful,  repeated 
examinatins  by  an  ophthalmologist  will  often 
yield  information  which  when  taken  in  conjunction 
with  the  other  findings,  may  prove  to  be  of  the 
greatest  service.  Choked  disc  is  not  commonly 
present  until  late. 

From  mystagmus  alone  as  elicited  by  the  Bar- 
any  and  caloric  tests,  one  should  not  attempt  to 
say  where  the  lesion  is.  It  is  enough  if  one  can 
say  from  such  findings  that  there  is  an  intra- 
cranial lesion  present.  In  the  presence  of  a 
unilateral  ear  infection  the  inference  as  to  loca- 
tion then  becomes  obvious.  The  rupture  of  such 
an  abscess  into  the  ventricle  may  be  promptly 
characterized  by  upward  or  downward  spon- 
taneous nystagmus  and  the  end  is  not  far  off. 

Subdural  abscess  of  the  posterior  fossa  in  con- 
tradistinction  to  that  in  the  middle  fossa,  is  more 
commonly  characterized  by  spontaneous  nystag- 
mus. It  is  commonly  held  also,  that  posterior 
fossa  subdural  abscesses  are  more  commonly  ac- 
companied by  choked  disc.  The  other  ocular  find- 
ings are  not  characteristic.  It  is  again  well  to 
stress  the  pitfalls  which  await  the  unwary  who 
attempt  to  localize  brain  abscess  on  the  basis  of 
the  exact  interpretations  of  the  Barany  and 
caloric  tests  as  evidenced  by  the  elicited  ocular 
nystagmus.  Again  let  it  be  said  that  it  is  enough 
to  be  able  to  say  that  the  labyrinths  are  active 
and  that  the  findings  point  to  the  presence  of  an 
intracranial  lesion. 

Lateral  sinus  thrombosis,  unless  the  process  ex- 
tends into  the  cavernous  sinus  has  no  character- 
istic eye  findings.  About  25  per  cent  of  our  cases 
have  shown  some  degree  of  swelling  of  the  optic 
disc,  none  of  them  to  the  point  where  the  disc 
might  be  said  to  have  been  choked.  The  phe- 
nomena of  the  change  of  the  filling  and  emptying 
time  of  the  retinal  vessels  has  not  proved  as  use- 
ful in  our  hands  as  the  Tobey-Queckenstedt  test, 
and  for  that  reason  is  not  done  as  a routine. 

Neoplasms  of  the  Eighth  Nerve,  of  which  the 
most  common  are  the  acoustic  neuromata,  are  oc- 
casionally found.  The  growth  ordinarily  takes 
place  so  slowly  that  years  pass  before  the  initial  ; 
symptoms  of  mild  tinnitus  and  advancing  deaf-  | 
ness  are  superseded  by  pressure  symptoms  which 
may  result  in  ocular  symptoms.  In  the  later- 
stages  of  the  development  of  such  tumors  we  have 
transient  swelling  of  the  optic  disc  and  transient 
spontaneous  nystagmus  which  may  or  may  not  be 
normal  in  type  and  direction.  Again,  in  studying 
the  elicited  nystagmus,  it  is  much  safer  to  con- 
clude from  the  absence  of  response  from  one  set 
of  canals  or  the  other,  that  there  is  an  intra- 
cranial lesion,  than  to  attempt  to  give  a localiza- 
tion of  the  tumor  based  on  the  presence  of  ab- 
normal or  the  absence  of  normal  nystagmus. 

2600  Union  Central  Building. 


Tularemiai  *f 


A Summary  of  Recent  Researches,  with  a Consideration  of 

103  Dayton  Cases 

Walter  M.  Simpson,  M.S.,  M.D.,  F.A.C.P , Dayton,  Ohio 


ONE  of  the  most  remarkable  chapters  in 
modei'n  medical  history  is  that  which  deals 
with  the  rapid  evolution  of  tularemia  from 
the  obscurity  of  a clinical  curiosity  to  the  promi- 
nence of  an  important  public  health  problem. 
Furthermore,  the  recent  establishment  of  tulare- 
mia, undulant  fever  and  psittacosis  as  important 
nosologic  entities  leads  one  to  a thoughtful  con- 
sideration of  the  probability  that  there  are  many 
other  distinctive  diseases  yet  to  be  recognized  in 
that  large  group  of  obscure  febrile  diseases, 
variously  designated  by  such  general  names  as  in- 
fluenza, la  grippe,  gastro-enteritis,  septicemia, 
pneumonia,  et  cetera. 

Eight  years  ago  tularemia  was  practically  an 
unknown  name  in  the  medical  literature;  reports 
of  but  fifteen  cases  had  appeared  up  to  that  time. 
Since  then,  thanks  to  the  diligent  efforts  of  a few 
investigators,  the  name  has  become  a common- 
place. Tularemia  has  now  been  recognized  in  all 
but  five  states  of  the  union.  Descriptions  of  the 
disease  have  appeared  in  the  medical  literature  of 
every  civilized  nation. 

The  Dayton  investigations  of  tularemia  were 
begun  in  November,  1927,  during  which  month  24 
acute  cases  of  tularemia  were  encountered.  The 
discovery  of  such  a large  number  of  cases  in  one 
month  stimulated  an  investigation  of  the  preva- 
lence of  the  disease  in  Dayton  prior  to  1927.  As 
a result  of  these  investigations  29  confirmed 
cases  of  tularemia,  which  had  occurred  prior  to 
1927,  were  discovered1’2’3.  It  was  demonstrated 
that  tularemia  has  been  prevalent  in  this  com- 
munity since  1908.  Eleven  additional  cases4 
were  described  in  January,  1930.  Eight  additional 
cases  were  encountered  during  1929-19  3 05.  Six- 
teen cases  were  encountered  during  1930-1931, 
and  fifteen  cases  were  investigated  by  the  writer 
during  1931-1932.  This  brings  the  total  of  the 
Dayton  cases  to  103.  This  represents  the  largest 
number  of  cases  to  be  reported  from  such  a cir- 
cumscribed area. 

Recent  developments  indicate  that  tularemia  is 
probably  world-wide  in  its  distribution.  The  dis- 
ease independently  described  by  Ohara  in  Japan 
is  now  known  to  be  tularemia6.  Laboratory  work- 
ers have  acquired  the  disease  in  England.  Dur- 
ing 1928  and  1929,  over  1,000  cases  were  recog- 
nized in  the  Union  of  Soviet  Socialist  Republics1. 
Four  of  the  Russian  workers  paid  the  apparently 

* From  the  Diagnostic  Laboratories  of  the  Miami  Valley 
Hospital,  Dayton,  Ohio. 

f Read  before  the  Section  on  Public  Health  and  Indus- 
trial Medicine  of  the  Ohio  State  Medical  Association,  Dayton, 
May  3,  1932. 


inevitable  toll  for  their  investigations;  all  ac- 
quired tularemia  in  the  laboratory,  thus  bringing 
the  total  number  of  laboratory  infections  to  24. 

More  recent  reports  by  Thj^tta8  and  Salvesen9, 
tell  of  the  recognition  of  50  cases  of  tularemia  in 
Norway;  Thj^tta  has  also  accumulated  evidence 
which  demonstrates  that  the  disease  is  by  no 
means  a new  one  in  Norway.  Tularemia  is  now 
known  to  be  prevalent  in  Sweden10.  Two  occur- 
rences of  tularemia,  one  in  Ontario11’  “,  the  other 
in  British  Columbia13,  together  with  the  discovery 
of  Bacterium  tularense  in  the  snowshoe  rabbit  of 
British  Columbia,  suggests  the  likelihood  that 
tularemia  in  the  Canadian  fauna  is  a widespread 
infection  of  many  years’  standing.  Reports  of  the 
recognition  of  the  disease  in  other  countries,  in 
which  it  undoubtedly  exists,  are  eagerly  awaited 
by  students  of  tularemia. 

The  reports  of  the  Russian  cases  introduced  a 
new  animal  source  of  infection — the  water-rat  or 
water-vole  of  Europe  (Arvicola  amphibius), 
which  is  hunted  for  its  valuable  fur.  While  wild 
rabbits  constitute  the  most  important  reservoir  of 
infection  for  other  animals  and  man,  new  animal 
hosts  and  insect  vectors  have  been  discovered. 
These  observations  are  of  the  greatest  practical 
importance  because  they  indicate  the  ever-widen- 
ing spread  of  the  infection  to  other  forms  of 
animal  and  insect  life,  a situation  which  is  almost 
certain  to  be  reflected  in  an  increase  in  the  in- 
cidence of  the  disease  among  human  beings.  The 
disease  has  been  found  to  exist  in  nature  among 
wild  rats  and  meadow  mice  (Microtus  calif omicus 
aestuarinus),  in  California14’15.  The  writer4  has 
recently  repoi'ted  a case  of  oculoglandular  tulare- 
mia in  a man  resulting  from  contact  with  a wood- 
chuck (Marmota  flaviventer;  ground  hog).  Re- 
cent reports16’ 17, 18  have  attributed  the  develop- 
ment of  tularemia  in  human  beings  to  the  skin- 
ning of  opossums  (Didelphis  virginiana),  musk- 
rats ( Ondatra  zibethica)  and  the  fox  squirrel.  Be- 
lote10  has  recently  reported  a case  of  tularemia  in 
which  it  seems  probable  that  the  disease  was  ac- 
quired from  domesticated  rabbits.  If  it  can  be 
established  that  this  individual  acquired  the  dis- 
ease from  domesticated  rabbits  it  will  be  the  first 
case  of  its  kind  on  record. 

While  McCoy  and  Chapin20  were  engaged  in 
their  investigations  of  the  “plague-like  disease  of 
rodents”  in  California  in  1911,  they  attempted  to 
infect  five  sheep  (Ovis  aries)  with  subcutaneous 
injections  of  saline  emulsions  of  spleen,  liver  and 
other  tissues  from  guinea  pigs  which  had  died  of 


35 


36 


The  Ohio  State  Medical  Journal 


January,  1933 


Bacterium  tulartnse  infection.  Three  of  the 
sheep  were  infected;  two  died.  Francis21  injected 
a sheep  with  a pure  culture  of  Bacterium  tular- 
ense;  the  animal  died  of  the  disease  on  the 
twenty-third  day  after  the  inoculation.  In  the 
spring  of  1923,  Parker,  of  the  Public  Health  Ser- 
vice Laboratory  at  Hamilton,  Montana,  learned  of 
several  instances  of  heavy  losses  among  sheep  in 
eastern  Montana  and  southern  Idaho.  The  affected 
sheep  were  known  to  be  heavily  infested  with  the 
wood  tick  (Dermacentor  andersoni  Stiles).  A few 
months  after  these  discoveries,  Parker,  Spencer 
and  Francis22  demonstrated  that  the  wood  tick 
was  a common  host  and  transmitter  of  tularemia. 
The  belief  of  Parker  and  Francis  that  the  w'ood 
ticks  had  infected  the  sheep  with  tularemia  was 
supported  by  the  recovery  of  Bacterium  tularense 
from  the  spleens  of  guinea  pigs  which  had  been 
injected  with  ticks  removed  from  sick  sheep  and 
by  the  reproduction  of  the  disease  in  guinea  pigs 
inoculated  with  tissues  from  the  same  sheep.  In 
view  of  the  fact  that  wood  ticks  which  have  fed  on 
rabbits  infected  with  tularemia  are  capable  of 
harboring  the  organism  throughout  the  winter 
and  infecting  other  animals  in  the  spring,  it  seems 
possible  that  the  spread  of  the  disease  among 
sheep  in  tick-infested  areas  may  assume  consider- 
able economic  importance.  Of  even  greater  im- 
portance is  the  possibility  of  human  infection 
from  the  handling  of  infected  carcasses,  or  from 
the  contamination  of  the  hands  with  the  tissues  of 
crushed  infected  ticks  or  with  tick  excrement, 
while  shearing  or  skinning  sheep.  Geiger  and 
Meyer23,  in  their  recent  report  of  the  widespread 
occurrence  of  tularemia  in  Nevada,  state  that  the 
source  of  human  infection  in  two  cases  was  direct 
contact  with  the  tissues  or  hides  of  sheep. 

The  development  of  typical  ulceroglandular 
tularemia  in  a man  who  had  been  bitten  on  the 
hand  by  a coyote  pup  ( Cards  lestes)  stimulated 
Parker  u,  in  1926,  to  investigate  the  suscepti- 
bility of  coyotes  to  tularemia.  Three  young 
coyotes  were  fed  with  the  tissues  of  guinea  pigs 
and  Belgian  rabbits  just  dead  of  tularemia.  The 
coyotes  died  13,  22  and  53  days,  respectively,  after 
the  infectious  material  was  first  given.  Typical 
acute  tularemia  infection  was  produced  in  guinea 
pigs  injected  with  emulsions  of  tissue  of  the  dead 
coyotes  and  the  organism  was  recovered.  The 
presence  of  the  infection  in  the  salivary  glands  of 
two  of  the  coyotes  introduced  the  possibility  of  a 
new  avenue  for  the  transfer  of  the  infection  to 
man  by  the  bite  of  a wild  rodent  or  carnivore.  A 
more  recent  report  by  Kunkel23  tells  of  the  de- 
velopment of  ulceroglandular  tularemia  in  a man 
who  contaminated  a fresh  cut  on  a finger  while 
disposing  of  the  carcass  of  an  adult  coyote  which 
he  had  killed. 

Domestic  cats  and  kittens  (Felis  catus)  in- 
oculated by  McCoy  and  Chapin26  and  Wherry21 
with  tissues  of  infected  guinea  pigs  and  cultures 


of  Bacterium  tularense  did  not  acquire  the  dis- 
ease. These  findings  led  these  investigators  to 
assume  that  the  domestic  cat  is  naturally  immune 
to  the  disease.  Because  they  were  led  to  suspect 
that  the  domestic  cat  may  have  been  a contact 
carrier  or  a naturally  infected  transmitter  of  the 
disease  in  two  cases  of  tularemia  occurring  in 
human  beings  in  Minnesota,  Green  and  Wade28 
fed  infected  guinea  p’g  tissues  to  two  cats.  One 
cat  died  six  days  after  eating  the  liver  of  a guinea 
pig  dead  of  tularemia;  the  injection  of  the  cat’s 
tissues  into  guinea  pigs  resulted  in  their  death 
from  tularemia.  The  other  cat  was  sacrificed  on 
the  eighteenth  day;  a guinea  pig  inoculated  with 
the  cat’s  splenic  tissue  died  of  tularemia.  By  feed- 
ing infective  material  or  by  injections  of  heavy 
suspensions  of  pure  cultures  of  Bacterium  tular- 
ense to  six  cats  and  seven  kittens,  Francis29  suc- 
ceeded in  reproducing  the  disease  in  two  kittens; 
the  remaining  eleven  animals  were  entirely  un- 
affected. From  these  studies  it  seems  reasonable 
to  conclude  that  the  domestic  cat  is  but  mildly  sus- 
ceptible to  the  disease. 

The  writer30  inoculated  on  the  same  day  two 
dogs,  two  guinea  pigs  and  two  Belgian  hares  with 
virulent  cultures  of  Bacterium  tularense  recently 
recovered  from  the  blood  of  a human  being  who 
had  died  four  days  and  seven  hours  after  the  on- 
set of  illness.  The  two  guinea  pigs  died  in  four 
days,  wdth  the  characteristic  gross  and  micros- 
copic manifestations  of  tularemia  and  the  organ- 
ism was  recovered  in  pure  culture.  One  of  the 
Belgian  hares  died  on  the  seventh  day  after  in- 
oculation; the  other  died  on  the  eighth  day. 
Postmortem  examination  revealed  the  character- 
istic lesions  of  tularemia  and  the  organism  was 
recovered.  The  two  dogs  remained  entirely  well 
for  two  months,  at  the  end  of  which  time  they 
were  sacrificed.  Complete  autopsies  failed  to  re- 
veal the  characteristic  pathologic  anatomy  of 
tularemia;  serologic  and  bacteriologic  studies  were 
entirely  negative.  The  dog  appears  to  possess  a 
natural  immunity  to  the  disease. 

The  horse,  cow,  hog,  fox,  pigeon,  domestic 
chicken  and  turkey  do  not  appear  to  be  sus- 
ceptible to  either  natural  or  experimental  infec- 
tion with  Bacterium  tularense. 

For  many  years,  trappers  and  hunters  in  many 
regions  have  observed  that  decimation  of  wild 
rabbits  and  certain  game  birds  occurred  during 
the  same  season.  In  1925,  Parker  and  Spencer01 
pointed  out  that  the  common  rabbit  tick  (Haem- 
aphy salis  leporis-palustris)  which  was  known  to 
be  an  important  rabbit-to-rabbit  transmitter  of 
tularemia,  was  also  found  on  game  birds.  These 
two  workers  succeeded  in  experimentally  infect- 
ing the  blue  grouse  of  Montana  with  tularemia. 
Green  and  Wade32  have  found  that  the  ruffed 
grouse  and  the  Hungarian  partridge  possess  a 
high  degree  of  susceptibility  to  experimentally  in- 
duced Bacterium  tularense  infection. 


January,  1933 


Tularemia — Simpson 


37 


Early  in  1929,  Parker33  described  the  experi- 
mental production  of  tularemia  in  quail  ( Colinas 
virginianus).  Later  in  that  year,  Green  and 
Wade34  reported  the  natural  occurrence  of  tulare- 
mia in  quail.  More  recently,  Parker33  has  reported 
a case  of  tularemia  in  a human  being  in  which  the 
infection  was  acquired  from  quail.  In  an  investi- 
gation of  a recent  localized  epizootic  among  sage 
hens  ( Centrocercus  urophasianus ) in  Montana, 
Parker  succeeded  in  recovering  Bacterium  tular- 
ense  from  the  tissues  of  dead  and  killed  sage  hens 
and  also  from  the  infesting  ticks  of  the  species 
Haemaphysalis  cinnambarina.  These  findings  pro- 
vide convincing  evidence  that  at  least  some  species 
of  gallinaceous  birds  constitute  a potential  source 
of  human  infection. 

Deer  flies  (Chrysops  discalis  Williston)  and 
wood  ticks  (Dermacentor  andersoni  Stiles)  are 
important  animal-to-animal  and  animal-to-man 
transmitters  of  the  disease  in  the  northwestern 
states.  The  development  of  many  cases  of  tick- 
borne  tularemia  in  the  southern  states,  where 
Dermacentor  andersoni  is  not  found,  introduced 
the  probability  that  the  infecting  ticks  were  either 
Dermacentor  variabilis  or  Amblyomma  ameri- 
canum,  common  man-biting,  three-host  ticks  of 
that  region.  Green36  has'  recently  isolated  Bac- 
terium tularense  directly  from  the  eastern  wood 
tick  (Dermacentor  variabilis).  Parker,  Brooks 
and  Marsh31  tell  of  the  occurrence  of  Bacterium 
tularense  in  the  wood  tick,  Dermacentor  occi- 
dentalis  Newmann,  collected  from  tick-infested 
cattle  in  San  Benito  County,  California. 

This  rapid  succession  of  recent  reports  of  new 
animal  hosts  and  insect  vectors  brings  a realiza- 
tion of  the  probable  perpetuation  of  the  disease 
and  of  the  numerous  avenues  for  human  infection. 

While  Francis38  has  collected  information  on 
five  fatal  cases  which  terminated  with  severe 
meningeal  symptoms,  direct  evidence  that  Bac- 
terium tularense  was  capable  of  producing  menin- 
gitis in  human  beings  was  not  obtained  until  the 
recent  report  by  Haizlip  and  O’Neil39,  of  Cincin- 
nati. The  turbid  spinal  fluid  of  a patient  who 
presented  the  characteristic  clinical  picture  of 
tularemia  was  injected  into  a guinea  pig,  which 
developed  typical  acute  tularemia;  the  organism 
was  recovered  in  pure  culture  from  the  guinea  pig 
spleen.  Bryant  and  Hirsch40  have  recently  en- 
countered a fatal  case  of  chronic  leptomeningitis 
in  which  characteristic  tularemia  lesions  were 
found  in  the  leptomeninges,  contiguous  brain  tis- 
sues, ependyma,  subependymal  tissues  and  choroid 
plexus.  In  addition  to  focal  lesions  of  the  menin- 
ges, which  closely  resembled  miliary  tubercles, 
there  was  a diffuse  acute  exudative  meningitis. 
Hartman41  has  reported  his  autopsy  observations 
in  a case  of  acute  tularemia  with  diffuse  enceph- 
alitis, unaccompanied  by  meningitis.  Microscop- 
ically, the  lesions  in  the  brain  were  similar  to  the 


tularemia  lesions  of  the  lymph  glands,  lungs, 
spleen  and  liver. 

Permar  and  Machlachlan43  have  reported  their 
autopsy  findings  in  a fatal  case  of  tularemia  in 
which  an  unusual  form  of  acute  lobar  pneumonia 
developed.  Histologic  studies  revealed  multiple 
miliary  foci  of  necrosis  throughout  the  lungs 
similar  to  those  seen  in  the  spleen,  lymph  nodes 
and  liver  in  acutely  fatal  cases  of  tularemia.  The 
development  of  clinical  evidence  of  tularemic 
pneumonia  carries  sei'ious  prognostic  import. 

If  one  is  guided  by  the  figures  derived  from  the 
literature,  the  death  rate  in  this  disease  is  about 
4 per  cent.  It  is  the  writer’s  firm  belief  that  the 
disease  terminates  fatally  in  a much  higher  per- 
centage of  cases  than  such  figures  would  indicate. 
At  least  seven  deaths  from  tularemia  have  occur- 
red in  and  about  Dayton ; during  the  past  autumn 
the  writer  learned  of  seven  fatalities  among  ap- 
proximately 100  cases  of  tularemia  which  were 
officially  reported  in  Ohio  during  that  period. 

DIAGNOSIS 

The  most  important  factor  in  the  diagnosis  of 
tularemia  is  to  have  the  disease  in  mind.  The 
history  of  contact  with  wild  rabbits,  followed  in 
two  or  three  days  by  the  development  of  an  in- 
dolent ulcer,  frequently  at  the  site  of  an  injury 
produced  by  a sharp  fragment  of  rabbit  bone, 
regional  adenopathy,  and  onset  symptoms  of  an 
influenza-like  character  present  presumptive  evi- 
dence of  tularemia.  The  most  common  errors  in 
diagnosis  have  been  to  consider  that  the  disease 
was  due  to  streptococcus  infection  or  typhoid 
fever.  The  development  of  nodular  lymphangitis 
has  led  to  a mistaken  diagnosis  of  sporotrichosis. 
Because  of  the  fact  that  the  serum  agglutinins  in 
tularemia  will  occasionally  cross-agglutinate 
Brucella  melitensis  and  Brucella  abortus,  serolo- 
gists  have  confused  the  disease  with  undulant 
(Malta)  fever.  The  proportionately  higher  titer 
reached  by  tularemia  agglutinins  and  the  employ- 
ment of  agglutinin  absorption  tests  leave  little 
doubt  as  to  the  diagnosis.  On  the  other  hand 
tissue  pathologists  have  clung  to  the  histopatho- 
logic diagnosis  of  tuberculosis  because  of  the  re- 
markable similarity  of  the  granulomatous  lesions. 

The  simplest  and  best  method  for  obtaining 
confirmation  of  the  clinical  diagnosis  is  to  collect 
4 to  5 c.c.  of  the  patient’s  blood,  exactly  as  one 
collects  it  for  the  Wassermann  test.  Either  the 
serum  or  the  whole  blood  may  be  sent  to  any 
laboratory  which  has  on  hand  the  necessary 
Bacterium  tularense  antigen  for  agglutination  re- 
actions. This  test  is  highly  specific.  The  ag- 
glutinins usually  appear  some  time  during  the 
second  week  of  the  illness ; in  rare  instances,  anti  - 
tularense  agglutinins  do  not  appear  until  the 
second  to  the  fourth  week  of  illness.  It  is,  there- 
fore, useless  to  collect  the  blood  during  the  first 
week  or  ten  days.  The  titer  reaches  its  maximum 
(1:1280  to  1:2560)  in  the  fourth  to  the  seventh 


38 


The  Ohio  State  Medical  Journal 


January,  1933 


week,  followed  by  a gradual  decline  until,  at  the 
end  of  the  first  year,  the  average  titer  is  about 
1:160.  Experiences  of  all  investigators  are  in 
accord,  namely,  that  agglutinins  have  never  en- 
tirely disappeared  from  any  case ; that  subsequent 
exposure  to  infection  does  not  tend  to  elevate  a 
tulcirense  titer  acquired  by  the  original  attack; 
and  that  one  attack  of  the  disease  confers  perma- 
nent immunity. 

A second  confirmatory  method  is  to  isolate 
Bacterium  tularense  from  guinea  pigs  inoculated 
with  the  blood  of  the  patient,  or  with  material 
taken  as  early  as  the  first  week  from  the  primary 
lesion,  or  from  the  enlarged  regional  lymph  nodes 
at  the  time  of  surgical  or  spontaneous  drainage. 
The  writer  succeeded  in  two  instances  in  growing 
the  organism  directly  upon  artificial  culture  media 
from  human  tissues. 

Foshay43,  of  Cincinnati,  has  developed  a diag- 
nostic intradermal  test  for  tularemia.  He  has 
found  that  the  intradermal  injection  of  dilute  sus- 
pensions of  Bacterium  tularense  produces  lasting, 
unequivocal  skin  reaction  in  all  patients  with 
tularemia.  The  reaction  becomes  positive  a week 
before  agglutinins  appear  in  the  blood,  occurring 
as  early  as  the  fourth  day  of  the  disease.  It  has 
not  been  found  to  be  positive  in  any  other  disease. 
The  test  becomes  negative  only  when  convales- 
cence is  complete.  Foshay44  has  also  succeeded  in 
demonstrating  the  presence  of  Bacterium  tular- 
ense in  the  tissue  sections  of  the  lesions  of  tulare- 
mia in  human  beings. 

TREATMENT 

The  most  important  phase  of  the  treatment  is 
prophylaxis.  This  is  best  accomplished  by  the 
education  of  market  men,  hunters  and  housewives 
as  to  the  dangers  of  the  infection  and  the  manner 
in  which  it  is  acquired,  by  urging  thorough  cook- 
ing to  destroy  the  infective  agent,  and  by  the 
warning  that  all  individuals  who  handle  wild  rab- 
bits should  wear  rubber  gloves.  Foshay45  has  re- 
cently reported  successful  prophylactic  vaccina- 
tion against  tularemia. 

Strict  confinement  to  bed  during  the  febrile 
period  is  of  primary  importance.  It  is  useless, 
and  often  dangerous,  to  incise  the  primary  lesion. 
It  is  unwise  to  excise  or  incise  the  enlarged  reg- 
ional lymph  nodes  until  definite  evidence  of  sup- 
puration is  present.  There  is  no  evidence  that 
any  intravenous  chemotherapeutic  agent  (iodides, 
arsphenamin,  mercurochrome,  acriflavin  or  other 
dyes)  has  appreciably  altered  the  course  of  the 
disease. 

There  is  some  evidence  that  the  use  of  immune 
serum  may  have  value  in  the  treatment  of  the 
disease.  During  the  past  two  years  eight  of  our 
patients  who  were  suffering  from  the  acute  mani- 
festations of  the  disease  were  transfused  with 
varying  amounts  (200  to  500  c.c.)  of  blood  from 
compatible  donors  who  had  made  a complete  re- 
covery from  tularemia.  This  form  of  treatment 


appears  to  have  arrested  the  progress  of  the  dis- 
ease in  these  persons.  No  definite  conclusions  can 
be  drawn  from  the  apparently  favorable  response 
in  such  a small  number  of  cases. 

Foshay40  has  recently  described  the  develop- 
ment of  an  apparently  potent  goat  antiserum  for 
the  treatment  of  tularemia.  The  intravenous  in- 
jection of  about  10  c.c.  of  the  anti  tularense  serum 
on  two  successive  days,  resulted  in  an  abrupt 
cessation  of  fever,  malaise,  chills,  sweats,  arth- 
ralgias and  myalgias,  within  forty-eight  hours 
after  the  second  injection.  There  also  occurred  a 
rapid  reduction  in  the  volume  of  the  involved 
lymph  nodes  to  an  average  of  one-half  of  their 
former  diameters.  The  goat  antiserum  developed 
by  Foshay  gives  promise  of  being  a potent  and 
reliable  therapeutic  measure  in  the  treatment  of 
this  disease. 

SUMMARY  AND  CONCLUSIONS 

1.  During  the  past  five  years  tularemia  has 
rapidly  assumed  the  position  of  an  important 
public  health  problem.  Its  widespread  prevalence 
in  North  America,  together  with  reports  of  its 
existence  in  Norway,  Sweden,  Russia,  Japan  and 
England,  indicate  that  the  disease  is  probably 
world-wide  in  its  distribution. 

2.  Newly  discovered  animal  hosts  and  insect 
vectors  indicate  the  ever-widening  spread  of  the 
disease  and  further  insure  its  perpetuation. 
While  the  wild  rabbit  remains  the  most  important 
source  of  infection  for  other  animals  and  man, 
many  new  sources  of  human  infection  have  been 
described. 

3.  One  hundred  and  three  cases  of  tularemia 
have  been  encountered  by  the  writer.  This  repre- 
sents the  largest  number  of  cases  to  be  reported 
from  such  a circumscribed  area. 

4.  The  clinical  manifestations  of  the  disease 
are  distinctive  and  are  not  easily  confused  with 
any  other  disease.  The  agglutination  test  is  highly 
specific. 

5.  A goat  anti  tularense  serum  has  been  de- 
veloped by  Foshay,  which  gives  promise  of  pro- 
viding a reliable  specific  therapeutic  agent  against 
tularemia. 

BIBLIOGRAPHY 

1.  Simpson,  W.  M. : Tularemia  (Francis’  Disease): 
A Clinical  and  Pathological  Study  of  Forty-Eight  Non- 
Fatal  Cases  and  One  Rapidly  Fatal  Case,  with  Autopsy, 
Occurring  in  Dayton,  Ohio.  Ann.  Int.  Med.,  1928,  1,  1007- 
1060. 

2.  Simpson,  W.  M. : Tularemia  (Francis’  Disease)  : 
Report  of  Four  Additional  Cases.  Ohio  State  Med.  J.,  1928, 
ZJt,  860-862. 

3.  Simpson,  W.  M. : Tularemia,  8vo.  cloth  book,  pub- 

lished by  Paul  B.  Hoeber,  Inc.,  New  York,  September,  1929. 

4.  Simpson,  W.  M. : Recent  Developments  in  Tularemia 

(Francis’  Disease)  : With  a Report  of  Eleven  Additional 

Cases.  J.  Lab.  and  Clin.  Med.,  1930,  15,  311-323. 

5.  Simpson,  W.  M. : Tularemia : A Summary  of  Recent 

Investigations  and  a Consideration  of  the  Dayton  Experience 
with  Eighty-eight  Cases  111.  Med.  J.,  1931,  GO,  207-215. 

6.  Ohara.  H. : Concerning  an  Acute  Febrile  Disease 

Transmitted  by  Wild  Rabbits:  A Preliminary  Report.  Jik- 

ken  Ibo,  March  12,  1925  ; Human  Inoculation  Experiment 
with  a Disease  of  Wild  Rabbits,  with  a Bacteriological  Study. 
Kinsei  Igaku,  1925,  12,  No.  6 ; On  an  Acute  Febrile  Disease 
Transmitted  by  Wild  Rabbits.  Japan  Med.  World,  1926,  6, 
263-270 ; Experimental  Inoculation  of  Disease  of  Wild  Rab- 


January,  1933 


Tularemia — Simpson 


39 


bits  into  Human  Body  and  Its  Bacteriological  Study.  Japan 
Med.  World,  1926,  6,  299. 

7.  Golov,  D.  A.,  Kniazevsky,  A.  N.,  Berdnikov,  V.  A. 

and  Tiflov,  V.  E. : Plague-like  Infections  (Tularemia?)  in 

the  Region  of  the  Basin  of  the  Oural  in  the  Spring  of  1928. 
Rev.  de  Microbiol.,  d’Epidemiol.  et  de  Parisitol.,  1928,  7, 
301-326 ; Nikanorow,  S.  M. : Tularemia  in  North  America 

and  Tularemia-like  Disease  in  U.  S.  S.  R.  Rev.  de  Microbiol., 
d’Epidemiol.  et  de  Parisitol.,  1928,  7,  289-293 ; Suvorov,  S. 
V.,  Wolferz,  A.  A.,  and  Voronkova,  M.  M. : Plague-like 
Lymphadenitis  in  the  Rayon  of  Astrakhan.  Rev.  de  Micro- 
biol. d’Epidemiol.  et  de  Parisitol.,  1928,  7,  293-299. 

8.  Thjotta,  Th. : Three  Cases  of  Tularemia : A Disease 

Hitherto  Not  Diagnosed  in  Norway.  Vid.-Akad.  Avh.  I. 
Mat.  Naturv.  Klasse,  No.  1,  1930,  Oslo,  (I.  Komnisjon  hos 
Jacob  Dybwad)  ; Norsk  Magasin  for  Laegevidenskapen,  Oslo, 
1930,  91,  224 ; Tularemia  og  dens  forekomst  i Norge,  Saer- 
tryk  fra  Nordisk  Medisinsk  Tidsskrift,  1930,  2,  177-180 ; 

Fortsatte  iakttagelser  over  tularemiens  forekomst  i Norge. 
Saertryk  av  Norsk  Mag.  f.  Laegev,  January,  1931,  32; 
Occurrence  of  Tularemia  in  Norway : Cases  of  Origin  Other 
Than  Through  Infection  from  Rabbits.  Norsk  Magasin  for 
Laegevidenskapen,  Oslo,  1931,  92,  32. | 

9.  Salvesen,  H.  A. : Four  Cases  of  Tularemia.  Norsk 

Magasin  for  Laegevidenskapen,  Oslo,  1931,  92,  28. 

10.  Granstrom,  K.  O. : Tularemia  Oculoglandularis, 

Acta  ophth.,  1932,  10,  parts  1-2. 

11.  Hudson,  H.  D.  L. : Preliminary  Report  on  a Case  of 

Tularemia.  Canadian  Med.  A.  J.,  1930,  22,  678-679. 

12.  McNabb,  A.  L. : Tularemia : The  First  Case  Re- 

ported in  Canada.  Canadian  Pub.  Health  J.,  1930,  21,  91-92. 

13.  Parker,  R.  R.,  Hearle,  E.  and  Bruce,  E.  A. : The 

Occurrence  of  Tularemia  in  British  Columbia.  Pub.  Health 
Rep.,  1931,  1+6,  45-46. 

14.  Dieter,  L.  V.,  and  Rhodes,  B. : Tularemia  in  Wild 

Rats.  J.  Infect.  Dis.,  1926,  88,  541-546. 

15.  Perry,  J.  C. : Tularemia  Among  Meadow  Mice 

(Microtus  calif ornicus  aestuarinus)  in  California.  Pub. 
Health  Rep.,  1928,  1+8,  260-263. 

16.  Mease,  J.  A.,  Jr.:  Tularemia  from  Opossums. 

J.A.M.A.,  1929,  92,  1042 

17.  Schwartz,  H. : Tularemia  from  the  Muskrat. 

J.A.M.A.,  1929,  92,  1180. 

18.  Kirkwood,  T. : Tularemia  from  the  Fox  Squirrel. 

J.A.M.A.,  1931,  96,  941. 

19.  Belote,  G.  H. : Tularemia:  Report  of  an  Unusual 

Case.  Arch.  Derm,  and  Syphilol.,  1931,  23,  926-933. 

20.  McCoy,  G.  W.,  and  Chapin,  C.  W. : Bacterium 
tularense  the  cause  of  a Plague-like  Disease  of  Rodents. 
Pub.  Health  Bull.,  53,  U.S.P.H.S.,  p.-21,  1912;  Further  ob- 
servations on  a Plague-like  Disease  of  Rodents  with  a Pre- 
liminary Note  on  the  Causative  Agent,  Bacterium  tularense. 
J.  Infect.  Dis.,  1912,  10,  61-72. 

21.  Francis,  E. : Tularemie.  Cited  by  Kolle  and  Wasser- 

mann : Handbuch  der  Pathogenen  Mikroorganismen,  1928, 

1+,  16. 

22.  Parker,  R.  R.,  Spencer,  R.  R.,  and  Francis,  E. : 
Tularemia  Infection  in  Ticks  of  the  Species  Dermacentor 
andersoni  Stiles,  in  the  Bitterroot  Valley,  Montana.  Pub. 
Health  Rep.,  1924,  29,  1057-1073. 

23.  Geiger,  J.  C.,  and  Meyer,  K.  F. : Tularemia  in 

Nevada.  California  and  West.  Med.,  1929,  31,  38 ; Biennial 
Report  of  State  Board  of  Health  of  Nevada  (For  period 
ending  Dec.  31,  1928),  pp.  10-14. 

24.  Parker,  R.  R.,  and  Francis,  E. : Susceptibility  of  the 

Coyote  (Canis  lestes)  to  Tularemia.  Pub.  Health  Rep.,  1926, 
1+1,  1407-1410. 

25.  Kunkel,  G.  M. : Report  of  Case  of  Tularemia  Con- 
tracted from  a Coyote  (Canis  lestes)  in  New  Mexico.  Pub. 
Health  Rep.,  1930,  1+5,  439. 

26.  McCoy,  G.  W. : Plague-like  Disease  of  Rodents. 

Pub.  Health  Bull.  43,  p.  53,  1911 ; McCoy,  G.  W.,  and  Chapin, 
C.  W. : Bacterium  tularense,  the  Cause  of  a Plague-like 

Disease  of  Rodents.  Pub.  Health  Bull.  53,  p.  21,  1912. 

27.  Wherry,  W.  B.,  and  Lamb,  B H. : Infection  of  Man 
with  Bacterium  tularense  in  wild  Rabbits,  and  the  Danger 
of  its  Transfer  to  Man.  J.A.M.A.,  1914,  63,  2041. 

28.  Green,  R.  G.,  and  Wade,  E.  M. : Tularemia  in  the 
Cat.  Proc.  Soc.  Exper  Biol,  and  Med.,  1928,  25,  856-857. 

29.  Personal  communication  to  the  author. 

30.  Simpson,  W.  M. : Tularemia:  Study  of  Rapidly 

Fatal  Case  (Four  Days,  Seven  Hours).  Arch.  Path.,  1928, 
6,  553-574. 

31.  Parker,  R.  R.,  and  Spencer,  R.  R. : Tularemia  and 
Its  Occurrence  in  Montana.  Montana  State  Board  of  En- 
tomology, Sixth  Biennial  Report,  1925-1926,  pp.  30-41. 

32.  Green,  R.  C.,  Wade,  E.  M.,  and  Dewey,  E.  T. : 
Ruffed  Grouse  are  Susceptible  to  Tularemia.  Proc.  Soc. 
Exper.  Biol,  and  Med.,  1928,  25,  515-517. 

33.  Parker,  R.  R. : Quail  as  a Possible  Source  of  Tul- 
aremia Infection  in  Man.  Pub.  Health  Rep.,  1929,  1+1+,  999- 
1000. 

34.  Green,  R.  G.,  and  Wade,  E.  M. : A Natural  Infec- 
tion of  Quail  by  Bacterium  tularense.  Proc.  Soc.  Exper,  Biol, 
and  Med.,  1929,  26,  626-627. 

35.  Parker,  R.  R.,  Philip,  Cornelius  B.,  and  Davis,  G.  E. : 
Tularemia : Occurrence  in  the  Sage  Hen.  Pub.  Health  Rep. 
1932,  1+7,  479-487. 

36.  Green,  R.  G. : The  Occurrence  of  Bacterium  tul- 

arense in  the  Eastern  Wood  Tick,  Dermacentor  variabilis. 
Amer.  J.  of  Hygiene,  1931,  11+,  600-613. 

37.  Parker,  R.  R.,  Brooks,  C.  S.,  and  Marsh,  Hadleigh : 


The  Occurrence  of  Bacterium  tularense  in  the  Wood  Tick, 
Dermacentor  occidentalis,  in  California.  Pub.  Health  Rep., 

1929,  1+1+,  1299-1300. 

38.  Francis,  in  Cecil’s  Textbook  of  Medicine,  W.  B. 
Saunders  Company,  Philadelphia,  1930. 

39.  Haizlip,  J.  O.,  and  O’Neil,  A.  E. : A Case  of  Menin- 

gitis Due  to  Bacterium  tularense.  J.A.M.A.,  1931,  97,  704. 

40.  Bryant,  A.  R.,  and  Hirsch,  E F. : Tularemic  Lep- 
tomeningitis: Report  of  a Case.  Arch.  Path.,  1931,  12,  917- 

923. 

41.  Hartman,  F.  W. : Tularemic  Encephalitis : Path- 

ology of  Acute  Tularemia  with  Brain  Involvement  and  Co- 
existing Tuberculosis.  Amer.  J.  Path.,  1932,  8,  57-61. 

42.  Permar,  H.  H.,  and  Maclachlan,  W.  W.  G. : Tul- 

aremic Pneumonia.  Ann.  Int  Med,  1931,  5,  687-698. 

43.  Foshay,  L.  : Personal  communication  to  the  author. 

44.  Foshay,  L. : A New  Method  for  Staining  Bacterium 

tularense  in  Tissue  Sections.  J.  Lab.  and  Clin.  Med.,  1931, 
17,  193-195. 

45.  Foshay,  L. : Prophylactic  Vaccination  Against  Tul- 

aremia. Am.  J.  Clin.  Path.,  1932,  2,  7. 

46.  Foshay,  L. : Serum  Treatment  of  Tularemia. 

J.A.M.A.,  1932,  98,  552. 

DISCUSSION 

Leo  F.  Ey,  Columbus:  Since  tularemia  was 

first  recognized  as  having  definite  public  health 
aspects,  we  have  naturally  considered  the  name  of 
Francis  as  synonymous  with  tularemia.  In  like 
manner,  we  in  Ohio  associate  the  name  of  Walter 
M.  Simpson  with  tularemia  for  reasons  well 
known  to  all  of  us.  Dr.  Simpson  has  given  us  a 
volume  of  valuable  information  in  the  brief  time 
allotted  him  for  the  subject. 

It  is  intended  in  this  discussion  to  give, you  a 
summary  of  reports  of  cases  together  with  other 
details  that  have  come  to  our  attention  since  the 
work  was  undertaken  several  years  ago.  It  was 
largely  at  the  instigation  of  Dr.  Simpson,  who  laid 
before  us  the  results  of  his  early  investigations 
of  this  disease  in  Montgomery  County,  that  we 
made  arrangements  to  ascertain  the  prevalence  of 
the  infection  in  other  counties  of  the  State. 

According  to  a previous  publication,  by  Berry, 
the  first  report  of  the  presence  of  tularemia  in 
Ohio  was  between  the  period  of  1914  and  1925, 
and  the  first  direct  report  of  the  occurrence  of  the 
infection  in  Ohio  reached  us  in  November,  1925, 
from  Dr.  Bozman,  of  Hebron.  The  agglutination 
test  was  made  by  Dr.  Francis  and  the  result  was 
positive  in  high  dilution. 

By  a singular  coincidence,  tularemia  and  undu- 
lant  fever  were  simultaneously  introduced  to  the 
American  public  and  because  of  the  similarity  of 
the  symptoms  and  methods  employed  in  making 
laboratory  diagnosis,  the  diseases  were  sometimes 
confused.  Both  were  advanced  and  developed 
under  practically  parallel  conditions. 

Actual  investigation  of  tularemia  in  Ohio  was 
seriously  undertaken  by  the  Ohio  Department  of 
Health  late  in  1927.  In  that  year  11  cases  were 
discovered  and  several  of  these  were  confirmed  by 
Dr.  Francis.  In  the  following  years,  our  labora- 
tory found  5 in  1928;  17  in  1929;  49  in  1930;  61 
in  1931;  and  13  to  date  in  1932. 

In  1928,  undulant  fever  and  tularemia  were 
made  reportable  and  notifiable  diseases.  For  that 
year  19  cases  of  tularemia  were  placed  on  record; 
in  1929,  29  cases;  in  1930,  84  cases;  and  in  1931, 
118  cases  were  reported.  To  date  there  have  been 
22  cases  for  1932. 

Dr.  Simpson  personally  reported  103  cases 
making  a total  of  341  on  the  official  records.  He 
proved  conclusively  that  this  disease  was  present 
as  early  as  1908  and  the  total  includes  the  cases 
that  he  discovered  by  his  intensive  and  exhaustive 
studies. 

The  death  rates  are  as  follows:  1929,  2 deaths; 

1930,  8 deaths;  1931,  4 deaths;  and  1932,  1 
death. 

In  ox-der  to  give  you  some  idea  of  the  clinical 
featui-es  of  the  cases  that  we  encountei-ed,  I will 


40 


The  Ohio  State  Medical  Journal 


January,  1933 


summarize  the  information  derived  from  121 
questionnaires  received  from  attending  physi- 
cians for  the  years  1930  and  1931. 

In  arriving  at  the  diagnosis,  Dr.  Simpson  em- 
phasized the  necessity  of  having  the  disease  in 
mind.  Tularemia  can  be  said  to  be  a seasonable 
disease  in  Ohio.  Consequently,  anyone  showing 
suspicious  lesions  and  who  has  been  in  contact 
with  wild  game,  immediately  can  be  classed  as  a 
potential  case.  In  addition,  other  symptoms,  such 
as  temperature,  chills  and  sweats  will  have  mani- 
fested themselves,  so  that  in  the  majority  of  cases 
little  time  should  be  lost  in  establishing  a diag- 
nosis. 

In  checking  over  the  121  questionnaires,  we 
find  that  116  persons  handled  rabbits;  2 handled 
squirrels  and  1,  a muski’at.  The  source  of  in- 
fection was  not  indicated  in  2 cases.  Furthermore, 
73  or  60  per  cent  of  these  patients  were  infected 
in  November;  38  in  December;  2 in  August;  1 
in  September;  5 during  October;  January  and 
February,  1 each. 

The  questionnaires  also  revealed  that  90  per- 
sons showed  their  initial  lesions  on  the  fingers; 
18  on  the  hand,  and  one  on  the  right  arm.  The 
time  required  for  healing  at  finger  sites  covered 
from  one  week  to  four  months.  Ninety-three  pa- 
tients showed  regional  lymph  node  involvement 
and  the  time  of  healing  was  from  five  days  to  five 
months. 

Clinical  types  indicated  in  the  reports  received 
were  as  follows:  75  ulceroglandular ; 30  glandu- 
lar; 11  typhoid;  3 oculoglandular. 

The  age  groups  for  both  sexes  show  the  great- 
est number  of  cases  in  the  decade  between  40  and 
50,  there  being  40  cases  or  33  per  cent;  and  28  in 
the  decade  between  30  and  40.  Six  cases  were 
given  in  the  decade  between  10  and  20  years. 

Among  the  occupations,  housewives  lead  with  a 
total  of  36  or  about  30  per  cent.  Produce  handlers, 
including  others  who  come  in  contact  with  sus- 
ceptible animals,  number  14.  Farmers  gave  the 
next  highest  figure  with  9 on  record.  These  data 
alone  offer  a solution  for  prophylaxis  of  the  in- 
fection. Wearing  rubber  gloves  or  providing 
other  suitable  protection,  particularly  to  the 
hands,  would  cause  the  disease  to  be  eliminated 
as  far  as  human  beings  are  concerned. 

Tularemia  has  been  reported  from  practically 
every  county  in  the  southern  portion  and  from 
scattered  counties  in  the  northeast  section  of  the 
State.  A large  area  in  the  northwest  and  a few 
counties  in  north  central  Ohio  apparently  have 
escaped  to  date.  It  is  interesting  to  note  that 
counties  bordering  the  Ohio  River,  from  Hamilton 
to  Washington  inclusive,  reported  cases  con- 
sistently. 

During  the  past  hunting  season,  our  laboratory 
cooperated  with  the  Department  of  Conservation 
in  a study  to  ascertain  the  extent  of  tularemia  in 
the  rabbit  population.  Unfortunately,  due  to  the 
extremely  warm  weather,  very  few  good  speci- 
mens were  received  so  that  satisfactory  examina- 
tions could  not  be  carried  out.  Later,  towards  the 
close  of  the  season,  we  identified  Bacterium  tul- 
arense  in  several  specimens  and  on  the  basis  of 
these  findings  we  estimated  that  the  infection 
was  present  in  from  3 to  4 per  cent  of  the  rabbit 
population. 

Although  it  is  gratifying  to  know  that  many 
physicians  have  become  thoroughly  familiar  with 
the  symptomatology  of  the  disease,  thus  being  able 
to  properly  render  correct  diagnoses  and  reports, 
the  questionnaires  do  indicate  the  tendency  on  the 
part  of  others  to  neglect  blood  confirmation  of 


their  cases.  If  this  becomes  a general  practice,  we 
feel  the  records  will  be  incomplete.  It  is  urged  in 
all  cases  to  augment  the  clinical  diagnosis  by 
serological  tests.  The  specificity  of  the  test  is 
widely  recognized,  although  in  some  cases,  a 
positive  reaction  may  be  slow  to  appear.  Cer- 
tainly, if  a positive  agglutination  test  cannot  be 
obtained  after  four  to  six  weeks  from  date  of  on- 
set of  the  illness,  a definite  diagnosis  of  tularemia 
is  not  justified. 

Since  undulant  fever  and  tularemia  examina- 
tions have  been  made  routine  procedures  in  most 
public  health  and  clinical  laboratories,  quite  a few 
febrile  infections  which  formerly  were  obscure  are 
now  recognized  readily.  Today,  it  is  the  rule  that 
when  the  Widal  gives  negative  findings,  we  apply 
tests  for  undulant  fever,  and  for  tularemia  when 
indicated.  We  know  from  experience  that  when 
the  agglutination  reaction  is  negative  for  typhoid, 
either  undulant  fever  or  tularemia  tests  may  re- 
veal the  type  of  infection.  Thus,  we  are  in  a bet- 
ter position  today  to  render  a higher  type  of 
diagnostic  service  to  physicians  and  patients. 

Edward  E.  Campbell,  M.D.,  Columbus:  It  isn’t 
often  that  we  have  the  opportunity  of  having  a 
subject  presented  by  one  who  has  done  as  much 
original  work  as  has  been  done  by  Dr.  Simpson 
on  tularemia.  It  is  to  him  that  we  are  most  in- 
debted for  the  recognition  and  study  of  this  dis- 
ease. 

Prior  to  his  work  there  had  been  only  fifteen 
cases  reported  and  they  had  all  occurred  West  of 
the  Mississippi  River.  As  you  know  they  were 
studied  chiefly  by  members  of  the  United  States 
Public  Health  Service. 

There  remains  very  little  to  be  said  in  the  way 
of  discussion,  but  I would  like  to  emphasize  one 
point  which  was  brought  out  by  the  speaker  con- 
cerning the  diagnosis  of  the  disease  and  that  is, 
“The  most  important  factor  in  the  diagnosis  of 
tularemia  is  to  have  the  disease  in  mind”. 

During  the  last  hunting  season  there  came 
under  my  observation  two  cases  of  tularemia 
which,  I believe,  are  worthy  of  mention  because 
of  the  location  of  the  initial  lesion  and,  in  the  one 
case,  the  occurrence  of  a relapse  four  months 
afterward. 

The  first  one  is  unique  in  that  it  is  the  second 
case  of  the  oculoglandular  type  to  be  reported 
occurring  as  the  result  of  direct  infection.  This 
man  took  the  precaution  of  using  rubber  gloves  in 
the  cleaning  of  the  rabbits,  but  during  the  pro- 
cedure a drop  of  blood  from  the  rabbit  entered  his 
eye  and  within  48  hours  the  initial  lesion  made  its 
appearance  on  the  lower  lid.  He  was  seen  by  me 
ten  days  after  his  exposure  at  which  time,  in  ad- 
dition to  the  initial  lesion,  there  was  enlargement 
of  the  pre-auricular  and  sub-maxillary  glands. 
Blood  examination  at  this  time  was  negative  for 
tularemia,  but  ten  days  later  it  was  positive  in  a 
dilution  of  1-160.  It  later  became  positive  in  a 
dilution  1-1280.  Fifteen  days  after  the  initial  in- 
fection an  eruption  made  its  appearance  on  his 
face  and  within  the  next  two  days  had  spread 
over  his  entire  chest  and  back,  being  maculo- 
papular  and  papulo-pustular  in  character.  Both 
tonsils  showed  small  punctate  areas  of  exuda- 
tion. Four  weeks  after  the  exposure  the  pre- 
auricular  gland  was  incised  and  drained  of  about 
8 cc.  of  creamy  pus.  This  healed  quite  rapidly. 
The  sub-maxillary  gland  did  not  show  any  ten- 
dency to  break  down  so,  at  the  suggestion  of  Dr. 
Simpson,  who  saw  the  case  with  me  about  this 
time,  we  had  these  subjected  to  both  X-ray  and 
radium  treatment  and  in  the  course  of  a month 
they  had  practically  disappeared. 


January,  1933 


Cataract  Operation — Wright 


41 


An  interesting  phase  of  the  case  was  the  oc- 
currence of  a relapse  two  months  after  all  ob- 
jective symptoms  had  disappeared  and  four 
months  after  the  initial  infection.  This  was  char- 
acterized by  fever,  chills  and  generalized  aching. 
The  temperature  reached  101.6.  The  glands  in 
the  neck  did  not  swell  but  those  in  both  axillae 
became  markedly  swollen  and  tender.  On  the 
fourth  day  the  glands  became  less  tender  and  an 
eruption  developed  involving  the  face  and  chest 
just  as  it  did  at  the  onset.  All  of  the  above 


symptoms  cleared  up  in  a few  days  and  the 
patient  resumed  his  usual  duties,  although  he 
states  that  he  tires  very  readily. 

The  other  case  was  inoculated  through  a 
previously  infected  wound  of  the  finger,  and 
owing  no  doubt  to  the  presence  of  this  wound,  the 
diagnosis  was  overlooked  by  the  attending 
physician. 

It  looks  as  though  tularemia  will  be  with  us 
for  some  time  to  come  and  it  behooves  us  all  to 
keep  it  ever  in  mind. 


The  Imtraeapsmlar  Operation  of  Cataracts  A 'Survey  of 


Fifty  Years*  Experience 


* 


J.  W.  Wright,  M.D.,  Columbus,  Ohio 


IN  the  author’s  experience  of  fifty  years,  ex- 
ceeding one  thousand  cataract  extractions, 
the  intracapsular  extraction  has  conduced  to 
the  most  successful  results;  however,  in  the  avoid- 
ance of  annoying  complications,  the  simplest  pro- 
cedure possible  should  be  employed,  in  that  the 
operation  is  confined  solely  to  the  incision  within 
the  cornea,  other  structures  of  the  eye  remaining 
intact.  Nevertheless,  there  is  a tendency  by  many 
operators  to  invariably  involve  adjoining  struc- 
tures, which  often  necessitates  complicated  pro- 
cedures, such  as  an  iridectomy,  an  encroachment 
on  the  ciliary  body  and  canal  of  Schlemm,  with 
the  consequence  of  an  obstruction  in  the  outflow 
of  the  ocular  secretions,  and  subsequent  inflam- 
matory actions  involving  the  iris,  ciliary  body 
and  choroid,  or  on  the  other  hand,  the  eye  may  be 
sacrificed  through  the  intervention  of  a glaucoma 
a considerable  time  after  the  operation  has  been 
regarded  as  successful. 

A conservative  estimate  places  70  per  cent  of 
the  customary  operations  as  more  or  less  de- 
fective from  the  retention  within  the  eye  of 
fragments  of  capsular  and  lenticular  matter, 
which  in  the  process  of  absorption  cause  inflam- 
matory action,  often  resulting  in  iritis,  with  a 
drawn-up  or  excluded  pupil,  and  an  occasional 
loss  of  the  eye.  Capsular  substance  does  not  ab- 
sorb, but  when  unattached,  contracts  upon  itself, 
and  as  an  extraneous  substance,  drops  down  be- 
hind the  iris  upon  the  ciliary  body,  where  it  in- 
cites a passive  inflammatory  action  involving  the 
entire  uveal  tract,  and  ultimately  the  loss  of  the 
eye,  after  other-wise  favorable  results.  In  con- 
sideration of  such  complications,  the  intracapsular 


^Editorial  Note — The  author  of  this  paper,  now  in  his 
ninetieth  year,  after  60  years  of  practice,  was  one  of  the 
pioneers  in  ophthalmology,  and  is  an  honorary  member  of 
the  American  Ophthalmological  Society.  At  the  Seventy- 
Fifth  Annua]  Meeting  of  the  Ohio  State  Medical  Association 
m 1921,  Lt.  Col.  Henry  Smith,  C.  I.  E.,  I.  M.  S.,  Amritsar, 
Punjab,  India,  who  presented  the  oration  on  Ophthalmology, 
paid  a distinct  tribute  to  Dr.  Wright,  as  the  first  surgeon  to 
extract  cataract  in  the  capsule  by  expression.  A paper  by 
Dr.  Wright  on  the  subject  was  published  in  1884.  Later,  in 
the  Annual  Proceedings  of  the  State  Society  in  1886  and 
1888,  other  papers  by  Dr.  Wright  were  published,  followed 
by  articles  by  him  in  a number  of  medical  journals. 


operation,  when  well  accomplished,  doubtless 
yields  the  most  successful  results. 

Many  expert  operators  confidently  adopt  the 
methods  of  their  clinicists,  involving  numerous 
unnecessary  and  confusing  details.  There  can  be 
no  essential  advancement  in  the  methods  of 
operating  in  blindly  confining  ourselves  to  those 
of  our  predecessors.  More  and  more,  original  in- 
vestigation, enhanced  by  professional  experience, 
contributes  to  progress.  The  progressive  physi- 
cian, in  his  special  line  of  service,  is  not  so  much 
influenced  by  what  was  formerly  taught,  as  in 
that  which  has  been  attained  through  more  recent 
procedures  and  painstaking  efforts  in  a varied 
practical  experience.  In  an  uncomplicated  cata- 
ract, the  least  operative  procedures  and  the  fewest 
instruments  possible  should  invade  the  eye.  In 
the  author’s  experience,  many  successful  opera- 
tions have  been  accomplished  with  but  one  in- 
strument, a Graefe  knife. 

The  extraction  of  the  cataractous  lens,  what- 
ever the  method,  is  not  an  ordinary  procedure,  but 
an  intricate  and  refined  accomplishment,  requir- 
ing adequate  skill  and  dexterity,  in  keeping  with 
the  delicate  structures  involved,  best  achieved  by 
the  skilled  operator  who  has  an  accurate  knowl- 
edge of  the  parts  to  be  invaded,  the  hazards  to  be 
encountered,  and  the  avoidance  of  doubtful  com- 
plicated procedures.  The  choice  of  a method 
therefore,  should,  after  a skillful  examination  of 
all  eye  structures,  contribute  to  the  most  success- 
ful results. 

No  patient’s  eyes  should  be  sacrificed  in  the 
training  of  cataract  extraction.  To  attempt  the 
operation  in  the  absence  of  requisite  preparatory 
attainments,  is  inexcusable.  The  experience  at- 
tained in  witnessing  such  procedures  usually  ac- 
corded students  in  a clinic,  is  of  doubtful  utility, 
and  cannot  adequately  prepare  one  for  such  ser- 
vice. The  aspiring  operator  should  witness  the 
extraction  of  the  lens  of  an  animal  eye,  preferably 
that  of  the  pig,  by  an  experienced  operator,  under 
whom  he  should  practice,  until  positive  manipu- 
lation in  the  technique  and  use  of  instruments 


42 


The  Ohio  State  Medical  Journal 


January,  1933 


have  been  attained,  and  thereafter  as  clinical  as- 
sistant, previous  to  taking  upon  one’s  self  a 
patient  requiring  the  operation.  Making  the  cor- 
neal incision  and  delivering  the  lens  are  the  suc- 
cessful accomplishments  of  an  expert  operator. 

There  is  no  organ  of  the  entire  body  so  sen- 
sitively adjusted  comparable  to  the  eye,  being 
composed  of  various  intricate  structures,  and 
liberally  supplied  by  one-half  of  the  cranial 
nerves.  Each  structure  is  endowed  with  func- 
tional activities  in  the  promotion  of  the  best  pos- 
sible acuity  of  vision.  An  involvement  or  com- 
plication in  any  of  their  activities  should  be  defi- 
nitely considered  previous  to  a cataractous  ex- 
traction. The  eye  being  so  sensitively  constructed, 
the  operator  requires  especially  skilled  manipula- 
tive procedures  in  his  efforts  of  extraction. 

A clear  cornea  with  a normal  acting  pupil,  re- 
sponding promptly  to  the  effects  of  light  and 
shade,  with  normal  vision  with  properly  adjusted 
lenses,  are  the  usual  results  of  a successful,  un- 
complicated intracapsular  extraction.  In  com- 
plicated extractions,  where  an  iridectomy  is  re- 
quired, the  actions  of  the  pupil  being  lost,  ex- 
posure to  prevailing  lights  often  contributes  to 
retinal  disturbances,  when  satisfactory  vision  can- 
not be  attained.  Furthermore,  when  post-opera- 
tive procedures  are  required  in  the  formation  of 
an  artificial  pupil,  or  the  needling  process  in 
breaking-up  retained  lenticular  matter,  the  results 
are  far  from  satisfactory.  Unfortunately,  in  an 
occasional  cataract  extraction,  other  structures 
of  the  eye  may  be  involved  by  pathologic  con- 
ditions, when  the  most  expert  operator,  through 
the  most  advanced  methods,  is  confronted  by  con- 
ditions, requiring  very  complicated  procedures. 

Fortunately,  the  results  recently  acquired 
through  experimental  and  clinical  research,  in- 
dicate that  many  organic  structures,  as  age  ad- 
vances, become  disabled  from  defective  nutrition, 
often  the  effects  of  a contributing  organ,  more  or 
less  remote,  which,  if  taken  in  their  incipiency, 
are  submissive  to  lenient  proficient  measures, 
barring  serious  operative  procedures.  That  many 
affections  of  the  eye,  have  been  so  relieved,  doubt- 
less incipient  senile  opacity  of  the  crystalline  lens, 
should  likewise  be  benefited  through  such  effec- 
tive measures.  As  the  profession  becomes  more 
enlightened  in  the  cause  of  many  organic  defects, 
more  attention  will  doubtless  be  accorded  the  fact, 
that  there  is  an  impelling  effort  in  the  normal 
human  organism  to  rid  itself  of  any  affection  that 
may  invade  its  structures,  mainly  accomplished  in 
the  promotion  of  its  nutritive  activities,  which 
may  be  essentially  facilitated,  when  taken  in  its 
incipiency,  through  the  efforts  which  our  com- 
petent professional  service,  at  present,  provides. 


Cleveland — Dr.  Samuel  C.  Lind  described  his 
recent  visit  to  Soviet  Russia  in  an  address  before 
the  Delta  Tau  Delta  Alumni  Association. 


Changes  in  Staff  Heads  at  State  Depart- 
ment of  Health 

Several  changes  in  the  administrative  staff  of 
the  State  Department  of  Health  have  been  an- 
nounced as  follows: 

Dr.  E.  R.  Shaffer,  for  a number  of  years  head 
of  the  Bureau  of  Local  Health  Administration 
and  for  the  past  year  supervisor  of  public  health 
nursing  in  addition  to  his  other  duties,  has  been 
appointed  chief  of  the  Division  of  Child  Hygiene, 
filling  the  vacancy  created  by  the  resignation 
some  time  ago  of  Dr.  A.  B.  Lippert,  new  health 
commissioner  of  Shelby  County. 

Dr.  R.  W.  DeCrow,  for  the  past  two  years 
head  of  the  Bureau  of  Venereal  Diseases,  will 
succeed  Dr.  Shaffer  as  head  of  the  Bureau  of 
Local  Health  Administration.  Dr.  H.  H.  Haues 
will  take  over  the  work  which  Dr.  DeCrow  has 
been  directing. 

Dr.  E.  R.  Hayhurst  has  been  named  chief  of 
the  Division  of  Hygiene  and  acting  consultant 
for  the  Bureau  of  Industrial  Diseases. 


NEW  BOOKS 

Final  Report  of  the  Commission  on  Medical 
Education;  a discussion  of  certain  public  aspects 
of  medicine,  some  of  the  economic  problems  con- 
fronting the  profession,  the  question  of  the  future 
supply  of  physicians,  as  well  as  features  of  post- 
graduate medical  education,  the  internship,  medi- 
cal licensure  and  premedical  education;  published 
by  the  Commission  under  the  direction  of  Wil- 
lard C.  Rappleye,  M.D.,  director  of  study;  630 
West  168th  Street,  New  York  City. 


Matters  pertaining  to  the  College  of  Medicine, 
University  of  Cincinnati,  were  disposed  of  at  a 
recent  meeting  of  the  Board  of  Directors  of  the 
University,  as  follows:  Dr.  Thomas  A.  Ratliff, 
assistant  professor  of  psychiatry,  was  granted  a 
year’s  leave  of  absence  for  post-graduate  work; 
Dr.  Frank  E.  Stevenson  was  promoted  from  as- 
sistant to  associate  professor  of  pediatrics.  Dr. 
Waldo  E.  Nelson  was  promoted  from  instructor 
to  assistant  professor  of  pediatrics.  Dr.  Robert 
F.  Hiestand  was  appointed  clinician  in  the  de- 
partment of  medicine,  out-patient  dispensary. 
Drs.  K.  L.  Stoll,  George  Heidelman  and  Mary 
Knight  Asbury  were  appointed  instructors  in 
ophthalmology  and  clinicians  in  the  out-patient 
dispensary.  Dr.  Clare  E.  Ritter shofer  was  named 
instructor  in  pediatrics. 


Cincinnati — Dr.  Frank  W.  Hendley,  connected 
with  the  U.  S.  Veterans  Bureau  since  the  World 
War,  has  retired.  He  had  been  a member  of  the 
Ohio  National  Guard  since  1889  and  during  the 
World  War  served  as  a major  in  the  medical  re- 
serve corps,  U.S.A. 


Hamilton — Dr.  Harry  F.  Deubel  has  been  tak- 
ing post-graduate  work  in  New  York  City. 


The  President’s  P&ge 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


Festering  sores  in  our  economic  body  continue  to  retard  business  recovery.  In- 
dustrious citizens  are  unable  to  obtain  employment.  The  charity  list  grows  and  the 
doctor  gives  his  services  to  ailing  and  harassed  humanity.  This  is  the  condition  being 
brought  home  to  us  in  most  of  the  cities. 

Poultices  and  panaceas  have  been  tried  but  apparently  with  little  or  no  benefit. 
In  medicine  we  have  been  taught  that  an  ulcer  heals  from  the  bottom  but  only  when 
the  base  is  clean.  Logically,  the  treatment  of  present  day  economic  conditions  is  sur- 
gical. Ruthless  destruction  of  parasitic  growths,  prosecutions  for  graft,  and  the  cul- 
tivation of  thrift  and  honesty  should  be  prescribed.  Once  antiseptics  and  disinfectants 
have  been  properly  applied  improvement  will  ensue.  Let  the  patient  then  rest  while 
natural  processes  bring  about  his  recovery. 

We  have  had  too  much  of  surveys  and  commissions.  They  have  been  productive  of 
little  or  no  benefit.  We  have  awaited  the  result  of  a five  year  study  of  the  Costs  of 
Medical  Care.  By  the  time  the  report  was  issued  the  conditions  under  which  the  survey 
was  made  have  changed.  The  conclusions  drawn  can  not  help  but  be  inapplicable  to 
the  present  time.  Each  one  of  us  will  profit  in  his  own  way  from  his  experience,  and 
I am  sure  will  face  the  problems  of  the  new  year  with  a determination  to  contribute  to 
the  best  of  his  ability. 

Our  interest  and  activity  to  be  effective  in  the  protection  and  promotion  of 
scientific  medicine  must  be  united.  Individual  efforts,  laudable  as  they  may  be,  are 
ineffectual.  Only  by  cooperation  through  medical  organization  can  our  policy  and 
viewpoint  secure  results.  Now  as  never  before,  each  member  should  concern  himself 
with  strengthening  our  State  Medical  Association.  As  a basic  prerequisite  it  is,  of 
course,  necessary  that  each  member  pay  his  dues  for  the  calendar  year  1933  if  he  has 
not  already  done  so  and  that  special  efforts  be  made  by  each  county  medical  society  to 
enlist  into  membership  every  eligible  new  member. 

Ours  is  a profession  in  which  economics  play  a secondary  role.  To  place  our  ideals 
and  future  conduct  in  the  hands  of  individuals  in  other  professions  or  business  who  can 
not  appreciate  our  problems  can  only  result  in  disaster.  Until  such  time  as  the 
dreamers  and  business  representatives  can  come  before  the  people  and  prove  their 
abilities  to  guide  the  destinies  of  our  profession  better  than  is  now  being  done  it  is 
ridiculous  to  take  seriously  to  heart  the  recommendations  contained  in  the  majority 
report  on  the  Costs  of  Medical  Care.  If  memory  serves  me  a survey  of  their  activities 
will  show  many  more  errors  of  omission  and  commission  from  which  the  public  gen- 
erally has  suffered  than  can  rightfully  be  charged  to  practitioners  of  medicine. 

May  the  New  Year  bring  you  happiness  and  prosperity. 


43 


Numerous  Important  Policy  and  Organization  Problems 
Considered  by  the  Council  At  Its  Past  Meeting  for 
1932  Preparations  Made  for  1933 


The  Council  of  the  Ohio  State  Medical  Associa- 
tion met  in  the  headquarters  office,  Columbus,  at 
1:00  P.  M.  on  Sunday,  December  11,  1932. 

The  Officers  and  Councilors  present  were: 
President,  Dr.  Platter;  President-Elect,  Dr.  Cum- 
mer; Ex-President,  Dr.  Houser;  Treasurer,  Dr. 
Beer;  Councilors,  Drs.  Caldwell,  Huston,  Klotz, 
Hein,  Paryzek,  Davidson,  Shanley,  Seiler,  Good- 
man; Dr.  Alcorn,  chairman,  and  Dr.  Upham, 
member  of  the  Policy  Committee;  Dr.  Southard, 
State  Director  of  Health;  Executive  Secretary 
Martin  and  Assistant  Executive  Secretary  Nelson. 

The  minutes  of  the  Council  meeting  held  on 
October  2,  1932  (published  on  pages  791  to  794, 
inclusive,  of  the  November,  1932,  issue  of  The 
Journal) , were  read,  and  on  motion  by  Dr.  Klotz, 
seconded  by  Dr.  Seiler  and  carried,  were  ap- 
proved. 

1933  ANNUAL  MEETING  PLANS 

Dr.  Cummer,  President-Elect  and  chairman  of 
the  Council  Program  Committee,  reported  in  de- 
tail on  progress  to  date  for  the  1933  annual  meet- 
ing, to  be  held  in  Akron  on  Tuesday  and  Wednes- 
day, May  2 and  3,  1933.  Special  reference  was 
made  to  the  general  sessions  with  a program  of 
maximum  appeal  to  members  in  general  practice, 
which  will  be  held  on  Wednesday  morning  and 
Wednesday  afternoon,  May  3.  Analysis  was  made 
of  the  action  and  recommendations  by  the  Council 
Program  Committee  on  the  Section  programs; 
each  of  the  Sections  being  confined,  at  the  coming 
meeting,  to  one  session  each,  which  will  be  held  on 
Tuesday  afternoon  of  the  annual  meeting. 

Upon  motion  by  Dr.  Paryzek,  seconded  by  Dr. 
Huston  and  carried,  the  Council  commended  the 
Program  Committee  and  approved  the  report  and 
recommendations  submitted  by  Dr.  Cummer,  in- 
cluding eliminations  and  changes  in  the  tentative 
programs  as  submitted  by  the  Section  officers. 

Dr.  Davidson,  chairman  of  the  Council  Commit- 
tee on  Arrangements  for  the  annual  meeting,  re- 
ported on  local  plans. 

On  motion  by  Dr.  Klotz,  seconded  by  Dr.  Seiler 
and  carried,  the  Council  left  entirely  with  the 
Summit  County  Medical  Society  the  question  of 
whether  or  not  a banquet  should  be  held  on  Tues- 
day evening  of  the  annual  meeting,  on  which  eve- 
ning the  annual  addresses  of  the  President  and 
President-Elect  are  tentatively  scheduled;  and 
with  the  understanding  that  if  a banquet  is  held 
that  the  Summit  County  Medical  Society  assume 
all  responsibility,  financial  and  otherwise,  for  such 
function. 

Dr.  Houser  suggested  that  consideration  be 
given  to  the  possibility  of  the  annual  addresses 


being  presented  at  the  organization  luncheon  on 
Tuesday  noon,  with  the  idea  that  such  meeting  be 
open  to  the  entire  membership. 

On  motion  by  Dr.  Caldwell,  seconded  by  Dr. 
Houser  and  carried,  the  Council  requested  the 
Program  Committee  to  investigate  the  feasibility 
of  such  suggestion. 

On  motion  by  Dr.  Huston,  seconded  by  Dr. 
Goodman  and  carried,  the  question  of  securing  a 
speaker  of  national  prominence  to  present  an 
analysis  of  the  recently  issued  report  of  the  Com- 
mittee on  the  Costs  of  Medical  Care,  together  with 
other  details  of  the  program  set-up  and  features 
for  the  Tuesday  evening  meeting,  was  left  in  the 
hands  of  Dr.  Platter,  Dr.  Cummer  and  Dr.  David- 
son, with  power  to  act  on  behalf  of  the  Council. 

PROBLEMS  OF  WORKMEN’S  COMPENSATION 

Dr.  Paryzek  presented  in  detail  a verbal  report 
on  a conference  held  in  Columbus  on  December  6, 
attended  by  a committee  of  roentgenologists,  mem- 
bers of  the  Board  of  Trustees  of  the  Ohio  Hos- 
pital Association  and  officers  of  the  Medical  De- 
partment of  the  Industrial  Commission,  to  con- 
sider a proposed  regulation  to  require  all  hos- 
pitals owning  X-ray  equipment  to  include  X-ray 
service  in  the  per  diem  contract  rate  with  the  In- 
dustrial Commission  in  workmen’s  compensation 
cases. 

A review  of  the  previous  Council  discussion  and 
action  was  presented  by  Dr.  Paryzek,  with  em- 
phasis on  the  policy  of  the  Ohio  State  Medical  As- 
sociation that  hospitals  not  be  required  to  include 
X-ray  service  in  their  per  diem  contract  with  the 
Industrial  Commission,  unless  agreed  upon  in 
each  case  by  the  hospital  and  the  roentgenologists 
on  the  staff.  A review  of  the  record  on  this  mat- 
ter also  showed  that  the  Medical  Department  of 
the  Industrial  Commission  had  permitted  hos- 
pitals to  exclude  X-ray  service  in  making  their 
annual  contracts  with  the  Industrial  Commission, 
and  that  such  ruling,  over  a period  of  years,  had 
contained  such  flexible,  permissive  arrangement 
under  the  regulations  governing  contracts  with 
hospitals;  and  which,  when  X-ray  service  was  not 
included  in  the  contract,  permitted  roentgenolo- 
gists to  submit  fee  bills  and  secure  payment  for 
services  m workmen’s  compensation  cases  in  ac- 
cordance with  the  established  fee  schedule.  Atten- 
tion was  also  called  to  previous  correspondence  on 
this  and  allied  matters  between  the  Commission 
and  the  headquarters  office  of  the  State  Associa- 
tion. 

As  a result  of  the  conference  on  December  6, 
as  reported  by  Dr.  Paryzek,  it  was  agreed  that  no 
new  ruling  would  be  adopted  requiring  hospitals, 


44 


January,  1933 


State  News 


45 


in  their  1933  contracts  with  the  Industrial  Com- 
mission, to  include  X-ray  service  as  a part  of  the 
per  diem,  and  which,  if  enforced,  would  have  pre- 
vented roentgenologists  from  submitting  their  fee 
bills  direct.  It  was  further  agreed  that  a commit- 
tee of  three  from  the  Ohio  Hospital  Association 
and  a committee  of  three  from  the  Ohio  State 
Medical  Association  would  confer  on  questions  of 
X-ray  service  and  other  mutual  questions  involv- 
ing workmen’s  compensation  cases,  and  report  to 
the  Industrial  Commission  prior  to  August  1, 
1933;  following  which  time,  changes,  if  any,  in 
the  hospital  contract  for  1934  might  be  agreed 
upon. 

Upon  motion  by  Dr.  Paryzek,  seconded  by  Dr. 
Seiler  and  carried,  the  President  was  authorized 
and  requested  to  appoint  a special  committee  of 
three  as  contemplated  in  the  understanding  ar- 
rived at  with  the  representatives  of  the  Ohio  Hos- 
pital Association,  and  for  the  purposes  as  pre- 
sented in  the  foregoing  report. 

Dr.  Hein  reported  on  the  expressed  willingness 
of  officials  of  the  Industrial  Commission  to  ac- 
quiesce in  the  official  request  previously  made 
from  the  Council  of  the  Ohio  State  Medical  Asso- 
ciation for  the  adoption  of  a new  routine  in  the 
Claims  Department  of  the  Commission,  which 
would  eliminate  in  notices  and  communications 
from  the  Commission  to  claimants,  quotations 
from  reports  made  by  physicians,  on  which,  dis- 
allowance of  claim  are  based.  In  this  connection, 
reference  was  made  to  Council  action  on  this  mat- 
ter at  the  meet:ng  on  October  2 (page  792,  No- 
vember, 1932,  Journal). 

LEGAL  AND  PROFESSIONAL  QUESTIONS 

There  was  submitted  for  the  consideration  of 
the  Council,  a communication  under  date  of  De- 
cember 7,  1932,  from  the  Montgomery  County 
Medical  Society,  setting  forth  proposed  amend- 
ments to  Chapter  V,  Section  2 of  the  By-Laws  of 
that  society,  with  a request  for  action  by  the 
Council. 

Dr.  Huston  explained  the  purpose  of  such  pro- 
posed amendments.  Dr.  Cummer  pointed  out  that 
such  amendments  could  not  be  approved  by  the 
Council,  in  view  of  the  fact  that  such  amendments 
were  proposed  specifically  as  “temporary”;  that 
their  action  is  proposed  to  be  limited  to  the  year 
1933  and  a proposed  provision  permitting  de- 
linquent members  to  be  carried  on  the  rolls  of  that 
society  and  the  Ohio  State  Medical  Association 
beyond  the  year  in  which  their  dues  have  been 
paid  in  the  State  Association,  contrary  to  specific 
constitutional  provisions.  Without  taking  any 
official  action  the  Council  concurred  in  Dr.  Cum- 
mer’s comments. 

A report  was  submitted  supplementing  previous 
discussions  on  conferences  and  proposed  future 
conferences  between  the  Medical  Defense  Commit- 
tee and  a special  committee  of  the  State  Bar 
Association  on  the  subject  of  the  unauthorized 


practice  of  law,  and  involving  questions  in  regard 
to  the  legal  service  features  of  the  Medical  De- 
fense Plan.  The  Council  approved  correspondence 
and  records  on  this  matter,  with  authorization  to 
the  Medical  Defense  Committee  to  proceed  as  out- 
lined. 

A communication  addressed  to  the  Council, 
under  date  of  November  5,  from  a member  of  the 
Clinton  County  Medical  Society  was  read  and  con- 
sidered, in  which  an  appeal  was  asked  from  action 
contemplated  by  the  Board  of  Censors  of  that 
society.  A communication  also  was  submitted 
from  the  secretary  of  that  society,  under  date  of 
December  8,  relative  to  action  by  the  Society  on  a 
report  from  the  Board  of  Censors,  in  which  the 
physician  who  had  anticipated  such  action  was 
suspended  from  membership.  It  was  agreed  by 
the  Council  that  a communication  from  a member 
antedating  official  action  by  a county  society  could 
not  be  construed  as  an  appeal  from  action  taken 
subsequent  to  such  premature  appeal. 

COST  OF  MEDICAL  CARE 

Dr.  Upham  discussed  in  detail  reactions  by  the 
American  Medical  Association  and  others'  to  the 
recently  issued  final  report  of  the  national  Com- 
mittee on  the  Costs  of  Medical  Care.  He  referred 
to  recent  articles  in  the  Journal  of  the  American 
Medical  Association  on  this  subject,  to  conferences 
and  discussions  recently  held  in  Chicago,  and  to 
newspaper  editorials  and  articles  referring  to  the 
report. 

Other  members  of  Council  participated  in  the 
discussion,  and  attention  was  called  to  the  fact 
that  abnormal  conditions  exist  at  the  present 
time  both  in  relation  to  public  and  individual 
health,  aggravated  by  economic  distress  and  un- 
employment; and  that  as  proposals  suggested  in 
the  report  of  the  Committee  on  the  Costs  of 
Medical  Care  are  inadequate  to  meet  emergencies 
such  as  at  present,  that  they  were  impractical 
and  undesirable,  especially  in  normal  times.  At- 
tention was  also  called  to  the  tendency  in  relief 
programs  to  ignore  the  vital  contributions  made 
by  physicians  in  private  practice. 

OFFICIAL  STATEMENT  ADOPTED 

As  a basis  for  an  official  statement  by  the 
Council  in  regard  to  the  contents  of  the  final  re- 
port of  the  Committee  on  the  Costs  of  Medical 
Care,  Dr.  Upham  read  a statement  which  was 
thoroughly  discussed  and  which,  on  motion  by  Dr. 
Caldwell,  seconded  by  Dr.  Goodman  and  carried, 
was  adopted  as  the  official  policy  and  declaration 
by  the  Council  on  this  subject. 

This  report  and  statement  incorporated  as  a 
part  of  these  minutes  is  published  elsewhere  in 
this  issue  of  The  Journal. 

Upon  motion  by  Dr.  Huston,  seconded  by  Dr. 
Paryzek  and  carried,  it  was  expressed  as  the  sense 
of  Council  that  each  Councilor,  in  his  personal 
contacts  with  the  county  societies,  emphasize  the 
importance  of  thoroughly  discussing  and  under- 


46 


The  Ohio  State  Medical  Journal 


January,  1933 


standing-  the  report  of  the  Committee  on  the 
Costs  of  Medical  Care;  and  that  each  society 
should  have  a committee,  either  a committee  at 
present  organized  on  public  relations,  civic  affairs 
or  some  similar  committee  to  study  the  report  of 
the  Committee,  to  present  recommendations  to 
their  respective  societies  and  to  call  attention  to 
the  official  action  taken  by  the  Council  of  the 
State  Association. 

It  was  further  agreed  that  Councilors  urge  an 
early  meeting  of  each  society  for  a consideration 
of  this  entire  matter,  with  the  idea  that  the  med- 
ical profession,  through  the  county  societies,  be 
thoroughly  informed  in  order  to  meet  and  answer 
propaganda,  which  would  undoubtedly  be  per- 
sistent and  cumulative,  for  radical  changes  in 
medical  service  to  the  public.  Attention  was  called 
to  articles  and  editorial  comments  in  the  Decem- 
ber 3 and  the  December  10  issues  of  the  Journal 
of  the  American  Medical  Association,  with  recom- 
mendation that  they  be  read. 

LEGISLATIVE 

Dr.  Alcorn,  the  chairman,  and  other  members 
of  the  Policy  Committee,  discussed  at  length  some 
of  the  problems  anticipated  in  the  forthcoming 
session  of  the  Ohio  General  Assembly,  which  will 
meet  on  January  2.  This  discussion  included 
numerous  subjects  of  prospective  legislation. 
Emphasis  was  placed  on  the  importance  of  prompt 
cooperation  by  the  legislative  chairman  of  each 
county  society  and  academy  of  medicine  with  the 
Policy  Committee  of  the  State  Association  and  the 
State  Association  headquarters.  The  primary  im- 
portance of  contact  locally  with  legislators,  in 
order  that  the  medical  profession’s  information 
and  viewpoint  be  conveyed  to  them,  was  empha- 
sized. 

The  legislative  bulletin  issued  December  12  by 
the  Policy  Committee  was  distributed  to  members 
of  Council,  accompanied  by  copies  of  a legislative 
reference  handbook,  which  are  being  sent  to  the 
legislative  committeeman  in  each  county  society 
and  to  members  of  the  Legislature,  as  a compila- 
tion of  reference  material  to  be  used  when  issues 
involving  public  health  and  medical  practice  arise 
during  the  legislative  session. 

Special  consideration  was  given  to  a proposed 
bill  sponsored  by  the  Ohio  Hospital  Association  to 
reimburse  hospitals,  from  the  “repair  and  mainte- 
nance fund”  administered  by  the  Division  of 
Motor  Vehicles  in  the  Secretary  of  State’s  De- 
partment, for  the  care  of  indigent  persons  injured 
in  motor  vehicle  accidents.  Previous  discussions 
by  the  Council  on  this  matter  were  reviewed. 
Reference  was  made  to  the  different  and  opposed 
viewpoints  of  various  groups  in  Ohio.  Attention 
was  called  to  the  fact  that  if  the  medical  pro- 
fession advocated  such  legislation,  it  could  not 
consistently  oppose  centralized,  socialized  state 
medical  practice  for  other  types  of  diseases  and 
injuries.  Favor  was  expressed  by  several  members 


of  Council  for  legislation  to  provide  drivers’  re- 
sponsibility and  which,  it  was  estimated,  would 
meet  a majority  of  the  problems  which  the  Hos- 
pital Association  bill  is  intended  to  remedy. 

On  motion  by  Dr.  Davidson,  seconded  by  Dr. 
Seiler  and  carried,  the  Council  reaffirmed  its 
previous  attitude  as  expressed  in  the  past  toward 
the  proposed  hospital  motor  vehicle  accident  bill. 

On  motion  by  Dr.  Caldwell,  seconded  by  Dr. 
Houser  and  carried,  the  Council  expressed  itself 
as  favoring  the  principle  of  drivers’  license  and 
drivers’  responsibility  legislation.  This  action,  of 
course,  anticipated  that  each  proposal  as  intro- 
duced would  be  considered  on  its  merits,  and  that 
official  policy  would  be  decided  at  that  time. 

Special  attention  was  also  called  to  the  effect 
that  a proposed  state  retail  sales  tax  would  have 
on  physicians,  and  as  applying  to  them  would  be, 
in  effect,  a state  income  tax  bill. 

Discussion  was  had  in  regard  to  the  proposed 
program  of  social  insurance,  with  a report  on  the 
organizations  and  alignments  among  Ohio  groups 
for  and  against  the  unemployment  insurance  and 
old-age  pensions  proposals.  Reference  was  made 
to  the  basic  social  theories  in  connection  with 
these  proposals  and  proposals  for  socialized  state 
medicine. 

The  legislative  programs  of  various  allied  pro- 
fessions and  organizations  were  also  discussed. 

BUDGET  AND  FINANCE, 

The  Council  went  into  executive  session  at  this 
point,  and  the  Auditing  and  Appropriations  Com- 
mittee, through  Dr.  Goodman  the  chairman,  sub- 
mitted the  following  report  and  recommendations, 
including  the  proposed  budget  for  the  Ohio  State 
Medical  Association  for  the  calendar  and  fiscal 
year  of  1933 : 

REPORT  AND  RECOMMENDATIONS  OF  THE  AUDITING 
AND  APPROPRIATIONS  COMMITTEE 

“In  common  with  every  organization  and  associa- 
tion under  present  conditions  of  economic  stress, 
we  have  been  confronted  with  financial  problems. 
However,  it  is  the  opinion  of  the  Auditing  and 
Appropriations  Committee,  after  securing  in- 
formation on  other  voluntary  associations  and 
organizations,  that  the  Ohio  State  Medical  Asso- 
ciation is  in  a remarkably  favorable  financial  con- 
dition. 

“In  spite  of  our  apprehension  at  the  outset  of 
the  present  calendar  year  now  drawing  to  a close, 
we  are  especially  pleased  to  be  able  to  report  to 
the  Council  at  this  time  that  we  have  been  able 
to  accumulate  approximately  the  average  yearly 
balance  maintained  over  a period  of  the  past 
fifteen  years,  to  add  to  our  reserve  accumulation. 

“Although  our  net  advertising  revenue  from  The 
Journal  for  the  calendar  year  1932  was  approxi- 
mately $3,500  less  than  for  the  calendar  year  of 
1931,  and  in  spite  of  a reduced  profit  from  exhibit 
space  at  the  annual  meeting  below  the  average  for 
recent  previous  years,  we  were  able,  through 
effective  business  arrangements  and  printing  con- 
tracts made  in  advance  of  the  present  calendar 
year,  to  effect  a saving  in  the  printing  of  The 
Journal  during  the  past  year  of  more  than  $3,000 
under  the  printing  costs  of  the  preceding  year. 


January,  1933  State  News  47 


Through  bids  secured  for  the  contract  for  1933, 
we  hope  to  make  a further  saving  during  the 
coming  year  of  between  $800  and  $1,500  under 
the  amount  for  the  past  year.  In  addition  to  our 
advantageous  contract  for  the  past  year,  a frac- 
tion of  the  saving  is  accounted  for  by  the  re- 
latively fewer  number  of  pages  of  several  issues 
of  The  Journal,  the  total  pages  for  the  calendar 
year  1932  being  880  as  compared  with  1,000  for 
the  twelve  issues  in  the  Volume  of  1931. 

“Through  securing  bids  and  careful  buying  of 
various  supplies  and  other  printing  for  the  year 
1932,  an  additional  saving  has  been  effected.  It 
was  necessary  during  the  year  to  purchase  a new 
motorized  addressograph,  but  in  spite  of  the  cost 
of  that  machine,  $235,  and  other  necessary  re- 
placements and  supplies,  our  balance  accumula- 
tion for  the  year,  income  over  expenditures,  v/ill 
be  approximately  $4,000  (almost  twice  the  amount 
of  the  accumulation  from  the  preceding  year). 

“With  the  innumerable  problems  affecting  the 
medical  profession  which  have  arisen  recently  as 
incidental  to  or  arising  from  the  general  economic 
distress,  in  addition  to  the  development  of  social 
and  governmental  questions  in  relation  to  public 
health  and  medical  service,  there  is  a grea,ter  need 
today  for  strong  harmonious  and  effective  medical 
organization  than  ever  before,  and  we  must  main- 
tain an  adequate  budget  to  keep  organization 
machinery  in  high  gear  in  order  to  be  of  maximum 
service  to  the  membership. 

“As  indicated,  due  to  the  careful  supervision  of 
this  committee  and  efficient  management  in  our 
headquarters  office,  disbursements  for  the  current 
fiscal  year  1932  have  been  kept  well  within  the 
authorized  budget.  Every  precaution  and  safe- 
guard was  preserved  to  protect  and  add  to  our 
accumulative  balance.  All  inactive  funds  in  sav- 
ings accounts  or  otherwise,  were  converted  into 
government  bonds.  Funds  that  would  be  required 
before  the  end  of  the  year  were  placed  on  short- 
time  deposits  from  which  source  the  Association 
benefited  by  accrued  interest  until  such  funds 
wei’e  needed. 

“As  has  been  customary,  this  committee  em- 
ployed a certified  public  accountant  to  audit  the 
records  of  all  financial  transactions  of  the  Asso- 
ciation for  the  preceding  calendar  year  and  which 
constituted  a part  of  the  annual  report  of  this 
committee.  A similar  complete  audit  will,  of 
course,  be  made  after  the  end  of  the  present  fiscal 
calendar  year. 

“As  in  the  past,  all  bills  were  carefully  examined 
and  no  vouchers  were  issued  until  after  official 
approval.  Special  attention  was  given  to  accurate 
and  efficient  maintenance  of  records.  No  expenses 
were  incurred  unless  authorized  in  advance  by 
this  committee,  and  no  bills  were  paid  until  ap- 
proved by  the  committee. 

“While  present  changing  conditions  have  multi- 
plied the  problems  confronting  medical  organiza- 
tion and  have  increased  the  already  heavy  routine 
of  our  headquarters  office,  we  feel  that  this  would 
be  an  inappropriate  time  for  any  expansion  either 
in  the  personnel  of  the  office  staff  or  otherwise. 

“The  accompanying  proposed  budget  for  1933, 
with  comparative  list  of  the  budget  authorized 
for  and  appropriated  for  1932,  in  parallel  columns 
showing  suggested  reductions,  is  listed,  herewith:” 


1933 

Recommended 

1932 

Appr’n. 

Appr’n. 

Ohio  State  Medical  Journal.—. 

..--.$7,000 

$8,000 

Medical  Defense  

.....  4,000 

4,000 

Committee  on  Public 

Policy... 

.....  800 

1,000 

Executive  Secretary, 

Salary... 

.....  6,600 

6,600 

Executive  Secretary, 

Expense. 

.....  800 

800 

Ass’t.  Executive  Sec’y,  Salary 3,850  3,850 

Ass’t.  Executive  Sec’y,  Expense..  200  200 

President,  Expense  300  300 

Treasurer,  Salary  300  300 

Council,  Expense  600  700 

Annual  Meeting  500  500 

Auditing  and  Appr’n.  Committee  100  100 

Misc.  Committee  Expense 500  600 

Stationery  and  Supplies 600  700 

Postage  and  Telegraph 600  700 

General  Counsel  2,100  2,100 


Auditing  and  Appropriations  Committee. 

S.  J.  Goodman,  M.D.,  Chairman,  Columbus 
John  A.  Caldwell,  M.D.,  Cincinnati, 

I.  P.  Seiler,  M.D.,  Piketon. 

On  motion  by  Dr.  Goodman,  seconded  by  Dr. 
Cummer  and  carried,  the  Council  adopted  the 
foregoing  report  and  approved  and  authorized  the 
budget  as  recommended  to  cover  expenditures  of 
the  State  Association  for  the  calendar  and  fiscal 
year  1933. 

MISCELLANEOUS 

A report  on  membership  showed  a total  of  mem- 
bers paid  to  date  for  1932  of  5,330,  compared 
with  5,458  on  the  same  date  last  year  and  with  a 
total  for  1931  of  5,489. 

Dr.  Southard  and  Dr.  Platter  reported  on  the 
recent  Annual  Conference  of  Ohio  Health  Com- 
missioners held  in  Columbus,  November  16  to  18, 
inclusive.  They  emphasized  the  program  dis- 
cussion and  atmosphere  of  the  conference  as 
harmonizing  the  viewpoint  and  interests  of  the 
medical  profession  in  private  practice  and  of 
those  members  in  public  health  administration. 
It  was  also  pointed  out  that  the  program  was 
largely  built  about  the  features  of  preventive 
medicine  from  both  viewpoints.  Attention  was 
called  to  the  fact  that  a rather  detailed  news 
article  on  the  conference,  with  excerpts  from  ad- 
dresses, would  be  published  in  the  January,  1933, 
issue  of  the  Ohio  State  Medical  Journal. 

A brief  report  of  observations  and  high  lights 
in  the  recent  annual  session  of  the  Ohio  Welfare 
Conference  held  in  Columbus,  October  4 to  7, 
1932,  was  presented  and  ordered  placed  on  file. 

The  Council  adjourned  to  meet  at  the  call  of  the 
President  either  before  or  about  the  first  Sunday 
in  March,  1933. 

S.  J.  Goodman,  M.D., 
Secretary  of  Council. 


Applications  for  the  position  of  junior  medical 
officer  (interne)  in  the  government  service,  to 
fill  vacancies  on  the  staff  at  St.  Elizabeth’s  Hos- 
pital, Washington,  D.C.,  will  be  received  by  the 
Fourth  U.  S.  Civil  Service  District,  Washington, 
D.C.,  until  January  10,  1933.  Competitors  will 
be  rated  on  their  education,  training  and  experi- 
ence. Detailed  information  may  be  obtained  from 
the  secretary  of  the  United  States  Civil  Service 
Board  of  Examiners  at  the  post  office  in  any 
city  or  from  the  Commission’s  headquarters  at 
Washington. 


Official  Statement  Issued  Tby  the  Council  of  The  Ohio  State 
Medical  Association  on  the  Report  of  the  Committee 


An  official  statement  on  the  final  report  of  the 
national  Committee  on  the  Costs  of  Medical  Care, 
recently  released,  which  involves  various  pro- 
cedures affecting  the  organization  of  medical 
service  to  the  public  and  the  quality  of  such  ser- 
vice, was  formulated  and  adopted  by  the  Council 
(the  executive  board)  of  the  Ohio  State  Medical 
Association  at  its  meeting  December  11,  1932,  at 
Columbus. 

In  connection  with  the  questions  raised  and 
procedures  recommended  in  the  Costs  of  Medical 
Care  report,  the  Council  incorporated  in  its  state- 
ment reference  to  the  special  problems  of  public 
and  individual  health  during  the  present  winter 
resulting  from  the  economic  distress,  unemploy- 
ment, inadequate  food  and  shelter,  and  under- 
nourishment. 

The  statement  follows: 

* * * * 

With  problems  of  public  and  individual  health 
aggravated  by  economic  distress,  unemployment, 
inadequate  food  and  shelter,  and  under-nourish- 
ment, special  efforts  must  be  made  in  Ohio  during 
the  ensuing  winter  to  provide  necessary  health 
safeguards  and  medical  care. 

Physicians,  constituting  an  altruistic  profes- 
sion, always  have  and  always  will  concern  them- 
selves in  these  matters  in  the  interest  of  public 
welfare  and  public  protection. 

Adequate  support  must  be  given  to  official 
health  administration  in  every  community  to 
properly  cope  with  any  threatened  epidemic  and 
to  supervise  and  insure  sanitation.  Cooperation 
of  physicians  in  each  community  with  local  offi- 
cials legally  responsible  for  providing  care  in  in- 
dividual instances  of  illness  unable  to  provide 
medical  attention  for  themselves,  is  confidently 
expected. 

We  are  convinced  that  the  medical  profession 
will  continue  to  render  the  public  service  expected 
of  it  and  to  furnish  service  to  the  poor  and  needy, 
not  otherwise  provided  for,  until  practical  meth- 
ods of  providing  for  local  payment  for  medical 
service  for  all  the  indigent  are  established. 

At  this  particular  time  of  unrest  and  uncer- 
tainty, when  the  united  activity  of  all  individuals 
and  groups  in  public  relief  work  is  most  im- 
portant, socialized  programs  are  being  advocated 
which  would  disrupt  the  intimate,  confidential, 
professional  relationship  between  the  medical  pro- 
fession and  the  public. 

Such  movements,  undoubtedly,  have  received 
impetus  from  the  report  of  the  Committee  on  the 
Costs  of  Medical  Care,  recently  released. 

This  report  deserves  careful  consideration,  and 


in  its  advocacy  for  more  attention  to  disease  pre- 
vention, immunization,  and  sanitation,  it  deserves 
approval. 

However,  in  advocating  greater  socialization  of 
medicine,  the  majority  report  of  that  committee 
contains  many  suggestions  which  are  in  them- 
selves conflicting  or  impractical,  and  which  would 
establish  a mechanized,  expensive  system  through 
centralized  organization,  supervision  and  control, 
most  objectionable  even  in  normal  times. 

Whatever  developments  and  social  changes 
may  require  modification  of  the  relationship  of 
medical  service  to  the  public  must  in  the  public’s 
interest,  preserve  the  “free  choice”  by  the  in- 
dividual citizen  and  his  family  of  their  own  physi- 
cian and  must  not  destroy  the  intimate,  confiden- 
tial, professional  relationship  between  physician 
and  patient. 

The  majority  report  of  the  Committee  on  the 
Costs  of  Medical  Care  practically  ignores  the 
fact  that  the  medical  profession  is  well-organized 
in  scientific  societies,  county  and  state,  with  the 
primary  purpose  under  its  Constitution  of  “pro- 
moting the  science  and  art  of  medicine  and  the 
protection  of  public  health”. 

The  county  medical  societies,  comprising  within 
their  membership  the  great  majority  of  the 
ethical,  legally  qualified  physicians,  are  constantly 
working  with  local  civic  groups  and  official  agen- 
cies on  common  problems  within  the  field  of 
health  and  medicine.  It  is  our  belief,  therefore, 
that,  without  revolutionary  changes  in  the  method 
of  administering  medical  care  and  without 
creating  expensive,  official  super-structures,  that 
most  local  problems  now  can  be  handled  satisfac- 
torily locally  through  a maximum  of  local,  volun- 
tary cooperation.  There  is  a popular  trend 
against  “more  government”  adding  burdens  on 
the  taxpayers  or  placing  government  in  competi- 
tion with  business.  It  would  be  even  more  im- 
practical to  attempt  to  sovietize  professional  ser- 
vice. 

As  a proposed  solution  for  the  question  of 
medical  care  for  the  American  people,  the  major- 
ity report  of  the  Committee  on  the  Costs  of 
Medical  Care  recommends  extensive  socialization 
of  medicine;  group  practice;  group  payment 
methods  through  the  use  of  insurance,  through 
taxation  or  both;  the  coordination  of  medical 
service  as  functions  in  state  and  local  communi- 
ties. The  report  opposes,  however,  any  system 
which  would  require  reduction  in  the  average  of 
professional  incomes.  The  report  shows  that  ap- 
proximately 142,000  physicians  are  actively  en- 
gaged in  furnishing  medical  care  to  the  people 


48 


January,  1933 


State  News 


49 


of  this  country,  and  that  almost  900,000  others — 
nurses,  technicians,  assistants,  dentists,  pharma- 
cists, public  health  officials,  etc. — constitute  the 
personnel  in  health  services;  from  which  figures 
it  is  seen  that  there  is  a relatively  small  num- 
ber of  physicians  around  which  the  much  greater 
number  render  services  incidental  to  the  actual 
professional  medical  service.  The  report  also 
shows  that,  of  the  estimated  annual  expense  of 
medical  care  in  the  sum  of  $3,647,000,000,  less 
than  30  per  cent  of  the  total  amount  of  the  cost 
actually  goes  to  physicians’  services. 

As  pointed  out  by  that  committee,  an  average 
of  one-fifth  of  the  service  rendered  by  physicians 
to  patients  is  given  gratis.  Under  abnormal  con- 
ditions, such  as  at  present,  the  collections  of 
physicians  for  services  are  estimated  at  less  than 
50  per  cent  including  charges  made  for  services  to 
those  who  under  normal  conditions  would  be  able 
to  pay.  Naturally,  the  average  physician  expects 
to  render  a certain  amount  of  service  to  those 
who  are  recognized  as  indigents. 

A minority  report  of  the  Committee  on  Medical 
Costs,  signed  by  a number  of  physicians,  points 
out  that  the  community  or  medical  center  plan 
advocated  by  the  majority,  would  contain  evils 
of  its  own,  worse  than  the  evil  it  is  supposed  to 
alleviate;  and  that  it  would  establish  a medical 
hierarchy,  add  to  the  evils  of  bureaucratic  or 
political  dictatorship  and  destroy  the  funda- 
mental, continuous,  personal  relationship  between 
patient  and  physician,  and  that  the  multiplica- 
tion of  groups  or  clinics  would  result  in  duplica- 
tion and  expenses. 

Among  other  disadavantages  of  elaborate,  ex- 
pensive group  practice  are:  “restriction  of  free- 
dom of  action  in  respect  to  study,  travel,  attend- 
ance on  scientific  meetings  and  even  publication 
of  medical  articles  to  all  members  except  the 
heads  of  the  group;  comparatively  static  income 
of  members  of  a group  except  that  of  the  owner 
or  owners;  salary  cuts,  then  discharge  of  em- 
ployees to  reduce  overhead  in  times  of  depres- 
sion; disruption  of  groups  through  death  or  dis- 
ability of  some  able  man  or  men  around  whom 
the  group  has  been  built,  and  the  difficulty  with 
which  physicians  would  be  able  to  find  employ- 
ment in  another  group  or  are  able  to  enter  pri- 
vate practice  when  a group  closes”.  That  most 
of  the  schemes  advocated  in  the  report  would 
create  disadvantage  similar  to  those  experienced 
in  all  European  countries  now  burdened  with 
compulsory  insurance  schemes,  and  that  they 
would  result  in  inferior  medical  service,  is  the 
conclusion  of  many  who  have  studied  the  question. 

The  Council  of  the  State  Medical  Association 
agrees  with  the  minority  section  of  the  report  on 
the  Costs  of  Medical  Care,  which  includes  the 
declaration  “that  government  competition  in  the 
practice  of  medicine  be  discontinued  and  that 
its  activities  be  restricted  (a)  to  the  care  of  the 


indigent;  and  of  those  patients  with  diseases 
which  can  be  cared  for  only  in  governmental  in- 
stitutions; (b)  to  the  promotion  of  public  health; 
(c)  to  the  support  of  the  medical  departments  of 
the  Army  and  Navy,  Coast  and  Geodetic  Survey, 
and  other  government  services  which  cannot  be- 
cause of  their  nature  or  location  be  served  by  the 
general  medical  profession;  and  (d)  to  the  care 
of  veterans  suffering  from  bona  fide  service-con- 
nected disabilities  and  diseases,  except  in  the 
case  of  tuberculosis  and  nervous  and  mental 
diseases”. 

We  believe  provision  should  be  made  for  pay- 
ment locally  for  medical  service  to  recognized  in- 
digents to  relieve  the  medical  profession  alone  of 
this  burden;  the  study,  evaluation  and  coordina- 
tion of  medical  service  should  be  considered  im- 
portant functions  for  every  local  community;  the 
coordination  of  rural  with  urban  services  should 
receive  special  attention;  united  attempts  should 
be  made  to  restore  the  general  practitioner  to  the 
central  place  in  medical  practice;  the  corporate 
practice  of  medicine,  financed  through  inter- 
mediary agencies,  should  be  vigorously  and  per- 
sistently opposed  as  being  economically  wasteful, 
inimical  to  a continued  and  sustained  high  quality 
of  medical  care,  or  unfair  exploitation  of  the 
medical  profession;  and  methods  should  be  given 
careful  trial  which  can  rightly  be  fitted  into  our 
present  institutions  and  agencies  without  inter- 
fering with  the  fundamentals  of  medical  prac- 
tice. 

* * * * 

The  foregoing  statement  was  concurred  in  by 
the  following  physicians,  constituting  the  official 
board  of  the  Ohio  State  Medical  Association,  as 
well  as  by  Dr.  Geo.  Edw.  Follansbee,  Cleveland, 
chairman  of  the  Judicial  Council  of  the  American 
Medical  Association,  a past  president  of  the  State 
Association  and  the  only  Ohio  member  of  the 
national  Committee  on  the  Costs  of  Medical  Care, 
and  Dr.  J.  H.  J.  Upham,  Columbus,  a member  of 
the  Board  of  Trustees,  American  Medical  Associa- 
tion, and  a past  president  of  the  State  Associa- 
tion : 

Officers — H.  M.  Platter,  M.D.,  Columbus,  Presi- 
dent; C.  L.  Cummer,  M.D.,  Cleveland,  President- 
Elect;  James  A.  Beer,  M.D.,  Columbus,  Treas- 
urer; D.  C.  Houser,  M.D.,  Urbana,  Past  Presi- 
dent. Councilors  — John  A.  Caldwell,  M.D., 
Cincinnati;  E.  M.  Huston,  M.D.,  Dayton;  O.  P. 
Klotz,  M.D.,  Findlay;  B.  J.  Hein,  M.D.,  Toledo; 
H.  V.  Paryzek,  M.D.,  Cleveland;  H.  S.  Davidson, 
M.D.,  Akron;  E.  B.  Shanley,  M.D.,  New  Phila- 
delphia; E.  R.  Brush,  M.D.,  Zanesville;  I.  P. 
Seiler,  M.D.,  Piketon,  and  S.  J.  Goodman,  M.D., 
Columbus;  and  J.  B.  Alcorn,  M.D.,  Columbus, 
Chairman  of  the  Committee  on  Public  Policy. 


Important  Public  Health  Questions  Discussed  at  "Well' 
Attended  Annual  Conference  of  Ohio  Health  Coim 
missioners  and  Public  Health  Nurses 


Approximately  300  health  commissioners,  public 
health  nurses  and  other  official  health  workers  of 
the  state  attended  the  Thirteenth  Annual  Confer- 
ence of  Ohio  Health  Commissioners  with  the  State 
Department  of  Health,  held  November  16,  17  and 
18  at  the  Deshler-Wallick  Hotel,  Columbus. 

An  interesting  and  varied  program  was  pre- 
sented, practically  all  angles  of  public  health  ad- 
ministration being  discussed.  Particular  emphasis 
was  placed  on  public  health  administration  as  an 
integral  part  of  preventive  medicine  and  the  re- 
lationship between  official  public  health  work  and 
the  private  practice  of  medicine. 

The  conference  was  given  an  auspicious  be- 
ginning by  an  address  of  welcome  by  Governor 
George  White.  The  chief  executive  expressed  his 
appreciation  and  that  of  the  state  generally  to 
official  health  workers  for  the  work  they  have 
been  doing  and  what  they  have  accomplished  de- 
spite adverse  economic  conditions.  He  pledged 
support  to  sound  and  efficient  public  health  ad- 
ministration and  charged  those  present  to  carry 
on  with  additional  zeal  and  enthusiasm  in  the 
future.  Governor  White  complimented  Dr.  H.  G. 
Southard,  State  Director  of  Health,  for  his  effi- 
cient administration  of  the  state  department  dur- 
ing the  past  two  years  and  announced  to  the  con- 
ference that  Dr.  Southard  would  be  reappointed 
by  him  as  director  of  the  State  Department  of 
Health  for  the  term  1933-34. 

“Whither  Are  We  Going,  and  Why”,  Dr. 
Southard  Queries  in  Annual  Address 

Recognizing  that  public  health  work,  like  all 
other  endeavors  both  public  and  private,  is  con- 
fronted with  economic  and  legislative  problems  of 
great  importance,  Dr.  Southard  in  his  annual  ad- 
dress to  the  conference  on  the  afternoon  of  the 
opening  day,  outlined  and  discussed  some  of  these 
questions  in  the  light  of  present-day  developments 
and  the  transition  stage  through  which  society  is 
passing. 

Choosing  the  subject,  “Whither  Are  We  Going, 
and  Why”,  Dr.  Southard  pointed  out  that  public 
health  officials  must  have  a thorough  understand- 
ing of  what  is  and  what  is  not  included  in  the 
field  of  public  health  administration,  especially  at 
this  time  when  the  economic  depression  has  made 
it  necessary  to  develop  and  maintain  activities 
and  agencies  for  coping  with  the  results  of  dis- 
tress and  privation  and  to  curtail  all  but  neces- 
sary governmental  functions  and  activities. 

Dr.  Southard  stressed  the  fact  that  there  must 
be  a clear-cut  distinction  between  public  health 
work  and  welfare  and  social  service  activities. 

“Let  us  remember,”  he  said,  “That  health  work 


is  carried  on  in  order  to  keep  people  well  rather 
than  cure  the  sick;  that  welfare  and  social  ser- 
vice work  is  undertaken  in  the  hope  that  we  may 
prevent  dependency  and  suffering  as  well  as  afford 
relief.  The  one  is  the  specialty  of  preventive  medi- 
cine, with  its  divisions  of  administration,  sanitary 
engineering,  vital  statistics,  laboratory,  hygiene 
and  communicable  diseases.  The  other  is  welfare 
and  social  service,  and  should  not  conflict  with  so 
many  duplications  of  overhead.  While  I grant 
that  the  established  health  department  in  smaller 
cities  and  counties  may  well  afford  to  assume  the 
necessary  welfare  work  that  has  a health  angle, 
that  phase  is  separate,  and  distinct  from  the  offi- 
cial state  and  county  welfare  institutions  which 
are  handled  so  ably  by  the  Department  of  Wel- 
fare.” 

Dr.  Southard  sounded  a warning  concerning 
duplication  and  overlapping  in  public  health  work. 
He  suggested  that  all  agencies  doing  health  work 
be  coordinated  under  the  official  health  depart- 
ments so  that  the  sum  total  of  health  activities 
may  be  carried  on  more  effectively. 

Emphasizing  this  point,  he  declared : 

“When  government  costs  have  reached  the  point 
of  diminishing  returns  in  taxes  and  income,  we 
had  better  stop,  look  and  listen.  We  feel  we  do 
not  need  more  ramifications  and  duplications  of 
unofficial  agencies — better  fewer  under  the  direc- 
tion of  established  official  groups;  and  before 
more  official  groups  are  added  the  question  should 
be  submitted  to  a vote  of  the  people. 

“We  make  grateful  acknowledgement  of  the  as- 
sistance, cooperation,  high  ideals,  sincerity  of 
purpose,  honesty  and  enthusiasm  of  many  of 
these  unofficial  groups  but  a few  are  traveling 
along  the  way  without  knowing  whither  they  are 
going,  and  why. 

“What  economic  mistakes  are  committed  in  the 
name  of  social  service!  Public  health,  welfare, 
social  service,  physiology,  psychology  and  psychia- 
try ! It  is  time  we  should  differentiate  among  pub- 
lic health,  official  welfare,  social  service  and  up- 
lifting.” 

Director  Southard  pointed  out  that  public 
health  work  cannot  be  separated  in  any  sense  of 
the  word  from  the  field  of  medicine  and  that 
health  officials  are  in  the  final  analysis  specialists 
of  preventive  medicine,  depending  for  their  in- 
spiration and  opportunity  for  service  upon  gen- 
eral medicine  and  doing  honor  to  the  medical  pro- 
fession by  efficiently  handling  the  specialty  in 
which  they  are  engaged. 

Analyzing  the  accomplishments  of  official  health 
administi  ation  in  Ohio  since  the  passage  of  the 
Hughes-Griswold  Act  13  years  ago,  Dr.  Southard 
presented  some  interesting  data  relative  to  the 
economic  aspects  of  public  health  work  and  on  the 
achievements  of  Ohio  in  this  field  of  public  service. 

The  following  statistics  relative  to  expenditures 
for  public  health  service  in  the  state  for  the 
fiscal  year  1931  were  cited : 


50 


January,  1933 


State  News 


51 


Public  health  service  in  general  (county) 

health  districts $ 777,465.57 

Public  health  service  in  city  health  districts 2,081,006.33 

Total  expenditures,  including  the  state’s 

contribution  in  the  form  of  state  subsidy 

reimbursement 2,858,471.90 

Total  expenditures.  State  Department  of 

Health 553,085.28 

Total  expenditures  for  public  health  service 3,411,557.18 

Per  capita  cost  for  rural  health  service .325 

Per  capita  cost  for  city  health  service .476 

Average  per  capita  cost  for  state .506 

Average  cost  to  taxpayer  for  state  as  a whole 

per  $1000  property,  valuation : .252 

Discussing  public  health  as  a commercial  asset, 
Dr.  Southard  said: 

“Public  health  has  been  lifted  from  the  realm 
of  charity  to  the  realm  of  good  business.  Cham- 
bers of  Commerce,  Service  Clubs,  great  industries 
and  schools  have  all  voiced  their  interest  in  pub- 
lic health  as  a factor  in  good  business. 

“There  are  more  than  10,000  criminals  in  the 
major  penal  institutions  of  the  State  of  Ohio,  and 
more  than  1,400  boys  and  girls  in  correctional 
schools, — a large  proportion  being  there  because 
of  ill  health  that  could  have  been  prevented. 

“How  much  is  human  life  worth? 

“During  the  flu  epidemic,  alone,  profit  from  in- 
come decreased  one-third. 

“Statistics  have  shown  that  every  dollar  spent 
in  efficient  health  work,  up  to  the  saturation  point, 
saves  the  county  $8.00.  The  average  expended 
for  police  protection  in  American  cities  is  $5  00 
per  capita.  For  fire  protection,  $2.50  per  capita. 

“Fifty  cents  per  capita  for  health  work  would 
save  a county  of  40,000  people  $80,000  annually, 
and  yet  they  split  the  1/10  of  a mill  for  health 
work  to  save  money! 

“From  the  economic  side,  a large  percentage  of 
our  taxes  go  to  the  care  of  state  institutions. 

“Fifty  per  cent  of  the  school  children  of  Amer- 
ica suffer  from  physical  defects,  most  of  which 
could  have  been  prevented  or  remedied.  The  loss 
to  Ohio  in  one  year  because  of  failure  of  children 
to  make  grades  (due  to  handicapping  physical 
defects)  is  nearly  $2,000,000. 

“This  does  not  take  into  consideration  the  pain, 
the  suffering,  the  deaths;  the  blasted  hopes, 
aspirations  and  life-time  of  toil;  nor  do  we  realize 
the  lack  of  efficiency  it  engenders,  for  in  the  pre- 
face of  Physical  Education  and  Hygiene  for 
Ohio  Schools  we  ai’e  reminded  that  ‘The  health  of 
the  child  largely  determines  his  attitude  toward 
school  work,  largely  determines  his  interest  and 
application,  and  as  a result,  therefore,  determines 
his  general  accomplishment’.” 

To  show  the  effect  efficient  public  health  ad- 
ministration has  had  on  the  mortality  and  mor- 
bidity rates  of  the  state,  Dr.  Southard  presented 
the  following  data: 

“During  the  past  12  years  the  population  in 
Ohio  has  increased  16.2  per  cent;  10.1  per  cent  of 
this  gain  was  due  to  births  reported  over  the 
number  of  deaths,  and  6.1  per  cent  was  the  excess 
of  immigration  over  emigration. 

“With  this  increase  of  almost  one  million  in 
population  we  find  only  2.2  per  cent  more  deaths 
filed  in  the  year  1931  than  in  1920,  the  year  be- 
fore our  present  health  laws  became  operative. 

“Let  us  analyze  the  results  of  the  health  and 
medical  efforts  in  the  State  for  this  period,  grate- 
fully acknowledging  the  assistance  of  unofficial 
groups  in  this  field  of  education. 

“In  1920  every  128th  mother  was  sacrificed  in 
childbirth;  in  1931  every  163rd  mother  paid  the 
supreme  sacrifice  in  childbirth. 

“A  great  saving  in  lives  was  recorded  in  chil- 
dren under  one  year  of  age.  Every  12th  child 


born  in  1920  never  lived  to  see  a birthday;  today 
every  16th  child  bom  dies  during  the  first  year  of 
life. 

“Every  12th  death  that  occurred  in  the  State  in 
1920  was  due  to  tuberculosis;  but  in  1931  every 
18th  death  was  caused  by  some  form  of  this 
malady. 

“Forty-two  per  cent  of  all  the  deaths  in  the 
State  in  1920  were  among  school  children  between 
the  ages  of  5 to  19  years.  In  1931  only  28  per 
cent  of  the  deaths  were  in  this  group. 

“I  want  to  discuss  only  five  more  causes  of 
death  that  are  familiar  to  the  citizens  of  Ohio. 
In  1920  in  this  group  there  were  3,013  deaths  and 
in  1931  only  891,  a decrease  of  70.4  per  cent.  The 
diseases  and  percentages  of  decreases  are  as  fol- 
low: 


Typhoid  fever 40  per  cent 

Scarlet  fever 40  “ “ 

Diphtheria 70  “ “ 

Measles 79  **  “ 

Whooping  Cough 80  “ “ 


“Along  the  hazardous  road  of  life  this  cannot 
be  said  to  be  mere  coincidence;  but  is  the  result  of 
the  cooperation  of  the  family  physician  and  a 
well-rounded  health  program  in  each  health  dis- 
trict, which  includes  sanitation,  immunization, 
control  of  communicable  diseases  and  education. 

“What  was  the  economic  value  of  lives  saved  in 
Ohio  during  the  year  1931  by  the  reduction  of 
death  rate  for  ages  under  35  years? 

“A  comparison  of  the  death  rates  for  1920  and 
1931  in  this  age  group  revealed  last  year  a saving 
of  10,882  lives  and  that  the  persons  saved  were 
equivalent  to  a total  saving  in  money  capital  of 
$84,580,000,  with  an  actual  expenditure  of 
$3,411,557.18  for  public  health  services. 

“The  economic  value  of  lives  saved  in  Ohio 
since  the  Hughes-Griswold  Health  Law  became 
operative  in  the  age  group  under  35  years  of  age 
was  $764,419,000. 

The  estimated  expenditures  for  Public  Health 
service  during  the  past  twelve  years  was  $35,000,- 

000.  The  saving  in  money  value  of  man  over  this 
period  is  estimated  at  more  than  $700,000,000. 

Voicing  the  opinion  that  perhaps  some  changes 
would  be  needed  in  the  future  in  the  statutes  per- 
taining to  public  health  administration,  Dr.  South- 
ard listed  the  following  proposals  which  have  been 
suggested  by  various  individuals  and  groups,  and 
asked  that  the  health  officials  of  the  state  give 
them  careful  thought  and  study  so  that  a con- 
certed viewpoint  as  to  their  merits  or  demerits 
might  be  had: 

1.  Augmenting  funds  for  public  health  work 
with  money  from  a specific  tax  for  health  pur- 
poses. 

2.  Making  district  health  commissioners  regis- 
trars of  vital  statistics  for  their  respective  dis- 
tricts and  present  registrars  deputies  to  the 
health  commissioner-registrar. 

3.  Placing  inspection  of  milk,  food,  restaurants, 
hotels,  camp  sites  and  soda  fountains  under  one 
department. 

4.  Formation  of  a simplified  daily  record  sheet 
to  be  kept  by  each  local  health  department  so  that 
data  for  the  department’s  annual  report  may  be 
readily  obtained. 

5.  Placing  the  hospital  at  the  Mt.  Vernon  Sana- 
torium under  the  supervision  of  the  State  Depart- 
ment of  Health. 

6.  Formation  of  record  blanks  to  be  used  in 
milk  inspection. 

In  conclusion,  Dr.  Southard  said: 


52 


The  Ohio  State  Medical  Journal 


January,  1933 


“Unless  we  follow  the  ethics  of  preventive 
medicine; 

“Unless  we  are  willing-  to  assume  additional 
work  of  other  departments,  that  in  turn  the  state 
may  decrease  duplication  of  overhead  and  save 
money  ; 

“Unless  we,  as  a department,  are  willing  to  re- 
lease duties  that  may  well  be  better  handled  by 
other  departments; 

“Unless  we  are  willing  to  take  the  initiative 
in  recommending  still  fewer  and  better  health 
departments  with  fewer  overheads  and  still  better 
and  more  efficient  personnel; 

“Unless  the  city  and  county  health  departments 
are  willing  to  take  an  inventory  after  12  years 
under  the  Hughes-Griswold  Law  and  profit  by 
their  study; — 

“The  Legislature  may  wreck  what  has  been  so 
well  builded.” 

Organized  Medicine  and  Official  Health  Workers 
Must  Cooperate,  Dr.  Platter  Says 

Greetings  of  the  medical  profession  to  the 
official  health  workers  of  Ohio  was  extended  by 
Dr.  H.  M.  Platter,  Columbus,  president  of  the 
Ohio  State  Medical  Association. 

Mentioning  in  general  terms  some  of  the  prob- 
lems confronting  public  health  administrators, 
especially  that  of  how  to  carry  on  effectively  with 
reduced  budgets,  Dr.  Platter  said  the  medical  pro- 
fession of  the  state  is  ready  and  willing  at  all 
times  to  cooperate  in  sound,  practical  public 
health  programs  and  to  give  its  support  to  those 
who  are  making  an  earnest  endeavor  to  develop 
necessary  and  beneficial  public  health  activities. 

“It  seems  to  me,”  he  said,  “one  contingent  which 
you  can  commandeer  to  aid  you  in  looking  after 
human  ills  is  your  county  medical  society  whose 
members  have  been  educated  from  the  beginning 
that  service  comes  first.  Nearly  all  of  you  are 
active  members  of  organized  medicine  and  should 
bring  to  the  attention  of  the  members  of  your 
county  society  your  need  for  their  active  support 
in  a sound  health  program.” 

Dr.  Platter  expressed  the  belief  that  more  and 
more  the  practitioner  of  general  medicine  must 
take  up  the  practice  of  preventive  medicine  if  he 
is  to  meet  present  day  requirements.  He  said  that 
such  practice  is  necessary  for  the  practicing  phy- 
sician to  maintain  his  position  and  that  the 
broadening  of  medical  practice  now  taking  place 
to  include  preventive  medicine  will  result  in 
greater  support  by  the  entire  medical  profession 
for  official  public  health  work  generally. 

Concluding  his  brief  talk,  Dr.  Platter  warned 
against  the  pessimistic  attitude  toward  the  future 
taken  by  some  individuals. 

“To  satisfactorily  solve  the  many  economic  and 
social  problems  which  impinge  upon  you  and 
members  engaged  in  active  general  practice  is  a 
gigantic  task  at  the  present  time.  We  must 
neither  become  indolent  nor  skeptical  so  far  as  the 
future  is  concerned.  America  is  still  the  land  of 
opportunity  and  now  that  the  heat  of  a political 
campaign  has  subsided  your  sober  common  sense 


must  tell  you  we  shall  survive  and  work  out  our 
problems. 

“Individual  members  of  your  county  medical 
society  should  be  recruited  to  help  bear  some  of 
your  burdens.  Perhaps  present  conditions  will 
develop  a clearer  understanding  of  each  other’s 
rights  and  duties  and  a higher  degree  of  coopera- 
tion. It  is  well  to  remember  that  the  medical  re- 
sources of  a community  have  never  been  mobilized 
except  in  times  of  epidemic,  and  too,  in  times  of 
need  that  the  profession  has  never  been  found 
wanting. 

“It  is  a very  great  pleasure  for  me  to  extend  a 
greeting  on  behalf  of  the  State  Association,  and 
bring  to  you  a friendly  and  earnest  desire  on  the 
part  of  the  membership  to  cooperate  with  you  in 
your  efforts. 

“This  is  the  morning  after.  The  nation  should 
shake  hands  with  itself  and  say  with  heartfelt 
emphasis,  ‘Thank  goodness  it  is  over.  We  can  all 
get  busy  and  do  something’.  In  your  business  and 
in  general  practice  the  same  slogan  can  be 
adopted — ‘Let  us  together  tackle  the  problems  in 
our  respective  fields  and  thereby  win  the  appro- 
bation of  an  harassed  public’.” 

Miscellaneous  Public  Health  Projects  and 
Questions  Summarized  and  Discussed 

Some  interesting  discussions  of  miscellaneous 
public  health  questions  and  special  health  pro- 
jects being  carried  on  in  various  parts  of  the 
state  were  held  during  the  conference. 

Dr.  0.  D.  Tatje,  health  commissioner  of  Ports- 
mouth, described  the  work  being  carried  on  in  that 
city  through  a centralized  health  center.  He  tr>ld 
of  the  different  services  provided;  the  amount  of 
work  handled  annually;  the  layout  and  equipment 
used  by  the  various  departments,  and  the  person- 
nel needed  to  conduct  the  service. 

Dr.  Tatje  expressed  the  opinion  that  the  Ports- 
mouth health  center  is  of  distinct  value  to  the 
community  and  that  because  of  the  careful  and 
ethical  manner  in  which  it  is  operated,  it  has  won 
the  approval  and  cooperation  of  the  medical  pro- 
fession of  that  city. 

How  the  Cincinnati  Children’s  Clinic  for  the 
Treatment  of  Syphilis  and  Gonorrhea  operates 
was  described  by  Dr.  Carl  A.  Wilzbach,  director 
of  health  education,  Cincinnati  Public  Health 
Federation. 

Value  of  the  work  being  done  by  the  4-H  Clubs 
in  the  rural  communities  was  emphasized  by  W. 
H.  Palmer,  State  Club  Leader.  Mr.  Palmer  de- 
scribed some  of  the  activities  carried  on  in  the 
schools  by  the  clubs  and  stressed  the  point  that 
the  health  “H”  in  the  program  is  considered  of 
primary  importance  by  those  conducting  the  pro- 
gram. 

Preventive  medicine  from  the  standpoint  of  the 
laity  was  discussed  by  two  speakers — Charles 
Scott  Berry,  Ph.D.,  director,  Bureau  of  Special 


January,  1933 


State  News 


53 


Education,  Ohio  State  University,  and  Donald  H. 
Tippett,  D.D.,  pastor  of  the  Bexley  M.  E.  Church. 

Dr.  Berry  stressed  the  importance  of  coopera- 
tion between  official  and  non-official  health 
agencies,  pointing  out  that  a well-i'ounded  pro- 
gram in  each  county  with  both  official  and  non- 
official groups  cooperating  and  working  would 
have  a beneficial  effect.  He  stressed  the  import- 
ance of  public  support  in  public  health  activities 
and  pointed  out  that  voluntary  groups  in  many 
instances  could  act  as  the  contact  factor  between 
the  official  health  department  and  the  public.  Dr. 
Berry  expressed  the  belief  that  the  health  com- 
missioner should  take  the  initiative  and  be  the 
leader  of  any  combined  program  developed  but 
that  he  should  depend  on  the  lay  organization  and 
groups  to  help  him  carry  on  a campaign  of  public 
education  in  his  district.  He  described  to  some 
extent  the  work  being  done  by  a special  commit- 
tee, of  which  he  is  chairman,  authorized  by  the 
Ohio  Conference  on  Child  Health  and  Protection 
to  organize  the  state  and  put  into  effect  the  recom- 
mendations made  at  the  recent  White  House  Con- 
ference on  Child  Health  and  Protection. 

Rev.  Mr.  Tippett  made  an  emphatic  plea  for  the 
maintenance  of  effective  public  health  work, 
pointing  out  the  influence  of  such  work  in  char- 
acter building.  He  expressed  the  belief  that  now 
more  than  ever  before,  society  is  confronted  with 
moral  problems  of  great  importance  and  that  each 
individual  must  be  strong  physically  and  mentally 
to  be  adequately  prepared  to  meet  those  issues 
which  threaten  the  moral  fabric  of  society. 

A discussion  of  some  of  the  practical  problems 
confronting  public  health  administration  was 
made  by  Dr.  E.  R.  Hiatt,  health  commissioner  of 
Miami  County.  Dr.  Hiatt  declared  that  in  his 
opinion  there  are  a number  of  weak  points  in  the 
present  public  health  set-up  in  Ohio.  He  sug- 
gested that  the  present  system  might  be  improved 
by  removing  the  office  of  State  Director  of  Health 
from  the  list  of  political  appointees;  by  giving  the 
State  Department  greater  discretionary  power  in 
the  distributing  of  the  state  health  subsidy;  by 
having  health  funds  in  each  county  raised  by  a 
special  tax  levy  for  health  purposes,  and  by  the 
coordination  and  combination  of  health  depart- 
ments in  the  same  county.  The  discussion  which 
followed  his  paper  indicated  a wide  difference  of 
opinion  among  health  commissioners  as  to  some  of 
the  suggestions. 

The  viewpoints  of  medical  educators  toward 
preventive  medicine  were  summarized  by  Dr. 
Thomas  J.  LeBlanc,  associate  professor  of  pre- 
ventive medicine,  University  of  Cincinnati,  and 
Dr.  J.  A.  Doull,  head  of  the  department  of 
hygiene  and  bactei’iology,  Western  Reserve  Uni- 
versity. 

Dr.  LeBlanc  spoke  on  “Instructing  Medical 
Students  in  Preventive  Medicine”.  He  suggested 
including  instruction  in  preventive  medicine  in 
each  year  of  the  medical  course  and  advocated  a 


better  and  more  uniform  arrangement  of  sched- 
ules for  class  room  and  clinical  work  in  this  phase 
of  medicine. 

Dr.  Doull  made  a plea  for  interest  and  activity 
on  the  part  of  the  practicing  physician  in  the 
field  of  preventive  medicine  in  his  paper  on  “The 
Role  of  the  Physician  in  Public  Health  Pro- 
cedure”. He  suggested  how  the  practicing  phy- 
sician can  assist  in  controlling  preventable  dis- 
eases by  adopting  preventive  methods  as  a part  of 
his  daily,  routine  practice. 

Officers  Elected  at  Business  Session  of 
Federation  of  Public  Health  Officials 

On  Thursday  evening,  November  17,  a dinner 
session  was  held  by  the  Ohio  Federation  of  Public 
Health  Officials.  The  session  was  presided  over 
by  Dr.  F.  M.  Houghtaling,  health  commissioner 
of  Sandusky  and  Erie  County,  president  of  the 
organization  for  the  past  year. 

A new  Constitution  and  By-Laws  was  presented 
and  adopted  after  a lengthy  discussion. 

The  following  officers  for  1932-33  were  elected: 

President,  Dr.  G.  T.  Wasson,  Bucyrus,  health 
commissioner  of  Crawford  County;  first  vice 
president,  Dr.  W.  G.  Rhoten,  Wooster,  health  com- 
missioner of  Wayne  County;  second  vice  presi- 
dent, Miss  Mary  A.  Ewalt,  Eaton;  secretary  and 
treasurer,  Dr.  E.  R.  Shaffer,  State  Department  of 
Health. 

These  officers  and  one  representative  elected  by 
each  of  the  five  districts  comprising  the  organiza- 
tion will  constitute  the  executive  committee.  Be- 
fore the  meeting  adjourned,  resolutions  on  the 
deaths  of  Dr.  John  E.  Monger,  former  State 
Director  of  Health;  Dr.  M.  V.  Replogle,  health 
commissioner  of  Williams  County;  Dr.  0.  R. 
Eylar,  health  commissioner  of  Pike  County,  and 
Dr.  B.  J.  Evans,  health  commissioner  of  Zanes- 
ville, were  adopted.  Approximately  88  health 
commissioners  and  nurses  attended  the  meeting. 

Papers  on  Immunology,  Periodic  Health 
Examinations  and  Mental  Hygiene  Read 

Phases  of  preventive  medicine  which  call  for 
understanding,  cooperation  and  activity  on  the 
part  of  the  practicing  physician,  the  research 
scientist,  the  public  health  official  and  the  public 
health  nurse  were  discussed  by  Dr.  Charles  A. 
Doan,  director,  Department  of  Medical  and  Sur- 
gical Research,  Ohio  State  University;  Dr.  Henry 
C.  Schumacher,  associate  professor  of  mental 
hygiene,  Western  Reserve  University,  and  Dr. 
V.  C.  Rowland,  Cleveland,  chairman  of  the  Com- 
mittee on  preventive  Medicine  and  Periodic  Health 
Examinations,  Ohio  State  Medical  Association. 

Dr.  Doan,  speaking  on  the  subject,  “Immun- 
ology in  the  Control  of  Communicable  Diseases”, 
reviewed  some  of  the  newer  views  regarding 
immunology,  based  on  experiments  which  have 
been  conducted  in  some  of  the  larger  research 
laboratories.  He  analyzed  data  which  has  been 


54 


The  Ohio  State  Medical  Journal 


January,  1933 


collected  through  animal  experimentation  with 
some  of  the  more  common  communicable  diseases, 
describing  at  length  how  the  experiments  were 
conducted  and  under  what  conditions.  These 
latest  research  tests  have  demonstrated  con- 
clusively in  many  instances,  he  said,  that  although 
immunology  is  of  great  importance  in  the  control 
of  certain  types  of  communicable  disease,  heredity 
is  one  of  the  leading  factors  and  shows  why  some 
individuals  are  more  susceptible  to  certain  dis- 
eases than  others  and  why  the  mortality  rates  are 
higher  in  some  groups  of  individuals  than  in 
others. 

Moreover,  Dr.  Doan  pointed  out,  the  newest 
experiments  have  indicated  that  diet  is  also  a 
factor  which  must  be  reckoned  with  and  probably 
is  one  of  the  chief  reasons  why  morbidity  and  mor- 
tality rates  vary  in  different  groups.  His  general 
conclusion  was  that  those  engaged  in  the  control 
of  communicable  diseases  should  not  consider  im- 
munization the  sole  control  factor  but  should  take 
into  account  the  factors  of  heredity  and  environ- 
ment in  dealing  with  the  problem.  He  intimated 
that  experiments  now  under  way  but  not  yet  com- 
pleted might  reveal  information  which  will  have  a 
tendency  to  change  in  many  respects  present-day 
methods  of  combatting  communicable  diseases. 

As  the  basis  for  his  discussion  on  “The  Mental 
Health  of  Childhood”,  Dr.  Schumacher  used  a 
number  of  the  nineteen  points  embodied  in  The 
Children’s  Charter  formulated  by  the  Hoover 
White  House  Conference  on  Child  Health  and 
Protection,  stressing  the  fact  that  mental  well- 
being is  largely  a public  health  problem  and 
should  be  dealt  with  as  such. 

Dr.  Schumacher  emphasized  the  importance  of 
sound  physical  and  mental  health  among  potential 
parents.  Periodic  physical  examinations  would 
go  far  in  discovering  whether  the  prospective 
parent  is  fit  to  accept  the  responsibilities  of 
parenthood,  he  said.  This,  coupled  with  good  pre- 
natal care,  he  believes,  would  give  greater  as- 
surance that  more  children  would  be  provided 
with  sound  health  at  birth,  which  in  turn  would 
prevent  later  mental  retardation. 

The  speaker  also  touched  on  the  effects  on  the 
child  of  spiritual  and  moral  training,  stressing 
the  importance  of  that  type  of  training  which 
makes  it  possible  for  the  child  to  hold  in  check 
primitive  impulses  that  cannot  be  expressed  with- 
out danger  of  punishment  for  the  violation  of  the 
laws  and  customs  of  society,  and  which,  on  the 
other  hand,  does  not  make  the  child  so  rigid  in  his 
conformity  as  to  precliide  his  enjoyment  of  life  to 
the  fullest,  yet  within  the  bounds  of  morality. 

Dr.  Schumacher  emphasized  the  necessity  for 
striking  a happy  medium  in  guiding  the  child  to 
develop  personality  and  character,  declaring  every 
child  needs  to  be  dealt  with  as  a separate  in- 
dividual being  whose  total  needs  are  different 
from  those  of  any  other  child. 

The  importance  of  good  home  care,  home  in- 


fluence and  parental  love  and  affection  on  the 
young  child  must  not  be  overlooked,  Dr. 
Schumacher  said,  pointing  out  that  the  placing  of 
infants  and  toddlers  in  orphanages  and  nurseries 
precludes  the  influence  which  the  child  receives  in 
a good  home,  even  though  it  may  be  a foster 
home. 

Normal  development  of  the  child  may  be  ser- 
iously interfered  with  by  the  results  of  com- 
municable diseases,  malnutrition,  bad  teeth,  de- 
fective vision  and  hearing,  postural  defects,  etc., 
Dr.  Schumacher  pointed  out.  He  urged  commun- 
ity activity  in  seeing  that  communicable  diseases 
are  controlled ; food,  water  and  milk  supplies  safe- 
guarded, and  children  frequently  examined  for 
physical  defects.  Dr.  Schumacher  cited  specific 
examples  of  how  defective  physical  health  fre- 
quently results  in  retarded  mental  development; 
often  mental  breakdown. 

Health  education  should  be  stressed  and  pro- 
moted, Dr.  Schumacher  said,  so  that  every  child 
will  be  made  health  conscious.  Also,  he  empha- 
sized the  value  of  teaching  the  child  how  to  use 
his  leisure  time  and  of  providing  children  with 
safe  play  space  under  proper  supervision. 

In  conclusion,  he  urged  modification  of  present 
methods  of  dealing  with  the  delinquent  child  and 
advocated  that  efforts  be  made  to  handle  the  de- 
linquent in  such  a way  that  he  can  eventually  be 
returned  to  society  where  he  can  grow  up  as  a 
safe  citizen  and  an  asset  to  his  community. 

Preventive  medicine  as  it  applies  to  the  various 
age  groups,  from  birth  to  old  age,  was  discussed 
by  Dr.  Rowland.  Considerable  emphasis  was 
placed  on  the  value  of  the  periodic  health  exami- 
nation in  the  practice  of  preventive  medicine. 
However,  Dr.  Rowland  pointed  out,  the  periodic 
health  examination  is  just  one  part  of  the  whole 
field  of  preventive  medicine,  the  practice  of  which 
now  includes  all  activities  in  connection  with 
pathological  physiology,  personal  hygiene,  specific 
immunization,  prophylactic  treatment,  etc. 

Although  but  an  integral  part  of  the  whole 
field  of  preventive  medicine,  the  physical  examina- 
tion, Dr.  Rowland  said,  provides  a splendid  op- 
portunity for  a frank  discussion  between  physi- 
cian and  patient  of  functional  disorders,  faulty 
habits  and  the  prophylaxis  of  disease  tendencies 
which  frequently  can  be  anticipated  in  the  in- 
dividual patient.  Because  of  this,  the  physical  ex- 
amination in  general  practice  can  be  of  much 
benefit  to  the  physician  as  well  as  to  his  clientele. 

Dr.  Rowland  emphasized  that  the  medical  pro- 
fession generally  is  beginning  to  realize  the  neces- 
sity of  engaging  in  the  practice  of  preventive 
medicine  as  well  as  curative  medicine.  He  urged 
that  medical  schools  provide  more  adequate  in- 
struction in  preventive  medicine  not  only  in  for- 
mal courses  but  as  a regular  part  of  all  clinical 
teaching. 

Dr.  Rowland’s  discussion  of  preventive  medicine 
in  relation  to  the  various  age  groups  contained 


January,  1933 


State  News 


55 


a wealth  of  valuable  data  concerning  the  mor- 
bidity and  mortality  rates  of  various  diseases  and 
conditions  peculiar  to  or  most  prevalent  in  each  age 
group.  It  was  pointed  out  how  general  application 
of  the  principles  of  preventive  medicine  by  the 
family  physician,  including  the  periodic  health 
examination,  would  tend  to  prevent  occurrence  of 
functional  and  chronic  ailments  in  many  persons. 

Problems  of  Interest  to  Nurses  Raised  in 
Talks  by  Miss  Fagen  and  Miss  Brouse 

A part  of  the  program  was  devoted  to  the  con- 
sideration of  public  health  nursing  questions. 
Those  who  discussed  some  of  these  problems  were 
Miss  Marguerite  Fagen,  R.N.,  president  of  the 
Ohio  State  Nurses’  Association,  Cincinnati,  and 
Miss  Clara  F.  Brouse,  R.N.,  chief  examiner, 
Nurse  Registration,  State  Medical  Board,  Co- 
lumbus. 

Miss  Fagen  spoke  on,  “Qualifications  of  Nurses 
Holding  Responsible  Public  Health  Positions”, 
and  Miss  Brouse  on  “Importance  of  Registration 
of  Graduate  Nurses”. 

Approximately  75  attended  the  nurses’  lunch- 
eon held  at  noon,  November  17,  at  which  a musical 
program  was  rendered  by  the  Nurses’  Glee  Club 
of  White  Cross  Hospital,  Columbus. 

Venereal  Diseases,  Blindness  and  Rural 
Sanitation  Questions  Are  Discussed 

The  program  at  the  closing  session  of  the  con- 
ference on  Friday  afternoon,  November  18,  was 
furnished,  with  one  exception,  by  heads  of  dif- 
ferent bureaus  or  divisions  of  the  State  Depart- 
ment of  Health.  The  only  speaker  not  connected 
with  the  State  Department  was  Dr.  R.  H.  Mark- 
with, 'health  commissioner  of  Summit  County,  who 
discussed  the  subject,  “A  Rural  Sanitation  Pro- 
gram”. 

Dr.  Markwith  pointed  to  the  present  movement 
of  population  back  to  rural  communities  as  an  in- 
dication of  the  need  for  the  development  of  a bet- 
ter rural  sanitation  program  in  each  county  in 
order  to  prevent  at  the  source,  disease  and  suf- 
fering. He  declared  that  one  of  the  hardest  tasks 
of  the  health  commissioner  is  to  sell  to  the  public 
the  idea  that  sanitary  improvements  are  impera- 
tive. Dr.  Markwith  pointed  out  that  in  cities 
sanitary  problems  can  be  corrected  on  a large 
scale  through  common  sources  but  that  in  rural 
areas  there  are  literally  hundreds  of  small  groups 
of  persons  which  must  be  dealt  with,  since  sani- 
tation there  is  largely  a matter  of  each  resident 
providing  his  own  services  without  a health 
hazard  for  his  neighbor. 

Dr.  Markwith  explained  that  a rural  sanitation 
program  should  be  divided  into  four  major  di- 
visions: water  supply,  sewage  disposal,  nuisances 
and  dairy  and  food  control.  He  described  the  ac- 
tivities of  the  health  officer  in  handling  the  prob- 
lems of  each  of  these. 

F.  H.  Waring,  chief  engineer,  State  Department 


of  Health,  in  his  address  on  “A  Resume  of  En- 
ginering Problems”,  expanded  on  some  of  the 
questions  discussed  by  Dr.  Markwith,  especially 
that  of  public  water  supplies.  Mr.  Waring  em- 
phasized the  importance  of  the  health  commis- 
sioner’s job  in  seeing  that  his  community  is  sup- 
plied with  a safe  public  water  supply.  He  cited 
figures  which  show  that  approximately  75  per 
cent  of  the  population  of  the  state  is  at  present 
served  by  public  water  supplies.  He  said  that 
this  fact  alone  shows  the  catastrophy  which  would 
result  if  these  supplies  were  not  adequately  safe- 
guarded, inspected  periodically,  and  improved 
when  necessary.  Mr.  Waz-ing  urged  that  every 
health  commissioner  make  an  effort  to  retain 
adequate  trained  personnel  for  supervision  of  the 
public  water  supplies  under  his  jurisdiction, 
warning  that  a grave  situation  might  develop  in 
those  communities  where  budgets  do  not  take  into 
consideration  the  employment  of  at  least  one  per- 
son competent  to  look  after  this  activity. 

Mr.  Waring  pointed  out  how  the  health  com- 
missioner can  assist  the  State  Department  in  the 
problem  of  public  water  supply: 

First,  by  discovering  obvious  defects  in  existing 
systems;  by  driving  home  to  local  officials  the 
necessity  for  correction  of  these  defects,  and  by 
initiating  a campaign  for  systems  in  communities 
which  do  not  now  have  them  but  should. 

Second,  by  keeping  posted  on  the  latest  de- 
velopments in  water  supply  and  water  treatment; 
by  cooperating  with  the  State  Department  on 
the  matter;  by  preaching  the  gospel  of  preven- 
tion of  water-borne  trouble;  by  endeavoring  to 
educate  the  people  of  his  community  as  to  the 
necessity  and  value  of  a good  water  supply. 

Third,  by  impressing  upon  local  officials  that 
now  is  the  time  to  improve  their  public  water 
systems  or  to  build  a new  one,  if  at  all  possible, 
because  of  the  cheaxmess  of  labor  and  material. 

The  subject  of  “Food  Poisoning”  was  dis- 
cussed by  Leo  F.  Ey,  chief,  Division  of  Labora- 
tories, State  Department  of  Health,  from  the 
standpoint  of  the  duties  of  the  health  commis- 
sioner. Mr.  Ey  emphasized  two  points  in  par- 
ticular: (1)  the  necessity  for  the  health  commis- 
sioner to  be  on  the  job  promptly  in  instances  of 
mass  food  poisoning  and  to  preserve  all  the  evi- 
dence available  for  early  laboratory  analysis,  and 
(2)  the  necessity  for  the  health  commissioner  to 
differentiate  between  food  poisoning  outbreaks 
which  have  a criminal  angle  and  those  which  do 
not.  It  was  pointed  out  that  in  a case  where  evi- 
dence of  intentional  poisoning  is  present,  the  local 
county  prosecutor  and  coroner  should  be  promptly 
notified  to  conduct  the  investigation.  Mr.  Ey 
pointed  out  that  any  laboratory  called  upon  to 
make  an  investigation  of  food  poisoning  is  ser- 
iously handicapped  unless  it  has  the  cooperation 
of  the  local  health  officer  and  is  accorded  efficient 
help  by  him. 

Review  of  the  statutes  relative  to  reporting  of 


56 


The  Ohio  State  Medical  Journal 


January,  1933 


cases  of  inflammation  of  the  eyes  of  the  newborn 
was  presented  by  Dr.  W .P.  Johnson,,  chief,  Bureau 
of  Prevention  of  Blindness,  State  Department  of 
Health.  Dr.  Johnson  said  that  in  1931,  947  such 
cases  were  reported  to  the  State  Department  and 
that  23  of  these  proved  to  be  of  gonorrheal  origin. 
Of  the  23  cases,  complete  vision  was  saved  in  18, 
three  became  totally  blind  and  in  each  of  two 
cases  one  eye  was  saved.  Prompt  and  adequate 
attention  in  eye  inflammations  in  the  newborn  will 
in  the  great  percentage  of  cases  result  in  full  re- 
covery, Dr.  Johnson  pointed  out. 

Dr.  R.  W.  DeCrow,  chief,  Bureau  of  Venereal 
Diseases,  State  Department  of  Health,  described 
the  work  the  state  is  doing  in  this  field.  Data  on 
the  venereal  disease  situation  in  Ohio  was  pre- 
sented as  follows:  Forty-eight  venereal  clinics 
have  been  established  for  the  treatment  of  in- 
digent cases;  246,163  treatments  were  given  in 
these  clinics  in  1931 ; 9,661  cases  of  syphilis  and 
4,039  cases  of  gonorrhea  were  reported  during 
1931  to  the  State  Department,  probably  only  a 
part  of  the  actual  number  of  cases  in  existence; 
5544  ampoules  were  furnished  by  the  State  De- 
partment to  physicians  in  1931;  80,216  Wasser- 
manns  and  10,216  smears  were  made  by  the 
laboratory  of  the  State  Department  last  year;  the 
case  rate  of  syphilis  in  Ohio  in  1931  was  143.0  per 
100,000  population  compared  to  a case  rate  of 
100.4  in  1921,  indicating  not  so  much  an  increase 
in  prevalence  as  an  increase  in  the  number  of 
persons  who  are  taking  advantage  of  treatment; 
decrease  in  the  death  rate  from  syphilis  during 
the  same  period  from  10.56  to  8.29. 

Mrs.  Mary  Cartwright,  lecturer,  State  Depart- 
ment of  Health,  suggested  ways  and  means  the 
health  commissioner  could  contact  the  public  and 
how  health  education  could  be  carried  on  in- 
directly by  him  by  selling  his  work  to  schools, 
luncheon  clubs,  boys’  and  girls’  organizations, 
parent-teacher  associations,  farm  groups,  local 
newspapers,  etc. 

* * * % 

Following  is  a list  of  those  who  registered  at 
the  Conference,  exclusive  of  employes  of  the  var- 
ious bureaus  and  divisions  of  the  State  Depart- 
ment of  Health. 

Health  Commissioners — Dr.  S.  J.  Ellison,  Adams  County ; 
Dr.  J.  J.  Sutter,  Allen  County ; Dr.  G.  B.  Fuller,  Ashland 
County ; Dr.  W.  S.  Weiss,  Ashtabula  County ; Dr.  J.  M. 
Higgins,  Athens  County ; Dr.  R.  C.  Hunter,  Auglaize  County ; 
Dr.  F.  R.  Dew,  Belmont  County;  Dr.  John  G.  Anderson, 
Brown  County ; Dr.  C.  J.  Baldridge,  Butler  County ; Dr.  G. 

C.  Dowell,  Carroll  County  ; Dr.  L.  A.  Woodburn,  Champaign 
County ; Dr.  R.  R.  Richison,  Clark  County ; Dr.  C.  R.  Col- 
burn, Clermont  County ; Dr.  W.  K.  Ruble,  Clinton  County ; 
Dr.  T.  T.  Church,  Columbiana  County ; Dr.  D.  M.  Criswell, 
Coshocton  County ; Dr.  G.  T.  Wasson,  Crawford  County ; Dr. 
Robert  Lockhart,  Cuyahoga  County ; Dr.  W.  D.  Bishop, 
Darke  County;  Dr.  B.  B.  Barber,  Delaware  County;  Dr.  F. 
M.  Houghtaling,  Erie  County ; Dr.  O.  M.  Kramer,  Fairfield 
County;  Dr.  James  F.  Wilson,  Fayette  County;  Dr.  B.  E. 
Neiswander,  Franklin  County;  Dr.  F.  W.  Shane,  Gallia 
County;  Dr.  Walter  Corey,  Geauga  County;  Dr.  W.  C. 
Marshall,  Greene  County ; Dr.  D.  L.  Cowden,  Guernsey 
County ; Dr.  E.  H.  Schoenling,  Hamilton  County ; Dr.  S.  F. 
Whisler,  Hancock  County ; Dr.  J.  H.  Holcomb,  Hardin 
County ; Dr.  J.  M.  Scott,  Harrison  County  ; Dr.  J.  R.  Bolles, 
Henry  County ; Dr.  John  L.  Walker,  Highland  County ; Dr. 
W.  B.  Lacock,  Hocking  County ; Dr.  J.  C.  Elder,  Holmes 
County ; Dr.  B.  C.  Pilkey,  Huron  County ; Dr.  J.  W.  Clark, 


Jackson  County;  Dr.  J.  P.  Young,  Jefferson  County;  Dr.  H. 
W.  Blair,  Knox  County ; Dr.  E.  R.  Stewart,  Lawrence 
County ; Dr.  Edward  M.  Cass,  Licking  County ; Dr.  W.  H. 
Carey,  Logan  County;  Dr.  H.  R.  O’Brien,  Lorain  County; 
Dr.  F.  F.  DeVore,  Lucas  County  ; Dr.  Robert  Trimble,  Madi- 
son County ; Dr.  N.  Sifritt,  Marion  County ; Dr.  T.  W. 
Mahoney,  Medina  County ; Dr.  W.  S.  Ellis,  Meigs  County ; 
Dr.  E.  R.  Hiatt,  Miami  County ; Dr.  J.  W.  Weber,  Monroe 
County ; Dr.  H.  H.  Pansing,  Montgomery  County ; Dr.  R.  L. 
Pierce,  Morrow  County ; Dr.  Beatrice  Hagen,  Muskingum 
County ; Dr.  G.  M.  Mason,  Noble  County ; Dr.  C.  B.  Fine- 
frock,  Ottawa  County;  Dr.  F.  J.  Crosbie,  Perry  County. 

Dr.  C.  C.  Beale,  Pickaway  County ; Dr.  R.  T.  Leever, 
Pike  County;  Dr.  R.  D.  Worden,  Portage  County;  Dr.  J.  I. 
Nisbet,  Preble  County;  Dr.  Frank  Light,  Putnam  County; 
Dr.  M.  C.  Hanson,  Richland  County ; Dr.  R.  E.  Bower,  Ross 
County ; Dr.  F.  M.  Teeple,  Sandusky  County ; Dr.  G.  W. 
Fishbaugh,  Scioto  County;  Dr.  J.  J.  Heaton,  Seneca  County; 
Dr.  A.  B.  Lippert,  Shelby  County ; Dr.  Floyd  Stamp,  Stark 
County ; Dr.  R.  H.  Markwith,  Summit  County ; Dr.  L.  A. 
Connell,  Trumbull  County ; Dr.  J.  Blickensderfer,  Tuscarawas 
County ; Dr.  J.  D.  Boylan,  Union  County ; Dr.  Charles  R. 
Keyser,  Van  Wert  County;  Dr.  Edward  Blair,  Warren 
County  ; Dr.  Alfred  G.  Sturgis,  Washington  County ; Dr.  W. 

G.  Rhoten,  Wayne  County ; Dr.  H.  J.  Powell,  Wood  County  ; 
Dr.  L.  W.  Naus,  Wyandot  County ; 

Dr.  M.  D.  Ailes,  Akron  ; Dr.  W.  H.  Burns,  Alliance ; Dr. 
James  H.  Park,  Ashtabula  ; Dr.  H.  A.  Finefrock,  Barberton  ; 
Dr.  W.  J.  Shepard,  Bellaire ; Dr.  W.  G.  Carlisle,  Bucyrus ; 
Dr.  Clyde  L.  Vorhies,  Cambridge ; Dr.  F.  M.  Sayre,  Canton  ; 
Dr.  W.  H.  Peters,  Cincinnati ; Lewis  E.  Miller,  Circleville ; 
Dr.  Harold  J.  Knapp,  Cleveland ; Dr.  N.  C.  Dysart,  Colum- 
bus ; Barbara  A.  Gosley,  R.N.,  Conneaut ; Dr.  A.  O.  Peters, 
Dayton  ; G.  O.  Higley,  Delaware ; Dr.  C.  F.  Savage,  Delphos  ; 
J.  D.  Craig,  Dover;  Dr.  Edward  Miskall,  East  Liverpool; 
Arthur  S.  Johnston,  East  Palestine;  Dr.  George  F.  French, 
Elyria;  Martha  Laffey,  R.N.,  Findlay;  L.  W.  Gibson,  Fos- 
toria ; Dr.  E.  L.  Vermilya,  Fremont;  Dr.  D.  R.  Williams, 
Girard ; C.  R.  Cornell,  Grandview  Heights ; W.  J.  Reeves, 
Kent;  Martha  Dingoss,  R.N.,  Kenton;  Dr.  Wallace  J.  Benner, 
Lakewood ; Dr.  C.  B.  Snider,  Lancaster ; Dr.  Valloyd  Adair, 
Lorain;  Dr.  J.  B.  McClure,  Marietta;  Dr.  Kenneth  D.  Smith, 
Marion;  John  Donovan,  Martins  Ferry;  John  F.  Williams, 
Massillon  ; Dr.  George  D.  Lummis,  Middletown  ; A.  M.  Reese, 
Mingo  Junction;  Dr.  Julius  Shamansky,  Mt.  Vernon;  Dr.  W. 

H.  Knauss,  Newark ; Dr.  C.  L.  Bell,  Norwalk ; Dr.  L.  O. 
Saur,  Norwood ; Dr.  H.  V/.  Lautenschlager,  Oakwood ; Mrs. 
Clara  C.  Wilder,  Painesville ; L.  G.  Whitney,  Piqua ; Dr.  O. 

D.  Tatje,  Portsmouth  ; Dr.  George  C.  Bishop,  St.  Bernard  ; 
Dr.  C.  P.  McKee,  St.  Marys ; Dr.  Paul  M.  Spurney,  Shaker 
Heights ; Dr.  O.  M.  Craven,  Springfield ; Julius  A.  Pizzo- 
forrato,  Steubenville;  Dr.  W.  S.  Holley.  Toledo  : T>”.-  U.  D. 
McCulloch,  Toronto;  J.  W.  Cahill,  Uhrichsville ; Dr.  R.  H. 
Good,  Van  Wert;  Dr.  N.  C.  Tarr,  Wellsville ; ur.  A.  D. 
DeHaven,  Xenia;  Dr.  Coyt  H.  Height,  Youngstown;  Dr.  E. 
R.  Brush,  Zanesville. 

Public  Health  Nurses — R.  Ethel  Wallace,  Gallipolis  ; Mar- 
garet W.  Weaver,  Logan;  Mary  E.  Weems,  Bellaire;  May- 
belle  Sherman,  Norwalk ; Luetta  Speice,  Cambridge ; Lenore 
Wheaton,  Dover ; Charlotte  Phelps,  Circleville ; Lucy  Craft, 
Caldwell  ; Mary  C.  Ryan,  Norwalk  ; Harriet  Hunt,  Norwalk  ; 
Louise  Steele,  Woodsfield;  Mary  I.  Breneman,  Marion;  Edna 
Travis,  Marion ; Alma  Denney,  Marion ; Mabel  E.  Wade, 
Oberlin ; Charity  M.  Sherod,  Oberlin ; Mildred  Keyser, 
Urbana ; Ellen  DeHart,  Urbana ; Mabel  Green,  Fremont ; 
Helen  W.  Doll,  Fremont ; Edith  Zook,  Mansfield ; Miriam 
Wolf,  Mansfield  ; Lucille  Lindsay,  Mansfield  ; Jennie  Ruth, 
Jackson;  Corrinne  Himmler,  Cincinnati;  Pearl  Whitten- 
myer,  Xenia ; Martha  Reiter,  Napoleon ; Bertha  Clemmer, 
Wooster ; Margaret  McWethy,  Wooster ; Ethel  Switzer,  Ash- 
land ; Sara  E.  Dover,  Ravenna ; Hazel  R.  Hipp,  Oberlin  ; 
Lucille  M.  Roberts,  Logan ; Georgia  Sikes,  Portsmouth ; 
Golda  Young,  Portsmouth  ; Fannie  Howe,  Lancaster ; Mary 
Ford,  Delaware;  Helen  G.  Hart,  Cincinnati;  Nadean  G. 
Pace,  Zanesville ; Mabel  Hastings,  Marion  ; Gertrude  Gorman, 
Piqua  ; Alice  Beckman,  Batavia ; Winifred  Cole,  Kent ; 
Grace  Beckwith,  Kent ; Pauline  Baker,  London ; Catherine 
Cox,  Akron  ; Sue  Laubaugh,  Akron ; Essie  Bliss,  New  Lex- 
ington ; Helen  McMahon,  Kenton ; Ruth  Schlinder,  New 
Philadelphia  ; M.  Patricia  Riley,  Sandusky  ; Nettie  E.  Witter, 
Sandusky ; Nelle  Martin,  Columbus ; Rhea  B.  Denton,  Lan- 
caster ; Naomi  O.  Chase,  Pomeroy ; Weavaline  Whitmer, 
Troy ; Mary  Miller,  Troy ; Genevieve  Sennet,  Hamilton ; 
Esther  Hamann,  Hamilton  ; Jeanette  Owen,  Chardon  ; Helen 
Wilkinson,  Chardon ; Flora  H.  Booth,  Akron ; Margueritte 

E.  Fagen,  Cincinnati ; Clara  F.  Brouse,  Columbus  ; Elizabeth 
P.  August,  Columbus ; Sue  Z.  McCracken,  Lakewood ; Julia 
Klenke,  Springfield  ; Mary  C.  Gaffney,  Springfield ; Caroline 
E.  Miller,  Springfield  ; Lucy  E.  Lynn,  Portsmouth ; Gladys 
R.  Hughes,  Portsmouth ; Helen  T.  Hayden,  Mansfield ; Ruth 
Hursh,  Mansfield. 

Guests — PI.  G.  Swain,  McArthur ; Noel  F.  George,  Ottawa ; 
Dr.  H.  M.  Austin,  Newark ; Dr.  R.  Mellon,  Youngstown ; 
Dr.  O.  C.  Ricksecker,  Wilmot;  E.  P.  Reep,  Girard;  Eliza- 
beth Hendershot,  Akron  ; Mattie  B.  Pierce,  Columbus  ; Ruth 
C.  Hachtel,  Reynoldsburg ; Gertrude  Phillips,  New  Phila- 
delphia ; Elsa  Chambers,  Fayetteville ; Richard  L.  Marlow, 
Athens;  Harold  Borcher,  Chillicothe;  E.  K.  Miler,  Chilli- 
cothe ; Margaret  M.  Jones,  Columbus;  Mi’s.  W.  E.  Miley, 
Marion  ; Lily  Rose,  Marion ; Effie  M.  Folsom,  Columbus  ; 
Mrs.  R.  R.  Noyer,  Columbus ; R.  P.  Fowler,  Oberlin,  and 
Alice  Keller,  Zanesville. 


Mick Winter  Examinations  by  State  Medical  Board  Taken  by 
44  Medical  Students  and  953  Nmrses  **  Questions  Asked 


Forty-four  medical  students  and  953  nurses 
took  the  mid-winter  examinations  given  Decem- 
ber 6,  7 and  8 in  Columbus  by  the  State  Medical 
Board  and  Nurses’  Examining  Committee  of  the 
Board. 

Results  of  the  examinations  will  be  announced 
at  the  next  meeting  of  the  Board  scheduled  for 
Tuesday,  January  3. 

In  addition,  the  following  seeking  certificates 
to  practice  in  their  particular  field  were  ex- 
amined: 11  osteopaths,  14  chiropractors,  3 mech- 
anotherapists,  6 electro-therapists,  1 cosmetic- 
therapist,  and  20  masseurs. 

The  questions  asked  applicants  for  licenses  to 
practice  medicine  and  surgery  were  as  follows: 
ANATOMY 

1.  Outline  the  course  of  the  superficial  femoral  artery. 

Give  origin  and  distribution. 

2.  Discuss  the  position  and  relations  of  the  right  kidney. 

3.  How  are  the  innominate  veins  formed  ? 

Name  the  veins  emptying  into  the  left  innominate 

vein. 

4.  Give  the  course  and  distribution  of  the  seventh 
cranial  nerve. 

5.  Draw  a diagram  to  illustrate  a cross-section  of  the 
spinal  cord  in  the  thoracic  portion,  indicating  the  motor 
tracts. 

PHYSIOLOGY 


10.  In  inspecting  school  children  and  finding  some  with 
enlarged  tonsils  and  adenoids,  what  would  be  your  advice  to 
parents  ? Give  reasons  for  the  advice  given. 

MATERIA  MEDICA 

1.  What  drug  is  antagonistic  to  pilocarpin  and  in  what 
dose  ? 

2.  State  the  source  of  ichthyol  and  give  its  use  in  medi- 
cine. 

3.  Give  the  therapeutic  uses  of  Sodium  Nitrite  and  dose. 

4.  Under  what  conditions  may  cathartics  be  useful  in 
the  treatment  of  diarrhea  or  dysentery? 

5.  Give  indications  for  the  use  of  bromides  and  explain 
how  they  are  given  in  large  doses. 

6.  What  remedies  would  you  use  in  treatment  of  a case 
of  acute  arthritis?  Give  doses. 

7.  Iodin — (a)  how  obtained?  (b)  name  the  official 
preparations. 

8.  What  is  the  difference  between  anesthetics  and 
anodynes  ? 

9.  Give  the  average  dose  of  podophyllin ; mild  chloride 
of  mercury ; magnesium  sulphate ; Dover’s  powder ; liquor 
potassii  arsenitis  ; tr.  of  nux  vomica  ; fl.  ext.  of  nux  vomica. 

10.  Give  preparations,  uses  and  dose  of  manganese. 

MATERIA  MEDICA 
(Homeopathic) 

1.  Name  outstanding  symptoms  of  agaricus. 

2.  Name  five  common  nosodes. 

3.  What  is  the  difference  between  lachesis  andt  crotalus 
horridus  ? 

4.  What  are  rectal  symptoms  of  collinsonia? 

5.  What  are  the  leading  symptoms  of  gelsemium  ? 

6.  What  are  urinary  symptoms  of  cannabis  sativa  ? 

7.  When  would  you  prescribe  hypericum  ? 

8.  When  is  aurun  tryphilum  indicated  in  throat  disease  ? 

9.  What  is  a polycrest? 

10.  Give  the  skin  symptoms  of  urtica  urens. 

PRACTICE 


1.  Discuss  the  function  of  the  anterior  pituitary  body. 

2.  Discuss  carbohydrate  metabolism. 

3.  What  is  meant  by  conditioned  reflexes  ? 

Give  examples  and  discuss. 

4.  What  would  be  the  results  of  lateral  hemisection  of 
the  spinal  cord  in  the  mid-dorsal  region  ? 

5.  State  and  explain  how  the  vision  of  man  is  affected 

by: 

(a)  section  of  the  left  optic  tract 

(b)  destruction  of  the  cerebral  cortex 

6.  What  is  known  of  the  mechanisms  utilized  in  the 
control  of  body  temperature?  Give  evidence  in  favor  of  the 
existence  of  such  mechanisms. 

7.  What  are  the  physiological  effects  of  a dietetic  defi- 
ciency of  vitamin  A? 

8.  Discuss  the  physiological  effects  upon  the  normal  rest- 
ing individual  of  continued  “overventilation”  due  to  volun- 
tary deep  rapid  breathing. 

9.  Describe  the  effects  of  excision  of  the  left  superior 
cervical  sympathetic  ganglion. 

10.  Emotional  crises  inhibit  the  movements  of  the  in- 
testine. Describe  the  mechanism  by  which  this  inhibition 
is  induced. 

CHEMISTRY 

1.  What  is  Cyanogen?  Name  two  compounds. 

2.  What  is  Mercurous  Chloride?  Give  formula. 

Name  mineral  acids  that  are  incompatible  and  why. 

3.  Name  five  common  vegetable  poisons  and  give  anti- 
dotes. 

4.  What  is  the  difference  between  Glucoses  and  Saccha- 
roses? 

5.  How  is  mercury  detected  in  the  Saliva  ? 

BACTERIOLOGY,  PATHOLOGY  AND  HYGIENE 

1.  How  would  you  differentiate  the  micrococcus  intra- 
cellularis  l}y  staining  and  culture? 

2.  How  would  you  identify  the  bacillus  typhosus  in  feces? 

3.  What  is  the  usual  cause  of  abscess  of  the  liver  and 
describe  the  pathologic  results. 

4.  Describe  the  pathology  of  a tuberculous  kidney. 

5.  Give  the  common  location  and  pathologic  results  of 
an  acute  intussusception. 

6.  What  measures  would  you  take  if  you  detected  one 
or  more  cases  of  undulant  fever  in  a rural  community? 

7.  What  instructions  for  protection  of  others  would  you 
give  a patient  with  a syphilitic  mucous  patch  on  the  lip? 

8.  What  are  some  of  the  results  of  malnutrition  in 
school  children  ? 

9.  What  are  some  of  the  possibilities  and  what  would 
be  your  duty  in  finding  children  attending  school  with  a 
“sore  throat” ? 


1.  Discuss  influenza,  its  etiology,  transmission,  most 
serious  complications  and  treatment  of  a typical  uncom- 
plicated case. 

2.  Give  the  symptoms  and  treatment  of  epidemic  an- 
terior poliomyelitis. 

3.  Discuss  the  treatment  of  scarlet  fever — 

(a)  preventive  (b)  management  of  a case 

4.  Give  the  symptoms  and  treatment  of  mumps  with  a 
complicating  orchitis. 

5.  Discuss  stomatitis  in  infants — causes,  symptoms  and 
treatment. 

6.  Describe  an  attack  of  angina  pectoris. 

Give  treatment  (a)  immediate  (b)  following  the 

attack. 

7.  Discuss  the  management  of  chronic  congestive  heart 
failure. 

8.  Discuss  the  symptoms  and  treatment  of  duodenal  ulcer. 

9.  Discuss  the  treatment  of  chronic  constipation. 

10.  What  conditions  may  be  indicated  by 

(a)  nocturia  (b(  hematuria  (c)  pyuria. 

DIAGNOSIS 

1.  How  would  you  establish  the  diagnosis  of  bronchogenic 
carcinoma  ? 

2.  Differentiate  between  hydatid  cyst  of  the  left  lobe  of 
the  liver,  and  cyst  of  the  pancreas. 

3.  Give  the  causes  of  pathological  fracture  of  bones. 

In  what  type  is  the  clavicle  usually  first  involved  ? 

4.  Name  three  diseases  in  which  family  history  would  be 
significant  in  establishing  a diagnosis. 

5.  Differemiate  between  multiolcular  cystic  kidney  and 
renal  sarcoma. 

6.  State  the  causes  of  three  types  of  jaundice  and  differ- 
entiate them. 

7.  How  would  you  proceed  to  establish  a diagnosis  of 
hypersecretion  of  Adrenals— Thyroids — Parathyroids  ? 

8.  State  the  salient  points  in  making  a diagnosis  of : 

(a)  High  post-cecal  appendicitis 

(b)  Ureteral  calculi 

(c)  Kink  in  upper  part  of  ureter 

9.  A patient  35  years  of  age  complains  of  expectorating 
bright  red  blood  for  two  days.  This  has  occurred  several 
times  before  over  a period  of  years — he  is  well  nourished, 
has  no  cough,  no  tenderness  or  pain  about  the  stomach, 
there  is  no  nose  bleed.  Make  a tentative  diagnosis. 

10.  Differentiate  between  stricture  of  the  rectum  caused 
by  lues  and  one  of  malignancy. 

SURGERY 

1.  Discuss  the  surgical  aspect  of  pulmonary  tuberculosis. 

2.  What  neurological  manifestations  may  follow  arthritis 
of  the  cervical  spine? 

3.  Name  the  causes  of  perineal  swelling. 


57 


58 


The  Ohio  State  Medical  Journal 


January,  1933 


4.  Write  what  you  can  on  intracranial  pressure  and  its 
relation  to  surgical  problems. 

5.  Outline  the  diagnosis  and  clinical  course  of  multiple 
myeloma. 

6.  What  do  you  consider  to  be  the  indications  for  medical 
or  surgical  treatment  of  duodenal  ulcer  ? 

7.  Briefly  discuss  the  choice  and  value  of  anesthetics  in 
the  following: 

(a)  Large  distended  abdomen  due  to  intestinal 
obstruction 

(b)  Chronic  deficiencies  of  heart  and  lungs 

(c)  Brain  operations 

(d)  Circumcision  in  a child 

8.  Discuss  the  management  of  compound  comminuted  in- 
fected fracture  of  the  middle  third  of  tibia  and  fibula. 

9.  What  occurs  when  the  following  arteries  are  ligated : 

(a)  Right  anterior  cerebral 

(b)  Left  anterior  cerebral 

(c)  Left  common  carotid 

10.  Discuss  the  management  of  a case  of  streptoccic  sep- 
ticemia 'following  injury. 


OBSTETRICS 

1.  When  does  puerperal  infection  usually  develop? 

Describe  the  general  symptoms  and  treatment. 

2.  Give  indications  for  the  use  of  forceps  and  principal 
danger. 

3.  Define  false  labor  pains  and  true  labor  pains. 

4.  What  are  the  characteristic  symptoms  of  placenta 
previa  ? Give  treatment. 

5.  Give  the  causes  and  management  of  prolapsed  cord. 

SPECIALTIES 

1.  What  is  a ptyergium  ? Outline  treatment. 

2.  What  is  meant  by  a central  scotoma? 

3.  Why  is  submucous  resection  the  procedure  of  choice 
in  nasal  operations  ? 

4.  What  is  meant  by  a positive  Rinne  test? 

5.  What  symptoms  may  follow  skull  fracture  when  the 
frrcture  line  is  through  the  mastoid  process  of  the  temporal 
bone  ? 


New^  Nc||gs  From 

County  Societies  Academies 


First  Distirct 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(George  B.  Topmoeller,  M.D.,  Secretary) 

December  5 — - General  Session.  Program : 
“Landry’s  Paralysis  with  Autopsy”,  Dr.  Charles 
E.  Kiely;  discussions  by  Dr.  A.  W.  Foertmeyer 
and  Dr.  Irving  H.  Schroth;  “Purulent  Ear  Dis- 
ease and  Its  Relationship  to  Nasal  Infection”,  Dr. 
M.  F.  McCarthy;  discussions  by  Dr.  Samuel 
Iglauer  and  Dr.  M.  L.  Cooper. 

December  12 — General  Session.  Supplemental 
report  by  the  Committee  on  Public  Relations. 
Program:  “Syphilis  of  the  Lung,  with  Report  of 
a Case”,  Dr.  S.  D.  Simon;  discussions  by  Dr. 
Alfred  Friedlander  and  Dr.  John  H.  Skavlem; 
“Resection  of  the  Superior  Hypogastric  Plexus 
for  the  Relief  of  Pelvic  Pain”,  Dr.  Louis  G.  Herr- 
mann; discussions  by  Dr.  J.  R.  Stark  and  Dr.  E. 
A.  Kindel. 

December  19 — General  Session.  Program:  “An 
Appraisal  of  Gynecological  Endocrinology  and 
Organo-Therapy”,  Dr.  Emil  Novak,  Baltimore. 

Butler  County  Medical  Society  held  its  annual 
meeting  November  17  at  the  Middletown  Hospital. 
The  following  officers  were  elected:  President, 

Dr.  Harold  0.  Lund,  Middletown;  vice  president, 
Dr.  T.  A.  Munns,  Oxford;  secretary-treasurer, 
Dr.  Walter  Roehl,  Middletown;  legislative  com- 
mitteeman, Dr.  E.  T.  Storer,  Middletown;  medical 
defense  committeeman,  Dr.  D.  M.  Skinner,  Hamil- 
ton; delegate,  Dr.  D.  M.  Blizzard,  Middletown; 
alternate,  Dr.  Malcolm  Cook,  Hamilton.  Follow- 
ing the  business  session,  Dr.  Alfred  O’Neil,  Cin- 
cinnati, read  an  interesting  paper  on  “Undulant 
Fever”. — News  Clipping. 

Clermont  County  Medical  Society  held  a dinner 
meeting  November  16  at  the  Grant  Memorial 


Building,  Bethel.  At  the  business  session,  officers 
for  the  ensuing  years  were  elected  as  follows: 
President,  Dr.  James  K.  Ashburn,  Batavia;  vice 
president,  Dr.  O.  C.  Davidson,  Bethel;  secretary- 
treasurer,  Dr.  Allan  B.  Rapp,  Owenville;  legisla- 
tive committeeman,  Dr.  W.  H.  Gaskins,  New  Rich- 
mond; medical  defense  committeeman,  Dr.  F.  H. 
Lever,  Loveland;  delegate,  Dr.  Ashburn;  alter- 
nate, Dr.  Rapp.  Dr.  John  A.  Caldwell,  Cincinnati, 
councilor  of  the  First  District,  was  a guest  of  the 
society  together  with  four  other  Cincinnati  phy- 
sicians who  contributed  the  scientific  program  as 
follows:  “Local  Anesthesia  and  Fractures”,  Dr. 
Caldwell;  “Diseases  of  the  Heart”,  Dr.  C.  J. 
Straehley;  “Minor  Surgery  Qualifications  and 
Equipment”,  Dr.  Charles  T.  Souther;  “Iritis”, 
Dr.  F.  X.  Siegel,  and  “Anesthesia  and  Abdominal 
Work”,  Dr.  Frank  E.  Fee. — News  Clipping. 

Clinton  County  Medical  Society  met  December 
6 at  the  Wilmington  Public  Library  with  a good 
attendance.  All  the  officers  were  re-elected  for  the 
year  1933.  They  are:  President,  Dr.  F.  A.  Peele, 
Wilmington;  vice  president,  Dr.  H.  E.  Gibson, 
Blanchester;  secretary-treasurer,  Dr.  William  L. 
Regan,  Wilmington;  legislative  committeeman, 
Dr.  E.  Briggs;  medical  defense  committeeman, 
Dr.  J.  F.  Fisher,  Sabina;  delegate,  Dr.  A.  C. 
Roberts,  Wilmington;  alternate,  Dr.  Elizabeth 
Shrieves,  Wilmington.  A report  of  the  Board  of 
Censors  recommending  the  suspension  of  a mem- 
ber of  the  society  was  read  and  adopted  by  the 
society. — Wm.  L.  Regan,  M.D.,  Secretary. 

Fayette  County  Medical  Society  met  December 
1 at  Washington  C.  H.  and  elected  officers  for 
1933  as  follows:  President,  Dr.  S.  E.  Boggs, 

Washington  C.  H.;  vice  president,  Dr.  L.  L.  Brock, 
Washington  C.  H.;  secretary-treasurer,  Dr.  James 
F.  Wilson,  Washington  C.  H.;  legislative  com- 
mitteeman, Dr.  R.  M.  Hughey,  Washington  C.  H.; 


January,  1933 


State  News 


59 


medical  defense  committeeman,  Dr.  A.  D.  Wood- 
mansee,  Washington  C.  H.;  delegate,  Dr.  E.  F. 
Todhunter,  Washington  C.  H.;  alternate,  Dr. 
Lucy  W.  Pine,  Washington  C.  H.  A resolution  on 
the  death  of  Dr.  George  W.  Blakeley  was  adopted. 
— James  F.  Wilson,  M.D.,  Secretary. 

Second  District 

Clark  County  Medical  Society  witnessed  motion 
pictures  taken  during  phases  of  the  construction 
of  the  new  Springfield  City  Hospital  at  its  meet- 
ing November  10  in  the  ballroom  of  the  Hotel 
Shawnee.  Following  the  pictures,  a buffet  lunch- 
eon was  served. 

At  the  November  23  meeting  of  the  society,  Dr. 
C.  L.  Minor  addressed  the  membership  on  “Special 
Reference  to  Systemic  Infections  as  Reflected 
in  Conditions  of  the  Eye,  Ear,  Nose  and  Throat”. 
— News  Clipping. 

Darke  County  Medical  Society  met  December  9 
at  the  Christian  Church,  Greenville.  Following  a 
business  session,  Dr.  E.  J.  Gordon,  Columbus,  ad- 
dressed the  society  on  “Periodic  Health  Examina- 
tions”. Dinner  was  served  following  the  meeting. 
— W.  D.  Bishop,  M.D.,  Secretary. 

Greene  County  Medical  Society  at  its  meeting 
on  December  1 at  the  Court  House,  Xenia,  elected 
officers  for  the  ensuing  year  as  follows:  Presi- 

dent, Dr.  L.  L.  Taylor,  Yellow  Springs;  vice  presi- 
dent, Dr.  C.  E.  Ream,  Bowersville;  secretary- 
treasurer,  Dr.  H.  C.  Schick,  Xenia;  legislative 
committeeman,  Dr.  H.  C.  Messenger,  Xenia;  dele- 
gate, Dr.  M.  M.  Best,  Xenia;  alternate,  Dr.  W.  T. 
Ungard,  Xenia.  Following  the  business  session 
Dr.  W.  M.  Simpson,  Dayton,  presented  an  in- 
structive paper  on  “The  Rheumatic  State”,  in 
which  he  reviewed  the  literature  on  rheumatic 
fever  and  discussed  Cobum’s  recent  work  on  the 
causative  factors. — H.  C.  Schick,  M.D.  Secretary. 

Miami  County  Medical  Society  met  in  regular 
session  December  2 at  the  Memorial  Hospital, 
Piqua.  Officers  for  1933  were  elected  as  follows: 
President,  Dr.  F.  D.  Kiser,  Tippecanoe  City;  vice 
president,  Dr.  W.  W.  Trostel,  Piqua;  secretary- 
treasurer,  Dr.  G.  A.  Woodhouse,  Pleasant  Hill; 
legislative  committeeman,  Dr.  G.  E.  McCullough, 
Troy;  medical  defense  committeeman,  Dr.  Mc- 
Cullough; delegate,  Dr.  Gainor  Jennings,  West 
Milton;  alternate,  Dr.  I.  B.  Kiser,  West  Milton. 
Unsual  case  reports  illustrated  by  X-ray  pictures 
were  presented  by  Dr.  Robert  Caywood,  Piqua, 
and  Dr.  Warren  Coleman,  Troy.  A discussion 
of  the  cases  presented  was  led  by  Dr.  B.  M. 
Hogle,  Dr.  A.  J.  Bausman,  Dr.  John  Beachler, 
and  Dr.  Robert  Spencer.  A round-table  discus- 
sion of  medical  economic  problems  was  held  and 
the  program  for  1933  reviewed.  The  recently 
issued  report  of  the  Committee  on  the  Costs  of 
Medical  Care  was  discussed  and  the  society  went 
on  record  in  opposition  to  the  majority  report  of 
that  committee  and  endorsed  the  major  recom- 


mendations of  the  minority  report. — G.  A.  Wood- 
house,  M.D.,  Secretary. 

Montgomery  County  Medical  Society  met  on 
December  16  at  the  Fidelity  Medical  Building. 
Dr.  Henry  Snow  presented  a paper  on  “Simple 
Heart  Measurements”,  illustrated  with  lantern 
slides.  A paper  on  “Increase  of  Heart  Disease” 
was  read  by  Dr.  M.  D.  Prugh.  The  papers  were 
discussed  by  Drs.  Kuhl  and  Weis. — Bulletin. 

Preble  County  Medical  Society  met  December 
15  at  the  Seven  Mile  Tavern,  near  Eaton.  The 
guest  speaker  was  Dr.  F.  E.  Hagie,  Richmond, 
Indiana,  who  spoke  on  “Hip  Injuries”.  Motion 
pictures  on  the  reduction  of  fractures  were  shown. 
— News  Clipping. 

Third  District 

Auglaize  County  Medical  Society  met  in  regu- 
lar session  December  8 at  the  City  Hall,  St. 
Marys,  with  a good  attendance.  Dr.  Howard  F. 
Webb,  Lima,  was  the  guest  speaker.  He  gave  an 
instructive  address  on  “Necessary  Laboratory 
Aids  in  General  Practice”.  Dr.  Webb  emphasized 
the  pathological  procedures  of  most  importance 
in  diagnosis  and  treatment  and  gave  helpful  sug- 
gestions to  practitioners  who  have  the  time  and 
facilities  to  do  their  own  laboratory  work.  At 
the  business  meeting  the  following  officers  for 
1933  were  elected:  President,  Dr.  E.  F.  Heffner, 
Wapakoneta;  vice  president,  Dr.  H.  J.  Gudenkauf, 
Minster;  secretary-treasurer,  Dr.  Charles  C.  Ber- 
lin, Wapakoneta;  censor,  Dr.  Charles  P.  McKee, 
St.  Mary’s;  delegate,  Dr.  Guy  E.  Noble,  St. 
Marys;  alternate,  Dr.  Roy  C.  Hunter,  Wapa- 
koneta.— Charles  C.  Berlin,  M.D.,  Secretary. 

Hancock  County  Medical  Society  met  on  De- 
cember 7 at  the  Elks’  Home,  Findlay.  Dr.  Max 
Ballin,  chief  of  staff,  Harper  Hospital,  Detroit, 
gave  an  interesting  address  on  “Parathyroidism”, 
illustrated  with  lantern  slides.  The  paper  was 
discussed  by  Dr.  W.  H.  Gordon.  Following  the 
program,  officers  for  1933  were  elected  as  fol- 
lows: President,  Dr.  E.  A.  King,  Mt.  Cory;  vice 
president,  Dr.  J.  H.  Marshall,  Findlay;  secretary. 
Dr.  H.  O.  Crosby,  Findlay;  treasurer,  Dr.  E.  J. 
Thomas,  Findlay;  legislative  committeeman,  Dr. 
H.  R.  Wynn,  Findlay;  medical  defense  commit- 
teeman, Dr.  D.  B.  Biggs,  Findlay;  delegate,  Dr. 
J.  M.  Firmin,  Findlay;  alternate,  Dr.  P.  C.  Pen- 
nington, Findlay. — H.  0.  Crosby,  M.D.,  Secretary. 

Hardin  County  Medical  Society  held  its  regular 
luncheon  meeting  November  17  at  the  Kenton 
Cafe,  Kenton.  The  program  was  presented  by 
Dr.  V.  H.  Hay  and  Dr.  E.  H.  Hedges,  both  of 
Lima.— News  Clipping. 

Logan  County  Medical  Society  met  November  4 
at  the  Hotel  Logan,  Bellefontaine.  The  meeting 
was  addressed  by  Dr.  John  Tucker,  Cleveland, 
on  “The  Newer  Aspects  in  the  Diagnosis  and 
Treatment  of  Peptic  Ulcer”.  The  address  was 


60 


The  Ohio  State  Medical  Journal 


January,  1933 


thoroughly  enjoyed  by  all  present  and  was  dis- 
cussed freely  by  the  membership.  At  the  busi- 
ness session,  the  following  officers  for  the  en- 
suing year  were  elected;  President,  Dr.  0.  C. 
Amstutz,  Bellfontaine;  vice  president,  Dr.  John 
Maurer,  West  Liberty;  secretary-treasurer,  Dr. 
W.  H.  Carey,  Belief ontaine ; legislative  committee- 
man, Dr.  J.  P.  Harbert,  Bellefontaine;  medical 
defense  committeeman,  Dr.  Harbert;  delegate, 
Dr.  C.  K.  Startzman,  Bellefontaine;  alternate. 
Dr.  F.  R.  Makemson,  Bellefontaine. 

At  a dinner  meeting  of  the  society  on  Decem- 
ber 2,  the  guest  speaker  was  Dr.  George  M.  Cur- 
tis, professor  of  research  surgery,  Ohio  State 
University,  Columbus.  His  subject  was  “The  Sig- 
nificance of  Clinical  Investigation”.  Dr.  W.  C. 
Breidenbach,  superintendent  of  the  Stillwater 
Sanatorium,  Dayton,  was  a guest  of  the  society 
and  gave  a short  talk  on  the  tuberculosis  clinics 
which  are  being  held  in  Bellefontaine. — W.  H. 
Carey,  M.D.,  Secretary. 

Marion  Academy  of  Medicine  met  December  6 
at  the  Marion  City  Hospital.  At  the  business 
session,  Dr.  E.  L.  Brady  was  re-elected  president 
of  the  Academy  for  the  ensuing  year.  Other  of- 
ficers elected  were:  Vice  President,  Dr.  Maud  L. 

Bull;  secretary,  Dr.  J.  W.  Jolley;  treasurer,  Dr. 
John  W.  Bull;  trustees,  Dr.  C.  L.  Baker  and  Dr. 
H.  S.  Rhu;  delegate,  Dr.  E.  H.  Morgan;  alternate, 
Dr.  C.  J.  Altmaier;  legislative  committeeman,  Dr. 
Alatmaier. — News  Clipping. 

Seneca  County  Medical  Society  at  its  meeting 
on  November  17  at  the  Hotel  Shawhan,  Fostoria, 
elected  officers  for  the  ensuing  year  as  follows: 
President,  Dr.  Paul  Leahy,  Tiffin;  vice  president, 
Dr.  F.  H.  Pennell,  Fostoria;  secretary-treasurer, 
Dr.  R.  E.  Hershberger,  Tiffin;  medical  defense 
committeeman,  Dr.  R.  R.  Hendershott,  Tiffin ; 
delegate,  Dr.  Hendershott;  alternate,  Dr.  R.  C. 
Chamberlain,  Tiffin;  board  of  censors,  Dr.  T.  T. 
Rosendale,  Fostoria,  Dr.  R.  R.  Hendershott, 
Tiffin,  and  Dr.  C.  F.  Daniel,  Tiffin.  The  scientific 
program  consisted  of  a film  on  “Skin  Cancer” 
produced  at  Johns  Hopkins  University  and  pre- 
sented under  the  auspices  of  the  American  Jour- 
nal of  Cancer. — R.  E.  Hershberger,  M.D.,  Secre- 
tary. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO  AND 
LUCAS  COUNTY 

(A.  P.  Hancuff,  M.D.,  Secretary) 

December  2 — Annual  joint  meeting  of  the 
Academy  and  the  Toledo  Dental  Society.  Pro- 
gram: Symposium  on  Vincent’s  Angina.  “Medical 
Aspects”,  Dr.  E.  G.  Galbraith;  discussions  by  Dr. 
L.  R.  Effler,  Dr.  C.  R.  King  and  Dr.  T.  L.  Ram- 
sey; “Dental  Aspects”,  C.  C.  Sherwood,  D.D.S. ; 
discussions  by  Drs.  R.  F.  Cannon,  W.  J.  Cosgray 
and  J.  D.  Sullivan. 


December  9 — Section  of  Pathology,  Experimen- 
tal Medicine  and  Bacteriology.  Program : “A 

Comparative  Study  of  the  Excretion  of  Water 
and  Waste  Products  by  Normal  and  Pathological 
Kidneys”,  Dr.  F.  H.  Lashmet,  Ann  Arbor,  Mich- 
igan. 

December  16 — Medical  Section.  Program:  Clin- 
ical Pathological  Conference  by  members  of  the 
staff  of  St.  Vincent’s  Hospital  under  the  direction 
of  Dr.  T.  M.  Crinnion. 

Four  County  Medical  Society  met  December  1 
at  the  Knights  of  Pythias  Hall,  Bryan.  Forty- 
three  members  were  present.  Dr.  Lewis  Newberg, 
professor  of  research  medicine,  and  Dr.  Carl  D. 
Camp,  department  of  neuralgia,  both  of  the  Uni- 
versity of  Michigan,  were  the  guest  speakers. 
Dr.  Newberg  spoke  on  “A  Pract’cal  Kidney  Func- 
tion Test”  and  Dr.  Camp  on  “The  Cause  and  Pre- 
ventive Treatment  of  Headache”. — D.  J.  Slosser, 
M.D.,  Secretary. 

Putnam  County  Medical  Society  met  on  Decem- 
ber 6 at  the  Dumont  Hotel,  Ottawa.  Dr.  John  V. 
Hartman  and  Dr.  F.  M.  Wiseley,  both  of  Findlay, 
were  the  guest  speakers.  Dr.  Hartman  gave  an 
interesting  and  instructive  talk  on  “Intestinal 
Obstruction;  Its  Causes,  Symptoms  and  Methods 
for  Relief”.  He  emphasized  the  point  that  early 
diagnosis  is  essential  to  success  in  the  treatment. 
Dr.  Wiseley  discoursed  on  “Diabetes”.  He  gave 
some  new  points  on  the  treatment  obtained  while 
attending  lectures  in  Vienna.  He  also  spoke 
briefly  on  the  “Coronary  Heart”,  differentiating 
between  it  and  angina  pectoris.  There  was  a large 
attendance.  At  the  business  session,  the  following 
officers  for  1933  were  elected:  President,  Dr. 

Elisha  Blackburn,  Kalida;  vice  president,  Dr.  L. 
M.  Piatt,  Ottawa;  secretary-treasurer,  Dr.  W.  B. 
Light,  Ottawa;  correspondent  to  The  Journal, 
Dr.  J.  R.  Echelbarger,  Ottawa;  legislative  com- 
mitteeman, Dr.  C.  0.  Beardsley,  Ottawa;  delegate, 
Dr.  P.  D.  Bixel,  Pandora;  alternate,  Dr.  Echel- 
barger.— J.  R.  Echelbarger,  M.D.,  Correspondent. 

Sandusky  County  Medical  Society  met  in  regu- 
lar session  December  1 at  the  City  Hall,  Fremont. 
Dr.  Charles  J.  Wehr,  Bellevue,  was  the  principal 
speaker.  He  spoke  on  “Economics,  General  and 
Medical”. — News  Clipping. 

Wood  County  Medical  Society  at  its  regular 
meeting  on  November  17  at  Bowling  Green  was 
addressed  by  Dr.  Joseph  A.  Muenzer,  Toledo,  on 
“Hypothyroidism”. — R.  N.  Whitehead,  M.  D., 
Correspondent. 

Fifth  District 

ACADEMY  OF  MEDICINE  OF  CLEVELAND 

(Clarence  P.  Heyman,  M.D.,  Secretary) 

December  2 — Clinical  and  Pathological  Section. 
Program : “A  Case  of  Gauchet’s  Disease”,  Dr. 
Roy  Butler,  U.  S.  Public  Health  Service,  by  in- 
vitation ; “A  Case  of  Anemia  with  Pericardial 


January,  1933 


State  News 


61 


Effusion”,  Dr.  J.  P.  Anderson;  “Bilateral  Hy- 
dronephrosis with  Rupture  and  Plastic  Operation 
of  Opposite  Sides”,  Dr.  L.  F.  Huffman;  “A  Case 
of  Gastrectomy”,  Dr.  D.  Foldes;  “Some  Common 
Dermatoses  Due  to  Allergy”,  Dr.  M.  B.  Cohen. 

December  7 — Obstetrical  and  Gynecological  Sec- 
tion. Program:  “A  Study  of  Tubal  Patency”, 

Dr.  J.  L.  Reycraft;  “Rupture  of  Uterus  During 
Eclamptic  Convulsions  with  Report  of  a Case”, 
Dr.  L.  L.  Hoskins;  “Phenyl  Mercury  Nitrate;  Its 
Clinical  Uses  in  Gynecology”,  Dr.  Leonard  H. 
Biskind. 

December  7 — Ophthalmological  and  Oto-Laryn- 
gological  Section.  Program:  “Light  Injuries  to 
the  Eye;  Report  on  Cases  of  Eclipse  Blindness”, 
Dr.  George  L.  King;  “Milestones  of  Oto-Laryn- 
gology”,  Dr.  S.  S.  Quittner;  discussions  by  Dr.  J. 

E.  Cogan. 

December  9 — Joint  meeting  of  the  Experimental 
Medicine  Section  and  the  Cleveland  Section  of  the 
Society  for  Experimental  Biology  and  Medicine. 
Program:  “Cell  Injury  by  Antiseptics”,  V.  A 

Badertscher,  B.S.,  by  invitation;  “Some  New 
Choline  Derivatives,  Their  Pharmacologic  Action 
in  Relation  to  Their  Chemical  Constitution  and 
Physico-Chemical  Properties”,  Dr.  W.  F.  von 
Oettingen,  D.  V.  Eveleth,  Ph.D.,  and  R.  0.  Bow- 
man, B.A.,  by  invitation;  “Avertin,  Pentobarbital 
and  Amytal,  with  and  without  Morphine;  Experi- 
mental Comparison  of  Their  Tranquillizing  Ef- 
fects, Respiratory  Depression,  and  Their  Effi- 
ciency in  Gas  Anesthesia”,  Dr.  J.  M.  Gledhill  and 
by  invitation,  0.  W.  Barlow,  Ph.D.,  and  J.  T. 
Duncan,  B.S.  “The  Excretion  of  Bismuth  in  a 
Series  of  Clinical  Treatments”,  Dr.  T.  Sollmann, 
Dr.  H.  N.  Cole,  and  by  invitation,  Katharine  I. 
Henderson,  A.B. 

December  16 — Annual  meeting.  Presidential 
address  by  Dr.  H.  G.  Sloan.  Address,  “Public 
Health — A Responsibility  of  the  Medical  Pro- 
fession”, Dr.  A.  T.  McCormick,  state  health  com- 
missioner of  Kentucky. 

December  21 — Industrial  Medicine  and  Ortho- 
pedic Section.  Clinical  meeting  at  the  Cleveland 
Clinic. 

Erie  County  Medical  Society  was  addressed  on 
November  17  at  its  meeting  at  the  Sunyeandeand 
Club,  Sandusky,  by  Dr.  W.  N.  Taylor,  Columbus. 
— News  Clipping. 

Huron  County  Medical  Society  in  regular  ses- 
sion December  3 at  Norwalk  elected  the  follow- 
ing officers  for  1933 : President,  Dr.  W.  W.  Law- 
rence, Norwalk;  secretary-treasurer,  Dr.  George 

F.  Linn,  Norwalk;  legislative  committeeman,  Dr. 
W.  C.  Martin,  Mom-oeville. 

At  a meeting  of  the  society  on  November  15,  the 
society  was  addressed  by  Dr.  H.  V.  Paryzek, 
Cleveland,  councilor  of  the  Fifth  District,  on 
“Purpura  Haemorrhagiea”. — News  Clipping. 


Lorain  County  Medical  Society  held  a dinner 
meeting  on  November  10  at  the  Second  Congre- 
gational Church,  Elyria.  Approximately  50  at- 
tended. The  principal  speaker  was  Dr.  James  A. 
Dickson,  Cleveland,  who  spoke  on  “The  Diagnosis 
and  Treatment  of  Painful  Shoulder  Conditions”. 

At  the  annual  meeting  of  the  society,  held  on 
December  13,  Hotel  Antlers,  Lorain,  the  guest 
speaker  was  Dr.  Frederick  C.  Herrick,  Cleve- 
land, who  presented  a paper  on  “Complications  of 
Purulent  Appendicitis”. — Bulletin. 

Medina  County  Medical  Society  at  its  regular 
meeting  November  17  at  the  Evanon,  Medina, 
elected  the  following  officers  for  the  ensuing  year: 
President,  Dr.  Harry  Streett,  Litchfield;  vice 
president,  Dr.  E.  C.  Bell,  Lodi;  secretary-treas- 
urer, Dr.  J.  K.  Durling,  Wadsworth;  legislat:ve 
committeeman,  Dr.  E.  L.  Crum,  Lodi;  medical 
defense  committeeman,  Dr.  Crum;  delegate,  Dr. 
Crum;  alternate,  Dr.  H.  P.  H.  Robinson,  Medina. 
Following  the  business  session,  the  society  was 
addressed  by  Dr.  A.  M.  Rovin,  Detroit,  on 
‘Endocrinological  Aspects  of  Immunity”. — J.  K. 
Durling,  M.D.,  Secretary. 

Sixth  District 

Ashland  County  Medical  Society  met  November 
18  at  the  Samaritan  Hospital,  Ashland.  Dr.  H.  S 
Davidson,  Akron,  councilor  of  the  Sixth  District, 
was  present.  Dr.  Davidson  spoke  on  organization 
problems  and  complimented  the  society  upon  its 
100  per  cent  membership.  He  also  asked  the  so- 
ciety to  assist  in  making  the  1933  Annual  Meet- 
ing of  the  State  Association  at  Akron  an  out- 
standing success.  The  scientific  program  was 
presented  by  Dr.  A.  P.  Ormond  and  Dr.  John  H. 
Selby,  both  of  Akron.  Dr.  Ormond  presented  a 
paper  on  “The  Glands  of  Internal  Secretion”,  in 
which  he  discussed  their  control  by  the  reciprocal 
autonomic  nervous  system.  Dr.  Selby  spoke  on 
“Leukemias”.  He  discussed  the  current  facts  con- 
cerning the  different  types  of  leukemia — myelo- 
genous, lymphatic,  and  spleno-myelogenous.  He 
described  the  symptoms,  course,  and  methods  of 
treatment  of  these  conditions. — Paul  E.  Kellogg, 
M.D.,  Secretary. 

Mahoning  County  Medical  Society  held  its  an- 
nual public  health  meeting  on  December  15  at  the 
Stambaugh  Auditorium,  Youngstown,  to  which 
the  public  was  invited.  The  principal  speaker  was 
Dr.  Haven  Emerson,  professor  of  public  health 
administration,  College  of  Physicians  and  Sur- 
geons, Columbia  University.  His  subject  was 
“Preventable  Diseases  and  Their  Control  by  Per- 
sonal and  Fublic  Action”. — Bulletin. 

Portage  County  Medical  Society  met  in  regular 
session  December  1 at  the  residence  of  Dr.  W.  J. 
Thomas,  Ravenna.  Reports  of  the  officers  for  the 
past  year  were  read.  Dr.  R.  D.  Worden,  Ravenna, 
presented  a paper  on  “Medical  Practice  During 


62 


The  Ohio  State  Medical  Journal 


January,  1933 


the  Depression”,  and  Dr.  G.  J.  Waggoner,  chief  of 
staff,  Robinson  Memorial  Hospital,  gave  a report 
in  which  he  complimented  the  staff  for  its  excel- 
lent work  and  their  interest  in  the  meetings  of  the 
staff. — E.  J.  Widdecombe,  M.D.,  Secretary. 

Summit  County  Medical  Society  held  its  annual 
meeting  December  8 in  the  ball  room  of  the  May- 
flower Hotel,  Akron.  Following  the  business  ses- 
sion, an  excellent  concert  was  given  by  the  Doc- 
tors’ Symphony  Orchestra  of  Akron,  under  the 
direction  of  Dr.  A.  S.  McCormick. — Bulletin. 

Wayne  County  Medical  Society  met  in  regular 
session  November  8 at  Hygeia  Hall,  Wooster.  A 
series  of  motion  pictures  on  cancer  was  presented 
through  the  courtesy  of  the  American  Journal  of 
Cancer. — News  Clipping. 

Seventh  District 

Belmont  County  Medical  Society  held  its  regu- 
lar meeting  December  8 at  the  Belmont  Hills 
Country  Club.  The  guest  speaker  was  Rev.  J.  H. 
Lamy,  Martins  Ferry.  Following  the  address  a 
dinner  was  served. 

On  November  10,  the  society  met  jointly  with 
the  Belmont  County  Dental  Society  at  the  coun- 
try club.  The  guest  speakers  were  Dr.  Edward 
Armbrecht  and  Dr.  Howard  Phillips,  both  of 
Wheeling,  West  Virginia. — News  Clipping. 

Columbiana  County  Medical  Society  met  De- 
cember 8 at  the  office  of  Dr.  Seward  Harris,  Lis- 
bon. 

At  the  annual  business  session  of  the  society, 
the  following  officers  for  1933  were  elected:  Presi- 
dent, Dr.  J.  W.  Robinson,  Lisbon;  vice  president, 
Dr.  Chester  A.  DeWalt,  Columbiana;  secretary- 
treasurer,  Dr.  T.  T.  Church,  Salem. — News  Clip- 
ping. 

Tuscarawas  County  Medical  Society  elected  Dr. 
F.  B.  Larimore,  New  Philadelphia,  president  for 
1933  at  its  meeting  on  December  8 at  New  Phil- 
adelphia. Other  officers  elected  were : Vice  Pres- 
ident, Dr.  H.  C.  Kistler,  Newcomerstown ; secre- 
tary-treasurer, Dr.  George  L.  Sackett,  New  Phila- 
delphia.— News  Clipping. 

Eighth  District 

Athens  County  Medical  Society  was  addressed 
on  December  5 at  Athens  by  Dr.  J.  F.  Baldwin, 
Columbus.  The  society  was  entertained  at  dinner 
by  Dr.  and  Mrs.  S.  E.  G.  Pedigo  after  which  the 
meeting  was  held.  Dr.  Baldwin  spoke  on  ‘‘State 
Medicine”.  At  the  business  session,  the  following 
officers  were  elected:  President,  Dr.  C.  E.  Welsh, 
Nelsonville;  vice  president,  Dr.  C.  H.  Creed, 
Athens;  secretary-treasurer,  Dr.  T.  A.  Copeland, 
Athens. — T.  A.  Copeland,  M.D.,  Secretary. 

Licking  County  Medical  Society  was  addressed 
by  Dr.  E.  G.  Horton,  Columbus,  at  its  meeting 
November  25  at  the  Warden  Hotel,  Newark.  Dr. 


Horton  spoke  on  “The  Feeding  Problems  of  Chil- 
dren”.— News  Clipping. 

Muskingum  County  Academy  of  Medicine  held 
its  annual  meeting  December  7 at  Zanesville. 
Officers  for  1933  were  elected  as  follows:  Presi- 
dent, Dr.  C.  M.  Rambo ; vice  president,  Dr.  Charles 
J.  Roach;  secretary-treasurer,  Dr.  Beatrice  T. 
Hagen;  censors,  Dr.  G.  B.  Trout  and  Dr.  R.  D. 
Bateman;  legislative  committeeman,  Dr.  Robert 
S.  Martin;  delegate,  Dr.  M.  A.  Loebell;  alternate, 
Dr.  Trout.  Following  the  business  session,  an  in- 
teresting paper  was  read  by  Dr.  Ward  D.  Coffman 
on  “Ovarian  Tumors”.  A brief  talk  was  made  by 
Dr.  W.  J.  Fenton,  Washington,  D.  C.,  in  charge 
of  a first-aid  institute  being  conducted  in  Zanes- 
ville by  the  Red  Cross. — Beatrice  T.  Hagen,  M.D., 
Secretary. 

Perry  County  Medical  Society  was  addressed  on 
November  21  at  its  meeting  at  the  Park  Hotel, 
New  Lexington,  by  Dr.  R.  B.  Drury,  Columbus. — 
Bulletin. 

Ninth  District 

Jackson  County  Medical  Society  at  its  regular 
meeting  November  15  at  Jackson  was  addressed 
on  “Diabetes”  by  Dr.  Clyde  Fitch,  Portsmouth.— 
News  Clipping. 

Pike  County  Medical  Society  in  regular  session 
December  5 at  Waverly  elected  the  following  offi- 
cers for  the  ensuing  year:  President,  Dr.  L.  E. 

Wills,  Waverly;  vice  president,  Dr.  Paul  Jones, 
Stockdale;  secretary-treasurer,  Dr.  R.  T.  Lever, 
Waveidy.  Dr.  S.  M.  Sproat,  Chillicothe,  ad- 
dressed the  society  following  the  business  session. 
— News  Clipping. 

Tenth  District 

COLUMBUS  ACADEMY  OF  MEDICINE 

(John  H.  Mitchell,  M.D.,  Secretary) 

December  5 — General  Practitioners’  Section. 
Business  session. 

December  12 — Clinical  session  at  the  Children’s 
Hospital  with  clinic  by  the  hospital  staff  as  fol- 
lows: “Treatment  of  Tetanus”,  Dr.  H.  L.  Dono- 
hoe;  “Treatment  of  Edema  in  Nephritis”,  Dr.  M. 
Silberman;  “Congenital  Dislocation  of  the  Hip”, 
Dr.  E.  H.  Wilson;  “Lactic  Acid  Milk”,  Dr.  E.  G. 
Horton;  “Management  of  Squint  in  Childhood”, 
Dr.  A.  D.  P’rost;  “Therapeutic  Consideratons  in 
Juvenile  Syphilis”,  Dr.  R.  A.  Kidd,  Jr.;  “The 
Question  of  the  Tonsil”,  Dr.  E.  W.  Harris  and 
Dr.  H.  L.  Reinhart. 

December  19 — Dinner  meeting  at  the  University 
Club.  Address,  “Surgery — The  Old  and  the  New”, 
Dr.  J.  F.  Baldwin. 

Crawford  County  Medical  Society  held  its  an- 
nual meeting  December  5 at  the  Elks’  Grill, 
Bucyrus.  The  following  officers  for  1933  were 
elected:  President,  Dr.  E.  C.  Brandt,  Crestline; 
vice  president,  Dr.  C.  A.  Adams,  Galion;  secre- 


January,  1933 


State  News 


63 


tary -treasurer,  Dr.  R.  L.  Solt,  Bucyrus;  corre- 
spondent for  The  Journal,  Dr.  C.  A.  Lingenfelter, 
Bucyrus;  legislative  committeeman,  Dr.  W.  G. 
Carlisle,  Bucyrus;  medical  defense  committeeman, 
Dr.  R.  J.  Caton,  Bucyrus;  delegate,  Dr.  K.  H. 
Barth,  New  Washington;  alternate,  Dr.  A.  E. 
Loyer,  New  Washington.  Following  the  business 


session,  motion  pictures  on  the  following  subjects 
were  shown  and  described  by  Dr.  W.  L.  Yeomans; 
“Spinal  Anesthesia”,  “Colporrhaphy  For  Third 
Degree  Lacerations”,  “Ventral  Hernia  and  Lipec- 
tomy  on  450-Pound  Woman”.  A buffet  supper 
was  served  following  the  program. — News  Clip- 
ping. 


Henry  C.  Allen,  M.D.,  Circleville;  Bellevue  Hos- 
ital  Medical  College,  New  York,  1878;  aged  80; 
former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  November  20  at  Johns  Hopkins  Hospital, 
Baltimore.  Dr.  Allen  had  practiced  in  Circleville 
for  the  past  40  years.  Surviving  are  his  widow, 
two  daughters  and  one  brother,  Dr.  Charles  0. 
Allen,  Logan. 

Charles  Wilson  Averell,  M.D.,  Akron;  Tufts 
College  Medical  School,  Boston,  1903;  aged  67; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  November  22  following  an  extended 
illness  with  heart  trouble.  Dr.  Averell  was  a 
member  of  the  Masonic  Lodge  and  the  Univer- 
salist  Church.  He  leaves  his  widow,  three  daugh- 
ters, two  sisters  and  one  brother,  Dr.  E.  L.  Aver- 
ell, Akron. 

George  W.  Blakeley,  M.D.,  Washington,  C.H.; 
Columbus  Medical  College,  Columbus,  1878;  aged 
81 ; member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died 
November  17  following  a brief  illness.  Dr.  Blake- 
ley, a native  of  Athens  County,  two  years  ago 
was  honored  by  a community  banquet  celebrating 
the  fiftieth  anniversary  of  his  entrance  into  the 
practice  of  medicine.  He  had  practiced  in  Wash- 
ington C.H.  for  more  than  40  years.  Dr.  Blake- 
ley was  a member  of  the  Masonic  Lodge  and  the 
Presbyterian  Church.  Surviving  are  his  widow, 
one  sister  and  one  brother. 

Susannah  L.  Bryant,  M.D.,  Columbus;  Hahne- 
mann Medical  College  and  Hospital,  Chicago, 
1899;  aged  66;  died  December  6 following  an  ex- 
tended illness.  Dr.  Bryant  had  practiced  in 
Columbus  for  30  years.  Surviving  are  four 
brothers,  two  nieces  and  one  nephew. 

Harry  V.  Christopher,  M.D.,  London;  Univer- 
sity of  Illinois,  College  of  Medicine,  Chicago, 
1908;  aged  49;  member  of  the  Ohio  State  Medical 
Association  and  the  American  Medical  Associa- 
tion; died  November  14  following  a brief  illness. 
Dr.  Christpoher  began  the  practice  of  medicine  in 


London  as  an  associate  of  his  father,  the  late 
Dr.  W.  H.  Christopher.  On  June  23,  1917,  Dr. 
Christopher  enlisted  in  the  medical  corps  and 
served  with  the  166th  Infantry,  Rainbow  Divi- 
sion, during  the  World  War.  He  was  wounded 
twice  and  decorated  for  valiant  service  under  fire. 
In  1919  he  was  discharged  with  the  rank  of  Cap- 
tain. Later  he  was  promoted  to  the  rank  of 
Major  in  the  Medical  Officers  Reserve  Corps.  He 
was  prominent  in  National  Guard  activities  of  the 
state.  Dr.  Christopher  always  had  been  active  in 
civic,  social  and  political  circles.  He  served  as 
county  coroner;  as  a member  of  the  city  council 
and  a member  of  the  board  of  education.  He  was 
a member  of  the  Masonic  and  Eagles  lodges;  the 
Methodist  Episcopal  Church;  the  American 
Legion  and  Forty  et  8;  Kappa  Sigma,  Theta  Nu 
Epsilon,  Phi  Sigma  Si  and  Nu  Sigma  Nu  frater- 
nities; Rainbow  Division  Veterans  Association, 
and  was  a former  president  of  the  Madison 
County  Medical  Society.  Dr.  Christopher  was 
active  in  the  Boy  Scout  movement,  being  on  the 
executive  staff  of  the  Central  Ohio  Boy  Scout 
Area.  Surviving  are  his  widow,  two  daughters 
and  one  son.  Military  funeral  services  were  held, 
attended  by  many  army  and  National  Guard  offi- 
cers of  Ohio. 

George  B.  Farnsworth,  M.D.,  Cleveland;  Uni- 
versity of  Wooster,  Medical  Department,  Cleve- 
land, 1879;  aged  78;  died  November  3.  Dr.  Farns- 
worth was  an  active  Mason  and  Shriner  and  a 
member  of  the  Congregational  Church.  He  leaves 
his  widow  and  one  grandson. 

Herbert  F.  Gammons,  M.D.,  Amherst;  Boston 
University,  School  of  Medicine,  1909;  aged  44; 
member  of  the  Ohio  State  Medical  Association 
and  a fellow  of  the  American  Medical  Associa- 
tion; died  November  21  of  heart  trouble  and 
diabetes.  Dr.  Gammons  was  superintendent  of 
Pleasant  View  Sanatorium,  Lorain  County’s 
tuberculosis  hospital.  He  had  held  similar  posi- 
tions in  Texas,  Massachusetts,  Minnesota  and 
New  York  before  moving  to  Lorain  in  1931.  Dr. 
Gammons  was  affiliated  with  the  National  Tuber- 
culosis Association  and  the  Eagles  Lodge.  Sur- 


64 


The  Ohio  State  Medical  Journal 


January,  1933 


viving  are  his  widow,  two  daughters,  one  son,  one 
sister  and  one  brother. 

Robert  Henderson,  M.D.,  Urbana;  Columbus 
Medical  College,  Columbus,  1880;  aged  81;  former 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died 
November  16  following  a stroke  of  paralysis;  Dr. 
Henderson  had  been  a resident  of  Champaign 
County  for  the  past  51  years.  He  had  retired 
from  active  practice  several  years  ago.  Dr.  Hen- 
derson served  two  terms  as  mayor  of  Urbana  and 
had  served  several  terms  on  the  city  council.  He 
was  an  active  worker  in  the  Democratic  party. 
Surviving  are  one  son,  Dr.  Richard  T.  Henderson, 
Urbana,  one  daughter,  two  sisters  and  two  broth- 
ers. 

Calvin  B.  Holcombe,  M.D.,  Bremen;  Cincinnati 
College  of  Medicine  and  Surgery,  1864;  aged  94; 
died  December  1.  Dr.  Holcombe  served  with  the 
160th  Regiment,  O.V.I.,  during  the  Civil  War. 
He  practiced  in  Bremen  for  20  years  before  be- 
coming a surgeon  in  Central  Ohio  for  the  old 
T.  & 0.  C.  Railroad.  After  22  years  in  this 
work,  he  returned  to  Bremen  where  he  practiced 
until  his  retirement  several  years  ago.  He  is 
surived  by  one  son,  three  daughters  and  one 
sister. 

Frank  G.  Jones,  M.D.,  Cleveland;  Ohio  State 
University,  College  of  Homeopathic  Medicine, 
Columbus,  1915;  aged  41;  former  member  of  the 
Ohio  State  Medical  Association  and  the  Amer- 
ican Medical  Association;  died  November  3 of 
uremia  and  arterial  hypertension.  After  leaving 
medical  school,  Dr.  Jones  enlisted  in  the  British 
Army  with  which  he  served  for  two  years.  In 
1917  he  was  commissioned  in  the  American  Army 
with  which  he  served  until  the  end  of  the  war. 
Surviving  are  his  widow,  two  sons  and  two  daugh- 
ters. 

William  H.  Klayer,  M.D.,  Norwood;  Miami 
Medical  College,  Cincinnati,  1897;  aged  63;  died 
November  25  from  self-inflicted  gun  shot  wounds. 
Dr.  Klayer  had  not  been  in  active  practice  for 
several  years  because  of  heart  trouble.  He  was 
a member  of  the  Masonic  Lodge  and  was  a 
licensed  attorney.  Surviving  are  his  widow  and 
one  daughter. 

Albert  H.  Kr  eager,  M.D.,  Zanesville;  Ohio 
Medical  University,  Columbus,  1897;  aged  61;  died 
November  17  following  a heart  attack.  Dr. 
Kreager  was  a native  of  Newark.  He  leaves 
three  brothers  and  two  sisters. 

James  T.  Lawless,  M.D.,  Toledo;  University  of 
Michigan  School  of  Medicine,  1872;  aged  88; 
former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  November  30.  Dr.  Lawless  had  practiced 
in  Toledo  for  almost  60  years.  He  was  a Civil 
War  veteran  and  was  U.  S.  pension  examiner  in 
the  Toledo  district  for  many  years.  Dr.  Lawless 


was  for  many  years  a member  of  the  City  Board 
of  Health  and  the  Toledo  Public  Library  Board. 
For  years  he  was  one  of  the  most  active  mem- 
bers of  the  Toledo  Academy  of  Medicine  and  in 
the  affairs  of  St.  Vincent’s  Hospital.  He  is  sur- 
vived by  five  sons,  two  of  whom  are  Toledo  physi- 
cians, Dr.  James  T.  Lawless,  Jr.,  and  Dr.  Robert 
E.  Lawless. 

William  A.  Layer,  M.D.,  Greenville;  Baltimore 
Medical  College,  1895;  aged  64;  member  of  the 
Ohio  State  Medical  Association  and  the  Amer- 
ican Medical  Association;  died  December  5 follow- 
ing a stroke  of  paralysis.  Dr.  Layer  practiced 
in  Hillgrove  and  Castine  before  moving  to  Green- 
ville in  1921.  Dr.  Layer  was  a member  of  the 
Masonic  and  Odd  Fellows  lodges.  Surviving  are 
his  widow,  one  daughter  and  two  sisters. 

James  A.  McGrew,  M.D.,  New  Athens;  College 
of  Physicians  and  Surgeons,  Baltimore,  1886; 
aged  69;  member  of  the  Ohio  State  Medical  Asso- 
ciation and  a Fellow  of  the  American  Medical 
Association;  died  November  15  following  a stroke 
of  paralysis.  Dr.  McGrew  had  spent  his  entire 
life  in  New  Athens.  He  was  a member  of  the 
school  board  and  the  United  Presybyterian 
Church.  During  the  World  War,  Dr.  McGrew 
served  in  the  Medical  Corps.  Surviving  are  his 
widow,  one  son  and  one  daughter. 

Thomas  Mizer,  M.D.,  Cleveland;  Cleveland  Col- 
lege, of  Physicians  and  Surgeons,  1896;  aged  60; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  November  14  of  injuries  received  a 
month  before  when  struck  by  an  automobile.  Dr. 
Mizer  was  a native  of  Cleveland.  He  leaves  his 
widow,  two  sons  and  two  daughters. 

Ethelbert  S.  Ray,  M.D.,  Hamden;  Jefferson 
Medical  College,  Philadelphia,  1890;  aged  65;  died 
November  17  of  cerebral  hemorrhage.  Dr.  Ray 
had  practiced  in  Hamden  since  graduating  from 
medical  college.  He  was  an  active  member  and 
officer  of  the  Odd  Fellow  Lodge.  Dr.  Ray  is  sur- 
vived by  his  widow,  one  son,  and  one  brother, 
Dr.  A.  G.  Ray,  Jackson.  Three  other  brothers, 
two  of  whom  were  physicians,  preceded  him  in 
death. 

Frank  L.  Roebuck,  M.D.,  Ashland;  Starling 
Medical  College,  Columbus,  1892;  aged  64;  died 
September  14  following  an  extended  illness.  Dr. 
Roebuck  was  a native  of  Fayette  County.  Sur- 
viving are  one  son  and  one  daughter. 

Robert  G.  Schnee,  M.D.,  Cleveland  College  of 
Physicians  and  Surgeons,  1897;  aged  60;  mem- 
ber of  the  Ohio  State  Medical  Association  and 
the  American  Medical  Association;  died  Novem- 
ber 27  of  heart  disease.  Dr.  Schnee  was  patho- 
logist and  diagnostician  on  the  staffs  at  the  Huron 
Road,  Glenville  and  Grace  hospitals.  He  had  not 
been  engaged  in  general  practice  for  several 


January,  1933 


State  News 


65 


years.  Surviving  are  his  widow,  one  son,  and  his 
mother. 

Edwin  Scott,  M.D.,  Toledo;  Eclectic  Medical 
College,  Cincinnati,  1884;  aged  72;  died  Novem- 
ber 28.  Surviving  are  his  widow,  two  daughters 
and  one  son. 

Francis  G.  Smith,  M.D.,  Hamilton;  University 
of  Cincinnati,  College  of  Medicine,  1910;  aged  47; 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association ; died 
November  17  following  an  extended  illness.  Dr. 
Smith  was  a native  of  Butler  County.  Follow- 
ing his  graduation  from  medical  school,  Dr. 
Smith  served  on  the  surgical  staff  at  the  Ohio 
Soldiers’  Home  at  Sandusky  for  five  years.  He 
practiced  in  Reily,  Butler  County,  until  six  years 
ago  when  he  moved  to  Hamilton.  He  was  a mem- 
ber of  the  Masonic  Lodge.  Surviving  are  his 
widow,  one  son,  his  mother  and  two  brothers. 

John  P.  Symons,  M.D.,  Rockford;  Western  Re- 
serve University,  School  of  Medicine,  1889;  aged 
73 ; member  of  the  Ohio  State  Medical  Associa- 
tion and  a Fellow  of  the  American  Medical  Asso- 
ciation; died  November  17  of  heart  disease.  Dr. 
Symons  located  in  Rockford  after  his  graduation 
from  medical  school.  He  was  a member  of  the 
Masonic  Lodge  and  the  Presbyterian  Church,  and 
was  active  in  business  and  civic  affairs  of  Rock- 
ford. He  leaves  his  widow  and  one  son. 

Rupert  K.  Welliver,  M.D.,  Dayton;  University 
of  Michigan,  School  of  Medicine,  1908;  aged  51; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  November  26  at  his  summer  home  at 
Brooklyn,  Michigan,  following  an  extended  ill- 
ness. Dr.  Welliver  was  the  son  of  the  late  Dr. 
J.  E.  Welliver.  He  was  a member  of  the  staff 
at  the  Miami  Valley  Hospital.  Surviving  are  his 
widow,  one  daughter,  two  sons,  and  his  mother. 

Known  in  Ohio 

George  W.  Ridenour,  M.D.,  Detroit;  Detroit 
College  of  Medicine  and  Surgery,  1913;  aged  44; 
Fellow  of  the  American  Medical  Association;  died 
November  16  of  arterio  sclerosis.  Dr.  Ridenour 


formerly  resided  in  Defiance  County.  He  leaves 
his  widow,  formerly  of  Van  Wert,  two  sons  and 
two  sisters. 

William  A.  Schwallie,  M.D.,  Honolulu;  Medical 
College  of  Ohio,  Cincinnati,  1889;  aged  66;  died 
November  17.  Dr.  Schwallie  was  a native  of 
Brown  County.  He  is  survived  by  his  widow, 
four  daughters,  one  son,  three  brothers,  and  one 
cousin,  Dr.  A.  E.  Schwallie  of  Ripley. 


Sneak  Thief  Takes1  Instruments 

Dr.  Roy  D.  Hildebrand,  Newcomerstown,  is  a 
victim  of  a recent  sneak  thief  who  while  working 
at  Dr.  Hildebrand’s  home  stole  a number  of  new 
instruments  from  the  doctor’s  office.  Dr.  Hilde- 
brand asks  other  physicians  to  be  on  the  look- 
out for  the  thief  who,  he  believes,  may  attempt 
to  sell  the  instruments.  The  man,  according  to 
Dr.  Hildebrand,  is  a narcotic  addict  and  claims 
to  be  an  ex-service  man.  He  has  in  his  posses- 
sion some  disability  papers  from  the  Cleveland 
Veterans’  Bureau.  Dr.  Hildebrand  says  the  man 
gave  his  first  name  as  “Bob”  and  claims  ,to  be 
a sheet  metal  worker.  He  is  about  36  years  of 
age,  five  feet,  5 inches  tall,  about  142  pounds  in 
weight,  smooth  faced  and  wears  a gray  soft  hat 
and  a brown  plaid  overcoat. 


At  a recent  meeting  in  Chicago,  the  directors  of 
Alpha  Omega  Alpha,  honorary  medical  scholar- 
ship society,  adopted  the  following  resolutions  in 
recognition  of  the  eminent  services  of  the  late  Dr. 
William  W.  Root,  Slateiwille  Springs,  New  York, 
the  founder  of  the  society  and  secretary-treasurer 
from  the  time  of  its  organization  in  1902  until  his 
death:  That  the  stationery  and  official  documents 
of  the  society  bear  the  words:  “Founded  by  Wil- 

liam W.  Root,  1902”.  That  the  annual  lecture 
presented  each  year  by  a leading  medical  scientist 
be  known  as  the  “William  W.  Root  Alpha  Omega 
Alpha  Lecture”. 


Columbus — Colonel  David  Baker,  M.D.,  has  re- 
ported for  duty  as  surgeon  for  the  Fifth  Corps 
Area,  U S. A.,  with  headquarters  at  Fort  Hayes, 
Columbus. 


AN  approved  and  fully  equipped  Sanitarium 
for  convalescence,  diagnosis,  physical 
therapy,  and  medical  attention  under  recog- 
nized physicians. 

Created  like  a country  estate,  28  miles  south 
of  Pittsburgh.  No  mental  or  drug  cases. 
Admission  by  letter  from  physician  is  desired. 
Reports  will  be  made  to  him  on  request. 
Specially  interested  in  diabetes,  arthritis,  neu- 
ritis, anemias,  cardiovascular  diseases,  gen- 
eral orthopedic  conditions.  Isolation  for  nerv- 
ous cases.  Physical  therapy  in  all  phases. 
Address  professional  mail  to  G.  H.  McKinstry, 
M.D.,  Box  483  i;  Ilillsview  Farms,  Washing- 
ton, Pa.  Phone:  Washington  2650. 


66 


The  Ohio  State  Medical  Journal 


January,  1933 


It’S  Always  SUMMER 

for  INFANTS 
S.M.A.  ^ v! 


on 


— because  S.M.A. 
prevents  Rickets 
and  Spasmophilia. 


k^yUMMER  sun  is  an  effective  anti- 
rachitic agent  but  the  physician  cannot 
always  depend  on  it,  so  he  usually  pre- 
scribes cod  liver  oil. 

However,  it  is  sometimes  difficult  to 
get  the  infant  to  accept  cod  liver  oil, 
whereas  it  is  easy  to  give  it  to  him  in 
the  form  of  S.  M.  A.  — a dependable 
automatic  method  of  preventing  rickets. 

For  infants  deprived  of  breast  milk, 
S.  M.  A.  is  a close  adaptation  to  breast 
milk,  with  the  advantage  that  it  con- 
tains enough  biologically  tested  cod 
liver  oil  to  prevent  rickets  and  spasmo- 
philia and  the  additional  advantage  that 
this  cod  liver  oil  is  uniformly  distri- 
buted in  each  feeding  and  is  properly 
emulsified  for  easy  assimilation. 

S.  M.  A.  is  not  only  simple  for  the 
mother  to  prepare  but  also  simple  for 
you  to  prescribe,  relieving  you  of  ex- 
acting detail  in  infant  feeding. 

Physicians  have  prescribed  S.M.A.  for 
more  than  250,000  infants  with  excel- 
lent results. 


Don’t  you  want  to  try  S.  M.  A.  in 
your  own  practice?  A trial  supply  with 
feeding  suggestions  is  yours  for  the 
asking. 


What  is  S.  M.  A.? 

S.M.A.  is  a food  for  infants — derived 
from  tuberculin  tested  cows’  milk, 
the  fat  of  which  is  replaced  by  ani- 
mal and  vegetable  fats  including 
biologically  tested  cod  liver  oil;  with 
the  addition  of  milk  sugar,  potassium 
chloride  and  salts;  altogether  form- 
ing an  antirachitic  food.  When 
diluted  according  to  directions,  it  is 
essentially  similar  to  human  milk  in 
percentages  of  protein,  fat,  carbo- 
hydrates and  ash,  in  chemical  con- 
stants of  the  fat  and  in  physical 
properties. 

S.  M.  A. 
Corporation 

Mil  I Prospect  Avenue 
CLEVELAND,  OHIO 

San  Francisco  and  Toronto 

COPYRIGHT  1932,  S.M.A.  CORPORATION 


No  directions  are 
given  to  the  laity  and 
in  addition  from  the 
very  beginning  every 
package  of  S.M.A. 
has  borne  this  bold 
statement: ' 'Use  only 
on  order  and  under 
supervision  of  a lic- 
ensed physician.  He 
will  give  you  in- 
structions”. 


(Attach  to  your  prescription  blank  or  letterhead. ) 4 1'13 


iNEWS  NOTESs^OHIO 


Defiance — Dr.  E.  P.  Mitchell,  formerly  of  New 
Albany,  Indiana,  has  opened  offices  here  for  prac- 
tice in  eye,  ear,  nose  and  throat. 

Upper  Sandusky ■ — Dr.  R.  L.  Garster  who  re- 
cently completed  his  internship  at  City  Hospital, 
Youngstown,  has  opened  offices  here  for  general 
practice.  He  is  a graduate  of  the  College  of 
Medicine,  Ohio  State  University. 

Wilmot — Dr.  0.  C.  Ricksecker  has  been  ap- 
pointed health  commissioner  of  Stark  County. 

Tiffin — Dr.  C.  A.  Kuntz,  Fremont,  lieutenant 
governor  of  the  Fourth  Zone,  International  Lions’ 
Clubs,  was  a recent  speaker  before  the  Tiffin 
Lions  Club. 

Kent — Dr.  Guy  H.  Williams,  superintendent  of 
the  Cleveland  State  Hospital,  spoke  at  a recent 
meeting  of  the  Kent  Rotary  Club. 

Cincinnati — Dr.  M.  E.  Bowles  addressed  the 
local  Civitan  Club  on  “Cancer  Control”. 

Columbus — Experiences  on  a recent  trip  to 
Europe  were  described  by  Dr.  Isabel  Bradley  at  a 
meeting  of  the  Coumbus  Women’s  Medical  Club. 

Columbus — Announcement  has  been  made  of 
the  marriage  of  Miss  Helen  Slattery  and  Dr.  Roy 
Secrist,  a medical  examiner  for  the  State  Indus- 
trial Commission. 

Waverly — Dr.  Robert  T.  Lever  has  been  ap- 
pointed health  commissioner  of  Pike  County. 

Toledo — Dr.  Frederick  P.  Osgood,  who  recently 
returned  from  studies  in  Europe,  has  opened 
offices  for  general  practice. 

Findlay — The  Findlay  Rotary  Club  was  ad- 
dressed recently  by  Dr.  Carl  W.  Sawyer,  Marion, 
on  “Mental  Troubles”. 

Bucynis — Announcement  has  been  made  of  the 
mari'iage  of  Miss  Mary  Louise  Secrist,  Bucyrus, 
to  Dr.  Clarence  B.  Schoolfield,  Carbon,  West  Vir- 
ginia, formerly  of  Bucyrus  and  the  son  of  Dr. 
and  Mrs.  E.  R.  Schoolfield,  Bucyrus. 

Columbus — Dr.  Andre  Ci’otti  has  been  made  a 
Knight  of  the  Order  of  the  Crown  of  Italy,  the 
honor  having  been  conferred  upon  him  at  a ban- 
quet sponsored  by  Frank  J.  Cipriano,  Italian  con- 
sular agent  in  Columbus. 

Sidney — Dr.  C.  C.  Hussey  has  returned  from 
post-graduate  work  in  St.  Louis. 

Toledo — Dr.  Walter  V.  Prentice  has  been  named 
physician  at  the  Lucas  County  Jail,  succeeding 
the  late  Dr.  Ray  Bowen. 

Columbus — Drs.  Samuel  K.  Goldstein,  Milton  L. 
Goodman  and  Norris  A.  Krakoff  have  been  ap- 


January,  1933 


State  News 


67 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 


LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Association- 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Frances  Coup,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


In  Congestive  heart  failure 

Theocalcin 

( theobromine-calcium  salicylate ) 

Myocardial  stimulation  and  a 
potent  diuretic  effect  is  obtained 
with  1 to  3 tablets  t.  i.  d. 

Tablets  7\/ci  grains  each 
also  Theocalcin  powder 


Literature  and  samples  upon  request 

BILHUBER-KNOLL  CORP.,  154  Ogden  Ave.,  Jersey  City,  N,  J. 


68 


The  Ohio  State  Medical  Journal 


January,  1933 


X-Ray  Film  Consultation 

HUGH  J.  MEANS,  M.D.,  Radiologist 

683  East  Broad  Street  X-RAY  DIAGNOSIS  AND  THERAPY  Columbus,  Ohio 


pointed  city  physicians  by  the  city  health  depart- 
ment. 

Cleveland — Dr.  William  E.  Smith  is  taking  post- 
graduate work  at  Vienna  and  Hamburg. 

Mephanicsburg — Dr.  H.  E.  Ream,  formerly  of 
Bowersville,  has  opened  offices  here.  He  is  the  son 
of  Dr.  and  Mrs.  C.  E.  Ream,  Bowersville. 

Sandusky — Dr.  Ross  M.  Knoble,  former  house 
physician  at  Mt.  Carmel  Hospital,  Columbus,  and 
a graduate  of  the  College  of  Medicine,  Ohio  State 
University,  has  opened  offices  here. 

East  Liverpool — State  control  of  medicine  was 
assailed  by  Dr.  C.  H.  Bailey  in  an  address  before 
the  East  Liverpool  Rotary  Club. 

Youngstown — Dr.  W.  Z.  Baker  has  been  ap- 
pointed physician  at  the  Mahoning  County  Jail, 
succeeding  his  father,  the  late  Dr.  D.  W.  Baker. 

Greenville — Dr.  E.  G.  Husted  and  Dr.  J.  J. 
Moffett  were  recent  speakers  before  the  Green- 
ville Kiwanis  Club. 

Greenville — Dr.  Stuart  M.  Watson,  formerly  of 
Columbus,  has  opened  offices  here. 

Franklin  — Dr.  Selden  Hamilton  has  been 
granted  a Fellowship  in  surgery  by  the  Mayo 
Clinic,  Rochester,  Minnesota. 

East  Liverpool — Dr.  E.  W.  Miskall  addressed  a 
meeting  of  District  No.  3,  Ohio  State  Nurses’ 
Association  at  Youngstown. 

Youngstown — Drs.  Edward  C.  Baker,  M.  H. 
Bachman  and  O.  D.  Hudnut  attended  the  meeting 
of  the  American  Roentgenologist  Association  at 
Atlantic  City. 

Youngstown — Dr.  A.  W.  Thomas  addressed  a 
public  meeting  in  New  Castle,  Pa.,  recently  on 
“Public  Cooperation  with  the  Doctor  in  the  Pre- 
vention of  Disease”. 

Toedo— -Dr.  Leo  P.  Dolan  has  returned  to  active 
practice  having  recovered  from  injuries  received 
in  an  automobile  accident.  Dr.  Allen  S.  Avery, 
who  recently  completed  post-graduate  work  in 
New  York  and  Europe,  is  now  associated  with  Dr. 
Dolan. 

Toledo — Announcement  has  been  made  of  the 
marriage  of  Dr.  A.  P.  Hancuff,  secretary  of  the 
Toledo  Academy  of  Medicine,  and  Miss  Dorothy 
Henning. 

Cincinnati — Dr.  Edward  King  has  returned 
from  studies  in  Munich  and  Vienna. 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  advertisements  under  this  heading  are  50  cents 
per  line,  payable  in  advance.  Minimum  charge  of  $1.00 
for  each  insertion.  Price  coders  the  cost  of  remailing 
answers.  Forms  close  16th  of  the  month  preceding 
publication. 


Wanted — Position  by  medical  technician,  A.B.  degree. 
Qualified  in  X-ray,  physiotherapy,  laboratory  technique  and 
office  routine.  Address,  R.  A.,  care  Ohio  State  Medical 
J ournal. 


For  Sale — Drugs,  books,  operating  table,  instruments,  and 
general  office  equipment.  Address,  Mrs.  Marie  Speidel, 
Felicity,  Ohio. 


For  Sale — Estate  of  175  acres,  35  miles  from  Cleveland. 
Beautiful  location,  unusual  buildings,  city  water,  electricity 
available.  Ideal  for  club  or  sanitarium.  Address,  Mrs.  Kate 
L.  Corke,  R.F.D.  No.  2,  Ravenna,  Ohio 


Wanted — Physician  to  locate  at  Bourneville,  Ohio.  For  in- 
formation, communicate  with  Mr.  Clarence  Depoy,  Town- 
ship Trustee,  R.F.D.  No.  2,  Lyndon,  Ohio. 


Doctor  Needed — Southern  Ohio  town  of  500,  farming  and 
dairying  community.  Good  house,  three  room  office.  Rent 
for  reasonable  time,  subject  to  purchase.  Inquire,  E.  C. 
Schatzman,  Russellville,  Ohio. 


Cleveland — The  Board  of  Trustees  of  the  Uni- 
versity Hospital  has  elected  Dr.  Carl  H.  Lenhart 
professor  of  surgery  and  head  of  the  department 
of  surgery  of  the  University  Hospitals  and  the 
Out-Patient  Department  of  Western  Reserve 
University  and  the  University  Hospitals,  confirm- 
ing previous  similar  action  by  the  trustees  of  the 
University.  Dr.  Lenhart  succeeds  Dr.  Elliott  C. 
Cutler,  now  professor  of  surgery  at  Harvard 
University. 

Columbus — Dr.  E.  Harlan  Wilson  has  been  pro- 
moted from  instructor  to  assistant  professor  in 
orthopedics  at  the  College  of  Medicine,  Ohio  State 
University. 

Cleveland — Dr.  M.  A.  Blankenhorn  was  elected 
president  and  Dr.  C.  D.  Christie,  councilor  of  the 
Central  District  of  the  Society  for  Clinical  Re- 
search at  its  recent  meeting  in  Chicago. 

New  Philadelphia — The  local  Kiwanis  Club  was 
addressed  recently  by  Dr.  B.  C.  Barnard,  Alliance 
on  “The  Recent  Developments  in  the  Treatment 
of  Tuberculosis”. 

Alliance — Dr.  Russel  Haden,  Cleveland,  ad- 
dressed the  staff  of  the  Alliance  City  Hospital  on 
“The  Problem  of  Chronic  Rheumatism”. 

Youngstown — Dr.  A.  E.  Brant  addressed  the 
local  Rotary  Club  recently  on  the  subject,  “A 
Trip  Through  Surgery”. 


January,  1933 


State  News 


69 


Edward  Reinert 

Ph.G.,  M.D. 

247  East  State  Street  Columbus,  Ohio 

Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 

FRANK  GALLEN,  M.D.,  LEE  A.  HAYS,  M.D., 

Dermatology  Roentgenology 

Tel.  Main  1537  University  5842 


| W.  H.  MILLER,  M.  D.  | 

328  East  State  St.  Columbus,  Ohio 

Office  Telephone,  MAin  3743  Residence,  EVergreen  5644 

CL Jfo. ) 

Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

Prompt  and  Full  Report  j 


70 


The  Ohio  State  Medical  Journal 


January,  1933 


Miracle  Man  Locke  and  His  Subsidiary 
Shoe  Stock 

Ohio  physicians  who  have  had  occasion  to 
notice  within  the  past  few  months  the  widespread 
publicity  in  newspapers  and  magazines  concern- 
ing Mahlon  W.  Locke,  M.D.,  of  the  village  of 
Williamsburg,  Ontario,  the  so-called  “Miracle 
Man  of  1932”,  will  be  interested  in  the  comment 
regarding  Dr.  Locke  and  his  practice  made  by  the 
Bureau  of  Investigation  of  the  American  Medical 
Association  and  published  on  Page  1798  of  the 
November  19,  1932,  issue  of  The  Journal  of  the 
American  Medical  Association. 

The  Bureau’s  comment  contains  an  illuminating 
description  of  the  “toe-twisting”  practice  and  the 
subsidiary  shoe  factory  operated  in  connection 
with  his  practice — both  of  which,  obviously,  are 
lucrative  enterpidses.  The  Bureau  is  frank  to 
admit  that  just  what  manipulation  Dr.  Locke 
gives  is  not  clear,  “as  he  has  not  seen  fit  to  pass 
on  his  magic  formula  to  the  medical  profession”. 
Moreover,  it  points  out  that  as  far  as  is  known 
there  is  no  accurate  record  of  the  end-results  of 
the  manipulations  for  the  simple  reason  that  the 
doctor  keeps  no  books,  makes  no  appointments, 
knows  but  few  of  his  patients  by  name,  and  “does 
business  on  a cash  basis”. 

No  doubt  the  Canadian  physician  who  recently 
summed  up  the  case  of  Dr.  Locke  with  the  terse 
prediction  that  “when  the  tumult  and  the  shout- 
ing dies,  he  will,  no  doubt,  like  many  another,  pass 
into  oblivion,  but  with  his  pockets  well-lined”. 


A ruling  on  the  taxability  of  electrical  energy 
furnished  for  consumption  by  hospitals  was 
handed  down  recently  by  the  U.  S.  Bureau  of 
Internal  Revenue  in  answer  to  an  inquiry  for  an 
interpretation  of  Section  616  of  the  Revenue  Act 
of  1932.  The  Bureau’s  ruling  was  in  effect  that 
electrical  energy  furnished  for  consumption  by 
hospitals  which  are  not  organized  or  operated  for 
profit  and  no  part  of  the  net  earnings  of  which 
inure  to  the  benefit  of  any  private  stockholder  or 
individual  is  not  subjected  to  the  tax  imposed  by 
Section  616  of  the  Revenue  Act  of  1932.  However, 
the  use  of  electrical  energy  in  hospitals  which  are 
operated  for  profit  will  he  subject  to  the  tax. 


Ceveland — Dr.  R.  C.  Engel  has  been  re-elected 
chairman  of  the  Metals  Section  Health  Commit- 
tee and  a member  of  the  advisory  committee  of 
the  Industrial  Health  Division,  National  Safety 
Council. 

Cleveland — Dr.  A.  G.  Sar-Louis  is  in  Phila- 
delphia taking  post-graduate  work  in  obstetrics 
and  gynecology  at  the  University  of  Pennsylvania. 


Annual  Congress  on  Medical  Education,  Med- 
ical Licensure  and  Hospitals,  held  yearly  by  the 
American  Medical  Association,  will  convene  in 
Chicago,  February  13  and  14,  1933. 


DOCTOR’S  DIET 
MUST  BE  FOLLOWED  FOR 
REAL  RESULT 

Knox  Gelatine  is  the  food  safe  for  modifying 
prescribed  nutrients.  It  is  safe  because  Knox 
Gelatine  is  unsweetened,  unflavored,  uncolored 
— 100%  gelatine.  It  is  effective  because  Knox 
Gelatine  makes  your  dieted  patient  actually 
consume  the  food  you  prescribe.  Knox  Gela- 
tine makes  the  diet  appetizing  and  attractive. 
Knox  Gelatine  helps  your  patient  stick  to  your 
diet.  Your  results  in  nutritional  therapy  are  im- 
proved with  Knox  Gelatine. 

• 

On  request,  the  Knox  Gelatine  Laboratories,  434  Knox 
Ave.,  Johnstown,  N.  Y.,  will  send  you  facts  on  Gelatine 
in  the  Diet,  prepared  by  accredited  authorities,  and  free 
diet  recipe  books  to  give  to  patients. 


KNOX  is  the  real  GELATINE 

BE  SURE  TO  SPECIFY  KNOX 


February,  1933 


Advertisements 


73 


The  SAWYER  SANATORIUM 

White  Oaks  Farm,  Marion,  Ohio 

(L^g) 

TREATS  NERVOUS  AND  MENTAL  DISEASES 


THE  PATIO 


Provides  Thorough  Diagnosis,  Scientific  Treatment,  Homelike  Surroundings,  Complete 
Equipment,  Individual  and  Personal  Professional  Attention,  Splendid  Cuisine,  all  the 
modern  conveniences  of  the  best  private  homes.  Located  on  an  130-acre  farm. 
Presided  over  by  men  and  women  devoting  all  their  time  to  the  work. 

Send  for  Booklet,  Address 

SAWYER  SANATORIUM  WHITE  OAKS  FARM  MARION,  OHIO 


The  Ohio  State  Medical  Association 

Officers  1932-1933 

PRESIDENT 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone : ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year;  single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 

Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1933) Cleveland 

Gilbert  Micklethwaite,  M.D.  (1935) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager  i 


H.  M.  Platter,  M.D Columbus 

PRESIDENT-ELECT 

C.  L.  Cummer,  M.D — Cleveland 

TREASURER 

James  A.  Beer,  M.D Columbus 

EXECUTIVE  SECRETARY 
Don  K.  Martin ..  ..  Columbus 


State  Council 


First  District 

John  A.  Caldwell,  M.D Cincinnati 

Second  District 

E.  M.  Huston,  M.D Dayton 

Third  District 

0.  P.  Klotz,  M.D -Findlay 

Fourth  District 

B.  J.  Hein,  M.D Toledo 

Fifth  District 

H.  V.  Paryzek,  M.D. 1 Cleveland 

Sixth  District 

H.  S.  Davidson,  M.D Akron 

Seventh  District 

E.  B.  Shanley,  M.D New  Philadelphia 

Eighth  District 

E.  R.  Brush,  M.D. — Zanesville 

Ninth  District 

1.  P.  Seiler,  M.D — Piketon 

Tenth  District 

S.  J.  Goodman,  M.D— .Columbus 

Ex-Officio,  The  Ex-President 
D.  C.  Houser,  M.D. Urbana 


74 


The  Ohio  State  Medical  Journal 


February,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies  President 

First  District 


Secretary 


Adams R.  L.  Lawwell,  Seaman O.  T.  Sproull,  West  Union 

Brown R.  B.  Hannah,  Georgetown Geo.  P.  Tyler,  Jr.,  Ripley 

Butler H.  O.  Lund,  Middletown Walter  Roehl,  Middletown , 

Clermont J.  K.  Ashburn,  Batavia — Allan  B.  Rapp,  Owensville 

Clinton F.  A.  Peele,  Wilmington Wm.  L.  Regan,  Wilmington 

Fayette S.  E.  Boggs,  Washington  C.  H J.  F.  Wilson,  Washington  C.  H... 

Hamilton Parke  G.  Smith,  Cincinnati Geo.  B.  Topmoeller,  Cincinnati 

Highland J.  C.  Bohl,  Hillsboro W.  B.  Roads,  Hillsboro..— 


3d  Wednesday  in  April,  June,  Aug 

Oct. 

4th  Wednesday  in  Feb.,  May  and 
Nov. 

2d  Wednesday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  mpnthly. 

1st  Thursday,  monthly. 

Monday  evening  of  each  week. 
1st  Wednesday,  monthly. 


Warren J.  E.  Witham,  Waynesville James  Arnold,  Lebanon 1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 


Second  District Cyril  Hussey,  Sidney 


H.  R.  Huston,  Dayton. 


r, 

w. 

L. 

F. 

Montgomery..- 

A. 

. C. 

Shelby 

R. 

Third  District 

V. 

Allen 

. . E. 

Auglaize 

E. 

Hancock 

A. 

Hardin .. 

F. 

Logan  . 

o. 

Marion 

E. 

Mercer  . 

M. 

Seneca 

. Pa; 

-L.  A.  Woodburn,  Urbana 2d  Thursday,  monthly. 

.Roger  Marquart,  Springfield 2d  and  4th  Wednesday  noon 


L.  Taylor,  Yellow  Springs H.  C.  Schick,  Xenia. 


1st  Thursday,  monthly. 


and  August. 

Miss  M.  E.  Jeffrey,  Dayton 1st  and  3d  Friday  each  month 

3d  Thursday,  monthly. 

1st  Friday,  monthly. 


C.  J.  Brian,  Eaton 

A.  B.  Lippert,  Sidney 


Van  Wert 

Wyandot 


H.  Hay,  Lima . C.  E.  Hufford,  Toledo 

C.  Yingling,  Lima H.  L.  Stelzer,  Lima 

F.  Heffner,  Wapakoneta C.  C.  Berlin,  Wapakoneta 

E.  King,  Mt.  Cory H.  O.  Crosby,  Findlay 

M.  Elliott,  Ada — . — _ W.  N.  Mundy,  Forest 

C.  Amstutz,  Bellefontaine W.  H.  Carey,  Bellefontaine 

L.  Brady,  Marion J.  W.  Jolley,  Marion _ 

B.  Fishbaugh,  Celina F.  E.  Ayers,  Celina 

il  Leahy,  Tiffin R.  E.  Hershberger,  Tiffin 

A.  T.  Rank,  Van  Wert R.  H.  Good,  Van  Wert 

B.  A.  Moloney,  Upper  Sandusky J.  Craig  Bowman,  Up.  Sandusky 


Lima,  1932. 

3d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 
1st  Thursday,  monthly. 
17th  of  each  month. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Thursday,  monthly. 

3rd  Thursday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


Fourth  District (With  Third  District  in  Northwestern  Ohio  District) 

Defiance S.  E.  DeMuth,  Hicksville D.  J.  Slosser,  Defiance 3d  Thursday,  monthly,  except 

July,  August,  December. 

Fulton P.  S.  Bishop.  Delta Geo.  McGuffin,  Pettisville . 2nd  Thursday  monthly. 

Henry T.  P.  Delventhal,  Napoleon F.  M.  Harrison,  Napoleon 1st  Wednesday,  monthly. 

Lucas E.  B.  Gillette,  Toledo A.  P.  Hancuff,  Toledo Friday,  each  week. 

Ottawa R.  A.  Willett,  Elmore Cyrus  R.  Wood,  Port  Clinton 2d  Thursday,  monthly. 

Paulding L.  R.  Fast,  Paulding Gaile  L.  Doster,  Paulding 3d  Wednesday,  monthly. 

Putnam E.  Blackburn,  Kalida W.  B.  Light,  Ottawa 1st  Tuesday,  monthly. 

Sandusky D.  W.  Philo,  Fremont J.  C.  Boyce,  Fremont Last  Thursday,  monthly. 

Williams A.  Hathaway,  Edon B.  C.  Bly,  Bryan 3d  Thursday,  monthly. 

Wood F.  L.  Sterling,  Bowling  Green R.  N.  Whitehead,  Bowling  Green..  3d  Thursday,  monthly. 

Fifth  District H.  V.  Paryzek,  Councilor Chrm.  Com.  on  Arrangements Cleveland. 

Ashtabula J.  F.  Docherty,  Conneaut A.  M.  Mills,  Ashtabula 2nd  Tuesday,  monthly. 

Cuyahoga H.  V.  Paryzek,  Cleveland Clarence  H.  Heyman,  Cleveland 3d  Fri.  Feb.,  March,  May,  Sept., 

Nov.,  Dec. 

Erie H.  W.  Lehrer,  Sandusky G.  A.  Stimson,  Sandusky Last  Wednesday,  monthly,  except 

July,  Aug.,  Sept. 

Geauga H.  E.  Shafer,  Middlefield Isa  Teed-Cramton,  Burton Last  Wednesday,  Apr.  to  Oct. 

Huron W.  W.  Lawrence,  Norwalk Geo.  F.  Linn,  Norwalk 3d  Tuesday,  Feb.,  May, 

August,  Nov. 

Lake G.  O.  Hedlund,  Painesville B.  T.  Church,  Painesville ._  4th  Tuesday,  monthly. 

Lorain H.  C.  Stevens,  Elyria W.  E.  Hart,  Elyria 2d  Tuesday,  monthly. 

Medina Harry  Streett,  Litchfield. — J.  K.  Durling,  Wadsworth 1st  Thursday,  monthly. 

Trumbull E.  P.  Adams,  Warren. R.  H.  McCaughtry,  Warren Sd  Thursday,  monthly,  except 

June,  July,  August. 


February,  1933 


The  Ohio  State  Medical  Journal 


75 


Societies 


President 


Secretary 


Sixth  District 

A. 

E.  Brant,  Youngstown 

J.  H. 

Seiler,  Akron 

2d  Wed.,  Jan.,  April  & Oct. 

w. 

Paul 

E.  Kellogg,  Ashland.. 

2nd  Friday,  Sept,  to  May. 

L. 

C.  T. 

Bahler,  Walnut  Creek 

1st  Tuesday,  quarterly.  Jan., 

July,  October. 

J. 

..  ... W.  M.  Skipp,  Youngstown 

3d  Tuesday,  monthly. 

s 

E.  J. 

Widdecombe,  Kent. 

1st  Thursday,  monthly. 

c. 

Emery,  Mansfield 

Last  Thursday,  monthly. 

H. 

F.  S. 

VanDyke,  Canton 

2d  Tuesday,  monthly. 

J. 

A.  S. 

McCormick,  Akron  _ 

1st  Tuesday,  monthly. 

Wayne 

-E. 

H.  McKinney.  Doylestown .. 

R.  C. 

Paul,  Wooster.. 

2d  Tuesday,  monthly. 

Seventh  District  _ 


Belmont G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire 

Carroll (With  Stark  Co.  Society) 

Columbiana J.  W.  Robinson,  Lisbon T.  T.  Church,  Salem 

Coshocton Floyd  Craig,  Coshocton J.  D.  Lower,  Coshocton 

Harrison A.  C.  Grove,  Jewett _W.  C.  Wallace,  Hopedale 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville 

Monroe G.  W.  Steward,  Woodsfield _A.  R.  Burkhart,  Woodsfield 

Tuscarawas  F.  B.  Larimore,  New  Phila - G.  L.  Sackett,  New  Phila 


1st  Thurs.,  monthly,  4 p.  m., 
except  July  and  August. 

2d  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Wednesday,  monthly. 

Last  Thursday,  monthly. 

2d  Wednesday,  monthly. 

2d  Thursday,  monthly. 


Eighth  District 


Athens 


E. 

Guernsey  

C. 

Licking 

H. 

n 

Muskingum 

c. 

Noble  . 

Parry 

Washington 

w. 

G.  Ralston,  McConnelsville.. 


C.  W.  Brown,  Lancaster 

..E.  F.  Hunter,  Cambridge 

_G.  A.  Gressle,  Newark 

.C.  E.  Northrup,  McConnelsville_ 
.Beatrice  T.  Hagen,  Zanesville — 


G.  M.  James,  Marietta.. 


1st  Monday,  monthly. 

2d  Tuesday,  monthly. 

1st  and  3rd  Thursday  each  month. 
Last  Friday,  monthly. 

3d  Wednesday,  monthly. 

1st  Wednesday,  monthly. 


3d  Monday,  monthly. 

2d  Wednesday,  monthly 


Ninth  District 


Gallia O.  A.  Vornholt,  Gallipolis Milo  Wilson,  Gallipolis 1st  Wed.,  Feb.,  May,  Sept,  and  Dec. 

Hocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan Quarterly. 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 2nd  Tuesday,  monthly. 

Lawrence Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton. 1st  Thursday,  monthly 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 3d  Thursday,  bi-monthly. 

Pike L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly. 1st  Monday,  monthly. 

Scioto T.  G.  McCormick,  Portsmouth— Wm.  E.  Scaggs,  Portsmouth 2d  Monday,  monthly. 

Vinton O.  S.  Cox,  McArthur H.  S.  James.  McArthur 3d  Wednesday,  monthly 


Tenth  District 


Crawford E.  C.  Brandt,  Crestline : R.  L.  Solt,  Bucyrus r—  1st  Monday,  monthly. 

Delaware A.  R.  Callander,  Delaware E.  V.  Arnold.  Delaware ist  Tuesday,  monthly. 

Franklin Jonathan  Forman,  Columbus John  H.  Mitchell,  Columbus Every  Monday,  8:30  p.  m. 

Knox S.  O.  Gantt,  Centerburg R.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly. 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  Jefferson 4th  Wednesday,  monthly. 

Morrow F.  M.  Hartsook,  Cardington — T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly 

Pickaway A.  F.  Kaler,  New  Holland Lloyd  Jonnes,  Circleville 1st  Friday,  monthly. 

Ross Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 1st  Thursday,  monthly. 

Union E.  J.  Marsh,  Broadway Angus  Maclvor,  Marysville 2d  Tuesday,  monthly. 


76 


Advertisements 


February,  1933 


A MODERN  ETHICAL  HOSPITAL 

Rates:  $25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alcohol,  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  Not  limited  as  to  the  quantity 
used  but  can  give  the  patient  as  much  whiskey  as  his  condition  requires. 

NERVOUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoscine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  that  their  own 
home  affords. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 

tal. Female  attendants  only ; absolute  privacy ; com- 
fortable, well-appointed  ladies’  lounge. 

Cherokee  Road  (Long  Distance  Phone  East  1488) 

THE  STOKES  SANATORIUM 

Louisville,  Ky.  27  Years  Treating  Nervous  Patients. 


WHITING  MINERAL  SPRINGS 

Sanitarium  and  Baths 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and 
allied  diseases  together  with  cases  for  elimination  and  rest  cure. 

Medical  department  thoroughly  proficient  and  STRICTLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

DR.  U.  G.  WHITING,  Phy.  & Mgr.  MARTINSVILLE,  INDIANA 


THE  MERCER  SANITARIUM  - MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristown,  Pa.) 


AN  approved  and  fully  equipped  Sanitarium 
for  convalescence,  diagnosis,  physical 
therapy,  and  medical  attention  under  recog- 
nized physicians. 

Created  like  a country  estate,  28  miles  south 
of  Pittsburgh.  No  mental  or  drug  cases. 
Admission  by  letter  from  physician  is  desired. 
Reports  will  be  made  to  him  on  request. 
Specially  interested  in  diabetes,  arthritis,  neu- 
ritis, anemias,  cardiovascular  diseases,  gen- 
eral orthopedic  conditions.  Isolation  for  nerv- 
ous cases.  Physical  therapy  in  all  phases. 
Address  professional  mail  to  G.  H.  McKinstry, 
M.D.,  Box  483  i;  Ilillsview  Farms,  Washing- 
ton, Pa.  Phone:  Washington  2650. 


Backward  and  Problem  Children 

Require  intensive  scientific  training  in  a suitable 
environment 

THE  BANCROFT  SCHOOL 

One  of  the  oldest  private  boarding  schools  of  its 
kind  in  the  United  States.  An  incorporated  edu- 
cational foundation,  operated  not  for  profit,  organized 
to  give  the  fullest  possible  cooperation  to  physicians. 

Catalog  on  Request 

Address  Box  420  HADDONFIELD,  NEW  JERSEY 


CURDOLAC  FOODS 

For  Diabetics 

Council  Accepted 

Enable  you  to  outline  three  good  meals  for  your 
diabetics,  daily 

Curdolac  Wheat-Soya  Flour 

Curdolac  Soya  Cereal  Johnny  Cake  Flour 

Curdolac  Soya-Bran  Breakfast  Food 

Curdolac  Soya-Bran  Flour 

Curdolac  Breakfast  Cereal 

Curdolac  Casein  Compound 

Curdolac  Casein  Bran  Improved  Flour 

Curdolac  Soya  Flour 

Literature  and  Samples  on  Request 

CURDOLAC  FOOD  CO. 
Waukesha,  Wis. 


PUBLIC  H®AJLTinI=»  SOCIAL  WJSJLFAK 
MEMCAIL  BCO 


‘With  Editorial  Comment  by  D.K.M. 


Confronted  with  economic,  social  and  govern- 
mental problems  of  unusual  and  pressing  im- 
portance, the  Ohio  General  Assembly  convened  on 
January  2 in  Columbus 
for  its  90th  regular  ses- 
sion, a session  which 
promises  to  be  one  of 
the  most  vital  and  most 
complicated  legislative 
gatherings  in  the  history  of  the  state. 

Although  the  first  few  sessions  of  the  General 
Assembly  were  devoted  for  the  most  part  to  the 
organization  of  both  houses;  the  selection  of  the 
various  committees  to  review  and  pass  on  bills  in- 
troduced, and  numerous  routine  matters  inciden- 
tal to  getting  the  legislative  machinery  in  opera- 
tion, there  were  early  indications  of  the  difficult 
voyage  the  General  Assembly  is  destined  to  travel 
during  the  next  few  months. 

Moreover,  an  unprecedented  number  of  ex- 
tremely controversial  measures  were  dumped  into 
the  hopper  during  the  early  weeks  of  the  session. 
These,  and  others  which  are  now  being  drafted 
and  will  be  submitted  later,  promise  to  bring  forth 
heated  debate,  cause  political  wire-pulling  and 
maneuvering,  and  prolong  the  session  by  consum- 
ing time  which  might  well  be  devoted  to  measures 
of  state-wide  importance. 

Despite  the  early  indications  of  wrangling  and 
controversy  over  proposals  of  minor  importance 
and  those  sponsored  by  special-interest  groups, 
there  is  a strong  sentiment,  especially  among  the 
leaders  of  both  houses  of  the  Assembly,  in  favor 
of  a short  session,  of  keeping  new  legislation  at  a 
minimum,  and  of  giving  serious  consideration  only 
to  vital  and  fundamental  issues  of  general  in- 
terest and  concern. 

This  was  the  advice  given  to  the  General  As- 
sembly by  Governor  White  in  his  combined  in- 
augural address  and  formal  message  to  the 
Legislature  on  January  9 following  the  inaugural 
ceremonies  held  in  the  hall  of  the  House  of 
Representatives. 

“It  has  been  the  experience  of  every  session  of 
the  General  Assembly”,  Governor  White  said, 
“that  a multiude  of  laws  have  been  presented  for 
consideration  and  enactment.  The  vast  majority 
of  such  legislation  has  been  drawn  to  further  wel- 
fare, or  in  accordance  with  the  views  of  individ- 
uals. and  groups,  and  without  due  consideration 
for  its  effect  upon  the  state  as  a whole. 


“Too  often  legislation,  ill-advised  and  hastily 
conceived,  has  been  placed  upon  our  statute  books 
later  to  be  found  unworkable,  unwise,  or  even 
vicious.  Today,  under  the  stress  of  three  years 
of  economic  depression  such  legislation  will  be 
presented  to  you  in  greater  volume  than  ever  be- 
fore. During  an  emergency  such  as  the  present 
one,  we  are  prone  to  develop  an  hysteria  and  be- 
lieve any  and  every  condition  can  be  corrected  by 
legislation.  Grave  problems  indeed  confront  us 
and  there  is  danger  that  in  the  sincere  desire  to 
meet  them,  unsound  legislation  may  result;  the 
danger  is  not  in  too  little  legislation,  but  in  too 
much. 

“New  laws  should  be  confined  to  those  neces- 
sary to  meet  our  pressing  problems  and  to  insure 
the  very  essentials  of  government,  with  th'e  basic 
principle  kept  in  mind  that  expenditures  author- 
ized by  your  body  must  be  met  by  a similar 
amount  of  revenue  raised  in  such  manner  as  not 
to  hamper  the  return  of  economic  stability.  * * * 

“It  is  your  duty  and  mine  to  retain  the  lessons 
learned  and  to  safeguard  the  people  of  our  state 
as  well  as  its  economic  groups  from  exploitation 
of  one  by  the  other.  To  this  end  I urge  that  legis- 
lation be  confined  to  a minimum  and  that  none  be 
considered,  which  in  its  workings  will  beneficially 
affect  only  a group  rather  than  the  whole.” 

Whether  the  General  Assembly  will  heed  this 
sound  advice  and  warning,  from  the  Chief  Ex- 
ecutive, remains  to  be  seen.  Of  course,  there  are 
in  each  Legislature  a few  members  who  fail  to 
realize  that  the  success  of  a legislative  session  is 
determined  by  the  constructiveness  and  value  of 
the  measures  enacted  and  who  are  willing  to  sup- 
port insignificant  or  dangerous  proposals  spon- 
sored by  selfish  and  special-interest  groups.  How- 
ever, there  is  hope  and  reason  to  believe  that  the 
majority  of  the  present  Legislature  will  be  con- 
scientious and  judicious  in  their  attitude  toward 
all  proposals  introduced  and  will  be  willing  to 
listen  to  the  advice  of  their  constituents  in  their 
local  districts.  Obviously,  no  better  advice  could 
be  given  all  members  of  the  General  Assembly  at 
the  present  time  than  that  they  follow  the  con- 
structive suggestions  made  by  Governor  White 
relative  to  careful  discrimination  in  the  enact- 
ment of  new  legislation  and  confining  their  de- 
liberations solely  to  measures  of  general  public 
need,  interest  and  benefit. 

Organization  of  the  Senate  resulted  in  the  elec- 
tion of  Senator  David  H.  DeArmond,  Hamilton, 
of  the  2nd-4th  District  (Butler,  Warren,  Cler- 
mont and  Brown  counties)  as  president  pro-tem 
and  Democratic  floor  leader  and  Senator  Earl  R. 
Lewis,  St.  Clairsville,  of  the  20th-22nd  District 


Vital  Problems 
Confront  the 
Legislature 


89 


90 


The  Ohio  State  Medical  Journal 


February,  1933 


(Belmont,  Harrison,  Jefferson  and  Columbiana 
counties)  as  Republican  floor  leader. 

The  important  Senate  Committee  on  Health, 
to  which  will  undoubtedly  be  referred  many  of  the 
bills  in  which  the  medical  profession  will  be 
especially  interested,  is  composed  of  Senator  E. 
N.  Waldvogel,  Cincinnati,  First  District  (Ham- 
ilton County),  chairman;  Senator  W.  H.  Annat, 
Cleveland,  25th  District  (Cuyahoga  County)  ; 
Senator  J.  N.  Matthews,  Enon,  llth-12th  District 
(Darke,  Miami,  Shelby,  Champaign,  Clark  and 
Madison  counties)  ; Senator  Fred  J.  McManus, 
Toledo,  34th  District  (Lucas  County)  ; Senator  E. 
LeFever,  (M.D.),  Glouster,  9th-14th  District 
(Fairfield,  Hocking,  Athens,  Morgan,  Washing- 
ton, part  of  Noble  and  Monroe  counties)  ; Senator 
J.  G.  Lowery,  New  Concord,  15th-16th  District 
(Licking,  Delaware,  Muskingum  and  Perry  coun- 
ties), and  Senator  R.  E.  Pfeiffer,  Columbus,  10th 
District  (Franklin  and  Pickaway  counties). 

The  personnel  of  the  powerful  and  important 
Rules  Committee  in  the  Senate,  to  which  will  be 
referred  all  appointments  by  the  Governor  re- 
quiring Senate  confirmation,  which  will  formulate 
the  rules  under  which  the  Senate  will  conduct  its 
business,  and  which  later  on  will  serve  as  a calen- 
dar or  “steering”  committee  on  pending  bills, 
consists  of  Senator  D.  H.  DeArmond,  chairman, 
Senator  William  H.  Herner,  Norwalk,  Senator 
John  P.  Bower,  Rushylvania,  Senator  D.  J. 
Gunsett,  Van  Wert,  Senator  Paul  P.  Yoder,  Day- 
ton,  Senator  Earl  R.  Lewis  and  Senator  L.  L. 
Marshall,  Cleveland. 

The  House  of  Representatives,  consisting  of  84 
Democrats  and  51  Republicans,  organized  by 
electing  Frank  Cave,  Mansfield,  Speaker;  Keith 
Lawrence,  Cleveland,  Speaker  pro  tern  and  ma- 
jority floor  leader,  and  Charles  H.  Jones,  Jack- 
son,  minority  floor  leader. 

Those  appointed  by  Speaker  Cave  to  serve  on 
the  important  House  Committee  on  Health  were: 
Herman  Brandewie,  Fort  Loramie,  Auglaize 
County,  chairman;  Hugh  E.  Addison,  Columbus, 
Franklin  County;  C.  H.  Armbruster,  Napoleon, 
Henry  County;  S.  Peyton  Baker,  Akron,  Summit 
County;  Julius  W.  Headington,  Mt.  Vernon,  Knox 
County;  Robert  H.  Heilker,  Cincinnati,  Hamilton 
County;  Hugh  A.  McNamee,  Cleveland,  Cuyahoga 
County;  Oakley  Spaght,  Akron,  Summit  County; 
Corwin  H.  Swan,  Applecreek,  Wayne  County;  L. 
R.  Bostwick,  London,  Madison  County;  Mrs.  Ila 
Marshall  Cronin,  East  Liverpool,  Columbiana 
County;  Lawrence  A.  Kane,  Cincinnati,  Hamilton 
County;  John  S.  Pettit,  Belief  on  taine,  Logan 
County,  and  P.  H.  Rogers,  Grafton,  Lorain 
County. 


The  Rules  Committee  in  the  House,  which  later 
in  the  session  will  serve  as  a calendar  committee, 
consists  of  Speaker  Cave,  chairman;  Maurice  J. 
Allen,  Cincinnati;  J.  Freer  Bittinger,  Ashland; 
0.  E.  Brenneman,  Shauck,  Morrow  County;  Ma- 
jority Floor  Leader  Lawrence,  Minority  Floor 
Leader  Jones,  and  Arthur  Hamilton,  Lebanon, 
Warren  County. 

Groups  and  representatives  of  all  sorts  of  cults 
and  fadists  and  anti-health  agitators  were  on 
hand  as  the  General  Assembly  got  underway,  in- 
dicating that  new  attacks  will  be  made  on  the 
Medical  Practice  Act  and  on  existing  public  health 
laws.  Some  of  these  groups  are  exceptionally  well- 
organized  for  this  session  of  the  Legislature  and 
already  they  have  secured  a surprising  amount  of 
support  for  the  bills  they  hope  to  have  enacted, 
through  lobbyists  and  the  distribution  of  mis- 
ing  propaganda. 

Although  there  is  some  indication  that  the 
Legislature  will  refuse  to  consider  the  destructive 
and  selfish  measures  which  these  groups  are  ped- 
dling, due  to  the  necessity  for  prompt  action  on 
vital,  necessary  and  constructive  proposals,  there 
is  no  assurance  that  this  will  be  the  case. 

The  medical  profession  and  all  other  groups 
and  individuals  interested  in  maintaining  the  pres- 
ent safeguards  to  public  health,  scientific  medicine 
and  medical  practice  must  be  constantly  on  guard. 
Members  of  the  Legislature  should  be  seen  by 
their  physician  constituents  frequently.  The  im- 
portance of  retaining  the  present  sound  and 
beneficial  medical  and  health  laws  should  be  em- 
phasized to  members  of  the  General  Assembly. 
The  fallacies  and  dangers  of  meddling  with  ex- 
isting proper  statutes  relating  to  public  health 
and  medical  practice  should  be  pointed  out  to  the 
legislators. 

The  Committee  on  Public  Policy  of  the  State 
Association  and  the  state  headquarters  office  will, 
as  in  the  past,  closely  watch  all  legislation  and 
will  communicate  developments  and  suggestions 
to  the  county  legislative  committeeman  in 
each  county  society.  It  is  of  paramount  import- 
ance that  effective  contact  be  established  between 
physicians  and  the  legislators  from  their  city, 
county  and  district.  The  present  session  of  the 
General  Assembly  challenges  the  alertness  and 
active  interest  of  the  medical  profession  and  or- 
ganized medicine.  Hearty  cooperation  on  the  part 
of  the  entire  membership  will  be  necessary  to 
prevent  the  enactment  of  legislation  which  would 
be  detrimental  to  the  health  and  welfare  of  the 
public  and  lower  standards  which  are  essential  to 
scientific  medicine,  the  maintenance  of  good 
medical  practice,  and  the  protection  of  public 
health. 


February,  1933 


Editorial 


91 


Most  of  the  component  county  medical  societies 
and  academies  of  medicine  have  selected  their 
officers  for  the  current  year.  Some  are  veterans  in 

medical  organization. 


Local  Leadership 
In  Medical 
Societies 


Some  are  undertaking 
their  first  activities  at 
running  the  machinei’y 
which  promotes  the 
activities  of  the  or- 
ganized medical  profession  in  their  communities. 

Old  or  new,  each  has  definite  and  important 
responsibilities.  Each  has  a specific  obligation  to 
discharge.  Each  has  been  selected  because  his  col- 
leagues had  faith  in  his  ability  to  carry  on 
effectively  the  duties  of  the  office  he  holds ; to 
serve  the  membership  of  his  respective  society  in 
an  efficient  manner,  and  to  work  for  the  advance- 
ment of  scientific  medicine  and  the  medical  pro- 
fession as  a whole. 


It  has  been  said  on  numerous  occasions  that  any 
organization  is  as  active  and  as  strong  as  its 
leaders.  This  is  but  partially  true.  No  organiza- 
tion can  expect  to  function  with  a maximum  de- 
gree of  efficiency  and  effectiveness  unless  there  is 
100  per  cent  cooperation  and  interest  on  the  part 
of  its  members. 

However,  it  must  be  admitted  that  much  which 
an  organization  is  capable  of  accomplishing  de- 
pends on  its  leadership. 

Medical  organization  in  Ohio  is  confronted  with 
numerous  vital  problems,  affecting  in  many  ways 
the  practice  of  medicme  and  the  medical  profes- 
sion, collectively  and  individually,  as  it  faces  the 
future.  There  dare  not  be  one  weak  chain  in  the 
link.  Every  county  medical  society  and  academy 
of  medicine  must  function,  and  function  effec- 
tively. The  State  Association  cannot  do  so  with- 
out the  united  support  and  cooperation  of  its 
component  units. 

As  stated  before,  a county  medical  society  can- 
not wield  much  influence  or  achieve  those  things 
which  it  is  capable  of  achieving,  if  its  leaders 
fail,  either  to  perform  the  specific  tasks  allotted 
to  them  or  to  stimulate  among  their  memberships 
a desire  for  enthusiastic,  cooperative  and  united 
activity  in  the  program  of  organized  medicine. 

Election  to  any  one  of  the  various  offices  in 
his  local  medical  society  is  an  honor  of  which  any 
physician  may  well  be  proud.  However,  there  is 
more  to  be  considered.  Every  officer  must  realize 
that  he  was  elevated  to  office  for  the  very  definite 
purpose  of  using  his  exper'ence  and  knowledge  in 
promoting  the  interests  of  his  professional  broth- 
ers and  the  profession  as  a whole. 

The  officers  and  members  of  every  county  so- 
ciety and  academy  must  roll  up  their  sleeves  and 
get  to  work.  Sentiment  and  inactivity  will  not 
solve  the  questions  confronting  the  profession. 
Hard  work,  cooperation,  united  activity  and 
loyalty  to  the  policies  and  principles  of  medical 
organization  and  the  medical  profession  may. 


Strong  and  active  leadership  will  make  accom- 
plishment possible. 


Preliminary  arrangements  are  rapidly  being 
completed  for  the  87th  Annual  Meeting  of  the 
Ohio  State  Medical  Association  to  be  held  in 


Animal  Meeting 
Plans  Progress 

of  Dr.  H.  S.  Davidson, 
M.  Huston,  Dayton,  an< 
Philadelphia. 


Akron,  May  2 
under  the  general  di- 
rection of  the  Council 
Committee  on  Ar- 
rangements, consisting 
Akron,  chairman,  Dr.  E. 
Dr.  E.  B.  Shanley,  New 


Personnel  of  the  various  Akron  committees  to 
handle  local  details  and  arrangements  for  the 
meeting  is  now  being  selected  by  Dr.  J.  H.  Selby, 
president  of  the  Summit  County  Medical  Society. 
In  the  near  future  these  committees  will  begin 
functioning  under  the  direction  of  Dr.  E.  A. 
Weeks,  Akron,  who  has  been  appointed  general 
chairman  of  the  local  committees. 


Special  emphasis  is  being  placed  at  present  on 
completion  of  the  program  for  the  annual  'gather- 
ing. For  the  past  four  or  five  months,  the  Council 
Program  Committee,  consisting  of  Dr.  C.  L.  Cum- 
mer, Cleveland,  chairman,  Dr.  B.  J.  Hein,  Toledo, 
and  Dr.  E.  R.  Brush,  Zanesville,  has  been  work- 
ing diligently  in  cooperation  with  the  officers  of 
the  various  scientific  sections  to  assemble  a pro- 
gram for  the  Akron  meeting  which  promises  to 
be  one  of  the  most  interesting  and  attractive,  as 
well  as  best-balanced,  ever  presented  before  the 
State  Association. 


A number  of  innovations  in  the  program  have 
been  suggested  by  the  Program  Committee  and 
approved  by  the  Council,  the  principal  one  being 
the  scheduling  of  only  one  session  for  each  of  the 
six  scientific  sections — on  the  afternoon  of  the 
first  day,  May  2 — and  the  addition  of  one  general 
scientific  section — on  the  morning  of  the  second 
day,  May  3. 

Additional  information  on  all  phases  of  the 
Akron  meeting  will  be  published  in  later  issues  of 
The  Journal,  including,  of  course,  the  complete 
official  program  for  the  two-days  meeting  in  the 
April  issue. 

It  is  important  that  members  of  the  State  Asso- 
ciation begin  making  plans  now  to  attend  the 
Akron  meeting.  No  gathering  of  the  medical  pro- 
fession of  Ohio  to  be  held  during  the  year  will 
offer  a better  opportunity  for  review,  study  and 
discussion  of  the  many  vital  issues  confronting 
the  profession.  The  Akron  meeting  should  be  re- 
garded as  a chance  for  each  physician  to  improve 
his  knowledge,  renew  old  friendships  and  mak? 
new  ones,  refresh  his  memory  regarding  im- 
portant problems  affecting  public  health,  scientific 
medicine  and  medical  practice,  and  demonstrate 
his  active  and  cooperative  interest  in  the  program 
and  principles  of  organized  medicine.  The  pro- 


92 


The  Ohio  State  Medical  Journal 


February,  1933 


fession  must  face  the  future  with  united  ranks 
and  with  a concerted  viewpoint  regarding  serious - 
questions  that  have  arisen  during  the  past  year. 
No  better  time  and  place  for  crystallizing  our 
views  and  efforts  will  be  afforded  during  the  en- 
suing year  than  May  2 and  3 at  Akron. 


on 


To  those  wishing  to  know  what  some  of  the 
leaders  in  industry  and  business  think  about  the 
recently  issued  report  of  the  Committee  on  the 

Costs  of  Medical 
Care,  we  recom- 
mend the  following 
comment  on  the 
Cost  Report  subject  by  Merle 

Thorp,  editor  of 
Nation’s  Business,  official  publication  of  the 
Chamber  of  Commerce  of  the  United  States,  and 
one  of  the  best  informed  authorities  of  the  day 
on  social,  economic,  governmental  and  political 
trends  and  developments. 

Writing  in  the  January,  1933,  issue  of  Nation’s 
Business,  Mr.  Thorpe  declared: 


“It  is  a thankless  task  to  criticise  the  labors  of 
the  Committee  on  the  Costs  of  Medical  Care 
headed  by  Secretary-Doctor  Wilbur  of  the  De- 
partment of  Interior. 

“The  descent  into  paternalism  and  from  pa- 
ternalism into  socialism  is  easy — and  doubly  easy 
when  the  way  is  greased  by  sentiment,  by  the 
desire  to  better  the  health  of  the  community,  by 
sympathy  for  suffering,  by  the  knowledge  that 
costs  of  medical  care  fall  with  crushing  effect  on 
the  overalled  and  white  collared  poor. 


“The  Committee  would  have  medical  service 
provided  largely  by  ‘organized  groups,’  an  exten- 
sion of  the  already  increasing  method  of  practice 
through  clinics. 

“How  pay  for  this  group  service? 

“Here’s  part  of  the  Committee’s  recom- 
mendations: 


“1.  Voluntary  cooperative  health  insurance,  in 
which  organized  groups  of  consumers  unite  in 
paying  into  a common  fund  agreed  annual  sums, 
in  weekly  or  monthly  installments.  . . . 

“2.  Required  health  insurance  for  low-income 
groups.  . , . 

“3.  Aid  by  local  governments  for  health  insur- 
ance. Part  of  the  people,  because  of  their  low  in- 
come, cannot  pay,  even  on  a periodic  basis,  the 
full  cost  of  complete  service  in  cases  where  the 
community  relies  for  the  provision  of  medical 
service  primarily  upon  the  purchase  by  its  people 
of  voluntary  health  insurance.  Such  communities 
may  well  use  tax  funds  to  the  extent  necessary  to 
supplement  the  payments  of  these  low-income 
families.  When  health  insurance  is  required  by 
law,  it  may  also  be  necessary  and  desirable  that 
a contribution  be  made  from  government  funds. 

“The  socialism  of  medicine  is  but  a step  to- 
ward the  socialization  of  industry. 

“To  tax  A to  pay  B’s  doctor’s  bill  is  an  appeal- 


ing plan  particularly  when  we  put  in  on  the 
ground  of  conserving  public  health. 

‘But  why  not  then  tax  A to  pay  B’s  food  bill 
since  it  is  nutrition  that  is  essential  to  health? 

“It  is  comforting  to  know  that  the  doctors 
themselves  are  in  revolt  at  the  Wilbur  repoi’t.” 

It  might  well  be  added  that  it  is  interesting  to 
doctors  to  know  that  those  in  other  professional 
and  business  pursuits  do  not  find  the  majority  re- 
port of  the  Committee  on  the  Costs  of  Medical 
Care  wholly  acceptable. 


It  has  been  estimated  by  those  in  a position  to 
know  that  approximately  $500,000,000  in  Christ- 
mas Club  savings  were  distributed  by  the  banks 
of  the  country  shortly  before 
the  recent  holiday  season. 

Much  of  this  substantial  sum, 
undoubtedly,  was  used  to  fill 
Christmas  stockings  and  for 
holiday  festivities.  Some,  no 
doubt,  was  used  for  the  payment  of  year-end 
obligations. 

It  would  be  interesting  to  know  what  portion 
was  used  for  the  payment  of  those  obligations 
which  in  the  aggregate  make  up  the  nation’s  bill 
for  the  costs  of  illness.  One  may  well  hazard  the 
guess  that  only  a small  part  was  used  in  this 
manner,  probably  for  the  reason  that  it  was  not 
saved  with  that  in  mind. 

None  can  criticize  the  Christmas  Savings  Club 
idea.  It  is  a laudable  function  performed  by  the 
modern  bank.  It  provides  a plan  for  steady  sav- 
ings throughout  the  year.  The  contributor  does 
not  miss  the  small  sums  saved  each  week  which 
bring  joy  and  comfort  later  on.  Banks  have 
popularized  the  idea  until  it  has  become  a na- 
tional institution. 

Why  should  not  some  similar  plan  be  promoted 
for  the  specific  purpose  of  providing  a way  for 
the  individual  in  moderate  circumstances  to  ac- 
cumulate funds,  by  regular  savings,  to  be  used 
for  the  payment  of  medical,  hospital  and  nursing 
bills?  The  idea  is  not  unique  and  with  their  ex- 
perience in  the  Christmas  Club  movement,  banks 
would  be  fortified  to  handle  such  a plan  in  an 
efficient  way.  In  one  Western  city,  a thrift  sav- 
ings plan  whereby  taxpayers  can  accumulate  sums 
sufficient  to  pay  their  taxes  has  been  inaugurated. 
Savings  plans  for  various  other  purposes  have 
been  popularized  in  other  localities.  Why  not  one 
for  health  and  sickness? 

The  banking  interests  could  aid  materially  in 
partially  solving  an  economic  problem  of  con- 
siderable importance  to  the  public  generally  by 
giving  this  question  serious  consideration,  espe- 
cially when  normalcy  returns.  A suggestion  by 
the  medical  profession  in  various  communities  to 
local  bank  officials  might  be  instrumental  in 
starting  the  ball  rolling. 


Saving 

for 

Sickness 


Stanley  E.  Dorst,  A.B.,  M.D.,  Cincinnati,  Ohio 


SIX  years  ago  I read  a paper  before  the  medi- 
cal section  of  this  organization  which  pled 
for  a reconsideration  of  the  value  of  vaccine 
therapy,  asking  that  we  might  re-open  the  case, 
as  it  were,  and  forcasting  an  early  awakening  to 
the  fact  that  it  had  received  a mis-trial. 

It  is  neither  natural  modesty  nor  the  wish  to 
exaggerate  for  emphasis  which  compels  me  to  say 
that  this  paper  was  not  received  with  enthusiasm. 
I distinctly  recall  that  the  principal  discussant  in 
commenting  upon  my  remarks  could  find  it  pos- 
sible to  congratulate  me  only  upon  my  temerity 
in  daring  to  act  the  champion  for  such  a dis- 
reputable cause. 

My  enthusiasm  of  six  years  ago  had  been  the 
result  of  a two-years’  study  and  investigation  in 
an  effort  to  elaborate  what  was  at  that  time  the 
usually  accepted  routine  in  vaccine  therapy.  The 
subsequent  six  years  have  been  largely  spent  in 
the  further  study  of  this  problem  and  I am  today 
more  certain  than  ever  that  the  use  of  bacterial 
antigens  in  the  treatment  of  disease  must  come 
to  play  an  increasingly  important  part  in  the 
therapy  of  the  future.  It  seems  fair  to  claim  that 
my  forecast  of  awakened  interest  has,  in  part, 
been  fulfilled,  for  at  that  time  Dr.  Wm.  Wherry 
and  I seemed  to  be  among  the  few  advocates  for  a 
new  point  of  view.  Even  a superficial  review  of 
the  medical  literature  for  the  intervening  years 
reveals  a growing  interest  which  has  culminated 
in  a number  of  excellent  papers  whose  prototype 
will  be  sought  in  vain  in  the  literature  of  the 
previous  decade.  True,  the  methods  and  conclus- 
ions of  these  investigations  vary  widely  but  we 
find  one  motif  common  to  all.  They  are  unani- 
mous in  the  opinion  that  vaccine  therapy  and  its 
possible  development  has  been  distinctly  under- 
rated. The  very  fact  that  I have  been  asked  to 
address  this  general  assembly  on  such  a subject 
indicates,  to  me  at  least,  a changing  point  of 
view. 

It  must  be  freely  admitted  that  biological 
therapy  occupies  a curious  position  in  the  field  of 
medical  therapeutics  at  the  present  time.  Thirty 
years  ago  it  was  acclaimed  the  culminating 
achievement  of  a century  during  which  the  art  of 
medicine  stood  aside  and  watched  science  advance 
with  a rush  of  accomplishments  which  forced  the 
labor  of  many  past  centuries  into  the  misty 
shadows  of  metaphysics.  It  was  especially  that 
part  of  biological  therapy  which  dealt  with  vac- 
cines both  in  prophylaxis  and  treatment  which 
appeared  to  hold  the  most  promising  possibilities 
in  the  conquest  of  disease. 


Read  before  the  Third  General  Session,  Ohio  State  Medi- 

cal Association,  at  the  86th  Annual  Meeting,  Dayton,  May 

3 and  4,  1932. 

Department  of  Internal  Medicine  and  Louis  Kuhn  Diag- 
nostic Laboratory,  University  of  Cincinnati. 


After  thirty  years  what  has  come  of  those 
bright  visions?  We  ask  the  practical  man  of 
medicine  what  he  thinks  of  vaccine  therapy  and 
we  find  that  he  thinks  very  little  of  it — if,  indeed, 
he  thinks  of  it  at  all.  One  seems  to  sense  the 
opinion  that  vaccines  have  been  created  by 
avaricious  commercial  houses  to  delude  the  honest 
practitioner  of  the  art  of  medicine.  Such  a state- 
ment is  not  exaggerated  and  is  borne  out  by  the 
result  of  a survey  made  by  Ludwig  Hecktoen  in 
19291 *,  which  shows  conclusively  that  the  great 
majority  of  physicians  disfavor  vaccine  therapy 
of  any  sort.  He  gives  the  results  of  a question- 
naire i-eceived  from  1261  physicians.  It  is  a long 
questionnaire  but  the  answers  can  be  condensed 
into  this  striking  statement.  Of  the  1261  doctors 
canvassed  only  17  favored  the  use  of  vaccine 
therapy  at  all.  In  the  words  of  our  high  pres- 
sure advertisers — can  1200  doctors  be  wrong?  We 
believe  the  answer  is  yes  and  no.  They  certainly 
were  not  wrong  in  concluding  that  vaccine 
therapy  as  they  knew  it  had  failed  to  give  satis- 
factory results  but  they  were  wrong  in  assuming 
that  it  had  received  a fair  trial. 

To  justify  such  a statement  it  is  necessary  to 
review  hurriedly  certain  developments  belonging 
to  the  period  of  1900  to  1920.  The  practical  use  of 
bacterial  vaccines  is  the  acknowledged  outgrowth 
of  the  careful  investigations  of  Sir  A.  E.  Wright3. 
He  was  responsible  for  the  detailed  elaboration  of 
Metchnikoff’s  phagocytic  theory  which  held  that 
the  outcome  of  any  infection  depended  upon  the 
success  or  failure  of  the  phagocytes  to  ingest  and 
destroy  the  invading  organism.  Wright  demon- 
strated a direct  dependence  of  phagocytosis  upon 
a substance  in  the  immune  serum  and  proved  that 
some  factor  in  the  serum  component  acted  upon 
the  bacteria  directly,  was  bound  by  the  bacteria 
and  rendered  them  subject  to  phagocytosis.  This 
substance  was  named  opsonin  by  Wrigbt  and  he 
showed  that  the  opsonin  index  for  certain  organ- 
isms could  be  specifically  increased  by  active  im- 
munization with  dead  bacteria.  Wright’s  early 
efforts  were  directed  toward  the  control  of  typhoid 
fever.  The  dramatic  results  of  this  wo  rk  were 
responsible  for  the  early  enthusiasm  for  vaccine 
prophylaxis  and  it  was  quite  natural  that  the  day 
was  anticipated  when  similar  prophylaxis  might 
be  obtained  against  all  diseases  whose  causative 
agents  were  known.  The  failure  to  extend  the 
principle  over  such  a wide  field  was  largely  re- 
sponsible for  the  waning  of  this  early  enthusiasm. 

By  1902,  Wright  was  tremendously  interested 
in  introducing  the  use  of  bacterial  vaccines  into 
the  field  of  treatment  and  developed  a rather  elab- 
orate method  for  the  preparation  of  autogenous 
antigens  based  upon  the  determination  of  specific 
opsonic  indices.  This  work  was  carefully  done  and 


93 


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The  Ohio  State  Medical  Journal 


February,  1933 


was  summarized  by  Bullock  in  190  53,  who  con- 
cluded: ‘The  therapeutic  value  of  such  vaccine 
treatment  as  that  advocated  by  Wright  is  easy 
of  demonstration.  The  rational  explanation  of  the 
results  is  not  so  clear.  It  is  an  apparent  paradox 
that  an  individual  may  suffer  from  a staphylo- 
coccus furunculosis  for  months,  and  yet  the  intro- 
duction into  his  subcutaneous  tissue,  of  a small 
quantity  of  the  very  coccus  which  has  been  the 
cause  of  his  trouble,  may  bring  about  a disap- 
pearance of  already  existing  boils  and  preven- 
tion of  others  which,  according  to  all  clinical  evi- 
dence, would  have  occurred”.  Bullock  found  that 
a greater  number  of  inoculations  were  required  to 
effect  a cure  than  had  Wright  but  unfortunately 
this  suggestion  did  not  find  its  way  into  practice. 
The  paradox  he  pointed  out  still  troubles  us  today. 

It  is  quite  likely  that  the  subsequent  history  of 
vaccine  therapy  would  have  been  vastly  different 
had  the  careful  development  of  Wright’s  ideas 
been  continued.  He  was  interested  in  the  thera- 
peutic effect  of  bacterial  antigens  when  the  auto- 
genous strains  were  employed  and  these  selected 
and  controlled  in  a fairly  specific  manner.  It  is 
true  that  Wright  overstressed  the  significance  of 
the  opsonic  index  and  we  are  now  quite  certain 
that  phagocytosis  is  not  the  most  important  fac- 
tor in  successful  vaccine  therapy.  Nevertheless, 
carefully  directed  work  of  the  type  Wright  had 
instituted  was  absolutely  necessary  and  we  came 
to  grief  when  a “rule  of  thumb”  method  was 
adapted  to  a theory  of  treatment  which  was  still 
in  its  infancy. 

In  1908,  Mathews4  of  St.  Marys  Hospital,  Lon- 
don, suggested  that,  for  practical  purposes,  too 
much  time  was  involved  in  the  determination  of 
opsonic  indices.  In  order  to  shorten  and  simplify 
the  procedure  he  dispensed  with  any  effort  to 
select  specific  strains,  discontinued  the  use  of 
autogenous  antigens  entirely  and  in  brief  intro- 
duced the  “stock”  vaccine  into  treatment.  The 
downfall  of  vaccine  thei’apy  began  with  this  pro- 
cedure. Mathews  saved  time  but  he  almost  de- 
stroyed the  practice  of  using  vaccines  as  thera- 
peutic agents.  This  need  not  surprise  us  for  the 
methods  of  Wright  were  un wieldly;  hospital 
laboratories  equipped  to  carry  out  such  bacteri- 
ological studies  were  few  in  number,  and  we  can 
readily  understand  why  Mathews  hoped  to  de- 
velop a method  with  wider  application.  The  use 
of  stock  vaccines  in  the  succeeding  years  was 
vigorously  exploited.  The  preparation  of  such 
antigens  was  commercialized  and  these  were  used 
in  a most  indiscriminate  fashion,  until  the  whole 
business  fell  into  bad  favor,  as  so  distinctly 
shown  by  the  answers  to  Hektoen’s  questionnaire. 

In  retrospect  we  can  indicate  certain  factors 
which  contributed  heavily  to  this  result:  First 

the  lack  of  any  method  of  specific  selection; 
second,  the  substitution  of  stock  antigens  for 
autogenous  strains;  and  third,  the  practice  of 


using  massive  doses  over  a short  time-interval  in 
treatment.  Had  specifically  selected  autogenous 
strains  been  used  the  results  would  still  have  been 
vitiated  as  long  as  massive  doses  were  employed 
for  therapeutic  effect.  Wright  and  his  immediate 
successors  were  so  influenced  by  the  brilliant  re- 
sults achieved  in  the  prevention  of  typhoid  that 
they  continued  to  use  the  large  prophylactic  doses 
in  the  treatment  of  actual  infection.  In  other 
words,  they  failed  to  differentiate  between  the 
immunization  of  a healthy  person  against  a 
specific  disease  and  the  desensitization  of  an 
already  infected  individual.  I shall  hope  to  show 
that  this  difference  is  one  of  considerable  prac- 
tical importance. 

From  1907  to  1925  we  find  the  problem  of 
biological  therapy  immersed  in  that  sea  of  con- 
flicting names  and  ideas  which  remain  our  tan- 
gible evidence  of  the  labor  pains  responsible  for 
the  birth  of  immunology.  I shall  not  attempt  to 
lead  you  through  that  chaotic  labyrinth  for  the 
blind  cannot  lead  the  blind.  Out  of  that  turmoil 
have  come  certain  concepts  which  have  proved  to 
be  of  great  value  in  the  development  of  biological 
therapy  and  these  must  be  mentioned.  The  re- 
lationship between  serum  anaphylaxis  and  bac- 
terial anaphylaxis  was  carefully  studied  by  Zin- 
ser  and  Parker',  who  came  to  the  conclusion  that 
the  two  were  analogous.  This  conclusion  sug- 
gested the  idea  of  the  probable  allergic  nature  of 
infectious  diseases.  Some  have  gone  so  far  as  to 
state  that  no  organism  can  invade  the  human  host 
unless  his  tissues  have  been  first  sensitized  to  that 
specific  strain.  Whether  or  not  such  an  hypothesis 
will  hold  we  cannot  say  at  the  present  time  but 
the  concept  of  tissue  sensitivity  in  relation  to 
bacterial  invasion  has  been  of  first  importance  in 
the  development  of  our  theory  of  treatment. 

During  that  period  when  the  nature  of  allergic 
reactions  to  such  substances  as  pollens,  foods  and 
animal  extracts  was  being  intensively  investi- 
gated it  was  to  be  expected  that  extracts  of 
bacteria  would  be  similarly  studied.  We  may 
criticise  these  investigations  by  saying  again 
that  the  failure  to  deal  with  specific  autogenous 
strains  led  to  unfortunate  conclusions.  Dried  ex- 
tracts of  stock  bacteria  were  employed  similar  to 
the  extracts  of  foods  and  pollens.  This  postulates 
an  analogy  which  is  not  permissible.  While  the 
chemical  extracts  of  wheat  and  rag  weed  are  un- 
doubtedly substances  of  constant  composition  as 
long  as  the  same  method  of  extraction  is  em- 
ployed, this  cannot  be  said  of  bacteria.  A dried 
extract  of  a stock  strain  of  streptococcus  will  not 
answer  when  we  attempt  to  determine  sensitivity 
to  a spec'fic  streptococcus  invasion  for  the 
streptococci  are  a large  family  and  we  have  re- 
peatedly demonstrated  marked  sensitivity  to  the 
killed  bodies  of  a specific  strain  of  organism  when 
the  skin  tests  with  stock  extracts  were  negative. 

Wherry  ' and  Thomas1  were  the  first  to  demon- 


February,  1933 


Vaccine  Therapy — Dorst 


95 


strate  the  effectiveness  of  skin  reactions  to  speci- 
fic autogenous  strains  in  selecting  antigens  for 
vaccines.  They  have  given  us  a method  which  is 
superior  to  Wright’s  opsonic  index  and  which  is 
much  more  simple.  I believe  this  to  be  the  most 
important  advance  in  the  development  of  vaccine 
therapy  since  the  work  of  Wright.  Wherry’s 
hypothesis  is  so  interesting  that  it  merits  a brief 
review.  The  human  host  he  considers  as  a cylinder 
covered  entirely  by  skin  and  mucous  membranes 
and  any  parasite  entering  the  body  must  pass 
these  barriers.  So  far  as  the  parasite  is  con- 
cerned it  must  be  possessed  of  ferments  which  will 
enable  it  to  use  the  sources  of  carbon  and  nitrogen 
furnished  by  the  host  and  it  must  have  a type  of 
respiration  which  will  enable  it  to  survive  in  the 
relatively  low  tension  of  oxygen  found  in  the  tis- 
sues. Further,  it  must  either  find  the  food  sub- 
stances in  solution,  as  after  trauma,  or  be  pro- 
vided with  a mechanism  which  will  enable  it  to 
free  water  in  the  tissues  and  so  bring  about  a 
solution  of  the  food  substances  for  under  normal 
conditions  the  cells  of  the  host  are  composed 
largely  of  emulsion  colloids  and  contain  little  or 
no  free  water. 

As  I have  pointed  out  in  a previous  paper8  this 
theory  of  Wherry’s  seems  exceedingly  apt.  It  can 
be  readily  shown  that  bacteria  cannot  utilize  foods 
unless  they  are  in  solution.  This  fact  is  of  great 
importance  and  can  be  demonstrated  by  growing 
organisms  on  a colloidal  nutrient  material  cap- 
able of  holding  increasing  quantities  of  water,  like 
agar-agar.  Bacteria  will  grow  only  in  concen- 
trations holding  free  water.  In  3 per  cent  agar 
growth  is  retarded  and  at  5 to  8 per  cent  it  dis- 
appears while  it  is  most  luxuriant  in  % to  1 per 
cent  agar.  An  interesting  analogy  is  found  in  the 
fact  that  those  bacteria  which  are  able  to  produce 
an  extensive  local  edema  are  the  ones  which 
spread  most  rapidly  in  tissues,  e.g.,  B.  pestis,  B. 
Welchi,  streptococci,  etc.  The  mechanism  by 
which  these  bacteria  produce  the  hydration  of  the 
tissues  is  not  known  but  Wherry  believes  that  ihe 
toxic  substances  are  probably  of  such  a nature 
that  the  ferments  are  able  to  split  them  into 
amines  which  in  turn  produce  the  edema. 

When  one  injects  the  bodies  of  dead  bacteria 
into  the  skin  of  a human  being  one  of  three 
things  may  happen.  There  may  follow  the  ab- 
sorption of  the  material  without  any  immediate 
or  delayed  reaction  and  we  take  this  to  indicate 
resistance  or  immunity  to  the  given  strain. 
There  may,  on  the  other  hand,  be  an  immediate 
local  reaction  in  the  nature  of  an  urticarial  wheal 
with  a surrounding  halo  of  edema.  This,  we  be- 
lieve, means  that  the  organism  is  capable  of 
freeing  water  in  the  tissues  of  the  body  either  by 
its  own  direct  action  or  by  the  action  of  the  body 
ferments  on  its  protein  and  it  is  therefore  cap- 
able of  invading  the  individual.  It  indicates  sus- 
ceptibility but  does  not  necessarily  imply  that  the 


germ  has  already  infected  the  subject.  When, 
however,  the  initial  reaction  becomes  exaggerated 
and  24  hours  later  the  site  of  the  injection  be- 
comes very  red  and  edematous  we  interpret  this 
reaction  to  indicate  sensitivity. 

Such  a reaction  means  that  the  patient  has 
been  infected  by  the  specific  strain  and  is  still 
sensitive  to  it.  For  six  years  we  have  been  using 
this  24  hour  reaction  to  indicate  sensitivity  when 
attempting  to  select  antigens  from  a mixed  flora 
and  have  employed  it  in  hundreds  of  cases.  We 
are  firmly  convinced  that  autogenous  vaccines 
composed  of  antigens  selected  on  the  basis  of 
positive  skin  reactions  are  of  distinct  value  in 
the  treatment  of  such  diseases  as  bacterial 
asthma,  angio-neurotic  edema,  chronic  sinusitis, 
non-ulcerative  colitis  and  certain  types  of 
arthritis.  We  have  studied  the  problem  of  bac- 
terial sensitization  in  a large  series  of  such  cases 
and  during  the  period  of  desensitization  have 
watched  the  signs  of  clinical  improvement  paral- 
lel the  disappearance  of  skin  reactions9’  A 

We  have  already  suggested  that  the  error  in 
Wright’s  earlier  method  of  using  massive  doses  of 
vaccine  in  treatment  was  a most  significant  one. 
We  may  state  our  contentions  very  briefly.  Im- 
munization of  an  uninfected  individual  to  certain 
specific  oi’ganisms  may  be  accomplished  with  mas- 
sive doses  in  a short  time  but  the  desensitization 
of  an  infected  individual  must  be  carried  out  very 
slowly  using  small  doses  of  antigens  over  weeks 
and  even  months.  And  I will  answer  your  im- 
mediate objection  flatly  by  saying  that  we  have 
not  found  such  a procedure  impracticable. 

The  use  of  massive  doses  of  vaccine  in  treat- 
ment was  responsible  for  a peculiar  clouding  of 
the  issue  since  the  many  favorable  results  re- 
ported when  using  this  method  were  probably  the 
result  of  non-specific  protein  shock.  Indeed,  some 
writers  went  so  far  as  to  state  that  the  only  good 
which  came  out  of  vaccine  therapy  was  due  to  the 
reaction  to  foreign  protein.  We  believe  it  quite 
possible  that  any  good  resulting  from  the  mas- 
sive injection  of  stock  vaccines  may  well  have 
been  the  result  of  protein  reaction  and  we  con- 
sider this  method  dangerous  for  we  have  seen  it 
followed  by  frequent  severe  reactions  and  even 
the  sensitization  of  individuals  to  previously  in- 
nocuous strains  with  the  subsequent  development 
of  asthma,  arthritis,  etc. 

No  one  who  has  watched  the  two  methods  in 
similar  cases  can  possibly  confuse  the  temporary 
protein  reaction  with  the  progressive  desensitiza- 
tion of  individuals  susceptible  to  specific  strains. 
We  use  every  care  to  prevent  marked  local  or 
focal  reactions  for  we  find  that  they  interfere 
with  the  process  of  desensitization  and  frequently 
set  us  back  for  days  or  weeks.  Employing  a dilute 
suspension  of  the  selected  antigens  we  begin  with 
a half  minim  dose  and  if  a sharp  local  reaction 
follows  we  further  dilute  the  vaccine,  taking  the 


96 


The  Ohio  State  Medical  Journal 


February,  1933 


local  reaction  rather  than  the  bacterial  count  as 
our  index  of  density.  The  half  minim  dose  is 
given  on  alternate  days  for  four  to  six  doses  and 
then  increased  to  one  minim.  From  this  point  the 
dosage  is  increased  slowly,  keeping  always  within 
that  quantity  which  produced  a marked  local  re- 
action. The  vaccine  must  be  given  for  three  to 
six  months  if  we  are  to  achieve  desensitization 
with  a disappearance  of  the  skin  reaction,  but 
clinical  improvement  is  usually  more  rapid.  We 
would  emphasize  the  factor  of  haste  as  the  most 
detrimental  influence  in  vaccine  therapy  and  re- 
state that  the  desensitization  of  a sensitized  and 
infected  individual  cannot  be  accomplished  rapidly 
by  any  known  method. 

In  stressing  the  importance  of  avoiding  severe 
reactions  we  come  to  the  third  innovation  in 
modern  vaccine  therapy — the  use  of  detoxified 
vaccines.  When  dealing  with  very  highly  sen- 
sitized individuals  we  have  repeatedly  experienced 
great  difficulty  in  advancing  the  dose  beyond  a 
very  small  quantity,  for  instance,  one  minim  of  a 
dilute  solution.  A larger  dose  would  invariably 
be  followed  by  a sharp  local  and  focal  reaction 
and  we  have  learned  that  these  must  be  avoided. 
Such  minute  doses  will  not  introduce  a sufficient 
quantity  of  antigen  and  desensitization  lags  in  a 
discouraging  manner.  The  solution  appeared  to 
lie  in  the  discovery  of  some  method  of  treating 
the  suspension  of  bacteria  which  would  reduce  its 
toxicity  without  interfering  with  antigenic 
properties. 

Ramon13  was  the  first  to  suggest  a method  which 
consisted  in  treating  the  suspended  organisms 
with  formalin.  He  achieved  a certain  degree  of 
detoxification  for  a limited  number  of  strains — 
too  limited,  however,  for  general  use.  Later 
Wherry  showed  that  peroxide  of  hydrogen  had 
distinct  value  in  detoxifying  the  gram  positive 
cocci  and  about  the  same  time  Larson14  used 
sodium  ricinoleate  for  the  purpose  of  detoxifying 
diphtheria  toxin.  We  extended  the  use  of  sodium 
ricinoleate9  to  find  it  the  most  potent  agent  in 
the  detoxification  of  bacterial  antigens  we  had 
yet  investigated  and  have  used  it  extensively. 
Many  antigens,  whose  toxicity  made  therapeutic 
use  impossible,  after  treatment  with  sodium 
ricinoleate  can  usually  be  given  without  undue 
reaction  and  their  antigenic  power  is  unimpaired. 
My  colleague,  Dr.  Lee  Foshay,  has  carried  the  in- 
vestigation of  detoxifying  agents  further  and  has 
added  nascent  nitrous  acid  and  ui’ea  to  the  list. 
We  are  eagerly  awaiting  the  outcome  of  his  ex- 
periments with  these  chemicals. 

In  concluding  I would  like  to  restate  the  plea 
included  in  my  first  paragraph,  asking  for  a 
careful  reconsideration  of  the  entire  problem  of 
vaccine  therapy.  When  a therapeutic  method  has 
fallen  into  disfavor  with  the  profession  at  large 
it  is  difficult  to  keep  an  open  mind.  When  such  a 
method  is  as  technical  and  involved  as  the  one  we 


have  been  discussing,  fair  criticism  is  often  lack- 
ing and  ex-cathedra  judgment  frequently  sub- 
stituted in  its  place.  Certain  principles  which  I 
have  outlined  seem  to  me  of  first  importance  if 
vaccine  therapy  is  to  be  at  all  adequate.  They 
include,  if  I may  repeat  once  more: 

a.  The  use  of  autogenous  antigens. 

b.  The  selections  of  such  antigens  on  the  basis 
of  specific  intradermal  reactions. 

c.  The  use  of  the  desensitization  method  in 
treatment. 

d.  The  detoxification  of  antigens  to  which  the 
patient  is  very  highly  sensitized. 

REFERENCES 

1.  Hecktoen,  Ludwig  and  Irons,  J.A.M.A.,  92:864,  1929. 

2.  Wright,  A.  E.,  Series  of  Publications  Appearing  in 
The  Lancet,  London  and  the  Brit.  Med.  Jour.,  1900  to  1907. 

3.  Bullock,  W.  M.,  Practitioner,  London,  65:589,  1905. 

4.  Mathews,  J.,  Lancet,  London,  11  :925,  1908. 

5.  Zinser,  Hans  and  Parker,  Jr.  Exp.  Med.,  26:411,  1917. 

6.  Wherry,  W.  B.,  Jr.  Infect.  Diseases,  41 :177,  1927. 

7.  Thomas,  W.  S.,  and  Tourart,  M.D.,  Arch.  Int.  Med., 
34:79,  1924. 

8.  Dorst,  S.  E.  and  Wherry,  W.  B.,  Ohio  State  Med.  Jr., 
24:539,  1928. 

9.  Dorst,  S.  E.  and  Morris,  R.  S.,  Am.  Jr.  Med.  Sciences, 
180:650,  1930. 

10.  Morris,  R.  S.  and  Dorst,  S.  E.,  Ann.  Int.  Med., 
4:396,  1930. 

11.  Dorst.  S.  E.  and  Hopphan,  E.  L.,  Jr.  of  Lab.  and 
Clin.  Med.,  18:7,  1932. 

12.  Freiberg,  J.  A.  and  Dorst,  S.  E.,  Jr.  of  Lab.  and 
Clin.  Med.,  15:1109,  1930. 

13.  Ramon,  G.,  Bui.  Pasteur  Inst.,  30:15,  1932. 

14.  Larson,  W.  P.  and  Eden  H.,  Jr.  A.M.A.,  86:1000, 
1926. 


Infection  Following  Slight  Injuries  Takes 
Big  Toll 

The  percentage  of  injuries  to  Ohio  workers  de- 
veloping infection  in  1931  was  14.1  per  cent,  which 
is  a slight  increase  over  the  13.8  per  cent  shown  in 
the  1930  record,  the  Ohio  Industrial  Commission 
Monitor  points  out.  This  would  indicate  neglect 
some  place  along  the  line  in  the  attention  given  to 
first  aid  or  in  the  reporting  of  slight  injuries  by 
employees.  The  1931  percentage  looks  large  as 
compared  to  the  7.81  per  cent  of  infections  shown 
in  the  1931  report  of  the  Department  of  Labor  and 
Industry  of  Maine,  but  in  fact  it  simply  empha- 
sizes the  dangers  of  slight  injuries  occurring  in 
indoor  employment  as  compared  with  those  sus- 
tained by  workers  in  the  open,  which  represents  a 
considerable  proportion  of  the  industrial  activi- 
ties in  Maine.  Injuries  to  Ohio  workers  on  out- 
side jobs  develop  infection  very  infrequently  and 
this  only  serves  to  show  that  employees  in  mills 
and  factories  are  taking  needless  chances  of  in- 
fection in  neglecting  the  so-called  “trivial”  in- 
juries. A slight  splinter  wound  or  a mere  scratch 
is  potentially  a major  injury  and  if  neglected  will 
almost  invariably  result  in  infection.  Employers 
should  make  it  a point  to  frequently  stress  the 
infection  hazard  and  employees  should  seek  first 
aid  for  even  the  slightest  injury  if  future  distress- 
ing complications  are  to  be  avoided. 


A Survey  o£  1253  Consecutive  Deliveries 

C.  T.  Hemmings,  M.D.,  F.A.C.S.,  Cleveland,  Ohio 


THE  purpose  of  this  paper  is  two-fold.  Pri- 
marily, it  is  a departmental  survey.  Sec- 
ordinarily,  it  is  a study  from  the  experience 
of  one  institution  of  the  justice  of  assertions  re- 
cently made  by  lay  authors  in  books,  newspapers, 
and  magazines,  which  tend  to  undermine  con- 
fidence in  American  obstetrics. 

Popular  writers,  among  them  some  who  have 
done  much  to  enlighten  the  public  concerning  im- 
portant discoveries  and  improved  procedures, 
have  made  statements  derogatory  to  the  medical 
profession,  particularly  that  portion  of  it  that 
offers  obstetrical  services.  Civic  leaders,  too,  ad- 
dressing conferences  on  child  welfare,  frequently 
begin  their  observations  with  the  parents  and  em- 
phasize the  supreme  price  paid  by  the  American 
woman  in  bearing  children. 

Most  lay  writers  on  birth  control,  child  welfare, 
and  related  subjects  deal  in  some  fashion  with  an 
assumed  increasing  puerperal  mortality  in  this 
country.  Some  go  so  far  as  to  say  that  the 
United  States  ranks  fourteenth,  or  even  as  low  as 
twentieth  among  the  civilized  nations  of  the 
world.  Do  they  know  that  the  acknowledged  high 
puerperal  mortality  is  due,  not  to  anything  for 
which  the  physician  is  responsible,  but  rather  to 
the  rapid  increase  in  criminal  aboxTions?  In  this 
condition  death  is  the  direct  result  of  the  acts  of 
women  whose  welfare  has  not  been  controlled  or 
directed  by  a physician  skilled  in  obstetrical  px-o- 
cedure.  Little  consideration  is  given  to  the  fact 
that  in  a general  hospital  as  many  of  the  criminal 
abortions  ara  treated  in  surgical  departments  by 
men  who  are  not  specialists  in  this  field,  as  by 
those  who  are  thus  qualified.  Deaths  resulting 
from  this  cause  are  included  in  the  puerperal 
mortality  statistics  of  the  locality,  and  fingers  are 
scornfully  pointed  at  those  men  who  conscien- 
tiously and  scientifically  attend  women  in  mother- 
hood. 

Another  impression  that  lay  authors  are  in- 
clined to  leave  with  their  public  is  that  all  ma- 
ternal deaths  ax-e  the  result  of  delivei’ies  of  full 
term  babies.  As  a ixiatter  of  fact,  the  maternal 
death  rate  in  the  United  States  is  compiled  from 
all  deaths  occurring  in  the  puerperal  state,  which 
includes  the  thx-ee  stages,- — pregnancy,  parturi- 
tion, and  lactation.  In  the  maternal  death  rate 
ai'e  included  deaths  occurring  from  infected, 
spontaneous  abortions,  self-induced  and  criminal 
aboxfions,  ectopic  pi’egnancies,  and  other  path- 
ological phases  of  eai’ly  pregnancy.  Even  though 
these  cases  may  be  cared  for  and  tx-eated  in  sur- 
geries by  physicians  who  have  had  little  or  no 

Read  before  the  Section  on  Obstetrics  and  Pediatrics, 
Ohio  State  Medical  Association,  at  the  86th  Annual  Meeting, 
Dayton,  May  3-4,  1932. 

From  the  Division  of  Obstetrics,  St.  Luke’s  Hospital, 
Cleveland,  Ohio. 


ti’aining  or  experience  in  obstetrics,  the  ac- 
coucheur receives  the  bi-unt  of  the  abuse. 

Some  journalists  confine  their  attacks  to  less 
important  matters,  such  as  the  cost  of  matenxity 
care  and  exorbitant  obstetrical  fees.  One  of  the 
latest  of  these  is  one  wherein  the  author,  a promi- 
nent advocate  of  bix-th  control,  uses  the  high  rate 
of  puerperal  deaths  to  enhance  her  own  propa- 
ganda. The  purport  of  her  article  is  to  the  effect 
that,  if  every  woman  would  prevent  the  birth  of 
one  baby,  she  would  not  only  “break  the  backbone” 
of  the  depi’ession,  but  she  would  reduce  maternal 
mortality  as  well! 

Alludes  such  as  these  penetrate  the  mind  of 
the  public  and  directly  affect  the  work  of  the 
physician  who  attends  obstetrical  patients.  In 
fact  the  publicity  has  gone  so  far  as  to  assume 
the  proportions  of  propaganda.  As  an  Illinois 
physician  has  stated:  “These  articles  also  have  a 
tendency  to  undermine  the  confidence  that  the 
average  American  has  in  the  ability  .of  his 
physician.” 

The  writers  of  these  articles  are,  of  course,  not 
wholly  responsible,  but  certainly  they  are  pai’tly 
to  blame  for  the  far  too  prevalent  impression  that 
the  physicians  in  the  United  States  are  to  be  de- 
pended upon  less  than  those  in  certain  Eui’opean 
counti-ies.  Not  only  obstetricians  but  all  members 
of  the  medical  px-ofession  must  carry  the  re- 
sponsibility for  such  misstatements  and  misinter- 
pretations, until  they  have  made  every  effort  to 
px-esent  the  facts  to  the  public  in  a manner  that 
is  understandable  to  the  lay  mind. 

The  root  of  the  difficulty  seems  to  lie  in  the  use 
of  figui’es.  The  question  is:  Whence  do  the  sta- 
tistics come  which  are  used  by  lay  authors  in  this 
unfoi’tunate  manner?  Are  the  figures  correct? 
If  not,  can  correct  statistics  be  compiled  and 
broadcasted? 

A solution  of  the  problem  presented  by  these 
questions  may  be  attempted  in  thx-ee  ways: 

First ; by  improving  the  international  system 
for  standardizing  vital  statistics. 

Second;  by  investigating  our  own  methods  of 
prenatal,  natal,  and  postnatal  care. 

Third;  by  educating  women  in  regard  to  the  re- 
sponsibilities and  cai-e  of  motherhood,  and  assur- 
ing them  that,  as  the  years  progx-ess,  the  genei*al 
practitioner  and  the  obstetrician  are  better  px-e- 
pai-ed,  and  the  hospitals  are  better  equipped  to 
safeguard  prospective  mothers. 

Improved  standards  of  vital  statistics  are  the 
result  that  must  develop  out  of  the  l'equii-ements 
of  the  pi'ofession  and  out  of  the  experience  of 
members  of  the  various  national  bui-eaus.  The 
profession  should  require  of  itself,  individually 
and  collectively,  investigations  of  methods,  errors 
and  faults  in  order  that  constructive  ci’iticism 


97 


98 


The  Ohio  State  Medical  Journal 


February,  1933 


table  i 

DEPARTMENT  OF  COMMERCE,  BUREAU  OF  THE  CENSUS,  WASHINGTON 
Division  of  Vital  Statistics 

Assignment  by  the  United  States  and  Certain  Foreign  Countries  of  Cause  of  Death 
on  Identical  Copies  of  Selected  Death  Certificates,  1927,  on  which  one  or 
more  of  the  Causes  Stated  was  Puerperal  in  Nature. 


Country 

Total  copies 
of  selected 
certificates 

Stated  as 
puerperal 
without 
contribu- 
tory 
cause 

Tw< 

Total 

or  more  cau 
east  one  was 

Puerperal 

ses  give 
puerper* 

Rate 

n,  or  which  a 
al  in  nature 

Non 

puerperal 

t 

Rate 

Ratios  showing 
variations  in 
death  rates  for 
non  puerperal 
due  to  editing 
alone  (i) 

The  United  States____ 

1,073 

431 

642 

566 

88.2 

76 

11.8 

1.00 

Australia  

1,073 

431 

642 

564 

87.9 

78 

12.1 

1.03 

Canada  

1,073 

431 

642 

532 

82.9 

110 

17.1 

1.45 

Chile  

1,073 

431 

642 

518 

80.7 

124 

19.3 

1.63 

Czecho-Slovakia  

1,073 

431 

642 

470 

73.2 

172 

26.8 

2.26 

Denmark  ____  

1,073 

431 

642 

624 

97.2 

18 

2.8 

0.24 

England  & Wales  ..... 

1,073 

431 

642 

413 

64.3 

229 

35.7 

3.01 

Esthonia  

1,073 

431 

642 

427 

66.5 

215 

33.5 

2.83 

France  

1,073 

431 

642 

444 

69.2 

198 

30.8 

2.61 

Irish  Free  State 

1,073 

431 

642 

439 

68.4 

203 

31.6 

2.67 

Italy  

1,073 

431 

642 

540 

84.1 

102 

15.9 

1.34 

Netherlands  

1,073 

431 

642 

555 

86.4 

87 

13.6 

1.14 

New  Zealand 

1,073 

431 

642 

565 

88.0 

77 

12.0 

1.01 

Northern  Ireland 

1,073 

431 

642 

466 

72.6 

176 

27.4 

2.32 

Norway  

1,073 

431 

642 

407 

63.4 

235 

36.6 

3.09 

Scotland  

1,073 

431 

642 

559 

87.1 

83 

12.9 

1.09 

Sweden  

1,073 

431 

642 

429 

66.8 

213 

33.2 

2.80 

(i)  The  death  rate  for  United  States  is  used  as  the  base. 

No  replies  were  received  from  Belgium,  Finland,  Hungary,  Japan,  Lithuania,  Salvador.  Switzerland  and  Uruguay. 


may  begin  at  home.  If  each  hospital  of  sufficient 
size  would  annually  review  the  work  done  in  its 
obstetrical  department,  results,  which  would  be 
of  assistance  to  physicians  could  be  discussed  and 
published.  It  appears  that  if  this  were  done, 
those  interested  in  national  and  international 
scientific  welfare  studies  would  have  a firmer 
basis  upon  which  to  build  their  comparisons  and 
conclusions. 

A large  collection  of  summaries  from  many  hos- 
pitals in  this  country  would  soon  yield  an  accurate 
picture  of  the  work  done  in  American  institutions. 
Certainly  there  can  be  no  question  that  members 
of  the  profession  should  guard  their  comments 
and  criticisms  within  the  professional  circle,  be- 
cause their  statements  are  likely  to  be  used  by 
writers  and  speakers  who  understand  their  sig- 
nificance only  slightly. 

The  necessity  for  accuracy  of  statement  is  em- 
phasized by  the  experience  of  the  United  States 
Division  of  Vital  Statistics  as  shown  in  the  fol- 
lowing table.  In  1929  the  Division  issued  to  each 
of  seventeen  countries,  identical  copies  of  1073 
selected  death  certificates  on  which  one  or  more  of 
the  causes  stated  was  puerperal  in  nature.  Of 
these  only  431,  or  40  per  cent,  received  the  same 
interpretation,  being  listed  as  puerperal  without 
contributory  cause.  The  balance,  or  642  cer- 
tificates, or  60  per  cent,  were  interpreted  dif- 
ferently by  each  of  the  various  countries.  The 
United  States  Bureau  listed  76  of  the  causes  of 
death  as  non-puerperal,  New  Zealand  followed 


closely  with  77,  and  Norway  went  to  the  far  ex- 
treme, so  listing  235.  Denmark  with  only  18  non- 
puerperal  causes  was  the  only  country  which 
listed  fewer  than  76  as  non-puerperal.  Obviously, 
all  of  the  countries  except  Denmark,  given  the 
same  data,  would  show  a lower  puerperal  death 
rate  than  the  United  States.  Another  glance  at 
the  chai't  discloses  the  fact  that  on$y  Australia, 
the  Netherlands,  New  Zealand,  and  Scotland  in- 
terpret causes  of  maternal  death  in  approxi- 
mately the  same  way  that  we  do. 

A summary  of  our  survey  follows.  There  were 
1253  patients  delivered.  The  graph,  “Deliveries 
for  1930,”  shows  the  distribution  of  these  patients 
month  by  month,  the  average  being  104.4. 

CHART  I 


February,  1933  A Survey  of  1253  Consecutive  Deliveries — Hemmings 


99 


The  figures  represent  the  work  of  four  staff 
members,  seventeen  internes,  and  one  hundred 
twenty-two  visiting  physicians,  most  of  whom  are 
general  practitioners.  Various  techniques  de- 
veloped in  many  different  medical  centers  of  the 
country  are  represented. 

TABLE  II 

DISTRIBUTION  OF  CASES  AMONG  PHYSICIANS 


Delivered  by  obstetrical  staff 618 

Delivered  by  interne  staff 292 

Delivered  by  non-staff  physicians 343 


TOTAL 1253 


An  analysis  of  the  1253  deliveries  shows  that 
in  619,  or  49.4  per  cent,  the  membranes  ruptured 
spontaneously.  Four  hundred  and  forty-nine,  or 
35.8  per  cent  were  dry  labors,  and  in  14.6  per 
cent  artificial  rupture  was  done.  The  longest 
labor  was  125  hours  and  25  minutes,  and  the 
shortest  30  minutes — an  average  of  13  hours  and 
48  minutes.  The  average  labor  in  primigravidae 
was  18  hours  and  21  minutes,  and  the  average  in 
multigravidae  was  11  hours  and  52  minutes.  The 
average  length  of  labor  in  cases  of  spontaneous 
rupture  was  13  hours  and  79  minutes,  and  the 
average  dry  labor  lasted  12  hours  and  44  minutes. 
It  seems  that  dry  births,  in  which  the  membranes 
have  ruptured  before  the  onset  of  labor,  are  more 
common  than  might  be  expected,  and  that  the 
early  rupture  of  membranes  hastens  labor,  except 
in  occiput  posterior  positions  and  breech  pre- 
sentations in  primigravidae. 

In  this  entire  series  only  125  vaginal  examina- 
tions were  made,  or  one  to  each  ten  cases.  Many 
patients  had  no  internal  examination.  There  were 
3896  rectal  examinations  or  an  average  of  3.1  per 
case.  The  highest  number  of  rectal  examinations 
in  any  one  case  was  12.  The  frequency  of  rectal 


examinations  seems  to  have  had  no  appreciable 
effect  upon  maternal  morbidity. 

Eight  deaths  in  a series  of  1253  represent  a 
rate  of  .63  per  cent.  An  analysis  of  these  follows 
in  Table  III. 

Number  1.  This  patient  was  a gravida  iii  with 
normal  blood  pressure  and  normal  urinary  find- 
ings. The  delivery  was  by  low  forceps.  On  the 
sixth  day  postpartum  she  complained  of  severe 
pain  in  the  head.  This  was  followed  by  a pro- 
longed tonic  convulsion  from  which  she  never 
rallied.  The  autopsy  diagnosis  was  postpartum 
eclampsia,  although  the  convulsive  seizure  re- 
sembled that  of  grand  mal  epilepsy. 

Number  2.  This  was  an  eclamptic  who  was 
brought  into  the  hospital  by  a general  practitioner 
and  bag  induction  was  done  by  him.  He  asked 
for  help  in  delivering  his  patient.  Podalic  version 
was  completed  by  the  consultant.  During  this 
procedure  the  patient  developed  a convulsion 
under  anesthesia  and  died. 

Number  3.  The  patient  was  a grave  case  of 
toxemia  when  admitted.  Classical  Caesarean  was 
done  under  spinal  anesthesia.  The  patient  went 
into  eclamptic  coma  and  died  within  twenty-four 
hours.  The  baby  lived. 

Number  4.  A case  of  puerperal  eclampsia. 
The  patient  was  given  conservative  treatment  to 
no  avail.  She  became  progressively  worse.  A 
cervical  Caesarean  section  was  performed.  The 
mother  died  four  days  later  after  a series  of  con- 
vulsions followed  by  icterus  and  eclamptic  coma. 
The  baby  survived. 

Number  5.  The  toxic  psychosis  of  this  patient 
was  so  severe  that  induction  of  labor  was  in- 
dicated. Bag  induction  was  the  method  used,  and 
after  the  second  bag  failed  to  completely  dilate 
the  cervix,  the  patient’s  condition  becoming  ser- 
ious, manual  dilatation  and  podalic  version  were 
resorted  to.  Postpartum  hemorrhage  and  shock 
followed. 

Number  6.  This  patient  was  admitted  to  the 
hospital  with  lobar  pneumonia  and  in  premature 
labor.  She  was  delivered  spontaneously  of  a seven 
month  baby.  The  diagnosis  was  ablatio  placentae. 
The  ablatio  was  caused  by  focal  infection  from 
the  chest,  and  occasioned  premature  labor.  Sev- 


TABLE  HI 

ANALYSIS  OF  MATERNAL  DEATHS 


No. 

Diagnosis 

Procedure 

Cause  of  Death 

1. 

Postpartum  eclampsia 

Low  Forceps 

Postpartum  eclampsia 

2. 

Eclampsia 

Bag  induction  and 
Podalic  Version 

Eclampsia 

3. 

Eclampsia 

Classical  Caesarean 
(spinal  anesthesia) 

Eclampsia 

4. 

Eclampsia 

Cervical  Caesarean 
(spinal  anesthesia) 

Eclampsia,  acute 
yellow  atrophy 

5. 

Toxic  psychosis 

Manual  dilatation 
and  Podalic  Version 

Postpartum  hemorrhage 
and  shock 

6. 

Lobar  pneumonia  and 
Ablatio  placentae 

Pi’emature  spontaneous 
delivery 

Lobar  pneumonia 

7. 

Central  placenta 
praevia 

Manual  dilatation 
and  high  forceps 

Hemorrhage  and 
shock 

8. 

Pulmonary 

tuberculosis 

Forceps  control 

Puerperal  sepsis, 
pulmonary  tuberculosis, 
abscess  of  liver 

100 


The  Ohio  State  Medical  Journal 


February,  1933 


CHART  II 

ANALYSIS  OF  FETAL  DEATHS* 
hifant  Deaths — 40 


Premature — 10  Other  Causes — 30 

Broncho-pneumonia  13 

Intracranial  hemorrhage 4 

Volvulus  2 

Congenital  intestinal  occlusion 1 

Toxemia  of  mother 3 

Erysipelas  1 

Impetigo  contagiosa  1 

Diaphragmatic  hernia 1 

Monster  3 

Ablatio  placentae  1 


Stillbo'rn  Deaths — 44 


Not  Macerated — 31 


Macerated — 13 

Toxemia  of  mother 3 

Congenital  lues 1 

Ablatio  placentae 1 

Unknown  8 


*No  baby  under  1500 


Death  due  to 
Mechanical  Deliveries — 9 

Craniotomy  2 

Footling  1 

Full  Breech 1 

Frank  Breech 2 

Scanzoni  Manoeuver  and 

low  forceps 1 

Podalic  version 1 

Low  forceps  1 


grams  considered. 


Other  Causes — 22 

Toxemia  of  mother 4 

Ablatio  placentae 3 

Monster  3 

Cord  prolapse 3 

Placental  infarction 1 

Cord  compression 3 

Placenta  praevia 3 

Pyelitis  of  mother 
(severe  prenatal 

infection)  1 

Rupture  of  uterus 1 


eral  days  later  the  patient  died  of  lobar  pneu- 
monia. 

Number  7.  This  was  a case  of  central  placenta 
praevia  which  was  treated  by  manual  dilatation 
and  high  forceps.  Hemorrhage  and  shock  fol- 
lowed. Both  mother  and  fetus  died. 

Number  8.  This  patient,  a gravida  iii,  thirty- 
three  years  of  age,  was  suffering  with  pulmonary 
tuberculosis  with  abscess  cavity.  She  was.  de- 
livered by  forceps  control  without  lacerations. 
Pelvic  thrombosis  and  necrotic  endometritis  de- 
veloped, and  she  died  of  puerperal  sepsis  and  ab- 
scess of  the  liver. 

All  of  these  deaths  occurred  in  patients  who 
were  seriously  ill  at  the  time  of  admission.  The 
maternal  delivery  death  rate  of  .6  per  cent  is 
high,  the  usual  rate  for  St.  Luke’s  Hospital  being 
from  .1  to  .3  per  cent  annually.  However,  the  rate 


depends  upon  the  number  of  really  serious  cases 
admitted  during  the  year,  and  is  therefore  subject 
to  wide  variation. 

It  is  notable  that  four  of  the  above  eight  deaths 
followed  severe  eclampsia.  The  use  of  manual 
dilatation  and  high  forceps  in  a case  of  central 
placenta  praevia  is,  of  course,  contrary  to  ac- 
cepted procedure.  Podalic  version  was  used  in  two 
of  these  cases.  Notice  that  only  one  septic  death 
occurred  in  1253  deliveries.  This  was  probably  an 
autogenous  infection  from  the  pulmonary  abscess. 

There  were  84  fetal  deaths  in  this  series,  pre- 
senting an  incidence  of  6.6  per  cent.  Of  these  40 
were  infant  deaths  and  44  wei’e  stillborns.  Ten 
infant  deaths  were  due  to  prematurity  and  30 
were  due  to  other  causes.  Thirteen  stillborn 


February,  1933  A Survey  of  1253  Consecutive  Deliveries — Hemmings 


101 


COMPARISON  OF  METHODS  OF  TREATMENT  AND  THEIR  RESULTS 


Procdure 

Incidence 

Cervical 

Lacerations 

Perineal 

Lacerations 

Episiot- 

omies 

Maternal 

Morbidity 

Maternal 

Mortality 

Fetal 

Mortality 

No. 

% 

No. 

% 

No. 

% 

No.  | % 

No. 

% 

No. 

% 

No. 

% 

Spontaneous 

222 

17.7 

11 

4.9 

67 

30.0 

13 

5.0 

18 

8.0 

1 

.4 

24 

10.8 

Forceps 

Control 

477 

38.0 

28 

5.8 

125 

26.0 

163 

34.0 

34 

7.0 

1 

.2 

14 

2.9 

Low  Forceps 

290 

23.1 

40 

13.0 

75 

25.0 

140 

48.0 

30 

10.0 

1 

.3 

10 

3.0 

Mid  Forceps 

50 

3.9 

14 

28.0 

13 

26.0 

30 

60.0 

12 

24.0 

0 

0 

1 

2.0 

High  Forceps 

13 

1.0 

6 

46.0 

3 

23.0 

9 

69.0 

2 

15.0 

1 

7.5 

1 

7.5 

Breech 

Presentation 

51 

4.0 

8 

15.0 

15 

29.0 

12 

23.0 

8 

15.0 

0 

0 

11 

21.0 

Caesarean 

Classical 

Cervical 

32 

28 

53.0 

46.0 

20 

15 

62.0 

53.0 

1 

1 

3.0 

3.0 

6 

1 

18.0 

3.0 

Podalic 

Version 

99 

7.9 

20 

20.0 

24 

24.0 

30 

30. 

7 

7.0 

2 

2.0 

9 • 

9.0 

fetuses  were  macerated,  and  of  those  not  mace- 
rated 9 deaths  were  due  to  mechanical  deliveries 
and  22  to  other  causes. 

Considering  the  principal  procedures  followed 
in  this  series  we  find  that: 

First:  Forceps  control  carries  a low  maternal 
mortality.  We  believe  that  patients  are  frequent- 
ly benefited  by  this  method  of  controlling  the 
movement  of  the  head  through  the  vaginal  orifice 
under  anesthesia,  thereby  lessening  perineal 
Trauma  and  laceration,  and  eliminating  several 
hours  of  second  stage  labor.  Forceps  control 
shows  the  low  fetal  mortality  of  2.9  per  cent.  We 
believe  that  more  babies  are  saved  by  this  method 
than  by  spontaneous  delivery  inasmuch  as  some 
heads,  especially  the  smaller  type,  receive  injury 
occasionally  resulting  in  intracranial  hemorrhage 
while  dilating  a rigid  perineum.  The  high  rate  of 
fetal  mortality  of  10.8  per  cent  for  spontaneous 
deliveries  is  explained  by  the  fact  that  known 
stillborns  and  macerated  fetuses  are  usually  per- 
mitted to  deliver  in  this  manner.  This  also  ex- 
plains the  low  percentage  of  perineal  injuries. 
Forceps  control  yields  a lower  rate  of  perineal 
lacerations,  a lower  maternal  morbidity,  a lower 
maternal  mortality,  but  a much  higher  episiotomy 
incidence. 

Second:  Comparing  low  forceps  with  mid-for- 
ceps, a higher  rate  of  cervical  and  perineal  lacera- 
tions for  mid-forceps  is  found.  This  is  to  be  ex- 
pected, for  the  use  of  this  procedure  indicates  that 
more  serious  obstetrical  complications  were 
present.  The  low  maternal  and  fetal  mortality 
rate  for  mid-forceps  is  explained  by  the  fact  that 


many  of  these  mid-positions  are  recognized  by 
the  general  practitioner  as  indications  of  patho- 
logical conditions,  and  they  are  consequently 
turned  over  to  staff  consultants  for  delivery. 

Third:  Throughout  this  series  podalic  version 
was  used  in  two  ways: — for  delivery  of  carefully 
selected,  elective  cases,  and  in  the  treatment  of 
serious  pathological  conditions.  Considering  the 
2 per  cent  maternal  and  9 per  cent  fetal  mortality, 
this  major  procedure  should  be  adopted  only  after 
careful  study  of  all  the  factors  involved.  If  poda- 
lic version  is  compared  with  high  forceps,  the  lat- 
ter procedure  is  found  to  cause  more  cervical 
lacerations  and  episiotomies,  and  to  be  followed 
by  a higher  rate  of  maternal  and  fetal  mortality. 
As  a matter  of  fact,  the  high  forceps  operation  is 
discouraged  at  St.  Luke’s  Hospital. 

Fourth:  In  breech  presentations  there  is  an 

appalling  fetal  mortality,  that  of  frank  breech 
being  highest.  The  low  maternal  mortality  is 
striking,  being  zero  in  this  survey.  The  maternal 
morbidity  is  as  high  as  that  for  high  forceps. 
Breech  presentation  is  a pathological  condition 
which  demands  great  care  and  consideration. 

Fifth:  Comparing  the  two  forms  of  Caesarean 
operation,  there  is  a diminished  maternal  mor- 
bidity and  a lower  fetal  mortality  with  the  cer- 
vical operation.  The  high  fetal  mortality  for  the 
classical  operation  is  explained  by  the  fact  that 
in  cases  of  emergency,  where  the  time  factor  is 
important,  this  procedure  is  preferred,  and  the 
fetus  may  already  be  dead  or  worthless;  for  ex- 
ample, in  cord  complications,  in  central  placenta 
praevia,  and  in  severe  ablatio  placentae  cases. 

In  conclusion,  recalling  the  challenging  report 


102 


The  Ohio  State  Medical  Journal 


February,  1933 


TABLE  V 


1929 

MATERNAL  mortality  rate 

1929 

Puerperal  Deaths 

of  which  U.  S. 

Puerperal  Sepsis 

7. 

per  M.  Live  Births 

Reg.  Area 

2.6 

per  M.  Live  Births 

6.4 

tt  tt  tt  u 

Cleveland 

2.4 

ti  it  it 

tt 

5.2 

tt  tt  tt  tt 

New  York 

1.8 

tt  tt  tt 

tt 

6.5 

ti  it  tt  tt 

Chicago 

1.7 

ti  it  tt 

tt 

7.4 

ti  tt  a it 

Philadelphia 

2.8 

“ “ “ 

tt 

7.1 

tt  tt  tt  tt 

Detroit 

3.5 

a a tt 

tt 

6.4 

u tt  tt  tt 

Los  Angeles 

3.3 

tt  a tt 

tt 

of  the  Bureau  of  Vital  Statistics,  which  was  ob- 
tained through  the  kindness  of  Dr.  Richard  Bolt, 
Director  of  the  Cleveland  Child  Health  Associa- 
tion, it  will  be  remembered  that  puerperal  sepsis 
constitutes  30  per  cent  to  50  per  cent  of  the 
puerpei'al  deaths  of  the  country.  Because  the  task 
of  compiling  statistics  from  the  entire  registra- 
tion area  of  the  United  States  is  so  great,  reports 
from  the  Bureau  are  from  one  to  two  years  be- 
hind the  current  date.  The  chart  here  presented 
as  a part  of  the  1929  report  of  the  Bureau  of 
Vital  Statistics  was  compiled  from  completed  re- 
ports from  the  registration  area.  We  cannot  com- 
pare the  mortality  rate  of  St.  Luke’s  Hospital 
with  the  figures  presented  by  the  Bureau  as 
shown  above,  because  our  mortality  rate  is  in 
reality  a delivery  death  rate.  Comparison  of 
mortality  rates  for  deliveries  at  the  period  of 
viability  constitutes  the  only  fair  basis,  from  the 
standpoint  of  the  obstetrician. 

It  has  been  repeatedly  shown  that  criminal 
abortion  plays  an  important  role  in  raising  the 
puerperal  death  rate,  as  is  clearly  in  evidence 
when  abortions  are  considered.  From  recent  ob- 
servations, this  has  markedly  increased  during 
1930  and  1931,  because  of  the  living  and  financial 
conditions  now  existing.  This  condition  which 
will,  no  doubt,  appear  to  prejudice  statistics  un- 
favorably in  the  years  immediately  ahead,  is  not 
under  the  control  of  the  ethical  physician,  and  yet 
the  high  puerperal  death  rate  so  occasioned  is 
likely  to  be  used  widely  by  uninformed  writers 
and  speakers. 

Since  the  interpretation  of  statistical  termin- 
ology varies  so  widely  in  different  countries, 
figures  from  different  countries  are  necessarily 
incomparable.  They  should  be  used  only  for  the 
purpose  of  setting  up  an  international  system, 
certainly  not  for  release  to  lay  writers.  Only  pro- 
fessional experts,  whose  assistance  in  correcting 
statistical  systems  can  be  relied  upon,  should  at- 
tempt their  interpretation. 

Meanwhile,  it  is  desirable,  as  this  paper  and  its 
supplementary  survey  are  designed  to  show,  that 
at  least  annually,  each  hospital  and  each  prac- 


titioner should  make  a detailed  study  of  the  con- 
ditions and  results  found  within  the  field  of  his 
immediate  interest.  The  findings,  whether  favor- 
able or  unfavorable  to  the  institution  or  to  mem- 
bers of  the  staff,  will  be  useful  in  establishing 
sound  procedure  and  building  up  justifiable  con- 
fidence. If  careful  studies  are  made  over  wide 
areas,  it  will  be  found  that  physicians  are  prac- 
ticing better  obstetrics,  that  obstetrical  charts  are 
being  made  more  complete,  that  interns  are  re- 
ceiving better  training  and  are  producing  better 
results,  and  that  the  general  practitioner  is  doing 
better  work  than  at  any  previous  time. 

10515  Carnegie  Avenue. 

discussion 

Magnus  A.  Tate,,  M.D.,  Cincinnati,  Ohio:  A 

number  of  papers  have  been  presented  to  the  pro- 
fession during  the  past  few  years  along  the  line 
with  the  one  which  the  essayist  presents  to  us  to- 
day, namely,  a year’s  survey  of  the  Maternity 
Department  of  St.  Luke’s  Hospital,  of  Cleveland, 
Ohio.  Such  a tabulation  giving  the  number  of 
cases,  primipara  and  multipara,  length  of  labor, 
anesthetics  used,  methods  followed  out  during  de- 
livery, of  normal  and  abnormal  cases,  and  many 
other  phases  of  practice  as  detailed,  offers  us 
much  to  approve,  and  yet  there  are  some  state- 
ments made  which  bear  discussion.  The  question 
of  the  value  of  vaginal  versus  rectal  examination, 
has  created  much  discussion  and  statistics  col- 
lected show  that  there  is  little  if  any  difference 
from  the  standpoint  of  morbidity. 

The  viewpoint  on  craniotomy  as  given  by  most 
authorities  today  is,  that  craniotomy  is  not  justi- 
fiable on  the  living  child.  In  this  survey  three 
cases  are  mentioned,  but  no  indications  given  for 
the  performance  of  same. 

Three  cases  of  eclampsia  were  admitted,  and 
two  were  caesarionized.  The  general  mortality 
rate  of  20  to  40  per  cent  of  eclamptics  caesarion- 
ized has  brought  the  profession  to  question  the 
advisability  of  such  a procedure,  and  I believe 
that  only  when  the  child’s  life  can  be  saved  is  it 
justifiable. 

In  1253  deliveries  mentioned  there  were  60 
caesarean  sections — one  section  to  every  21  cases 
admitted.  A very  high  proportion.  There  were  13 
cases  of  high  forceps.  The  profession  is  now 
almost  a unit  in  condemning  the  use  of  high 
forceps. 


February,  1933  A Survey  of  1253  Consecutive  Deliveries — Hemmings 


103 


Four  hundred  and  seventy-seven  cases,  or  38 
per  cent  of  the  1253  delivei’ies  had  forceps  control, 
and  it  seems  pertinent  to  ask,  what  were  the  in- 
dications calling  for  this  large  number?  This 
survey  brings  to  light  the  vast  difference  between 
a private  and  a public  service.  A public  service 
open  to  all,  demonstrates  the  lack  of  prenatal  care 
of  cases  admitted,  which  is  so  essential  to  modern 
obstetrics.  We  also  note  that  in  this  survey  cases 
were  admitted  that  were  in  a very  serious  con- 
dition, and  notwithstanding  active  care,  they  suc- 
cumbed. This  gives  a mortality  rate  which  at 
times  subjects  many  of  our  hospitals  to  an  unjust 
censure  by  those  who  lack  appreciation  or  under- 
standing ' of  the  problems  in  question.  That 
criminal  abortions  and  ectopics  raise  the  mortality 
rate  is  evident  to  any  who  will  take  the  time  to 
analyze  records,  and  yet,  since  we  are  dealing 
with  the  pregnant  woman  I see  no  other  way  open 
at  present,  than  to  classify  these  cases  in  our  gen- 
eral records. 

Along  the  line  of  abortions  I beg  to  submit  the 
following,  taken  from  Taussigs’  recent  paper: 

‘There  are  about  700,000  abortions  annually  in 
the  United  States,  with  an  estimated  15,000 
deaths.  There  was  a noted  increase  in  abortions 
among  married  women  who  have  three  or  four 
children.  All  efforts  to  control  the  incidence  of 
criminal  abortion  by  legislation  have  resulted  in 
failure. 

Birth  control  may  prove  a factor  in  the  reduc- 
tion of  criminal  abortions.  Deaths  from  puerperal 
sepsis  following  abortions  are  relatively  seven 
Times  as  frequent  as  those  from  puerperal  sepsis 
after  childbirth.  The  average  maternal  death  rate 
following  abortion  in  the  civilized  world  is  ap- 
proximately 2.1  per  cent.  The  immediate  causes 
of  induced  abortion  in  Russia  are  as  follows: 


Towns  Country 
Districts 


□Poverty  66.4  58.2 

Tllness  19.3  29.7 

□Desire  to  conceal  pregnancy....  1.6  7.3 

Tnfant  to  breast 12.7  4.8 


I have  never  seen  any  such  tables  as  the  above 
•of  the  immediate  causes  in  the  United  States,  but 
I believe  that  there  must  be  a great  similarity. 
The  Russian  experiment  with  legalized  abortions 
indicates  a definitely  lower  maternal  mortality, 
with  operations  done  openly  in  hospitals,  than 
with  secret  illegal  operations  as  formerly”. 

This  high  puerperal  mortality  from  criminal 
abortions  is  one  of  our  serious  problems,  and  as 
long  as  human  beings  cling  to  the  beliefs  they 
have,  as  long  as  women  refuse  to  have  children, 
and  as  long  as  they  have  little  or  no  difficulty  in 
having  abortions  committed,  just  so  long  will  con- 
ditions continue  as  they  are,  and  the  profession 
must  go  on  giving  the  best  they  can  to  these  un- 
fortunate women. 

The  whole  subject  of  obstetrics  was  gone 
into  thoroughly  at  the  recent  White  House  Con- 
ference, held  in  Washington  last  year.  Many 
admirable  suggestions  were  made,  and  are 
being  carefully  considered  by  our  seats  of  medical 
education,  such  as ; a better  classification,  and  re- 
porting of  same,  increased  hours  of  obstetrical 
teaching,  more  hours  devoted  to  practical  work,  a 
definite  number  of  personal  attendances  of  cases. 
The  giving  of  degrees  to  those  qualified,  time  re- 
• quired  by  those  wishing  to  qualify  as  specialists. 


The  importance  of  drilling  students  in  mechanical 
work  upon  the  manikin,  and  of  the  value  of  pre- 
natal work,  etc.,  in  all  planning  to  place  obstet- 
rics upon  a higher  plane  so  that  the  qualified 
obstetrician  may  take  his  proper  place  before  the 
people  at  large.  Realizing  that  students  of  today 
make  for  a betterment  for  the  tomorrow,  it  is  the 
desire  of  the  conference  to  attempt  a standard- 
ization of  requirements  of  indications  necessitat- 
ing operative  work,  all  for  the  welfare  of  the 
profession,  and  the  women  of  our  land.  That  the 
profession  is  seriously  handicapped  by  lack  of 
cooperation  and  wilful  ignorance  upon  the  part  of 
some  of  our  women,  is  patent  to  all  obstetricians. 
Means  for  a betterment  of  existing  conditions  can 
only  come  about  by  a better  undertsanding  of  the 
meaning  of  modern  obstetrics,  and  the  application 
of  common  sense,  and  knowledge.  The  profession 
is  increasingly  appreciative  of  the  fact  that  time, 
conscience,  and  Nature’s  efforts  are  adjuncts 
worthy  of  serious  consideration.  When  and  how 
best  to  carry  a case  to  a favorable  termination 
means  knowledge  and  experience.  Operative  pro- 
cedures by  the  unqualified  can  only  be  looked  upon 
as  a menace  to  modern  obstetrics.  The  outcome  of 
an  adoption  of  the  principles  as  enumerated  by 
the  White  House  Conference,  the  formation  of  the 
American  Board  of  Obstetrics  and  Gynecology,  an 
earnest  cooperation  by  the  teaching  faculties  of 
our  medical  schools,  and  the  interest  evinced  by 
educated  laymen  means  an  awakened  interest  in 
obstetrics.  In  the  near  future  obstetrics  will  take 
its  right  pl^ce,  not  only  in  the  curricula  of  our 
schools,  but  in  the  minds  of  an  enlightened  and 
grateful  public. 

Wilson  G.  Clagett,  M.D.,  Dayton,  Ohio:  Dr. 

Hemmings  is  to  be  congratulated  on  making  a 
survey  of  this  kind. 

The  way  in  which  women  are  taken  care  of  in 
confinement  is  an  index,  more  or  less,  of  the  ad- 
vancement of  civilization. 

Thirty,  twenty-five  and  even  fifteen  years  ago, 
the  maternity  cases  delivered  in  the  hospital  were 
comparatively  few  in  number. 

This  situation  has  changed,  at  least  in  the 
larger  cities;  but  I was  surprised  to  find,  in  look- 
ing up  good  authority,  that  about  70  per  cent  of 
all  deliveries  are  still  conducted  in  the  home, 
though  DeLee  is  of  the  opinion  that  it  is  about  50 
per  cent. 

Laymen,  and  women’s  organizations,  through 
the  magazines  and  popular  periodicals,  are  urging 
the  institution  of  better  prenatal  care,  and  better 
hospitalization,  to  lower  maternal  mortality. 

Has  the  laity,  and  some  physicians  who  have 
voiced  so  much  adverse  criticism  on  this  subject, 
ever  examined  the  records  of  these  maternal 
deaths?  Do  they  realize  what  Dr.  Hemmings  has 
so  admirably  brought  out  in  his  paper  what  is 
meant  by  maternal  mortality?  That  this  means 
that  every  death  occurring  as  a result  of  preg- 
nancy during  any  stage  of  gestation  or  the  puer- 
perium  is  classified  as  maternal  mortality? 

Percentage  can  only  be  based  upon  a known 
quantity,  therefore,  the  percentage  of  maternal 
mortality  must  obviously  be  based  upon  the  total 
number  of  pregnant  women.  We  do  know  the 
number  of  pregnant  women  delivered  at  or  near 
term  and  consequently  have  a basis  for  estimat- 
ing the  percentage  of  maternal  deaths  occurring 
at  this  time. 

But  who  can  estimate  the  number  of  pregnant 
women  who  have  abortions,  though  every  physi- 
cian is  well  aware  of  the  prevalence  of  this  prac- 
tice? And  approximately  50  per  cent  of  the  re- 
corded maternal  mortality  is  due  to  abortions. 
The  percentage  of  maternal  mortality  due  to 


104 


The  Ohio  State  Medical  Journal 


February,  1933 


ectopic  pregnancy  could  only  be  determined  in  a 
similar  manner. 

The  Bureau  of  Vital  Statistics  should  differ- 
entiate the  causes  of  maternal  mortality  in  such 
a way  that  a death  occurring  at  or  near  term  due 
to  the  pregnancy  is  not  placed  in  the  same  cate- 
gory with  death  from  abortion  or  ectopic  preg- 
nancy. This  would  make  it  impossible  for  laymen 
or  physicians  who  are  attempting  to  regulate  the 
affairs  of  the  obstetric  field  to  quote  statistics  that 
are  neither  correct  nor  just. 

With  slight  variations  from  year  to  year  var- 
ious hospitals  over  the  country  are  showing 
similar  findings  to  this  survey  made  by  Dr.  Hem- 
mings,  and  I am  also  convinced  after  many  years 
of  obstetric  practice  in  the  homes  that  neither  ma- 
ternal mortality  or  morbidity  need  be  increased  by 
delivery  in  the  home. 

The  conduct  of  cases  in  the  home  requires  an 
able  assistant,  trained  to  give  anesthetics  and 
render  all  necessary  aid.  The  accoucher’s  time  is 
devoted  wholly  to  the  delivery  and  he  is  able  to 
maintain  a positive  aseptic  technic. 

I might  say  in  passing  that  the  man  whose  en- 
tire work  along  this  line  has  been  in  the  hospital 
may  have  some  difficulty  due  to  the  fact  that  he 
is  working  in  unaccustomed  surroundings. 

It  has  been  said  by  various  writers,  medical 
and  lay,  that  there  has  been  no  decrease  in  ma- 
ternal mortality  in  the  last  fifteen  years.  As  said 
by  Dr.  Hemmings  and  emphasized  in  this  dis- 
cussion about  half  of  these  so-called  maternal 
deaths  belong  in  another  category,  but  there  re- 
mains much  to  be  said  among  ourselves  on  this 
subject. 

The  demand  by  the  laity  for  short  and  painless 
deliveries  coupled  with  the  idea  that  there  must 
be  some  operative  procedure,  or  the  doctor  has 
not  earned  his  fee,  has  had  a detrimental  in- 
fluence on  sane,  obstetric  judgment.  Witness  the 
widening  field  in  which  caesarian  section  is  em- 
ployed. 

A survey  made  by  Dr.  Plass  of  138  hospitals  in 
reference  to  caesarian  section  shows  a mortality 
between  5 and  10  per  cent,  and  often  nearer  the 
latter  figure.  While  the  indications  for  caesarian 
section  may,  with  our  improved  surgical  technic, 
be  somewhat  extended,  we  must  not  forget  that  it 
is  only  the  exceptional  case  that  cannot  be  de- 
livered per  vaginum. 

It  must  be  remembered  that  section  is  still  a 
most  dangerous  operation  for  the  mother  and  does 
not  invariably  yield  a live  child.  It  is  a procedure 
that  should  not  be  chosen  because  it  is  an  easy 
way  out  of  an  obstetric  problem.  Needless  to  say 
there  should  never  be  a death  from  ruptured 
uterus  due  to  the  ill-advised  use  of  pituitrin. 

It  would  lengthen  this  discussion  too  much  to 
go  into  all  the  phases  of  forcep  and  other  ob- 
stetric procedures,  as  well  as  the  misuse  of 
anesthesia,  that  increase  maternal  and  fetal  mor- 
tality and  morbidity. 

Regrettable  as  it  may  seem,  it  would  be  better 
to  go  back  to  first  principles  and  if  one  is  not 
sufficiently  equipped  to  do  good;  at  least  let  him 
do  no  harm. 


Home  is  Scene  of  Numerous  Injuries, 
Survey  Shows 

One-half  of  the  non-fatal,  disabling  injuries 
cared  for  by  visiting  nursing  associations  in  this 
country  last  year  arose  out  of  activities  in  the 
home,  according  to  the  Metropolitan  Life  Insur- 
ance Company  Statistical  Bulletin.  Forty-five 
per  cent  of  these  disabling  injuries,  furthermore, 


resulted  from  activity  in  public,  outside  the  home 
and  outside  of  gainful  employment.  Only  5 per 
cent  were  chargeable  to  the  activity  of  earning  a 
living. 

Falls  accounted  for  43  per  cent  of  non-fatal 
home  injuries,  and  among  the  leading  elements  of 
hazard  were  falls  on  or  down  stairways,  falls  on 
floors,  from  balconies  and  porches  and  over  or 
from  chairs.  The  stepladder  accounted  for  nearly 
2 per  cent  of  the  home  injuries  reported.  Out  of 
2,317  falls,  only  19  occurred  in  bathtubs.  This 
seems  to  acquit  the  bathtub  of  the  blame  which 
has  been  attached  to  it  recently  as  a source  of  do- 
mestic injury.  The  student  of  domestic  hazards 
may  do  well  to  concentrate  attention  on  the  unsafe 
stairway,  the  slippery  floor,  the  skidding  rug  and 
the  shaky  stepladder. 

Burns  accounted  for  more  than  one-quarter  of 
the  home  injuries  requiring  nursing  care,  and  here 
the  chief  agencies  seemed  to  be  the  steaming  ket- 
tle, the  washboiler  and  stoves  and  grates.  Cuts 
from  knives,  and  wounds  from  ice  picks,  accounted 
for  15  per  cent  of  the  domestic  injuries.  Ma- 
chinery around  the  home  was  no  inconsiderable 
agency  of  injury;  last  year  sundry  domestic  ma- 
chines accounted  for  3 per  cent  of  the  injuries. 
Cats  and1  dogs  accounted  for  36  injuries  serious 
enough  to  require  nursing  care.  While  these  in- 
juries by  animals  were  less  than  one  per  cent  of 
the  total  arising  in  home  activities,  the  number  is 
sufficient  to  suggest  that  these  pets  give  rise  to  a 
considerable  toll  of  injury  in  this  country  each 
year.  Seventeen  of  these  36  animal  injuries  oc- 
curred among  children  under  fifteen  years  of  age. 


Arrange  Tri-State  Program 

An  interesting  and  instructive  program  is  being 
arranged  for  the  60th  annual  meeting  of  the 
Northern  Tri-State  Medical  Association,  to  be 
held  at  LaPorte,  Indiana,  on  April  11.  Among 
those  who  already  have  accepted  invitations  to  ad- 
dress the  association  are:  Dr.  Henry  A.  Chris- 
tian, professor  of  medicine,  Harvard  Medical 
School,  who  will  speak  on  “The  Use  of  Digitalis”; 
Dr.  Plinn  Morse,  pathologist,  Harper  Hospital, 
Detroit,  who  will  talk  on  “Acute  Vascular  Acci- 
dents”; Dr.  E.  B.  Gillette,  Toledo,  who  will  pre- 
sent a paper  on  surgery;  Dr.  Charles  P.  Emerson, 
professor  of  medicine,  University  of  Indiana,  who 
wil  speak  on  “Neuropsychoses”;  Dr.  Charles 
Lukens,  Toledo,  who  will  discuss  “Headache  As  a 
Symptom”,  and  Dr.  Ralph  Wilder,  Rochester, 
Minn.,  who  will  read  a paper  on  “The  Parathy- 
roids”. The  first  hour  of  the  meeting  will  be  de- 
voted to  a symposium  on  fractures.  Officers  of  the 
association  who  are  arranging  the  program  and 
details  for  the  meeting  are:  President,  Dr.  Ed- 
ward B.  Pedlow,  Lima;  vice  president,  Dr.  G.  0. 
Larson,  LaPorte;  secretary,  Dr.  E.  P.  Gillette, 
Toledo,  and  treasurer,  Dr.  H.  E.  Randall,  Flint, 
Michigan. 


A.  R.  Vonderahe,  M.D.,  Cincinnati,  Ohio 


THE  eye  differs  from  all  other  sense  organs 
in  the  fact  that  it  is  a direct  outgrowth  of 
the  brain.  The  intimate  relationship  with 
the  central  nervous  system  set  up  by  this  embry- 
ological  peculiarity  is  reflected  in  daily  clinical 
experience.  There  is  scarcely  any  serious  organic 
disease  involving  the  brain  which  is  not  reflected 
by  some  corresponding  functional  disturbance  in 
the  field  of  ophthalmology.  The  situation  is  made 
especially  manifest  because  the  visual  path 
traverses  the  greater  part  of  the  brain,  from  the 
optic  nerves  and  chiasm  in  the  frontal  zone,  the 
quadrigeminal  bodies  and  pulvinar  of  the  optic 
thalamus  in  the  middle  zone,  to  the  visual  areas 
in  the  occipital  zone;  while  the  mechanisms  for 
voluntary  and  involuntary  muscles  of  the  eye  in- 
volve the  mid-brain,  pons  and  medulla.  If  to  these 
we  add  the  association  centers  for  speech,  writing, 
and  voluntary  control  of  the  external  eye  mus- 
cles and  those  centers  which  form  the  substratum 
of  conscious  thought,  we  find  that  optic  mechan- 
isms so  invoive  all  areas  of  the  brain  that  any 
pathological  lesion  sufficiently  large  to  produce 
symptoms,  usually  produces  characteristic  visual 
or  muscular  signs  in  the  eye  depending  on  what 
portion  of  the  extensive  and  complicated  path- 
ways are  involved.  Knowledge  of  the  visual  paths 
and  muscular  systems  related  to  the  eye  is  sin- 
gularly complete,  so  that  we  have  arrived  at  a 
degree  of  predictability  with  respect  to  the 
localization  of  lesions  which  is  not  achieved  in 
other  portions  of  the  nervous  system  of  a similar 
degree  of  complexity. 

The  pathological  relations  of  the  nervous  sys- 
tem to  the  eye  may  be  considered  from  two  stand- 
points: first,  varieties  of  pathological  change  ir- 
respective of  localization  in  the  nervous  system ; 
and  secondly,  anatomical  localization  of  the  dis- 
ease process.  Both  are  of  course  important.  A 
convenient  division  of  types  of  pathological 
change  in  the  nervous  system  is  the  following: 
(1)  mechanical  injury;  (2)  vascular  disease;  (3) 
toxic  changes;  (4)  infections;  (5)  neoplasms; 
(6)  anomalies.  The  discussion  here,  however,  will 
be  presented  with  reference  to  the  anatomical 
location  of  the  lesion,  because  the  chief  problems 
are  met  in  this  form. 

SUPERFICIAL  STRUCTURES 

Proceeding  from  the  exterior,  the  first  structure 
of  importance  is  the  levator  palpebrae  muscle 
with  its  striated  muscle  innervated  by  the  oculo- 
motor nerve,  and  its  smooth  muscle  innervated  by 

Read  before  the  Eye,  Ear,  Nose  and  Throat  Section,  Ohio 
State  Medical  Association,  at  the  86th  Annual  Meeting, 
Dayton,  May  3 and  4,  1932. 


From  the  Department  of  Anatomy  (Neurology)  Uni- 
versity of  Cincinnati. 


the  cervical  sympathetic  nerve,  so  that  ptosis  may 
occur  not  only  from  involvement  of  the  oculomotor 
path  but  also  from  involvement  of  the  sympathetic 
path.  The  latter  occurs  characteristically  as  part 
of  Horner's  syndrome  as  a result  of  destruction  of 
any  portion  of  the  sympathetic  path  from  the 
twelfth  cervical  and  first  and  second  thoracic 
segments  of  the  spinal  cord,  onward  throughout 
its  long  course  through  the  neck.  The  innervation 
of  the  cornea  and  conjunctiva  presents  a point  of 
some  interest.  It  is  quite  generally  believed  that 
the  innervation  of  the  cornea,  sclera  and  con- 
junctiva involves  the  ophthalmic  division  of  the 
trigeminal  nerve.  In  a somewhat  unusual  case 
of  trauma  involving  the  superior  maxillary  nerve 
it  was  found  that  the  zone  of  anesthesia  involved 
the  lower  half  of  the  cornea  and  sclera.  In  sub- 
sequent cases  in  which  the  superior  maxillary 
nerve  was  destroyed  by  alcoholic  injections  for 
neuralgia,  similar  results  were  noted.  It  thus 
appears  probable  that  the  upper  half  ’of  the 
cornea  and  sclera  is  supplied  by  the  ophthalmic 
division  of  the  trigeminal  nerve,  while  the  lower 
level  is  supplied  by  the  superior  maxillary  di- 
vision of  the  trigeminal  nerve.1 

THE  VISUAL  PATHWAY 

The  visual  pathway  from  the  retina  to  the 
occipital  cortex  yields  characteristic  clinical  signs 
at  almost  every  point  of  its  course.  Complete 
blindness  in  one  eye  may  result  from  severe 
pathological  lesions  of  one  optic  nerve.  At  the 
chiasm  very  characteristic  alterations  of  the 
visual  field  are  produced  depending  upon  the 
peculiar  position  of  fibers  of  the  visual  path  in 
this  area.  Fibers  are  here  so  arranged  that  im- 
pulses of  the  temporal  half  of  one  retina  continue 
to  the  cerebral  centers  on  the  same  side,  while 
fibers  from  the  nasal  half  of  the  opposite  retina 
cross.  In  this  manner  an  object  in  one  visual 
field  is  represented  in  the  opposite  portion  of  the 
brain.  Just  how  the  fusion  of  two  images  occurs 
is  still  a matter  of  inquii’y.  Chiasmic  lesions  oc- 
cur characteristically  as  the  result  of  pressure  on 
this  structure  by  a growing  pituitary  tumor. 
They  also  occur  as  a result  of  internal  hydro- 
cephalus, wherein  the  distended  third  ventricle 
exerts  pressure  upon  the  chiasm.  In  an  interest- 
ing case  reported  by  Rhein,2  a pronounced  internal 
hydrocephalus  producing  visual  field  defects  char- 
acteristic of  pituitary  tumor,  was  caused  by  a 
tumor  of  the  cerebellum  obstructing  the  aque- 
duct of  Sylvius  and  so  inducing  marked  internal 
hydrocephalus.  In  this  case  the  error  was  made 
of  operating  for  pituitary  tumor  and  it  was  only 
at  autopsy  that  the  real  nature  of  the  condition 
was  manifest. 

The  visual  pathway  from  the  chiasm  continues. 


105 


106 


The  Ohio  State  Medical  Journal 


February,  1933 


posteriorly.  In  unilateral  lesions  posterior  to  the 
optic  chiasm,  homonomous  hemianopsia  becomes 
the  characteristic  clinical  symptom.  The  path- 
way continues  to  the  anterior  quadrigeminal 
bodies,  through  which  the  pupillary  light  reflex  is 
carried  out,  and  to  the  lateral  geniculate  body 
and  pulvinar  of  the  thalamus.  From  the  latter 
two  areas,  the  path  is  continued  as  the  optic 
radiation.  It  proceeds  to  the  medial  surface  of  the 
occipital  lobe  where  conscious  perception  of  the 
visual  image  is  produced.  In  lesions  of  the  optic 
radiation  there  is  produced  not  only  homonomous 
hemiamposia  but  the  Wernicke  phenomena  is 
px-esent,  i.e.,  when  a pencil  of  light  is  thrown 
upon  the  hemianopic  retina  the  pupils  respond  by 
contraction  although  there  is  no  perception  of 
light.  This  is  due  to  the  fact  that  the  reflex  path- 
way for  the  light  reflex  from  the  retina  to  the 
superior  quadrigeminal  bodies  is  intact.  In 
homonomous  hemianopsia,  as  referred  to  here,  it 
is  the  peripheral  visual  field  which  is  affected  as 
it  is  only  the  peripheral  visual  field  which  is  com- 
pletely crossed.  Central  or  macular  vision  is 
represented  in  both  visual  centers  of  the  brain 
and  may  be  retained  in  lesions  simply  of  one  side. 
The  center  for  macular  vision  is  in  the  anterior 
extremity  of  the  calcarine  fissui’e  on  the  median 
surface  of  the  occipital  lobe.  The  macula  is  re- 
garded as  the  organ  not  only  of  acute  vision  but 
of  psychic  vision,  that  is  of  words,  letters,  num- 
bers and  other  symbols.  In  general,  the  upper 
part  of  the  retina  is  x’elated  to  the  upper  part  of 
the  calcarine  fissure  so  that  this  area  is  the  cen- 
ter for  visual  pei’ception  in  the  lower  quadrant  of 
the  opposite  visual  field.  Similarly,  the  lower  pai’t 
of  the  retina,  (and  hence  the  upper  quadrant  of 
the  opposite  visual  field) , is  l'epresented  in  the 
lower  part  of  the  calcax-ine  fissure.  In  this  man- 
ner, a destx-uctive  lesion  involving  the  lower  part 
of  the  calcai’ine  fissure,  would  produce  a quadrant 
hemianopsia  of  the  opposite  visual  field.  The 
separate  structural  and  functional  i~elationships 
of  macular  and  peripheral  vision  are  illustrated 
in  certain  attacks  of  ophthalmic  migraine.  The 
z:gzag  aura  associated  wtih  migraine  tend  to 
occupy  the  peripheral  visual  field  while  the  cen- 
tral visual  field  may  be  dai’kened.  An  explana- 
tion of  these  findings  may  be  had  in  assuming 
that  there  has  been  a stimulation  of  the  peripheral 
visual  cortical  centei’s  and  an  inhibition  of  the 
macular  visual  cortical  centers.  The  first  recorded 
case  relating  hemianopsia  to  the  visual  cortical 
area  was  that  of  Levick3.  Since  that  time, 
abundant  experimental  and  pathological  observa- 
tions have  confirmed  and  elaborated  the  findings 
then  recorded.  It  appears  probable,  on  the  basis 
of  pathological  cases,  that  color  vision  has  a 
sepax-ate  representation  in  the  cex-ebral  cortex.  It 
also  appeal’s  probable  that  the  primary  colors  are 
separately  l’epresented. 


ASSOCIATION  CENTERS 

The  brain  does  much  more  than  merely  form  a 
substratum  for  the  visual  perception  of  some  ex- 
ternal object.  It  associates  objects  with  words 
giving  names  to  them.  It  analyzes  the  perception 
of  names  and  other  symbols  into  cerebral  visual 
images  of  the  objects  for  which  they  stand.  It 
associates  the  perception  of  objects  with  certain 
sounds,  indicating  an  association  pathway  with 
auditory  centers.  It  associates  objects  with  odors, 
tastes  and  all  other  forms  of  sensation  indicating 
association  pathways  with  the  cerebral  centers 
concerned  with  all  these  functions.  The  visual 
perception  of  objects,  too,  gives  rise  to  all  the 
varied  emotional  states  that  man  is  capable  of 
experiencing,  and  hence  there  are  association 
pathways  from  the  visual  centers  to  the  centers 
governing  emotion  and  visceral  function  in  the 
thalamus  and  diencephalon.  Of  great  importance 
also  is  the  motor  response  to  the  perception  of 
visual  objects.  The  individual  goes  towards  ob- 
jects he  desires  and  away  from  those  he  fears. 
There  are,  accordingly,  association  fibers  to  the 
brain  centers  for  voluntary  motion  and  perhaps 
also  to  other  motor  centers  not  directly  associated 
with  voluntary  motion. 

It  is  not  surprising,  then,  that  lesions  in  various 
portions  of  the  gray  and  white  matter  of  the  oc- 
cipital lobe,  exclusive  of  the  calcarine  cortex,  may 
produce  a wide  variety  of  curious  clinical  and 
psychological  phenomena.  These  disorders  occur 
when  association  centers  and  association  fiber 
tracts  are  injured.  These  association  areas,  gen- 
erally speaking,  are  located  on  the  lateral  surface 
of  the  occipital  lobe.  The  following  syndromes 
have  been  described: 

(1)  Mind  or  Object  Blindness:  In  this  con- 

dition, the  individual  is  unable  to  recognize  by 
sight  once  familiar  objects.  The  object  is  seen 
but  it  has  absolutely  no  meaning.  In  some  of  the 
older  writers  the  term  “psychic  blindness”,  or 
“soul  blindness”,  was  used  to  describe  this  con- 
dition. Occasionally,  the  patient  may  lose  all 
power  of  recognizing  the  meaning  of  an  object 
although  he  may  be  able  to  recall  the  meaning  as 
a visual  memory  when  the  object  is  no  longer 
present.  Here,  it  is  assumed  that  the  cortex  is 
intact  and  the  association  pathway  between  it  and 
the  calcarine  area  is  destroyed.  Mills4  records  a 
case  of  a woman  who  was  unable  to  recognize  her 
own  son  by  sight  although  she  was  able  to  recog- 
nize her  surroundings  and  orient  herself  with  re- 
gard to  them.  It  is  not  necessary,  in  the  produc- 
tion of  these  symptoms,  that  both  occipital  lobes 
be  involved.  It  is  only  necessary  that  the  associa- 
tion pathways  to  the  opposite  occipital  cortex,  the 
corpus  callosum,  be  involved. 

(2)  Word  Blindness : In  this  condition,  the  pa- 
tient loses  the  memory  of  the  meaning  of  words 
and  similar  symbols.  He  perceives  the  form  but  it 
has  no  meaning.  He  may  be  able  to  draw  the  word 


February,  1933 


Nervous  System  and  the  Eye — Vonderahe 


107 


Fig.  1.  Tumor  of  the  third  ventricle,  pressing  from 
above  upon  the  optic  chiasm  and  producing  bitemporal  visual 
field  defects. 


that  he  sees  but  it  has  no  significance.  The  corti- 
cal center  for  the  perception  of  the  meaning  of 
words  is  usually  held  to  be  the  left  angular  gyrus, 
a convolution  on  the  anterior  and  lateral  surface 
of  the  occipital  lobe  which  surrounds  the  posterior 
tip  of  the  superior  temporal  fissure.  If  the  lesion 
involves  the  cortex  of  the  angular  gyrus,  the 
patient  is  unable  to  write  words.  If  the  associa- 
tion pathway  from  the  calcarine  area  to  the 
angular  gyrus  is  destroyed,  he  will  be  able  to 
write  words  spontaneously  but  he  cannot  com- 
prehend words  which  are  seen.  A case  is  reported 
by  Hinchelwood'  wherein  an  individual  became 
word  blind  to  one  language  alone.  This  patient 
was  unable  to  read  English  but  could  read  Greek 
and  had  partial  word  blindness  for  Latin.  Cases 
are  also  recorded  by  Mills”  in  which  the  capacity 
to  read  numbers  was  retained  while  the  capacity 
to  read  words  was  lost.  In  one  particular  case 
the  individual,  when  examined  with  the  test  types, 
could  not  read  a single  word  although  he  could  at 
once  recognize  and  repeat  the  number  at  the  top 
of  each  paragraph.  Lowenfeld7  describes  a case 
in  which  the  individual  could  read  short  but  could 
not  read  long  words. 

(3)  Agrammatism:  In  extensive  involvement 

of  the  visual  speech  centers,  together  with  audi- 
tory speech  centers  and  motor  speech  centers,  pro- 
found disturbances  of  language  occur.  For  an  in- 
dividual to  express  himself  in  language,  it  is 
necessary  that  he  be  supplied  with  words  and  the 
meaning  of  words,  have  the  capacity  to  ennunci- 
ate  them  clearly,  and  arrange  them  in  sentence 
form.  As  a result  of  extensive  lesions  in  the  cor- 


Fig. 2.  Internal  hydrocephalus  in  a young  infant, 
secondary  to  subdural  hematoma.  The  third  ventricle  is 
enormously  enlarged  with  pronounced  destructive  changes 
of  the  chiasm. 

tical  language  areas,  as  above  enumerated,  speech 
may  become  mutilated  and  may  be  limited  to  the 
use  of  nouns  and  the  entire  grammatical  structure 
of  expression  may  be  severely  altered.  Mills8 
describes  recovery  in  a case  in  which  various 
phases  of  language  disorder  occurred.  At  first 
nouns  returned,  next  a few  verbs  were  acquired; 
adjectives,  adverbs,  prepositions  and  articles, 
whose  uses  are  to  modify,  limit,  or  express  re- 
lationship, were  most  seriously  lost. 

A recent  tendency,  traceable  in  large  part  to 
the  views  of  Pierre  Marie,  considers  a widespread 
area  of  the  brain  as  concerned  with  the  function 
of  speech.  This  area  includes  the  temporal  lobe, 
parietal  lobe  as  far  as  the  supramarginal  and 
angular  convolutions,  the  Island  of  Reil,  and, 
perhaps,  the  lower  frontal  convolution.  This  im- 
plies a trend  against  too  fine  a localization  of 
function  as  maintained  by  the  older  neurologists. 
A review  of  the  classical  cases,  however,  de- 
scribed by  the  older  group,  impresses  the  reader 
with  the  carefulness  and  accuracy  of  their  ob- 
servations. 

VISUAL  HALLUCINATIONS 

Before  the  cerebral  relationships  of  vision  are 
dismissed,  it  may  be  of  interest  to  consider  briefly 
the  subject  of  visual  hallucinations.  In  the  true 
visual  hallucination,  there  is  present  to  the  in- 
dividual a visual  representation  which  is  so  vivid 
and  real  that  he  is  convinced  that  an  external 
object  is  present.  So  real  does  this  false  sense- 
perception  become  that  no  amount  of  explanation 
or  argument  can  convince  the  individual  that  the 
entire  process  is  purely  nervous  in  origin.  Visual 
hallucinations  apparently  may  occur  from  irrita- 
tive lesions  anywhere  along  the  course  of  the 
visual  pathway.  C.  A.  Wood"  gives  instances  of 
visual  hallucinations  associated  with  faint  opaci- 


108 


The  Ohio  State  Medical  Journal 


February,  1933 


Fig.  3.  Multiple  hemorrhages,  in  a case  of  skull  frac- 
ture, involving  the  dorso-lateral  surface  of  the  parieto- 
occipital lobes  producing  signs  of  visual  aphasia. 

ties  of  the  vitreous  or  slight  choroidal  lesions. 
Horrax10  describes  several  cases  of  visual  hallu- 
cination associated  with  tumors  of  the  temporal 
lobe.  A curious  case  of  Lilliputian  hallucina- 
tions was  reported  by  Vonderahe11.  In  many  of 
these  latter  cases,  the  presence  of  diminutive 
hallucinations  has  been  definitely  associated  with 
the  use  of  toxic  amounts  of  mydriatic  substances. 
In  the  hallucinations  associated  with  organic  irri- 
tation of  some  portion  of  the  visual  apparatus,  it 
is  unusual  for  the  patient  to  build  up  a system 
of  delusions  based  on  the  hallucinatory  exper- 
iences. In  this  manner  a difference  is  noted  be- 
tween these  visual  hallucinations  and  those  that 
occur  in  dementia  praecox  where  a satisfactory 
organic  basis  has  never  been  demonstrated. 

INNERVATION  OF  EYE  MUSCLES 

The  control  of  the  external  and  internal  mus- 
cles of  the  eye,  with  the  exception  of  the  dilator 
pupillae,  have  their  centers  in  nuclei  in  the  brain 
stem.  These  nuclei  are  arranged  in  series  rather 
close  to  the  midline  of  each  side  of  the  aqueduct 
of  Sylvius.  The  nuclear  groups,  according  to 
E dinger,12  appear  in  the  following  order,  begin- 
ning anteriorly:  levator  palpebrae,  fibers  un- 

crossed; rectus  superior,  fibers  uncrossed;  rectus 
internus,  fibers  crossed  and  uncrossed;  obliquus 
inferior,  fibers  crossed  and  uncrossed,  and  rectus 
inferior,  fibers  crossed.  The  above  nuclei  give 
rise  to  fibers  which  reach  the  eye  from  the  oculo- 
motor nerve.  The  very  exact  anatomical  position 
of  the  nuclei  is  a matter  of  controversy.  An  ex- 
cellent resume  of  this  subject  is  given  by  Jelliffe 


Fig.  4.  Abscess  in  the  white  matter  of  the  left  occipital 
lobe  producing  right  homonomous  hemianopsia. 

and  White”.  Immediately  posterior  to  these 
nuclear  groups  is  the  nucleus  trochlearis  which 
sends  crossed  fibers  to  the  obliquus  superior.  A 
short  distance  posteriorly,  in  line  with  the  other 
cell  groups,  is  the  nucleus  abducentis  which  sends 
uncrossed  fibers  to  the  rectus  externus.  Lying  be- 
tween the  anterior  oculomotor  nuclei  is  the 
nucleus  of  Edinger-Westfall  which  supplies  fibers 
to  innervate  the  ciliary  muscle  and  the  con- 
strictor of  the  pupil. 

An  opportunity  was  afforded  to  observe  the 
course  of  paralysis  in  an  individual  with  a mild 


Fig.  5.  Hemorrhage,  secondary  to  vascular  disease,  in- 
volving the  tegmental  portion  of  the  pons,  implicating  the 
third,  fourth  and  sixth  cranial  nerves  and  the  posterior 
longitudinal  fasciculus. 

grade  of  encephalitis.  The  onset  was  character- 
ized only  by  ptosis,  indicating  an  involvement  of 
the  most  anterior  nuclear  group  concerned  with 
the  levator  palpebrae.  There  next  followed 
diplopia,  from  involvement  of  the  superior  rectus 
muscle.  As  the  lesion  progressed  further,  paraly- 
sis of  the  internal  recti  also  took  place. 

The  nuclear  group  which  supplies  motor  im- 
pulses to  the  dilator  of  the  pupil  is  located  in  the 
superior  cervical  ganglia  of  the  sympathetic  chain 
lesion  of  any  portion  of  the  sympathetic  arc, 


February,  1933 


Nervous  System  and  the  Eye — Vonderahe 


109 


with  a preganglionic  fiber  arising  from  the  eighth 
cervical  segment  and  first  and  second  thoracic  seg- 
ment of  the  spinal  cord.  As  noted  previously,  a 
lesion  of  any  portion  of  the  sympathetic  arc, 
from  the  cell  group  in  the  spinal  cord  to  the  en- 
trance of  nerve  fibers  into  dilator  pupillae,  gives 
rise  to  Horner’s  syndrome  (mydriasis,  exophthal- 
mus  and  vasodilatation  of  the  affected  side  of  the 
face).  The  harmonious  play  of  impulses  giving 
rise  to  conjugate  movements  of  the  eyes  in  the 
various  planes  of  space,  involves  a coordinating 
mechanism,  the  medial  longitudinal  fasciculus.  It 
is  through  this  coordinating  bundle,  for  example, 
that  the  external  rectus  of  one  eye,  innervated  by 
the  abducens  nerve,  acts  in  conjunction  with  the 
internal  rectus  of  the  other  eye,  innervated  by 
the  oculomotor  nerve,  to  produce  a conjugate 
movement  of  the  eyes  laterally.  Through  this 
bundle,  also,  the  motor  nuclei  to  the  eye  muscles 
are  brought  into  relationship  to  other  cranial 
nerves.  Thus,  the  eyes  turn  in  response  to  a loud 
noise  transmitted  over  the  eighth  nerve.  Fibers 
from  the  vestibular  nerve  are  components  of  the 
posterior  longitudinal  faciculus,  so  that  a con- 
ti'ibution  to  coordination  of  the  eyes  is  made  by 
the  semi-circular  canals.  It  is  over  this  system 
that  the  Barany  tests  produce  nystagmus. 

A point  of  importance  which  is  frequently  over- 
looked is  the  sensory  function  of  the  nerves  to 
the  external  eye  muscles.  Until  fairly  recently  it 
was  thought  that  these  nerves  were  purely  motor 
in  function,  largely,  no  doubt,  because  no  sensory 
ganglia  were  demonstrable  along  their  course. 
These  nerves,  however,  are  no  different  than 
nerves  to  muscles  elsewhere  in  the  body.  They 
contain  fibers  carrying  proprioceptive  sensation 
and  deep  pressure-pain  sensation  from  the  re- 
spective ocular  muscles.  Ganglion  cells  are  in- 
deed present,  not  gathered  together  into  a definite 
root  ganglion,  but  scattered  along  the  course  of 
the  nerve  trunk.  It  would  appear,  therefore,  that 
some  form  of  pain  may  arise  from  tension  in  these 
muscles  and  that  some  forms  of  muscular  im- 
balance may  result  from  involvement  of  the  pro- 
prioceptive sensory  fibers. 

Lesions  of  the  mid-brain,  pons,  and  upper-most 
portion  of  the  medulla  frequently  implicate  the 
nuclei,  root  fibers,  or  association  pathways  of  these 
nerves  and  various  combinations  of  symptoms  re- 
sult, all  of  which  may  be  analyzed  with  respect  to 
their  anatomical  localization  with  considerable 
accuracy. 

The  most  striking  clinical  pictures,  however, 
are  presented  by  involvement  of  the  coordinating 
mechanism  as  illustrated  in  the  following  case  of 
Spiller14.  There  was  a sudden  onset  of  diplopia 
and  symptoms  suggesting  a vascular  lesion.  The 
patient  had  marked  divergent  strabismus  with 
complete  loss  of  internal  rectus  action  in  both 
eyes  for  right  and  left  associated  lateral  move- 
ments, but  in  the  associated  movement  of  accom- 
odation and  convergence  both  internal  recti  acted. 


Diagnosis  was  made  of  a lesion  in  the  posterior 
part  of  the  pons  implicating  the  posterior  longi- 
tudinal bundle  of  each  side,  of  vascular  origin, 
with  softening. 

Of  all  the  eye  muscle  nerves,  perhaps  the  ab- 
ducens is  most  liable  to  involvement.  This  is  be- 
cause it  leaves  the  brain  stem  at  the  junction  of 
the  medulla  and  pons  and  has  an  unusually  long 
course  in  the  subarachnoid  space.  Any  form  of 
meningitis,  as  well  as  many  other  pathological 
conditions  which  involve  the  base  of  the  brain,  are 
almost  certain  to  involve  it.  This  tends  to  ac- 
count for  the  fact  that  internal  strabismus  is 
perhaps  the  most  common  of  all  types  of  eye 
muscle  disturbance. 

CONCLUSION 

This  paper  has  been  concerned  chiefly  with  the 
localization  of  functions  of  the  eye  in  various 
parts  of  the  nervous  system,  irrespective  of  the 
particular  type  of  disease  process.  The  various 
types  of  retinitis,  optic  neuritis  and  the  results 
of  cerebral  edema  and  intracranial  pressure  were 
not  included,  because  they  imply  a diffuse  in- 
volvement, and,  of  themselves,  are  of  minor  im- 
portance in  localizing  diagnoses. 

REFERENCES 

1.  Vonderahe,  A.  R.,  Corneal  and  Scleral  Anesthesia  of 
the  Lower  Half  of  the  Eye  in  a Case  of  Trauma  of  the 
Superior  Maxillary  Nerve.  Arch.  Neur.  and  Psych.  20 :836, 
Oct.,  1928. 

2.  Rhein,  J.  H.  W.,  Hypophysial  Pressure  Symptoms  Due 
to  Hydrocephalus  Causing  Cystlike  Distension  of  the  Third 
Ventricle.  Arch.  Neur.  and  Psych.  IS: 71,  Jan.,  192. 

3.  Levick,  Abscess  of  Brain,  Amer.  Jour.  Med.  Sc., 
52:413,  1866. 

4.  Mills,  C.  K.,  in  The  Eye  and  Nervous  System,  Ed. 
by  Posey  and  Spiller,  Philadelphia,  J.  B.  Lippincott  Co., 
1906,  p.  119. 

5.  Hinchelwood,  J.,  Four  Cases  of  Word  Blindness, 
Lancet,  1 :358,  (Feb.  8.)  1902. 

6.  Mills,  C.  K.,  loe,  cit  p.  142. 

7.  Lowenfeld,  L.  Ueber  zwei  Falle  von  Amnestischer 
Aphasia,  Deutsche  Zeitschr.  f.  Nervenheilk.  2 :1,  1892. 

8.  Mills,  C.  K.,  Treatment  of  Aphasia  by  Training, 
J.  A.  M.  A.,  43:1940,  (Dec.  24.)  1904. 

9.  Wood,  C.  A.,  in  The  Eye  and  Nervous  System,  Ed.  by 
Posey  and  Spiller,  Philadelphia,  J.  B.  Lippincott  & Co., 
1906,  p.  175. 

10.  Horrax,  G.  Visual  Hallucinations  as  a Cerebral 
Localizing  Phenomenon,  Arch.  Neur.  and  Psych.,  10:538 
(Nov.)  1923. 

11.  Vonderahe,  A.  R.,  Lilliputian  Hallucinations,  Arch. 
Neur.  and  Psych.,  22 :585,  (Sept.)  1929. 

12.  Bailey’s  Text  Book  of  Histology,  revised  by  O.  S. 
Strong  and  A.  Elwyn,  New  York,  Wm.  Wood  & Co.,  1926, 
p.  739. 

13.  Jelliffe  & White:  Diseases  of  the  Nervous  System, 
Philadelphia,  Lea  & Febiger,  1929,  p.  380. 

14.  Spiller,  Wm.  G.,  Ophthalmoplegia  Internuclearis 

Anterior:  A Case  with  Necropsy,  Brain  47:345,  (Aug.) 

1924.  Arch.  Neur.  and  Psych.  14 :546,  (Oct.)  1925. 


DISCUSSION 

Donald  J.  Lyle,  M.D.,  Cincinnati,  Ohio:  Dr. 

Harvey  Cushing1  in  his  recent  book  on  Intra- 
cranial Tumors  says : “The  ophthalmic  surgeon  is 
possibly  the  oldest  of  surgical  specialists  and  be- 


110 


The  Ohio  State  Medical  Journal 


February,  1933 


cause  of  his  ability  to  restore  sight  to  the  blind 
he  holds  a high  position  in  popular  esteem.  But 
ophthalmologists  have  traditionally  restricted 
their  surgical  field  to  the  orbit  and  have  not  ven- 
tured to  pursue  to  their  source  the  disorders  of 
vision  whose  causes  lie  within  the  skull.  Had  they 
so  pursued  the  sources  of  choked  disc  or  the 
sources  and  causes  of  the  primary  optic  atrophies, 
they  might  well  enough  have  long  preceded  the 
neurosurgeon  in  the  tasks  which  permit  him  to 
share  in  the  gratifying  occupation  of  restoring 
vision.” 

We  as  ophthalmologists  must  admit  the  truth 
of  this  statement  but,  with  the  tremendous  and 
continuous  advances  in  our  field  we  can  hardly  be 
expected  to  take  over  the  work  of  neurosurgery 
which  is  a specialty  in  itself.  As  to  the  diagnosis 
of  intracranial  conditions,  the  ophthalmologist, 
with  progressing  frequency,  is  requested  to  con- 
sult with  the  neurologist,  psychiatrist,  neuro- 
surgeon and  otolaryngologist  as  well  as  with  the 
general  physician  regarding  patients  in  whom 
symptoms  of  intracranial  lesions  are  found  or 
suspected.  It  has  been  necessary  for  the  prac- 


i  Cushing,  H,  Intracranial  Tumors : C.  C.  Thomas, 

Springfield,  111.:  1932,  pp.  69-70. 


ticing  ophthalmologist  to  refer  to  ■ more  or  less 
general  and  usually  copious  text  books  on  neur- 
ology, of  which  there  are  a number  of  excellent 
ones,  in  order  to  glean  from  here  and  there  with 
much  time  consuming  energy  that  which  pertains 
to  his  speciality. 

The  general  subject  of  intracranial  lesions  may 
be  divided  into: 

1.  Brain  injuries 

2.  Brain  tumors 

3.  Brain  abscesses 

4.  Vascular  lesions  of  the  brain 

5.  Anomalies  of  the  brain 

6.  Diseases  of  the  central  nervous  system  of 
greatest  interest  to  the  ophthalmologist  as  fol- 
lows : 

A.  Cerebro-spinal  syphilis 

B.  Hereditary  ataxia 

C.  Disseminated  sclerosis 

D.  Syringomyelia 

E.  Encephalitis 


General  Area 

Tract  or 
Center 

Eye 

Involvement 

Symptoms 

Syndromes 

MEDULLA 

A — Sympathetic 

Pupil 

Lid 

Orbit 

Miosis 

Ptosis  (partial) 
Enophthalmos  (relative) 

B — Vestibular 

Extrinsic  eye 
muscles 

Nystagmus 

PONS 

A — Abducens  nerve 
and  nucleus 

External  rectus 
muscle 

paralysis — internal 
strabismus 

B — Cortico-nuclear 

external  rectus 
& opposite  oculo- 
motor (int.  rectus) 

conjugate  deviatio  of 
eyes 

C — Posterior  long- 
itudinal body 

Extrinsic  eye 
muscles 

incoordination  of  eye 
movements 

MIDBRAIN 

A — Trochlear  nerve 
and  nucleus 

Superior  oblique 
muscle 

Paralysis — weak  down  and 
outward  eye  movement 

B — Oculomotor  nerve 
and  nuclei 

Extrinsic  eye 
muscles 
Levator  of  lid 
Para-sympathetic 

External  strabismus 

Ptosis 

Mydriasis 

C — Cortico-nuclear 

Extrinsic  eye 
muscles 

Eye  muscle  paralysis 
Paralysis  of  vertical 
gaze  especially 

INTERBRAIN 

A — Subthalamus 

Extrinsic  eye 
muscles 

Paralysis  of  vertical 
gaze 

B — Thalamus 

Optic  radiations 

Field  changes 

C — Epithalamus 

Optic  radiations 
Eye  muscles 

Field  changes 
Paralysis  of  vertical 
gaze  (nystagmus) 

D — Hypothalamus 

Optic  chiasm 

Field  changes 

END  BRAIN 

A — Knee  Internal 
Capsule 

Eye  motor  tract 

Conjugate  eye  deviation 

B — Posterior  Limb 
Internal  Caps. 

Efferent  visual 
radiations 

Paralysis  of  fixation 
gaze 

CORTEX 

A — Visuo-sensory 

Vision  center 

Field  of  vision  defects 

B — Visuopsychic 

Vision  center 

Association  visual 
defects 

C — Angular  gyrus 

Association 
motor  center 

Association  visuo-motor 
defects 

D — Frontal  lobe 
pre-central 

Eye  motor 
center 

Conjugate  deviation  and 
other  motor  defects 

*Presented  to  the  Eye,  Ear,  Nose  and  Throat  section  of  the  Ohio  State  Medical  Association,  Dayton, 
May  3,  1932,  in  discussion  of  Dr.  A.  R.  Vonderahe’s  presentation. 


February,  1933 


Occupational  Skin  Disease — Zwick 


111 


F.  Meningitis 

G.  Migraine 

H.  Epilepsy 

Toxins,  poisons  and  drugs. 

There  is  scarcely  an  area  in  the  brain  an  inch 
in  diameter  that  is  not  associated  with  the  eye 
either  directly  or  indirectly  through  reflex  or 
association  paths.  The  optic  nerve  with  its  tract 
and  radiations  passes  backwards  through  the 
brain  in  contact  with  the  temporal,  parietal  and 
occipital  lobes  and  also  the  hypothalamus,  thala- 
mus and  epithalamus.  The  sensory  and  psychic 
visual  centers  are  in  the  occipital  cortex,  the 
angular  gyrus,  the  stimulation  of  which  incites 
eye  movements,  is  in  the  parietal  lobe.  The  cen- 
ter for  the  control  of  the  eye  movements  is  in  the 
frontal  lobe.  The  oculomotor  and  trochlear  nuclei 
and  emergent  nerves  are  located  in  the  midbrain. 


The  abducens  nucleus  and  emergent  nerve  as  well 
as  the  facial  (to  the  orbicular  palperbrarum)  and 
the  trigeminus  (touch  and  pain  sensation)  are  in 
the  pons.  The  sympathetic  tract  which  ultimately 
innervates  the  smooth  (and  striated  to  some  ex- 
tent) muscles  of  the  eye  and  orbit  passes  down 
the  brain  stem  and  cervical  cord  to  emerge  and 
pass  up  the  neck.  There  are  several  tracts 
through  which  most  of  the  visual  and  eye  motor 
stimuli  pass  the  chief  volitional  one  being  the 
aberrant  pyramidal  tract  (corticonuclear)  to  the 
eye  muscle  nuclei  in  the  brain  stem.  The  reflex 
(for  the  most  part)  tracts  are  the  ascending 
(chiefly)  posterior  longitudinal  bundle,  the  de- 
scending tecto-nuelear  (colliculo-nuclear)  tract 
connecting  the  cranial  nuclei,  and  the  eferrent 
optic  radiations  to  the  eye  muscle  nuclei. 

A brief  outline  of  the  association  of  eye  symp- 
toms with  localized  brain  lesions  shown  in  the 
table  on  page  110. 


GceupatioiMiJ  Skim  Diseases^  Dermatologic  Hints  for 

Their  Elimination 

Karl  G.  Zwick,  M.D.,  Cincinnati,  Ohio 


INTRODUCTION 

“Clothed  in  air”,  primitive  man  gathering  his 
“daily  bread”  or  defending  himself  against 
enemies  was  exposed  to  occupational  injuries  and 
alterations  of  his  skin. 

Of  these  cutaneous  affections  we  have,  of 
course,  neither  direct  fossil  evidence  nor  chi'on- 
icled  record. 

But  the  observation,  that  in  modem  man  an 
exostosis  of  the  femur  is  frequently  associated 
with  a cutaneous  callosity,  makes  it  seem  prob- 
able to  me  that  the  same  association  existed  in  the 
case  of  the  exostosis  on  the  femur  attributed  by 
its  discoverer,  Eugene  Dubois  (1891)  to  the 
Java  ape-man,  the  Pithecanthropus  erectus. 
In  fact,  there  is  no  doubt  in  my  mind,  that  the 
habit  of  sitting  erect  produced  in  the  Java  man  a 
callus  formation  similar  to  the  “occupational 
stigmata”  we  see  today  as  a result  of  intermit- 
tent pressure  and  friction  on  the  cutaneous  layers 
over  a femoral  exostosis  or  other  bony  prominence. 

Passing  from  prehistoric  to  historic  times  we 
reach  firmer  ground. 

But  the  ancient  classical  authors  with  one  ex- 
ception are  silent  in  regard  to  occupational  dis- 
eases, although  some,  among  them  the  “Father  of 
History”,  Herodotus,  discuss  at  length  the  crafts 
and  industries  of  antiquity,  which  involve  some 
of  the  same  occupational  hazards  to  the  skin  we 
meet  with  in  modern  factories. 

Only  the  “Father  of  Medicine”,  Hippocrates, 
(124  o C,  ed.  Foesius)  mentions  an  affection  of 
the  skin  called  “hippuris”  which  is  caused  by 
strenuous  riding.  This  Greek  term  is  interpreted 


Read  before  the  Section  on  Public  Health  and  Industrial 
Medicine,  Ohio  State  Medical  Association,  at  the  86th 
Annual  Meeting,  Dayton,  May  3 and  4,  1932. 


by  Bernardino  Rammazini,  (1633-1714)  to  whom 
we  owe  the  first  systematic  treatise  on  diseases  of 
the  working  man,  as  callosities  and  ulcerations  of 
the  gluteal  region,  whereas  modern  philologists 
refer  to  it  as  a dubious  expression  indicating  a 
complaint  in  the  groin. 

We  do  not  depend  only  on  pictorial  or  written 
records  to  support  the  opinion  that  the  ancient 
artisans  were  exposed  to  the  same  occupational 
risks  as  the  modern  craftsmen. 

Chinese  and  Japanese  lacquer  work,  manufac- 
tured over  a thousand  years  ago  from  trees 
(Rhus  vernicifera)  belonging  to  the  poison  ivy 
and  sumach  family,  exerts  the  same  eczemato- 
genic  effects  on  those  who  handle  it  today,  as  it 
probably  did  on  the  workmen  who  created  it. 

(The  dermatitis  of  mah-jong  players  is  also 
caused  by  material  derived  from  the  Rhus  fam- 
ily-) 

Having  thus  linked,  as  it  were,  the  far  distant 
past  with  the  present,  I refer  you  concerning  the 
later  history  of  occupational  skin  diseases  to  the 
pertinent  translations  and  treatises  by  Fischer, 
Sachs  and  Rosner,  Koelsch  and  others  and  take 
up  the  consideration  of 

THE  INCIDENCE  OF  OCCUPATIONAL  SKIN  DISEASES 

Although  occupational  diseases  in  general  and 
those  of  the  skin  in  particular  have  always  been 
with  us,  it  has  not  been  very  long  since  industrial 
management  discovered  the  economic  force  of  the 
proverb  that  a penny  spent  for  prevention  is 
worth  a pound  of  cure. 

As  the  recent  statistical  report  of  the  Industrial 
Commission  of  Ohio  (Special  Bulletin  No.  2,  1931) 
embracing  the  years  1927,  1928,  1929,  contains  the 
statement:  “that  diseases  of  the  skin  are  respon- 
sible for  the  largest  number  of  claims  filed”,  it 


112 


The  Ohio  State  Medical  Journal 


February,  1933 


TABLE  1 

COMPARISON  OF  NUMBER  OF  COMPENSATION -CLAIMS 


State 

Year 

Number  of  Claims 
filed  for  all 
Occupational  Diseases 

Number  of  Claims 
filed  for 

Occupational  Dermatoses 

Percentage  of  Claims 
for 

Occupational  Dermatoses 
(in  round  figures) 

Connecticut 

1928 

164 

95 

58 

Massachusetts 

1927 

247 

89 

36 

New  Jersey 

1928 

232 

70 

30 

New  York . 

1930 

770 

150 

20 

1927 

Ohio 

1928 

3229 

2060 

64 

1929 

Total 

4642 

2464 

53.0 

seems  quite  apropos  to  bring  the  subject  of  oc- 
cupational skin  diseases  to  the  attention  of  the 
Section  of  Public  Health  and  Industrial  Medicine 
of  the  Ohio  State  Medical  Association. 

Expressed  in  figures  we  find  in  the  report  that 
(in  the  three  years  mentioned)  of  the  total  of 
3229  cases  recorded  2060  are  diseases  of  the  skin. 

Calculated  on  a percentage  basis,  the  2060  cases 
of  skin-disease  represent  64  per  cent  of  the  total 
number  of  3229  cases  of  occupational  diseases. 

Although  there  was  a compensable  disability  in 
only  39  per  cent  of  the  claims  filed,  (because  the 
disability  did  not  extend  over  7 days)  the  time 
lost  was  nevertheless  39,020  working  days. 

According  to  a statement  by  Chajes  (Zeitschr. 
f.  angew.  Chemie  1926,  Vol.  39,  p.  1017)  indus- 
trial dermatoses  represent  in  Germany  from  50-70 
per  cent  of  industrial  diseases  in  general.  In  the 
United  States  however,  the  percentage  of  Con- 
necticut (in  1928)  is  the  only  one  out  of  five 
states  which  approaches  the  percentage  of  Ohio. 
(See  my  compilation  in  Table  No.  1.) 

However,  strict  comparisons  are,  unfortunately, 
not  feasible  for  the  five  states,  because  statistics 
in  the  different  states  do  not  include  quite  the 
same  categories  of  skin  diseases,  as  is  indicated, 
for  example,  by  the  fact,  that  New  York  State 
registers  separately,  i.e.  not  under  “Dermatoses”, 
such  occupational  diseases  as  those  due  to:  poison 
ivy  and  soap,  whereas  those  due  to:  cement,  oil, 
vegetable  parasites,  alkali,  acid,  are  grouped  with 
the  “Dermatoses”. 


These  differences  in  classification  suggest  to 
you  that  possibly  an  advantage  might  be  gained 
from  a more  uniform  mode  of  registration.  Such 
uniformity  would,  in  my  opinion,  add  materially 
to  the  value  of  the  statistical  reports,  as  it  might, 
among  other  things,  enable  us  to  determine  and 
understand  why  in  Ohio  64  per  cent  of  the  com- 
pensation claims  are  for  occupational  diseases  of 
the  skin,  whereas  in  New  York  the  percentage  is 
only  20! 

Another  advantage  would  be,  that  if  we  were 
to  find  that  the  low  percentages  in  New  York  (20 
per  cent),  in  New  Jersey  (30  per  cent),  and  in 
Massachusetts  (36  per  cent)  against  64  per  cent 
in  Ohio  (in  three  years)  are  the  result  of  more 
adequate  preventive  measures,  these  measures 
would  deserve  an  investigation. 

If  on  the  other  hand,  the  higher  incidence  of 
skin-diseases  in  Ohio  is  due  to  special  manufac- 
turing conditions  or  to  special  products,  that  fact 
would  also  be  important,  as  the  knowledge  of  it 
nr'ght  urge  us  to  develop  improvements  in  the 
handling  of  damaging  materials. 

Although  from  the  dermatologic  standpoint  I 
have  several  other  pious,  statistical  wishes  I will 
give  expression  but  to  the  one,  that  the  time  in- 
terval be  recorded  which  elapses  between  the 
date  on  which  an  employee  develops  the  very  first 
symptoms  of  a beginning  industrial  dermatitis 
and  the  date  of  his  first  occupational  contact  with 
the  substance,  proved  to  be  or  suspected  to  be- 
the  eczematogenic  agent. 


Occupational  Skin  Disease — Zwick 


113 


February,  1933 


TABLE  2 

OCCUPATIONAL  CUTANEOUS  HAZARDS  AS  OBSERVED  IN  DERMATOLOGIC  PRIVATE  AND  CLINIC  PRACTICE 


Occupations 

Probable  Principal  Noxious  Agents 

1.) 

Domestic  Work. — Laundry  workers. 

Soap,  washing  powders,  alkalies,  water,  heat; 
insecticides,  cleaning  fluids. 

2.) 

Laborers. 

Exposure  to  cold;  water,  chemicals,  cement, 
lime,  tar. 

3.) 

Printers,  engravers,  lithographers. 

Turpentine  and  substitutes;  benzine;  colors, 
(inks?)  rosin;  cleaning  agents,  acids. 

4.) 

Painters,  plasterers,  bricklayers,  paper- 
hangers. 

Turpentine  and  substitutes;  benzine;  plaster, 
cement,  paste. 

5.) 

Cloth  and  fur  workers,  tailors  and 
cleaners,  milliners. 

Dyes,  mordants  (chrome  salts). 

6.) 

Metal-workers,  copper-smiths,  jewelers, 
electroplaters. 

Lubricating  oils,  polishes,  acids,  solutions  of 
metal  (cyanides),  metal  dust. 

7.) 

Chauffeurs,  auto-mechanics,  gas-station- 
attendants. 

Gasoline,  cleaning  fluids,  lubricating  oils,  paints, 
varnish,  denatured  alcohol. 

8.) 

Barbers,  cosmeticians,  morticians. 

Soap,  water,  denatured  alcohol,  hair-dyes,  scalp 
lotions  (quinine),  dry-shampoo  fluids,  em- 
balming fluids. 

9.) 

Oil  and  grease  workers. 

Fats  and  oils  handled  in  different  trades. 

10.) 

Bakers,  confectioners,  cooks,  butchers, 
grocers. 

Flour,  dough,  sugar  (yeast)?  (parasites),  meats, 
rabbits,  salt. 

11.) 

Physicians,  dentists,  nurses. 

Soap,  water,  disinfectants,  antiseptics,  alcohol- 
denaturants,  X-rays!  Anesthetics. 

12.) 

Tanners,  shoemakers,  and  other  leather 
workers. 

Lime,  chrome  salts,  formaldehyde,  dyes,  fungi, 
tan-liquors,  salt. 

13.) 

Chemists  and  druggists,  photographers. 

Numerous  chemicals  and  drugs,  developers. 

14.) 

Gardeners  (vocational  and  amateur), 
florists,  farmers. 

Irritating  plants  (Rhus,  Primula),  insecticides, 
fungi. 

15.) 

Wood  workers. 

Special  woods;  solvents  for  varnish,  glue. 

It  is  in  this  connection  I offer  the  dermatologic 
hint  that  a causative  agent  can,  frequently,  be 
determined  with  the  aid  of  a 

TOLERANCE  PROBE 

The  simplest  technic  for  performing  a “func- 
tional cutaneous  probe”,  as  Jadassohn  the  origin- 
ator of  the  principle  and  method  of  the  procedure 
called  it,  is  indicated  on  the  diagrammatic  sketch 
shown  in  Fig  1.  The  probe  is  first  made  on  the 
intact  skin.  If  negative  on  the  intact  skin,  the 
skin  may  be  subjected  to  the  manipulations  of  the 
von  Pirquet  or  of  the  Moro  test.  (In  order  to 
limit  the  area  of  skin  exposed  to  the  action  of  the 
substance,  I have  modified  the  technic  by  placing 
the  substance  within  a circle  punched  out  of  the 
adhesive  piaster  applied  to  the  skin.  It  is  im- 
portant to  use  a plaster  which  is  non-irritant) . 

Controls  should  not  be  omitted. 

The  readings  are  made  in  the  same  manner  as 
in  the  performance  of  the  von  Pirquet  test  or 
similar  procedures.  The  “grading”  of  the  results 
is  analogous.  If  no  reaction  is  observed  on  prev- 


iously normal  skin  after  various  intervals,  the 
probe  may  be  repeated  cautiously  on  skin  which 
has  been  the  site  of  an  eczematous  lesion  and 
may  be  allergic  or  hypersensitive. 

Jadassohn,  and  especially  Bloch  and  his  numer- 
ous able  collaborators  have,  thanks  to  the  probe, 
enlarged  our  theoretical  and  practical  knowledge 
of  cutaneous  pathology  in  many  directions. 


Oil  Silk. 


7b P/aste>r 
1f777777777777777777777mX377777777777777777trr. 


P/as  ter  jJ  P/as  ter 

Test  Substance 


Z wiV* 


Fig.  1.  Technic  of  Tolerance  Probe 


The  Prausnitz-Kustner  technic  which  requires 
the  intra -cutaneous  injection  of  a normal  in- 
dividual with  serum  from  an  eczematic  and  the 
subsequent  performance  of  the  Jadassohn  probe 
on  the  injected  area  is  very  valuable  but,  pos- 
sibly, only  exceptionally  applicable  to  routine  in- 
dustrial investigations. 

For  my  own  convenience  I have  made  a com- 


114 


The  Ohio  State  Medical  Journal 


February,  1933 


pilation  of  a number  of  substances  which  in  my 
experience  (dating  back  to  the  year  1908,  i.e.,  the 
time  of  my  first  connection  with  Jadassohn’s 
clinic)  are  frequently  a cause  in  the  genesis  of 
occupational  eczema.  Several  of  the  substances 
enumerated  in  my  list  (Table  No.  2)  have  to  be 
diluted  for  the  probe. 

Should  any  one  suggest  that  the  list  contains 
mostly  substances  in  common  use,  it  is  well  to  re- 
call the  proverb  that  “familiarity  breeds  con- 
tempt’’. The  ubiquity  of  a material  should  not 
lead  us  to  neglect  it  as  a possible  factor  in  the 
etiology  of  an  occupational  eczema.  In  a factory 
the  possible  factor  is  at  times  easily  traced,  if 
the  management  lends  its  assistance. 

When  new  manufacturing  processes  or  new  ma- 
terials are  introduced  a few  tolerance  probes  may 
prove  enlightening. 

The  usefulness  of  the  tolerance  probe  is  not 
limited  to  the  detection  of  the  causative  agent  in 
a given  case  of  occupational  eczema.  As  my 
second  dermatologic  hint  I suggest  that  the  tol- 
erance probe  might  be  valuable  in  preemployment 
examinations  of  applicants  for  a position. 

Of  course,  I do  not  suggest  that  the  probe  be 
made  indiscriminately  on  all  applicants,  but  I 
feel  confident  of  its  value  for  the  selection  of 
employees  for  positions  which  from  past  ex- 
perience are  known  to  involve  a considerable  risk 
with  reference  to  the  possible  development  of  an 
occupational  eczema. 

My  confidence  in  the  practical  usefulness  of  the 
tolerance  probe  is  enhanced  by  the  circumstance 
that  cosmeticians  and  barbers  employ  it  routinely, 
before  the  application  of  certain  hair-dyes  (prob- 
ably those  containing  paraphenylene  diamine).  If 
the  trial  spot  behind  the  ear  shows  even  a slight, 
inflammatory  reaction,  the  hair-dye  is  not  em- 
ployed, as  its  dangerous  possibilities  are  well 
known. 

THE  LIMITATIONS  OF  THE  TOLERANCE  PROBE 

If  the  limitations  of  a method  are  not  taken 
into  consideration,  it  may  fall  into  undeserved 
disrepute. 

For  that  reason  I bring  to  your  attention  the 
fact  that  the  probe  determines  nothing  but  the 
cutaneous  tolerance  of  an  individual  at  the  time 
when  the  probe  is  made.  It  is  in  a measure  retro- 
spective, inasmuch  as  the  probe,  generally,  re- 
veals whether  an  individual  is  congenitally  sen- 
sitive or  has  become  sensitized  or  hypersensitive 
to  a subtsance  by  previous  contact  with  it.  A 
sensitivity  is,  however,  in  some  persons  not 
specific  for  one  substance,  but  polyvalent. 

But  the  tolerance  probe  is  by  no  means  pro- 
phetic, inasmuch  as  it  does  not  enable  us  to  de- 
termine whether  or  not  an  individual  will  remain 
permanently  tolerant  or  resistant  to  the  sub- 
stance with  which  the  probe  was  made. 

In  fact  almost  every  physician  has  been  asked 


by  some  one  of  his  patients  to  explain  why  this 
or  that  substance  no  longer  agrees  with  him  or 
her. 

The  most  impressive  example  of  a change  in 
tolerance  which  has  come  to  my  personal  notice 
is  the  experience  of  the  chemist  Emil  Fischer, 
who  developed  a hypersensitiveness  or  allergy  (or 
also  idiosyncrasy  if  you  prefer,  according  to 
Doerr)  to  phenylhydrazine,  the  substance  which 
he  employed  in  his  fundamental  investigations  of 
the  sugars. 

His  case  is  paralleled  by  that  of  Bloch  who  can 
no  longer  enter  a room  where  a Chinese  primrose 
is  kept  without  suffering  an  attack  of  asthma  and 
developing  an  eczema. 

Both  celebrities  were  originally  not  sensitive 
to  their  pathogenic  agents. 

As  an  individual’s  tolerance  may  be  lost  or  re- 
gained (temporarily  or  permanently)  because  of 
internal  i.e.,  constitutional  alterations  the  result 
of  the  tolerance  probe  is  also  subject  to  variation 
for  intrinsic  reasons.  This  is  not  only  of  practical 
importance,  but  also  of  theoretical  significance 
because  the  observation  supports  the  view  that 
predisposition  plays  a role  in  the  etiology  of 
eczema  in  general,  and  of  occupational  eczema  in 
particular. 

I have  had  the  opportunity  to  observe  a patient 
who  developed  an  “eczema”  during  two  successive 
pregnancies,  but  was  free  from  all  cutaneous 
symptoms  at  other  times.  The  patient’s  tolerance 
could  not  be  probed,  but  her  occupational  con- 
tacts were  virtually  the  same  before,  during  and 
after  her  pregnancies. 

SUMMARIZING  AND  CLOSING  REMARKS 

As  occupational  skin-diseases  have  always  been 
with  us  and  as  the  incidence  of  industrial  skin- 
diseases  continues  high,  notwithstanding  the  in- 
troduction of  labor-saving  machines  which  reduce 
the  frequency  of  contact  with  harmful  substances, 
additional  prophylactic  measures  seem  necessary 
besides  those  suggested  by  McConnell,  R.  Prosser 
White,  and  others  which  retain  their  usefulness. 

It  is  suggested  that  a cutaneous  tolerance  probe 
may  be  useful:  (a.)  to  detect  eczematogenic  sub- 
stances; (b.)  to  detect  an  eczematous  predisposi- 
tion (sensitiveness,  idiosyncrasy)  in  applicants 
for  work. 

The  cutaneous  tolerance  probe  is  suggested  as 
an  additional  measure  for  determining  the  fitness 
of  an  individual  for  a specific  job,  besides  the  cus- 
tomary routine  physical  examination  of  the  body 
in  general  and  of  the  skin  in  particular. 

In  the  United  States  Public  Health  News  bear- 
ing the  release  date  of  May  5th,  1932,  attention 
was  called  to  a substantial  decrease  in  the  fre- 
quency of  hisability  due  to  diseases  of  the  skin 
throughout  the  year  1931.  (See  Table  3). 

Although  this  decline  in  the  incidence  of  skin 


February,  1933 


Occupational  Skin  Disease — Zwick 


115 


and  other  diseases  is  attributed  only  in  part  to 
the  factor  of  personnel  selection  (United  States 
Public  Health  Report,  Jan.  15th,  1932),  this  fac- 
tor is  credited  with  having  excluded  a group  con- 
taining a “large  proportion  of  potential  sickness 
than  the  group  which  remained”,  which  is  just 
what  one  hopes  to  do  with  the  selective  tolerance 
probe. 

Since  5 per  cent  of  all  individuals  are  known 
to  have  a congenital  defect  (=  idiosyncrasy)  of 
the  skin  which  predisposes  to  eczema ; and  because 
of  the  larger  percentage  of  individuals  who,  on 
account  of  their  acquired  state  of  allergy 
(=  hypersensitiveness) , have  a tendency  to 
eczema, — it  is  my  idea  that  the  fitness  of  the 
largest  organ  of  the  body  should  be  investigated 
more  frequently. 

TABLE  No.  3 

FREQUENCY  OF  DISABILITY  FROM  DIS- 
EASES OF  THE  SKIN  lasting  8 calendar  days 
or  longer  in  1931,  1930  and  1929. 


Annual  number  of  disabilities  per 
1,000  male  industrial  employees  in: 


1931 

1930 

1929 

1st  quarter 

3.1 

3.8 

4.3 

2nd  quarter 

2.9 

3.9 

4.8 

3rd  quarter 

3.7 

4.4 

4.6 

4th  quarter 

3.0 

3.7 

3.5 

*The  average  number  of  men  included  in  the  calculation 
was  approximately  149,000  in  1931  ; 160,000  in  1930  and 
164,000  in  1929.  (U.  S.  P.  H.  R.,  1932,  Vol.  47,  No.  19, 

P.  1000) 

Because  of  the  time  limit  imposed  on  the 
speaker  many  important  aspects  of  the  topic  were 
merely  touched  upon;  others,  equally  important, 
had  to  be  omitted  entirely.  By  means  of  the  cir- 
culating pictures  and  the  slides,  I have  in  a 
measure  tried  to  supply  the  deficiencies. 

19  W.  Eighth  Street. 

discussion 

C.  L.  Cummer,  M.D.,  Cleveland,  Ohio:  Dr. 

Zwick  has  rendered  us  a service  in  directing  our 
attention  to  increasing  importance  of  industrial 
dermatoses.  His  remarks  about  the  limitations  of 
the  contact  test  or  skin  probe  are  pertinent. 
Occasionally  the  sensitivity  is  purely  local,  and 
the  test  applied  at  other  pai’ts  of  the  body  may  be 
negative.  Furthermore,  the  patient  may  handle  a 
given  substance  for  months  or  years  with  perfect 
safety,  and  suddenly  develop  sensitivity  to  it. 

In  discussion,  I wish  to  stress  the  importance 
of  the  recognition  of  syphilitic  manifestations 
upon  the  skin.  It  has  long  been  recognized  that 
trauma  often  serves  to  precipitate  the  active  man- 
ifestations of  a previously  latent  syphilis,  and 
Klander,  who  reviewed  this  subject  reporting 
examples  of  paresis  appearing  after  accidents  in 
workmen  apparently  normal  before,  but  who  in 
reality  harbored  old  syphilitic  infections. 


Leaving  the  question  of  syphilis,  the  possibility 
of  malingering  always  must  be  remembered  by 
one  seeing  industrial  diseases,  for  industrial  com- 
pensation offers  to  people  so  inclined,  an  incentive 
for  the  simulation  of  disease.  Self-inflicted 
lesions,  in  the  production  of  which  a variety  of 
agents  are  employed,  range  from  excoriations  by 
finger  nails,  aggravated  by  secondary  infection, 
to  the  application  of  strong  chemicals  or  the  ac- 
tual injection  of  phenol  or  similar  destructive 
agents. 

When  presented  with  a patient  suffering  from 
an  apparently  eczematous  condition,  the  urgent 
problem  is  the  determination  of  the  cause,  for  this 
may  or  may  not  be  occupational.  As  an  example, 
a patient  had  what  apparently  was  an  eczematized 
ring-worm  of  the  hands,  which  cleared  up  with 
local  remedies  only  to  return  at  intervals  for 
several  years.  It  was  then  found  that  he  worked 
with  blue-prints,  and  consequently  a patch  test 
was  made,  using  5 per  cent  solution  of  bichromate 
of  potassium,  with  a positive  result.  Potassium 
bichromate  is  used  in  the  finishing  of  blue-prints, 
and  evidently  some  is  left  on  the  prints  because 
of  inadequate  washing.  Examples  of  the  effect  of 
other  irritants  are  found  in  the  hands  of  a plas- 
terer and  a cement  worker.  Incidentally,  it  must 
be  remembered  that  a worker,  possibly  himself 
immune,  may  carry  home  irritating  substances  on 
his  clothing  which  may  cause  a dermatitis  with 
other  members  of  his  family. 

Members  of  our  own  profession  are  not  exempt 
from  occupational  dermatoses,  and  this  applies 
also  to  dentists  and  nurses.  Unfortunately,  we 
cannot  qualify  as  beneficiaries  of  the  state. 
Handling  all  sorts  of  irritants,  occasional  cases  of 
dermatitis  must  be  expected. 

Another  occupational  disease  is  sporotrichosis. 
There  is  usually  associated  lymphangitis  extend- 
ing up  the  arm  from  the  primary  lesion. 

Tularemia  is  another  occupational  disease 
which  has  affected  butchers  who  have  contracted 
it  dressing  infected  rabbits.  It  seems  like  carrying 
coals  to  Newcastle  for  a stranger  from  beyond 
the  gates  to  even  mention  this  subject  in  Dayton, 
where  Simpson  did  such  excellent  w’ork  in  the 
description  of  this  disease. 

Recently,  Sir  Kenneth  Goadby,  a British 
referee  for  industrial  disease,  remarked  that  in- 
dustrial diseases,  such  as  lead  poisoning,  are 
diminishing  due  to  preventive  measures,  but  that 
industrial  dermatitis  is  increasing  and  that  most 
of  the  dermatitis  is  caused  by  such  apparently 
innocuous  substances  as  sugar  or  flour  in  the 
baking  and  allied  industries,  while  other  trades, 
such  as  dyeing,  french  polishing,  building  and 
laundering,  contribute  their  quota.  He  advocates 
the  more  general  use  of  gloves,  and  argues  that 
they  cannot  obstruct  the  nimbleness  of  the  fingers, 
since  surgeons  perform  most  delicate  operations 
with  them. 

Sidney  Littman,  M.D.,  Cleveland,  Ohio:  As 
always,  it  has  again  been  my  pleasure  to  be 
present  when  my  friend,  Dr.  Zwick,  has  some  mes- 
sage for  us.  Not  only  has  this  paper  been  in- 
structive and  helpful,  but  it  has  been  exceedingly 
interesting  as  well.  When  dealing  with  occupa- 
tional dermatoses,  it  should  be  borne  in  mind,  that 
it  is  necessary  to  determine  whether  the  allergen 
is  internal  or  external  in  origin.  If  of  external 
origin,  the  so  called  patch  test  may  be  employed 
to  determine  the  exciting  cause  with  a great  de- 
gree of  success.  Allow  me  to  call  your  attention 
to  a piece  of  work  recently  done  by  several  Brook- 
lyn observers,  which  was  excepted  in  the  late 


116 


The  Ohio  State  Medical  Journal 


February,  1933 


number  of  the  Journal  of  Allergy.  According  to 
their  results  the  skin,  itself,  may  become  sen- 
sitized to  various  allergens.  Briefly,  they  selected 
a group  of  new  born  infants  to  whom  rhus  antigen 
was  fed.  A week  later,  patch  tests  showed  nega- 
tive. In  another  series  of  new  born  infants,  the 
same  antigen  was  applied  to  the  skin,  which  was 
followed  a week  later  by  patch  tests.  Of  75  cases 
reported,  for  observation,  71  showed  positive 
tests.  They  concluded  that  this  simple  experiment 
tended  to  prove  the  fact  that  the  skin  itself  ac- 
quires sensitivity  from,  previous  exposure.  In 
another  of  known  instances  of  the  same  nature, 
is  novacaine  dermatitis  in  dentists. 

I feel  that  this  helps  to  explain,  at  least  in 
part,  the  nature  of  the  mechanism  of  many  oc- 
cupational dermatoses.  With  this  knowledge,  the 
problem  of  prophylaxis  and  treatment  is  rendered 
less  difficult. 

Milton  B.  Cohen,  M.D.,  Cleveland,  Ohio:  Dr. 

Zwick  recommends  the  patch  test  or  what  he  calls 
the  tolerance  probe  as  a means  of  determining 
susceptibility  to  skin  irritants  before  employ- 
ment and  as  a means  of  determining  the  etiology 
of  developed  lesions.  Since  70  per  cent  of  normal 
skins  can  be  sensitized  by  contact  with  irritants 
it  is  not  advisable  to  do  routinely  a large  number 
of  patch  tests  since  we  may  do  more  damage  than 
good.  It  is  very  interesting  that  the  type  of  hyper- 
sensitivity under  discussion,  especially  as  men- 
tioned by  Dr.  Littman,  is  true  epidermal  allergy 
and  has  nothing  to  do  with  the  internal  structures. 
Mucus  membrane  sensitivity  does  not  exist.  It  is 
important  to  remember  this  point  since  it  will 
aid  in  understanding  how  this  condition  may  be 
differentiated  from  the  eczema  seen  in  true  atopic 
eczema  which  is  associated  with  general  body  sen- 
sitivity, and  can  be  studied  by  scratch  or  intra- 
dermal  tests  but  never  by  the  patch  method. 

C.  G.  La  Rocco,  M.D.,  Cleveland:  It  is  with 
some  diffidence  that  I rise  to  discuss  Dr.  Zwick’s 
paper,  since  the  cases  I have  in  mind  are  only 
indirectly  a part  of  industrial  dermatoses. 

Some  time  ago  I saw  a young  man  that  had  a 
severe  laceration  about  the  wrist  which  refused 
to  completely  heal.  He  was  in  the  hands  of  com- 
petent industrial  surgeons.  In  discussing  this 
case  with  me,  I suggested  X-ray  therapy  and 
somewhat  to  my  own  surprise,  there  was  im- 
mediate favorable  response. 

Since  then  I have  seen  three  other  similar 
cases,  all  of  them  young  adults,  ranging  in  age 
from  eighteen  to  twenty-seven  years,  all  having 
lacerations  about  the  joints,  that,  apparently,  re- 
sisted all  efforts  to  effect  a complete  cure.  There 
was  nothing  in  their  blood  study  or  physical  ex- 
amination to  explain  the  lack  of  complete  repair. 
Encouraged  by  the  result  of  the  first  case,  these 
cases  were  also  treated  by  X-ray,  receiving  a 
quarter  skin  unit  weekly.  They  all  responded 
promptly,  from  two  to  four  weeks. 

At  the  same  time  these  patients  were  in- 
structed to  use  a one  to  six  thousand  warm 
permanganate  soaks  daily,  followed  by  boric  oint- 
ment dressings. 

Dr.  Karl  G.  Zwick,  (closing)  : The  generous 

discussion  brought  out  several  important  points, 
which,  for  lack  of  time,  I did  not  touch  upon  at 
all  or  did  not,  perhaps,  sufficiently  emphasize. 

Doctor  Cummer’s  instructive  slides  illustrated 
several  interesting  conditions.  In  connection  with 
his  demonstration  of  an  occupationally  acquired 
primary  lesion  of  syphilis,  it  may  not  be  amiss 


to  make  mention  of  the  tendency  of  patients  to 
forget  a previous  syphilitic  infection  when  ap- 
plication is  made  for  industrial  compensation. 

Every  now  and  then  the  desire  for  the  “gold 
cure”,  as  Dr.  Cummer  stated,  the  auri  sacra 
fames  or  “compensophilia”,  if  I may  employ  this 
etymological  hybrid,  prompts  an  individual  to 
attempt  “malingering”.  As  they  are  frequently 
most  difficult  to  detect,  the  “tolerance  probe” 
may  be  employed  to  advantage  in  some  of  these 
cases. 

Since  it  seems  that  my  choice  of  the  term 
“tolerance  probe”  instead  of  biological,  func- 
tional, patch,  etc.,  test  requires  an  explanation, 
permit  me  to  say,  that  I preferred  the  term  prin- 
cipally, because  it  indicates,  as  I use  it  in  con- 
nection with  industrial  medicine,  the  purpose  and 
object  of  this  mode  of  cutaneous  examination. 

Dr.  Littman  mentioned  certain  fundamental  in- 
vestigations. As  he  kindly  brought  their  results 
to  my  attention  some  time  ago  in  a letter,  I was 
able  to  apply  them,  cautiously,  to  my  discussion. 

Dr.  Cohen’s  remarks,  based  on  his  extensive 
practical  experience  and  his  important  experi- 
mental work  in  immunology,  developed  more  fully 
an  aspect  of  our  problem  which  I referred  to  re- 
peatedly. 

Apropos  of  Dr.  Liftman’s  and  Dr.  Cohen’s  re- 
marks the  report  of  Blumenthal  and  Jaffe  is  of 
interest.  They  observed  cutaneous  sensitizations 
which  followed  the  application  of  various  medica- 
ments to  wounds.  Similarly  I have  noted  a pre- 
disposition to  eczema  result  from  the  treatment 
of  occupational  injuries. 

Dr.  LaRoeco  contributed  a most  valuable 
therapeutic  suggestion,  which  has  to  me  a per- 
sonal appeal  as  it  supports  or  substantiates  some 
of  the  views  I discussed  in  my  notes  on  “The 
Biological  Foundations  of  Roentgen  Ray  Therapy” 
( Ohio  State  Medical  Journal,  1927,  Vol.  XXIII, 
p.  654). 


—The  United  States  Public  Health  Service  has 
recently  completed  a statistical  study  of  the  age 
and  sex  variation  in  cases  of  influenza  and  pneu- 
monia. This  study  summarizes  the  age  and  sex 
variation  in  influenza  and  pneumonia  morbidity 
and  mortality  during  the  1928-29  and  the  1918-19 
epidemics.  It  is  based  on  canvasses  following 
each  epidemic  of  families  including  nearly  150,- 
000  persons  in  about  12  localities  in  the  United 
States. 

While  there  are  some  similarities  in  the  1928-29 
and  1918-19  age  curves,  the  differences  are  more 
striking  than  the  similarities.  The  young  adult 
peak  in  pneumonia  incidence  and  in  mortality  in 
1918-19  was  absent  in  1928-29. 

Pnuemonia  incidence  and  the  death  rate  wei-e 
both  much  higher  in  1918-19  than  in  1928-29  but 
the  percentages  of  pneumonia  cases  that  were 
fatal  were  not  greatly  different  in  the  two  epi- 
demics. There  was  a very  large  difference  in  the 
percentage  of  cases  complicated  by  pneumonia 
in  the  two  epidemics;  but  once  pneumonia  ex- 
isted, the  chance  of  fatal  outcome  was  nearly  the 
same  in  both  years. 


Preventive  Medicine  and  Periodic  Health  Examinations 

V.  C.  Rowland,  M.D.,  Cleveland,  Ohio 


One  of  the  rapidly  developing  movements  in 
the  field  of  modem  medicine,  and  one  which  must 
be  recognized  and  seriously  considered  by  all  phy- 
sicians, is  that  which  provides  for  the  inclusion 
in  the  daily  practice  of  every  physician  all  in- 
dividual preventive  activities  in  connection  with 
pathological  physiology,  personal  hygiene,  specific 
immunization,  prophylactic,  and  other  procedures 
coming  under  the  broad  heading  of  personal  pre- 
ventive medicine. 

The  change  in  the  title  this  year  of  the  Periodic 
Health  Examination  Committee  of  the  Ohio  State 
Medical  Association  to  the  Committee  on  Preven- 
tive Medicine  and  Periodic  Health  Examinations 
is  in  keeping  with  the  trend  of  the  times  in  this 
field,  for  after  all  the  periodic  health  examination 
is  just  one  part  of  the  whole  field. 

The  Committee  on  Preventive  Medicine  and 
Periodic  Health  Examinations  has  devoted  con- 
siderable thought  to  this  emphasis  on  expansion 
of  the  practice  of  the  individual  physician  with 
subsequent  benefit  both  to  himself  and  his  pa- 
tients. It  is  the  belief  of  the  committee  that  the 
membership  of  the  State  Association  should  be 
acquainted  with  some  of  the  views  and  sugges- 
tions of  the  committee  on  the  subject. 

So,  at  the  request  cd:  the  committee,  I,  as  its 
chairman,  have  undertaken  in  this  paper  to  in- 
corporate some  of  the  ideas  and  suggestions  which 
have  been  in  the  minds  of  this  committee  and 
through  which  the  committee  desires  to  repeat  and 
re-emphasize  the  importance  of  active  participa- 
tion by  every  practicing  physician  in  the  field  of 
personal  preventive  medicine. 

The  other  members  of  the  Committee  under 
whose  direction  this  paper  is  published  are: 
Jonathan  Forman,  Columbus;  Beatrice  T.  Hagen, 
Zanesville;  R.  R.  Hendershott,  Tiffin,  and  C.  I. 
Stephen,  Ansonia. 

Preventive  activities  have  arisen  spontaneously 
and  independently  in  the  different  fields  of  medi- 
cine. All  of  these  need  to  be  correlated  in  the 
newer  conception  of  personal  preventive  medicine. 
The  whole  needs  to  be  vitalized  by  human  interest 
and  scientific  imagination  in  anticipation  of  dis- 
ease tendencies  and  directed  by  the  cold  facts  of 
vital  satistics. 

It  is  the  subjective  symptoms  of  the  functional 
stage  of  chronic  diseases,  which  so  often  long  pre- 
cede organic  changes,  which  need  to  be  stressed  in 
the  real  preventive  health  survey.  Naturally,  the 
health  examination  provides  the  best  opportunity 
for  the  frank  discussion  of  functional  disorders, 
faulty  habits,  and  the  px’ophylaxis  of  those  disease 


Chairman  of  the  Committee  on  Preventive  Medicine  and 
Periodic  Health  Examinations,  Ohio  State  Medical  Asso- 
ciation. 


tendencies  which  so  often  can  be  anticipated  in 
the  individual  patient. 

Simple,  concise  and  readily  accessible  records 
are  essential  with  the  data  reduced  as  much  as 
possible  to  figures  for  later  comparison.  Con- 
tinuity of  service  is  important  and  a follow-up 
system  may  be  pre-arranged.  This  expresses  a 
personal  interest  which  above  every  other  psych- 
ological factor  arouses  loyalty  in  a patient. 

This  approach  to  the  problem  of  personal  pre- 
ventive medicine  has  not  been  the  habit  of  thought 
of  the  practicing  physician  on  any  large  scale. 
Present  developments  demand  that  he  give  it 
serious  consideration,  and  that  the  curriculum  in 
medical  schools  provide  for  adequate  instruction 
in  preventive  medicine  not  only  in  formal  courses 
but  as  a regular  part  of  all  clinical  teaching. 

The  best  approach  to  the  whole  subject  is  by 
considering  it  in  chronological  order — by  age 
periods  from  birth  to  old  age. 

THE  FIRST  YEAR 

One  of  the  specialties  to  lead  in  preventive 
practice  quite  naturally  has  been  pediatrics.  The 
brilliant  reduction  of  mortality  rates,  especially  in 
intestinal  infections,  is  familiar  to  all.  Optimum 
nutrition,  clean  milk,  specific  immunization,  habit 
training,  etc.,  in  infancy  have  been  championed  by 
the  progressive  pediatrician.  This  preventive 
viewpoint  must  be  carried  over  to  the  family 
physician  so  that  all  children  may  have  the  ad- 
vantage of  early  prophylaxis  of  rickets,  scurvy, 
diphtheria,  smallpox,  tuberculosis,  intestinal  dis- 
ease or  nuti’itional  deficiences. 

The  American  Academy  of  Pediatrics  was  or- 
ganized in  1930  by  the  leading  pediatricians  of  the 
country  partly  as  a result  of  President  Hoover’s 
White  House  Conference  with  the  object  of  pro- 
moting Child  Health  and  Protection.  Professional 
leadership  is  necessary  for  the  numerous  child 
health  and  welfare  movements  throughout  the 
United  States.  Each  state  has  a committee  of  the 
Academy  to  act  in  a consultant  capacity  with  the 
state  madical  associations  and  to  aid  in  the 
popularization  of  preventive  child  care  by  pro- 
viding speakers  and  by  advice  and  cooperation. 
The  committee  on  Preventive  Medicine  and 
Periodic  Health  Examinations  has  been  desig- 
nated by  the  Ohio  State  Medical  Association  as 
the  official  liason  with  the  State  Committee  of  the 
American  Academy  of  Pediatrics.  The  preventive 
minded  pediatrician  will  have  innumerable  details 
at  hand  to  be  applied  to  child  welfare.  For  our 
present  purpose,  a summary  of  preventive  oppor- 
tunities in  the  various  age  periods  of  life  can  in- 
dicate only  outstanding  facts  and  a general  plan. 

Vital  statistics  indicate  that  the  first  year  is  a 


117 


118 


The  Ohio  State  Medical  Journal 


February,  1933 


critical  period  with  relatively  very  high  mortality. 
Prematurity  heads  the  list  with  23  per  cent  of  the 
total  mortality  of  the  first  year.  Some  of  this  is 
preventable  by  prenatal  care.  One  factor  in  the 
etiology  of  premature  birth  is  the  anemia  of 
pregnancy  to  be  referred  to  later,  in  which  we 
have  a recently  established  specific  preventive 
agent  in  liver  extract  and  iron.  Prenatal  care 
will  also  reduce  the  mortality  from  accidents  at 
birth. 

Of  especial  importance  from  the  preventive 
standpoint  is  the  recent  observation  that  the 
anemias  of  early  infancy  respond  to  liver  extract 
and  iron  as  the  anemias  of  pregnancy  although 
the  infant  does  not  share  directly  in  the  maternal 
anemia  of  pregnancy. 

Cod  liver  oil  and  full  vitamin  supplies  are  es- 
sential in  the  early  months  of  life.  Specific  im- 
munization against  diphtheria  and  smallpox  is 
advisable  at  four  to  six  months  because  reactions 
are  mild  at  this  time  and  the  mortality  of  the  dis- 
eases high. 

TWO  TO  FIVE  YEARS 

In  this  period  optimum  nutrition  remains  of 
paramount  importance  for  full  development  and 
also  for  high  x'esistance  against  infection. 

The  common  cold  from  multiple  contacts  and 
unnecessary  exposures  remains  one  of  the  great- 
est causes  of  morbidity  at  this  period.  Pneumonia 
is  the  first  cause  of  death,  accounting  for  43  per 
cent  of  the  total  mortality  of  the  second  year. 
Much  of  this  is  preventable  and  due  to  ignorance 
and  neglect  in  connection  with  colds  and  the  dis- 
eases of  childhood.  Persistent  infection  in  ade- 
noids and  tonsils  is  the  source  of  much  early  in- 
fectious damage.  Much  discretion  is  necessary  in 
the  selection  of  cases,  but  by  and  large,  there  is 
much  good  to  be  gained  from  properly  advised  re- 
moval of  infected  tonsils  and  adenoids.  Any  sug- 
gestion of  rheumatism  is  the  strongest  single  in- 
dication for  tonsillectomy,  as  it  is  well  known  that 
the  heart  is  attacked  very  early  in  childhood  with 
little  or  no  evidence  of  joint  involvement.  There 
is  some  very  recent  evidence  that  endocarditis  in 
slight  degree  is  much  more  common  than  formerly 
supposed.  Careful  routine  examinations  of  hearts 
at  autopsy,  by  special  methods,  in  patients  without 
any  history  of  rheumatic  or  other  infectious  dis- 
eases show  evidences  of  low  grade  damage  in  a 
majority  of  hearts.  Hence  the  campaign  for  the 
prevention  of  heart  diseases  must  begin  in  early 
childhood.  Greater  emphasis  should  be  put  upon 
the  removal  of  focal  infection  at  this  period. 
Rheumatic  infection  should  be  treated  like  tuber- 
culous infection  in  respect  to  prolonged  rest. 

A definite  plan  to  postpone,  at  least,  if  not  to 
prevent  the  specific  infections  such  as  measles  is 
worthwhile  because  of  the  greater  danger  of  in- 
fectious damage  at  a very  early  age.  Dental  care 
is  important.  This  is  the  period  in  which  diph- 


theria takes  its  greatest  toll,  ranking  second  only 
to  pneumonia. 

Vital  statistics  indicate  that  the  death  rate  by 
accident  at  this  time  of  life  is  abnormally  high. 
Conscientious  effort  in  the  direction  of  safety  in 
traffic  is  essential  at  this  period. 

Special  attention  should  be  given  to  abnormali- 
ties of  the  eyes  such  as  strabismus  in  order  to  pre- 
vent permanent  functional  amblyopia.  This  is  the 
period  for  the  beginnings  of  mental  hygiene  in 
connection  with  habit  formation  and  emotional 
control. 

FIVE  TO  TWELVE  YEARS 

Accidents  lead  all  causes  of  death  in  this 
period  amounting  to  about  one-third  of  all  deaths 
in  boys  from  five  to  nine  years.  In  the  pre-school 
round  up,  or  in  the  first  period  in  school,  check- 
ups on  specific  immunizations  and  removal  of  focal 
infections  are  in  order.  Diet  should  be  complete 
as  before  and  adequate  hours  of  sleep  and  rest 
provided  for,  especially  in  the  subnormal  child, 
with  open  air  exercise  in  play  periods.  Iodine 
should  be  used  for  the  prophylaxis  of  goiter. 

In  dental  care  conservative  orthodontia  is  of 
value  although  further  research  work  needs  to  be 
done  to  establish  the  biological  and  mechanical 
factors  in  malocclusion  and  developmental  faults. 
The  best  orthodontic  opinion  is  to  leave  much  to 
nature. 

Vision  should  be  checkeckand  corrected  if  neces- 
sary. The  neglected  discharging  ear  is  another 
menace  to  be  removed. 

Tuberculin  tests  in  the  schools  are  of  great 
value.  It  not  only  provides  for  the  special  care 
of  the  i-eacting  child  but  serves  to  locate  the  ap- 
parently healthy  carrier  of  the  disease. 

TWELVE  TO  EIGHTEEN  YEARS 

Heart  and  circulatory  disease  heads  the  mor- 
tality list  in  the  group,  followed  in  order  by  ac- 
cidents, pneumonia  and  appendicitis.  Toward  the 
end  of  the  period,  tuberculosis  crowds  to  the  top, 
especially  in  girls. 

The  period  of  puberty  and  adolescence  brings 
some  additional  developmental  problems,  both 
physical  and  mental.  Optimum  nutrition,  adequate 
rest,  removal  of  foci  of  infection,  and  personal 
hygiene  remain  important. 

Dental  prophylaxis  at  this  period  is  especially 
timely  since  caries  is  at  its  maximum  and  rapidly 
progressive.  Early  fillings  may  prevent  the  ac- 
cumulation of  a number  of  devitalized  teeth. 

Appendicitis  is  frequent  in  this  age  group  and 
is  undoubtedly  related  in  part  to  faulty  diet  and 
focal  infection.  The  total  mortality  is  consider- 
able, ranking  next  to  circulatory  diseases,  acci- 
dents, and  pneumonia.  Early  diagnosis  is  essen- 
tial. Proper  education  to  avoid  the  use  of  cathai-- 
tics  in  acute  abdominal  pain  is  important. 


February,  1933 


Preventive  Medicine — Rowland 


119 


The  X-ray  follow-up  of  tuberculosis  suspects  is 
important.  Heart  supervision  after  acute  infec- 
tions will  control  much  of  the  frequently  un- 
recognized low-grade  endocarditis.  The  treatment 
of  rheumatic  carditis  by  the  same  regimen  as 
tuberculosis,  by  prolonged  rest,  will  prevent  much 
late  mortality  from  rheumatic  heart  disease.  In 
addition  to  valvulitis,  coronary  endarteritis  and 
sclerosis  have  recently  been  described  as  not  un- 
common sequelae  of  rheumatic  infection  and 
probably  account  for  some  of  the  cases  of  coro- 
nary thrombosis  in  relatively  young  people.  There 
are  observations  in  high  school  boys  in  the  sub- 
normal weight  group  who  showed  a smaller 
average  weight  gain  together  with  less  satisfac- 
tory general  health  and  school  work  in  daily  foot- 
ball practice  as  compared  to  a control  group  not 
participating  in  football.  Intensely  competitive 
athletics  at  best  seem  to  carry  a higher  incidence 
of  heart  disease  in  later  life,  but  further  studies 
in  this  field  are  necessary. 

Disturbance  of  menstruation,  especially  delay 
beyond  15  years  calls  for  special  attention  to 
nutritional  deficiency,  dietetic  faults,  and  espe- 
cially anemia.  Specific  treatment  in  the  form  of 
the  recently  developed  hormones  of  the  anterior 
pituitary  and  ovary  may  aid  in  establishing  the 
normal  function,  although  the  main  reliance 
should  be  placed  upon  general  hygiene.  Hypo- 
plasia of  the  female  genital  organs,  occurs  much 
more  commonly  than  is  generally  appreciated.  It 
is  said  to  be  a large  factor  in  sterility  in  at  least 
400,000  American  marriages.  Robert  L.  Dicken- 
son in  the  recent  second  edition  of  “Outline  of 
Preventive  Medicine”  regards  focal  infection, 
syphilis,  rickets,  and  anemia  as  potent  factors  in 
developmental  retardation.  Unbalanced  nutrition, 
especially  inadequate  protein  intake  may  be  a 
primary  factor.  Menstrual  irregularities  during 
adolescence  should  be  regarded  as  suggestive 
symptoms.  Low  grade  simple  anemia,  achlorhy- 
dric or  otherwise,  may  be  effectively  and  advan- 
tageously treated.  In  preventive  work,  one  should 
concentrate  upon  all  the  potent  therapeutic  agents 
and  amplify  their  applications. 

This  is  the  time  to  anticipate  the  enormous 
wastage  from  nervous  and  mental  disease,  now 
requiring  about  as  many  institutional  beds  in  the 
United  States  as  all  other  diseases  combined.  The 
mental  conflicts  of  adolescence,  especially  with  an 
unstable  inheritance,  are  magnified  by  infections, 
intoxications,  excessive  strain  and  chronic  fatigue. 

EIGHTEEN  TO  TWENTY-FIVE  YEARS 

In  this  age  group,  as  well  as  part  of  the  pre- 
ceding and  following  or  from  15  to  34  years  of 
age,  pulmonary  tuberculosis  is  the  first  cause  of 
death,  accounting  for  roughly  50  per  cent  of  the 
mortality  of  the  period.  Race  and  economic 
station  are  of  course  important  factors.  Constant 
anticipation  of  this  infection  with  any  suggestive 


symptom  or  physical  type  or  history  of  exposure 
or  positive  tuberculin  test  should  lead  to  preven- 
tive measures  before  the  discovery  of  any  phy- 
sical signs.  However,  careful  study  of  the  early 
physical  signs  is  still  in  order  in  this  age  group. 
Public  health  services  through  tuberculin  testing, 
sputum  and  inoculation  laboratory  work,  contact 
and  collapse  therapy  clinics  should  cooperate  and 
let  it  be  known  that  they  are  more  than  willing  to 
cooperate  with  the  private  practitioner  who  is  so 
essential  in  the  preventive  phase  of  the  anti- 
tuberculosis campaign.  If  a physician  sends  a 
patient  to  an  institution,  reports  should  be  sent  to 
the  doctor.  Upon  discharge  the  patient  should  be 
referred  back  to  the  doctor  or  arrangement  made 
with  him  for  the  further  care  of  the  patient. 

Accidents  and  pneumonia  are  responsible  for 
approximately  25  per  cent  of  the  total  mortality 
of  this  age  group.  Much  is  preventable  by  edu- 
cational methods. 

Venereal  disease  comes  up  in  this  age  group  as 
an  enormous  public  health  problem.  There  are, 
according  to  a recent  survey,  about  a half  million 
new  cases  of  syphilis  reported  annually  in  the 
United  States.  Doubtless,  many  are  unreported. 
Gonorrhea  is  said  to  be  some  four  times  as  fre- 
quent. Aside  from  the  early  morbidity,  these  in- 
fections play  a large  part  in  late  mortality  from 
heart  disease,  (15  per  cent),  in  nervous  disease 
(11  per  cent  of  mental  hospital  admissions)  and 
in  gynecological  surgery.  Individual  education 
and  instruction  at  the  time  of  periodic  health  ex- 
amination are  important.  However,  in  the  light  of 
statistical  facts  any  measure  which  would  effec- 
tively reduce  this  enormous  morbidity  and  mortal- 
ity should  be  justifiable  in  modern  society.  Youth 
is  entitled  to  know  the  truth.  The  army  statistics 
on  the  efficacy  of  prophylaxis  are  incontrovertible. 
As  the  incidence  of  other  diseases  is  reduced  and 
the  factor  of  venereal  disease  becomes  relatively 
more  important,  it  certainly  would  seem  to  be  the 
duty  of  health  officers  and  the  private  physician, 
as  well  as  lay  social  hygiene  associations,  to  en- 
courage educational  methods  and  also  specific 
prophylaxis. 

It  would  seem  that  the  facts  warrant  the  active 
championing  of  these  measures  by  the  medical 
profession  because  of  the  enormous  preventive 
opportunity.  From  the  medical  standpoint,  not 
only  would  prophylaxis  be  more  effective  than  the 
most  expert  treatment  of  venereal  disease  but  it 
would  be  a unique  American  attack  upon  the  prob- 
lem and  a guard  against  the  socialization  of  the 
treatment  of  venereal  disease  at  public  expense  as 
now  exists  in  England  and  other  European  coun- 
tries. Sir  Arthur  Newsholme  states  that  “in 
Britain  patients  are  treated  at  special  clinics  at- 
tached to  hospitals  or  in  hospital  beds,  gratuit- 
ously, without  any  residental  restriction  and  with- 
out any  regard  for  financial  position”. 

The  British  Medical  Association  in  1916  ap- 


120 


The  Ohio  State  Medical  Journal 


February,  1933 


proved  this  recommendation  of  the  Royal  Com- 
mission on  Venereal  Diseases  with  the  resolution 
that  “The  best  modern  treatment  for  venereal  dis- 
eases should  be  readily  available  for  the  whole 
community  and  that  the  treatment  at  any  in- 
stitution included  in  a local  authority’s  scheme 
should  be  free  for  all.  There  should  be  no  refusal 
to  treat  a patient  who  is  unwilling  to  go  to  his 
own  doctor  ....  This  recognizes  the  exceptional 
nature  of  venereal  disease;  the  reluctance  of  pa- 
tients affected  by  them  to  go  to  their  private 
medical  attendant;  the  l'isk  that  they  may  go  to 
unqualified  persons  for  treatment  with  disastrous 
results  to  themselves  and  to  others;  and  the  im- 
portance to  the  community  of  adopting  the  best 
measures  for  inducing  sufferers  from  venereal  dis- 
ease to  seek  early  and  adequate  treatment”. 

Not  only  is  the  above  plan  an  enormous  burden 
upon  the  taxpayer,  as  is  realized  in  England,  but 
it  is  not  particularly  effective  from  the  public 
health  standpoint  although  some  reduction  in  the 
amount  of  venereal  disease  in  England  is  claimed. 
The  real  opportunity  in  venereal  disease,  as  in 
most  diseases,  is  in  prophylaxis  rather  than  cure. 
Newsholme  himself  says:  “In  this  direction  lie 
the  chief  future  triumphs  of  medicine  and  it  is 
for  private  practitioners  themselves  to  determine 
whether  this  work  shall  remain  largely  in  the 
domain  of  public  authorities  and  social  organiza- 
tions or  whether  private  practitioners  shall  carry 
out  this  work  for  every  family  in  their  care.  . . . 
The  program  here  indicated  cannot  wait;  hygien- 
ists and  their  organizations  will  not  wait;  edu- 
cated public  opinion  will  not  wait;  cannot  we  hope 
that  private  practitioners  will  make  it  a chief 
part  of  their  future  work? 

“The  great  sickness  insurance  systems  now 
established  in  most  European  counti-ies  have  not 
conduced  much  to  preventive  medicine  and  such 
organization  will  be  difficult  since  monetary  bene- 
fits depend  upon  medical  certification it 

would  require  almost  superhuman  competence  in 
the  management  of  the  insurance  scheme  . . . . 
and  superhuman  loyalty  and  integrity.” 

This  opinion  fi-om  an  advocate  of  socialized 
medicine  is  significant,  namely  that  personal  pre- 
ventive medicine  is  impracticable  through  health 
insurance. 

Obstetrical  difficulties  during  the  18  to  25  year 
period  are  at  a maximum.  Prenatal  advice  can 
prevent  many  serious  complications  at  parturition 
and  in  many  ways  lay  the  foundation  for  a good 
inheritance  in  the  offspring.  In  some  prenatal 
clinics  positive  Wassermann  inactions  have  been  as 
frequent  as  10  per  cent  and,  as  has  been  stated, 
congenital  syphilis  is  as  preventable  as  smallpox. 
Eclampsia,  nephritis  and  obstetrical  anomalies 
have  long  been  emphasized  in  prenatal  care. 

The  newest  phase  of  preventive  medicine  in  re- 
lation to  pregnancy  is  the  recognition  of  the  fre- 


quency and  importance  of  anemia.  The  specificity 
of  liver  extract  in  the  pernicious  or  hyperchromic 
anemia  and  of  massive  doses  of  iron  in  the  sec- 
ondary or  hypochromic  anemia  is  definitely  estab- 
lished. The  large  majority  of  women  show  some 
degree  of  anemia  in  the  latter  months  of  preg- 
nancy.  It  has  been  definitely  related  to  nutritional 
deficiencies  and  is  associated  with  an  absence  or 
diminution  of  HC1  in  the  stomach.  By  lowering 
the  general  resistance,  anemia  leads  to  many  ob- 
stetrical complications.  The  prenatal  control  by 
dietetic  supervision  and  specific  liver  and  iron 
treatment  presents  a new  and  far  reaching  pre- 
ventive opportunity. 

Much  education,  again  best  through  the  periodic 
health  examination,  is  necessary  to  reduce  the 
great  mortality  from  infected  abortions  and  also 
to  prevent  the  accidental  abortion  which  often 
occurs  in  the  first  three  months  at  the  time  of  the 
missed  period.  At  this  time  over-exertion  or  ex- 
citement or  jolting  in  an  automobile,  or  the  use 
of  a cathartic  may  induce  contractions.  Simple 
hygiene,  as  well  as  the  use  of  a pessary  support 
for  a definite  retroversion,  during  the  first  three 
months  will  prevent  many  miscarriages.  Post- 
partum, much  preventive  gynecology  can  be  prac- 
ticed by  the  routine  repair  of  gross  lacerations 
and  prevention  of  retroversion  and  sub-involu- 
tion. Chronic  cervicitis  often  persists  as  a focus 
of  infection  or  as  a precancerous  lesion.  In  this 
way  the  amount  of  late  gynecological  surgery, 
which  constitutes  about  one-fourth  of  all  major 
surgery,  will  be  greatly  reduced.  The  main  need 
in  reference  to  all  major  surgery  is  to  make  it 
unnecessary.  The  avoidance  of  operations  for 
severe  salpingitis  in  the  acute  stage  will  greatly 
reduce  mortality. 

During  this  age  period,  when  the  biological 
stresses  are  at  a maximum,  it  should  be  remem- 
bered, comes  the  peak  of  the  tuberculosis  curve. 
Its  relation  to  pregnancies,  various  chronic  in- 
fections, simple  stress  and  strain,  overwork  and 
loss  of  sleep,  alcholism  and  hyperthyi’oidism, 
nervous  and  mental  diseases  should  be  kept  in 
mind. 

In  this  connection,  the  red  cell  sedimentation 
test  may  be  mentioned  as  applicable  to  the 
periodic  health  examinations,  since  it  may  call  at- 
tention to  chronic  disease  without  reference  to 
differential  diagnosis.  For  centuries  it  has  been 
known  that  the  sedimentation  rate  was  accelerated 
in  chronic  infections  such  as  tuberculosis,  syphilis 
and  in  malignant  and  other  serious  disease. 

From  18  to  25  years  of  age  industrial  accidents 
and  disease  account  for  a great  deal  of  prevent- 
able morbidity  and  mortality  as  inexperienced 
youths  find  themselves  in  the  work-a-day  world. 
This  is  the  special  province  of  the  industrial  phy- 
sician after  public  health  rulings  are  complied 
with,  but  the  family  doctor  through  health  exami- 


February,  1933 


Preventive  Medicine — Rowland 


121 


nations  and  with  his  knowledge  of  the  family 
background  has  the  first  opportunity  to  prevent 
disaster. 

TWENTY-FIVE  TO  FORTY  YEARS 

In  this  age  period,  during  which,  as  Osier  says, 
“the  work  of  the  world  is  done”,  new  preventive 
opportunities  appear.  There  is  a gradual  shift 
from  pulmonary  tuberculosis  to  circulatory  dis- 
ease as  the  captain  of  tne  men  of  death.  Many 
heart  lesions  show  up  from  infection  earlier  in 
life.  This  is  a period  too,  in  which  the  havoc  of 
untreated  syphilis  becomes  apparent  in  the  cardio- 
vascular and  nervous  systems.  It  is  axiomatic 
that  circulatory  failure  from  syphilitic  aortic  in- 
sufficiency leads  progressively  to  death.  Yet  early 
treatment  of  the  disease  might  have  prevented 
the  disaster  entirely.  During  this  period  also  the 
stage  is  being  set  for  a variety  of  degenerative 
diseases,  part  and  parcel  of  Warthin’s  major  in- 
volution. From  now  on  circulatory  disease  plays 
a steadily  increasing  role  as  the  cause  of  death. 
Heredity  plays  an  important  part  in  the  form  in 
which  degenerative  disease  manifests  itself  but 
the  rate  at  which  it  proceeds  is  greatly  influenced 
by  preventable  factors.  Weight  which  should  be 
at  its  maximum  at  the  beginning  of  the  period 
should  not  progressively  increase  up  to  40. 
Obesity  is  undoubtedly  related  to  hypertension, 
diabetes,  gall  bladder  disease,  and  cardiovascular 
degeneration.  It  has  been  emphasized  that  the 
great  preventive  opportunity  is  before  40  years 
of  age.  Insurance  statistics  show  that  with  every 
increase  of  10  pounds  of  excess  weight  there  is  a 
proportionate  increase  in  mortality  rate  after  40 
years  of  age.  They  show  also  that  hypertension 
is  found  in  66  per  cent  of  people  over  40  who  are 
ten  pounds  or  more  overweight.  Obesity  tends  to 
produce  tachycardia  and  dyspnoea  with  its  resul- 
tant greater  strain  upon  the  circulatory  organs  and 
a more  rapid  rate  of  degeneration.  Most  obesity  is 
exogenous  and  therefore  subject  to  control.  Gall 
bladder  disease  represents  an  enormous  morbidity 
and  mortality,  with  or  without  surgery.  Its  re- 
lation to  obesity  is  undoubted,  yet  rarely  do  we 
hear  reference  to  the  prevention  of  gall  bladder 
disease,  even  with  chronic  indigestion  in  the 
obese.  Diagnosis  should  be  approached  more  from 
the  etiological  viewpoint. 

Diabetes  also  is  unmistakably  influenced  by 
obesity  in  the  vast  majority  of  cases.  It  is  twice 
as  frequent  in  women  as  in  men.  There  remain 
approximately  a million  cases  in  the  United 
States.  In  spite  of  the  discovery  of  insulin  in 
1922  and  its  very  general  use  in  the  treatment 
of  this  disease,  the  incidence  and  mortality  ratios 
to  population  from  diabetes  have  not  only  not  de- 
creased but  have  actually  increased.  At  the  same 
time  there  was  a corresponding  increase  in  the 
amount  of  sugar  and  carbohydrate  consumed  in 
the  United  States.  Indispensible  as  insulin  is,  the 


real  solution  of  the  problem  of  diabetes  depends 
largely  upon  dietetic  control. 

Cancer  becomes  important  in  this  age  group, 
the  curve  rising  as  that  of  tuberculosis  falls. 
More  disturbing  also  is  the  doubling  of  cancer  in- 
cidence since  1902.  At  the  present  time,  one  out  of 
twenty  individuals  over  40  years  of  age  dies  of 
cancer. 

Bloodgood  has  long  been  known  to  favor  the 
periodic  health  examination  in  the  campaign  of 
cancer  prevention  and  control.  He  refers  to  the 
necessity  of  a slow  process  of  education  in  intro- 
ducing an  idea  or  a method  among  the  people  and 
even  the  profession.  As  an  example  he  cites  the 
difficulty  experienced  in  establishing  smallpox 
vaccination  and  points  out  that  the  opposition  was 
not  only  from  the  public  but  originally  from 
members  of  the  profession.  The  same  process  he 
believes  has  to  be  gone  through  with  in  connection 
with  periodic  health  examinations,  and  personal 
preventive  medicine.  At  the  present  time,  it  is 
not  a question  of  evidence  or  argument  to  estab- 
lish the  value  of  periodic  health  examinations,  it 
is  simply  a question  of  gaining  public  confidence 
and  getting  proper  professional  action.  Blood- 
good  says  further  that  “The  local  unit  of  the 
medical  profession  is  the  county  medical  society 
and  the  county  health  officer  or  department.  This 
unit  can  be  aided  by  the  state  medical  society  and 
health  department,  and  these  state  organizations 
can  undoubtedly  be  stimulated  and  directed  by 
national  medical  societies  and  other  organizations, 
also  by  the  Public  Health  Service  which  is  a Fed- 
eral organization.  At  the  present  time,  with  few 
exceptions,  the  least  activities  are  on  the  part  of 
the  county  medical  and  health  organizations”. 

The  cooperation  of  the  dentist  is  of  exceptional 
value  in  relation  to  cancer  of  the  mouth  since  so 
many  mouth  cancers  result  from  localized  irrita- 
tion by  tobacco  or  ragged  teeth  and  ill-fitting 
plates.  This  is  now  being  emphasized  in  many 
dental  colleges.  It  is  well  known  also,  that  skin 
cancer  never  begins  in  a normal  spot  but  in  some 
abnormality,  wart,  or  mole.  Hence  greater  em- 
phasis is  necessary  upon  the  destruction  of  these 
precancerous  lesions  especially  since  they  can  be 
so  readily  removed  by  radium.  A similar  con- 
sideration applies  to  cancer  of  the  cervix.  The 
first  spot  is  not  cancer  and  there  may  be  no  pain 
or  discharge  until  cancer  has  fully  developed. 
Therefore,  the  only  protection  is  periodic  health 
examination. 

In  relation  to  cancer  of  the  breasts  the  follow- 
ing statistical  facts  given  by  Bloodgood  are  quite 
impressive.  When  a woman  seeks  advice  the 
moment  she  feels  anything  unusual  in  one  or  both 
breasts,  the  probability  of  finding  a lump  that  is 
cancer  is  less  than  10  per  cent  and  the  probability 
of  accomplishing  a cure  by  proper  treatment  is 
more  than  70  per  cent;  when  women  delay  six 
months  to  one  year  the  probability  of  the  lump 


122 


The  Ohio  State  Medical  Journal 


February,  1933 


being  cancer  approaches  80  per  cent  and  the 
chances  of  cure  are  reduced  to  10  per  cent. 

Sarcoma  of  bone  in  children  and  adults  can  be 
cured  by  X-ray  and  radium  in  some  instances,  by 
resection  with  transplantation  of  bone  and  restor- 
ation of  function  in  others,  and  by  amputation  in 
other  instances.  The  actual  percentages  of  cures 
has  been  increased  from  4 per  cent  in  1920  to  30 
per  cent  in  1932.  This  impiwement  has  nothing 
to  do  with  diagnosis  or  treatment  but  rests  upon 
getting  correct  information  to  a large  number  of 
people  of  the  fact  that  the  moment  any  trouble  is 
experienced  in  a bone,  the  first  thing  to  do  is  to 
see  his  physician  and  have  an  X-ray  taken.  The 
regular  use  of  X-ray  at  the  beginning  of  all  bone 
diseases  serves  to  get  the  necessary  early  diag- 
nosis and  treatment.  To  a lesser  extent  these 
causes  may  be  applied  also  to  gastro-intestinal 
cancer.  As  a statistical  example  of  what  might 
be  accomplished  in  cancer  control,  Bloodgood 
quotes  Colonel  Dale  of  Baltimore,  chief  surgeon  of 
the  Third  Corps  Area,  United  States  Army,  in  a 
study  of  832  army  women  who  had  routine  phy- 
sical examinations.  Twenty-two  of  the  women 
had  definite  pathological  conditions  most  of 
which  could  be  relieved  and  among  these  con- 
ditions were  six  examples  of  early  cancer,  five  of 
which  were  curable. 

There  is  a little  statistical  evidence  that  cancer 
may  be  more  frequent  in  the  obese  and  the  dia- 
betic. However,  practical  attempts  must  be  focused 
upon  the  precancerous  lesion  and  upon  the  popu- 
larization of  the  idea  that  cancer  is  at  the  onset  a 
purely  local  disease,  readily  curable  if  destroyed 
while  yet  local.  The  painless  character  of  early 
cancer  must  also  be  generally  appreciated  by  the 
laity. 

FORTY  TO  SIXTY  YEARS 

Heart  and  circulatory  diseases  rapidly  outdis- 
tance all  other  causes  of  death,  with  cancer  as  the 
second  cause  and  pneumonia  a close  third  in  this 
group.  During  the  forties,  degenerative  cardio- 
vascular disease  may  rapidly  progress  in  the  pres- 
ence of  stress  and  strain,  infection,  obesity  and 
hypertension.  Disability  or  death  may  occur  in 
the  form  of  circulatory  failure  or  cerebral  hemor- 
rhage or  coronary  occlusion,  occasionally  uremia. 
The  mortality  from  these  causes  is  so  high  in  the 
fifties  as  to  give  a relative  pei'iod  of  immunity 
from  this  particular  type  of  accident  in  later  life. 
During  this  period  also  of  slowly  decreasing  gen- 
eral resistance,  infection,  local  or  general,  res- 
piratory or  gastro-intestinal,  becomes  increasing- 
ly menacing.  Infection  and  metabolic  intoxica- 
tions such  as  diabetes,  hasten  the  degenerative 
process,  obviously  suggesting  the  appropriate 
preventive  measures.  Balanced  hygienic  living 
yields  increased  efficiency  as  well  as  greater  life 
expectancy.  In  women  the  menopausal  tendency 
to  obesity,  nervous  instability,  hypertension, 
lowered  resistance  to  infections  such  as  arthritis, 


may  to  a considerable  degree  be  controlled  by 
various  preventive  measures  and  possibly  to  some 
extent  by  the  newer  specific  hormones,  by  hypo- 
dermic injection. 

In  men  the  development  of  prostatic  hyper- 
trophy may  be  observed  as  well  as  early  malig- 
nancy by  periodic  examinations.  Chronic  urinary 
obstruction  is  a very  damaging  condition.  Urolog- 
ists state  that  most  prostatectomies  are  done  ten 
years  too  late. 

AFTER  SIXTY 

After  sixty,  circulatory  diseases  remain  the  first 
cause  of  death  but  under  favorable  conditions  run 
a less  rapidly  progressive  course.  With  a good 
background  in  normal  weight,  blood  pressure, 
absence  of  focal  infection,  good  general  hygiene, 
the  degenerative  process  may  stabilize  to  a con- 
siderable degree  and  within  limitations  permit  of 
more  comfort  and  health  than  in  the  earlier  period 
of  vascular  erythism.  It  has  been  said  that  there 
are  no  diseases  necessarily  characteristic  of  old 
age;  all  are  relative  to  the  state  of  preservation. 
Work  in  this  period  should  be  improved  in  quality 
and  reduced  in  quantity,  thus  allowing  longer 
periods  for  rest. 

In  the  sixties  the  cancer  curve  reaches  its  maxi- 
mum. The  total  incidence  has  doubled  (from  150 
to  300  annual  deaths  per  100,000)  in  the  last  thirty 
years,  the  period  in  which  tuberculosis  has  been 
more  than  cut  in  half.  Activation  of  a quiescent 
tuberculosis  of  earlier  life  should  be  guarded 
against  during  the  declining  years.  The  tuber- 
culous grandparent  should  be  carefully  isolated 
from  the  grandchildren.  Pneumonia  also  should 
be  remembered  as  the  “friend  of  the  aged.”  Next 
to  respiratory  infections,  the  urinary  tract  should 
be  kept  in  mind  as  a source  of  trouble  after  sixty. 

Under  favorable  conditions  advanced  age  may 
be  consistent  with  reasonable  health  and  happi- 
ness. No  one,  of  course,  wishes  to  linger  in 
senile  desuetude  but  we  all  wish  to  preserve  our 
useful  facilities  while  we  do  survive. 

Age,  rich  in  experience  and  freed  from  the  de- 
sires and  excesses  of  youth,  should  have  satisfac- 
tions all  its  own.  It  is  personal  hygiene  in  con- 
tradistinction to  public  hygiene  that  will  favor 
this  culmination  to  successful  living. 

The  true  physician,  faithful  to  the  ancient 
traditions  of  medicine,  will  best  serve  by  adapting 
his  practice  to  the  changing  needs  of  his  time  and 
in  the  future  quite  as  much  to  prevention  as  to 
cure  and  more  to  positive  healthful  living  than  to 
palliation. 

7106  Euclid  Avenue. 


The  1933  All  Ohio  Safety  Congress  will  be  held 
April  25,  26,  and  27  at  the  Neil  House,  Colum- 
bus, it  has  been  announced  by  Thomas  P.  Kearns, 
chairman  of  the  Committee  on  Arrangements  and 
head  of  the  Division  of  Safety  and  Hygiene,  State 
Department  of  Industrial  Relations. 


The  Presidents  P&ge 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


To  improve  the  quality  of  medical  service,  curative  and  preventive,  is  one  of  the 
major  purposes  of  medical  organization. 

So  long  as  recognized  medical  schools  continue  to  improve  their  methods  of  in- 
struction and  so  long  as  active  and  well-organized  component  medical  societies  stimu- 
late their  members  by  well-conceived  programs,  this  particular  obligation  is  being 
discharged. 

The  education  of  the  doctor  continues  throughout  his  professional  life.  Experience, 
study,  and  active  participation  in  the  deliberations  of  his  county  medical  society  increase 
his  value  to  the  community  and  to  his  profession. 

More  attention  should  be  given  to  topics  dealing  with  preventive  medicine  in  our 
programs.  Preventive  medicine  is  destined  to  play  a part  of  increasing  importance  in 
private  medical  practice.  We  must  recognize  this  fact.  Moreover,  we  must  devote 
thought  and  study  to  the  problems  of  medical  education.  Those  responsible  for  educa- 
tion and  training  of  the  doctors  of  the  future  need  our  help  and  counsel. 

We  have  achieved  a great  deal  in  our  efforts  to  improve  ourselves.  The  level  of 
the  quality  of  medical  service  is  constantly  rising.  However,  much  remains  obscure. 
Much  is  still  to  be  accomplished.  We  must  ever  be  alert  to  take  advantage  of  new 
opportunities  to  make  ourselves  better  doctors,  and,  thus,  be  of  greater  value  to  our 
communities. 

In  the  final  analysis,  the  future  of  medicine  will  be  determined  largely  by  how 
successful  we  are  in  our  efforts  to  give  the  public  the  best  possible  medical  service. 
Opposition  to  the  cults  and  the  foes  of  scientific  medicine,  justifiable  as  it  may  be,  will 
not  solve  our  major  problems  nor  those  of  the  public.  The  same  may  be  said  for  the 
proposal  that  we  wage  a campaign  of  publicity  to  educate  the  public  on  health  and 
medical  matters.  Much  can  be  said  of  the  merits  of  health  education.  However,  we 
must  not  forget  that  grave  mistakes  have  been  committed  in  the  name  of  health  and 
that  propaganda  has  proved  to  be  the  chief  weapon  of  the  irregular  and  the  charlatan. 

We  cannot  compel  the  public  to  accept  our  services.  We  can,  however,  stimulate 
the  demand  for  it.  We  can  make  it  of  such  caliber  that  the  public  will  readily  realize 
that  it  is  indispensable  to  the  needs  of  society.  We  should  insist  that  our  own  mem- 
bers possess  the  training  and  high  qualifications  so  essential  to  competent  medical 
service.  We  should  demand  that  such  service  be  rendered  on  all  occasions.  We  should 
prove  by  our  practice  and  conduct  that  the  medical  profession  is  the  best  qualified  to 
minister  to  the  sick  and  can  be  depended  upon  at  all  times  to  serve  the  public  to  the 
best  of  its  ability. 

Let  us  continue  to  educate  ourselves.  Let  us  continue  to  provide  the  community 
with  well-trained  medical  men.  Let  us  be  worthy  of  the  responsibility  which  is  ours. 
Let  us  realize  ourselves  and  endeavor  to  make  the  public  understand  that,  in  the  last 
analysis,  quality  is  the  essential  and  most  fundamental  element  in  good  medical  service. 
Let  us  remember,  as  Dr.  Willard  C.  Rappleye  has  expressed  it: 

“Medicine  will  occupy  its  proper  place  in  society  to  the  extent  that  it  provides 
leadership  and  properly  trained  personnel  for  the  program  of  medical  service,  which 
should  be  built  upon  thoughtfully-conceived  plans  of  medical  and  post-graduate  edu- 
cation, proper  organization  of  the  profession,  and  the  advocacy  of  unselfish  and  cour- 
ageous public  and  professional  policies.” 


123 


Federal  Income  Tax  Returns  Must  be  Made  Before  March  15 
^Procedure  Physicians  Should  Follow  Outlined  and 
Changes  in  Rates  and  Regulations  Analyzed 


Collectors  of  Internal  Revenue  have  mailed  to 
all  taxpayers  of  record,  blanks  for  making  fed- 
eral income  tax  returns  for  the  calendar  year 
1932. 

These  blanks  must  be  filed  with  collectors  on  or 
before  March  15,  1933,  and  should  be  made  in  ac- 
cordance with  and  pursuant  to  the  Revenue  Act 
of  1932,  enacted  last  June  by  Congress  and  which 
differs  in  many  respects  from  the  Revenue  Act 
of  1928  used  as  the  basis  for  returns  filed  last 
year. 

Failure  to  receive  a blank  does  not  relieve  a 
physician  of  the  responsibility  to  file  a return  on 
or  before  March  15,  1933.  If  blanks  are  not  re- 
ceived by  a physician  who  is  required  by  the 
Revenue  Act  of  1932  to  file  a return,  he  should 
apply  at  the  internal  revenue  office  of  the  district 
in  which  he  resides.  These  districts,  with  the 
name  and  address  of  collectors,  are  appended  to 
this  article. 

Among  the  important  changes  in  the  income  tax 
procedure  imposed  by  the  Revenue  Act  of  1932 
are: 

(1)  Increase  in  the  rates  of  taxation. 

(2)  Decrease  in  the  personal  exemptions. 

(3)  Elimination  of  the  earned  income  credit, 
meaning  that  all  taxable  income,  whether  earned 
income  or  income  from  other  sources,  is  subject 
to  the  same  rate  of  taxation. 

(4)  New  schedule  of  surtax  rates  on  net  in- 
comes, beginning  with  net  incomes  in  excess  of 
$6,000  instead  of  $10,000,  the  minimum  provided 
in  the  Revenue  Act  of  1928. 

(5)  Drastic  limitation  of  losses  on  sale  or  ex- 
change of  stocks  and  bonds  held  for  two  years  or 
less. 

Physicians  making  returns  on  income  for  the 
year  1932  should  compute  their  normal  tax  on  the 
following  basis : 

First  $4,000  over  the  personal  exemption  and 
credits  is  taxed  at  4%;  the  remainder  at  8%. 

Personal  exemptions,  which  are  credits  against 
net  income  for  the  purpose  of  computing  the 
normal  tax  but  not  the  surtax,  are  listed  as  fol- 
lows: $2,500  if  married  and  living  with  wife,  or 

if  head  of  a family;  $1,000  if  single  and  not  head 
of  family;  $400  credit  for  each  dependent  under 
18  years  of  age  or  physically  or  mentally  handi- 
capped dependent. 

The  surtax  rates  for  individuals  will  be  ex- 
plained in  the  following  detailed  analysis  of  the 
procedure  physicians  should  follow  in  filling  out 
blanks  for  1932  income: 


THOSE  WHO  MUST  FILE  RETURNS 

Every  physician  whose  net  income  for  1932 
was  $1,000  or  more,  if  single,  and  $2,500  or  more, 
if  married  or  the  head  of  a family,  must  file  an 
income  tax  return  with  the  Collector  of  Internal 
Revenue  of  his  district  on  or  before  March  15, 
1933.  He  also  must  file  a return  if  his  gross  in- 
come was  $5,000  or  more,  irrespective  of  marital 
status  and  irrespective  of  net  income. 

All  physicians  and  other  professinal  men  are 
required  to  use  Form  1040  in  submitting  their 
return,  regardless  of  the  amount  of  net  income. 
All  groups,  joint  ventures  and  other  incorporated 
organizations  are  regarded  under  the  Revenue 
Act  of  1932  as  partnerships  and  must  file  part- 
nership information  returns,  the  members  of  such 
groups  to  report  their  distributive  shares  as  their 
own  income. 

GROSS  INCOME 

Gross  income  includes  gains  made  from  profes- 
sional services,  business  activities,  certain  forms 
of  dividends  and  interest,  bad  debts  charged  off  in 
previous  years  but  since  collected,  bonuses  re- 
ceived as  compensation,  partnership  profits,  profits 
from  the  sale  or  exchange  of  real  estate,  rents 
and  royalties,  and  funds  received  from  other 
sources. 

PERSONAL  EXEMPTIONS 

If  married  and  living  with  wife,  or  the  head  of 
a family,  for  the  entire  year,  an  exemption  of 
$2,500  is  allowed;  if  single  and  not  a head  of 
a family,  an  exemption  of  $1,000  is  permitted. 
Credit  of  $400  is  permitted  for  each  dependent 
under  18  years  of  age  or  each  physically  or  men- 
tally handicapped  dependent  regardless  of  age. 
The  credit  is  not  allowed  in  the  case  of  a depend- 
ent minor  over  18  years  of  age,  even  if  such 
minor  is  attending  school.  In  case  of  a change 
during  the  calendar  year  of  the  status  of  the 
physician  in  so  far  as  it  affects  the  personal  ex- 
emption or  credit  for  dependents,  the  personal 
exemption  and  credit  should  be  apportioned  in 
accordance  with  the  number  of  months  before  and 
after  such  change.  Authority  for  prescribing 
rules  and  regulations  for  such  apportionment  was 
given  to  the  Commissioner  of  Internal  Revenue. 

ITEMS  NOT  REPORTABLE  AS 
INCOME 

The  following  items  should  not  be  included  in 
gross  income  since  they  are  exempt  to  income 
tax: 

Cash  or  value  of  property  acquired  by  gift,  be- 


124 


February,  1933 


State  News 


125 


quest  or  inheritance  (income  from  such  property 
is  taxable,  however)  ; insurance  proceeds;  dam- 
ages received  in  personal  actions ; dividends  on 
stock  of  Federal  Reserve  Banks,  land  banks,  and 
intermediate  credit  banks;  dividends  from  corpor- 
ate earning  accumulated  prior  to  March  1,  1913; 
state  jury  court  fees;  state  court  receivership 
fees;  stock  dividends  and  rights;  interest  received 
from  the  obligations  of  state  or  political  subdi- 
visions thereof;  interest  from  securities  issued 
under  the  Farm  Loan  Act;  interest  on  Liberty 
3%%  Bonds  and  U.  S.  Bonds  issued  prior  to 
September  1,  1917,  and  interest  on  the  obligations 
of  the  possessions  of  the  United  States. 

Interest  received  on  Liberty  4%  and  4%% 
Bonds  and  certain  other  U.  S.  obligations  is  ex- 
empt if  the  total  holdings  are  not  in  excess  of 
$5,000.  Interest  received  from  U.  S.  Treasury 
Notes  is  reportable  as  income.  However,  interest 
from  these  sources  is  subject  only  to  surtax  since 
it  is  deductible  as  credit  from  gross  income  in 
computing  net  income. 

It  will  be  noted  that  the  Revenue  Act  of  1932 
does  not  exempt  from  income  tax,  allowances  re- 
ceived under  the  provisions  of  the  War  Risk  In- 
surance, Vocational  Rehabilitation  and  World 
War  Veterans’  acts,  and  pensions  received  from 
a State  or  the  United  States. 

Moreover,  it  does  not  allow  the  previously  speci- 
fied $300  exemption  in  reporting  dividends  or  in- 
terest from  building  and  loan  associations. 

DEDUCTIBLE  ITEMS 

In  computing  net  income,  the  following  items 
may  be  deducted  from  gross  income: 

OFFICE  RENTAL — If  a physician  pays  rent 
to  another  person  for  office  space,  he  may  deduct 
the  amount.  However,  if  he  owns  his  own  home 
and  maintains  an  office  in  it,  he  cannot  claim  de- 
duction for  office  rent. 

AUTOMOBILE — The  cost  of  repair  and  upkeep 
of  an  automobile  used  in  professional  visits  may 
be  deducted.  That  part  of  the  salary  paid  to  a 
chauffeur  and  attributable  to  time  spent  in  driv- 
ing his  employer  on  professional  calls,  may  be  de- 
ducted. Sums  spent  for  taxi  hire,  car  fare,  etc., 
while  on  professional  calls,  may  be  deducted. 

Loss  on  an  automobile  used  in  professional 
business  through  depreciation  may  be  deducted. 
The  depreciation  which  should  be  deducted  annu- 
ally is  figured  by  dividing  the  cost  price  of  the 
machine  by  the  number  of  years  of  its  usefulness. 

If  a physician  has  one  automobile  which  is 
used  exclusively  in  professional  business,  he  may 
deduct  the  full  depreciation  each  year.  If  the 
machine  is  used  only  partly  in  professional  busi- 
ness, the  deductible  depreciation  should  be  com- 
puted on  the  basis  of  the  amount  of  time  the  car 
is  used  for  professional  purposes. 

If  a physician  possesses  two  cars,  each  of  which 
is  used  partly  in  professional  business,  the  de- 


ductible depreciation  on  each  car  should  be  com- 
puted on  the  basis  of  the  amount  of  time  each 
car  is  used  for  professional  purposes. 

In  other  words  if  an  automobile  is  used  only 
partly  for  business  purpose,  depreciation  may 
be  deducted  only  on  a proportionate  part  thereof, 
the  amount  of  depreciation  depending  on  the 
amount  of  time  the  machine  is  used  in  pro- 
fessional business. 

PROFESSIONAL  DUES— Dues  paid  to  pro- 
fessional associations  to  which,  in  the  interest 
of  his  profession,  the  physician  belongs  are  ex- 
empt and  may  be  deducted.  Expenses  incurred 
in  taking  graduate  courses  have  been  held  not 
to  be  deductible. 

TRAVELING  EXPENSES— Traveling  expenses 
incurred  by  a physician  in  attending  medical  con- 
ventions of  organizations  of  which  he  is  a mem- 
ber are  deductible  from  gross  income. 

SALARIES  AND  WAGES— Deductions  are 
permitted  for  the  salaries  of  nurses,  laboratory 
workers,  technicians,  assistants,  stenographers 
or  other  clerical  workers  in  a physician’s  office  so 
long  as  their  duties  are  connected  with  profes- 
sional work.  Wages  paid  maids  for  services  ren- 
dered in  connection  with  professional  practice 
also  are  deductible. 

MEDICINES,  INSTRUMENTS,  ETC.— Cost  of 
medicines,  used  in  the  office  to  treat  patients, 
medicine  dispensed,  bandages,  laboratory  ma- 
terials and  all  other  supplies  necessary  to  operate 
the  office  may  be  deducted.  One-fifth  of  the  pur- 
chase price  of  surgical  instruments  may  be  de- 
ducted annually  for  five  years  under  a deprecia- 
tion account.  All  office  fixtures,  appliances,  etc., 
used  in  office  or  laboratory  may  be  depreciated 
annually,  according  to  the  estimated  life  of  their 
usefulness.  The  customary  depreciation  for  office 
fixtures  and  furnishings  is  10%  annually. 

GENERAL  OFFICE  EXPENSE— The  cost  of 
telephone,  telegrams,  etc.,  used  in  professional 
services  may  be  deducted.  Expenditures  for  heat, 
light,  water,  etc.,  in  the  office  are  deductible. 

LIBRARY — The  original  cost  of  medical  books 
may  be  depreciated  10%  annually,  since  the  life 
of  these  is  usually  considered  10  years. 

DEBTS — If  the  physician’s  books  are  kept  ac- 
cording to  the  “Cash  Receipts  and  Disbursement” 
system,  he  may  not  charge  olf  any  unpaid  debt 
because  he  is  then  only  reporting  as  gross  income 
those  accounts  which  have  proved  to  be  good. 
Bad  accounts  have  not  been  reported  and  are 
therefore  not  deductible. 

If  books  are  kept  on  an  “Accrual  Basis”  (where 
expense  is  actually  incurred  and  payable  even 
though  not  yet  paid,  or  income  earned  although 
not  yet  collected),  it  is  permissible  to  charge  off 
all  debts  which  have  been  definitely  ascertained 
to  be  worthless  during  the  fiscal  year  covered 
by  the  report. 

The  physician  must  be  careful,  however,  to 


126 


The  Ohio  State  Medical  Journal 


February,  1933 


include  in  gross  income  bad  debts  which  have 
been  charged  off  in  previous  years  but  collected 
during  the  calendar  year  for  which  the  return  is 
filed. 

TAXES  AND  LICENSES— Any  tax  paid  upon 
materials  required  in  professional  work  are  ex- 
empt. All  license  fees  which  physicians  are  re- 
quired to  pay  are  deductible  items.  This  includes 
the  narcotic  tax,  automobile  license,  local  occu- 
pational taxes,  taxes  on  club  dues,  etc.  All  taxes 
paid  upon  real  or  personal  property,  whether  the 
property  is  used  for  business  or  otherwise  and 
all  interest  paid  upon  indebtedness  (except  in- 
terest paid  to  carry  nontaxable  securities)  are 
deductible.  The  Ohio  Gasoline  Tax  has  been  held 
as  not  deductible. 

Federal  taxes  upon  checks,  electrical  enei’gy, 
safety  deposit  box  rentals,  and  use  of  communi- 
cation facilities  are  deductible. 

LOSSES  BY  FIRE  AND  THEFT— Loss  of  and 
damage  to  a physician’s  equipment  by  fire,  theft, 
or  other  cause,  not  compensable  by  insurance  or 
otherwise  recoverable,  may  be  computed  as  a busi- 
ness expense,  and  is  deductible,  provided  evidence 
of  such  loss  or  damage  can  be  produced.  Such 
loss  or  damage  is  deductible,  however,  only  to 
the  extent  to  which  it  has  not  been  made  good 
by  repair  and  the  cost  of  the  repair  claimed  as  a 
deduction. 

INSURANCE  PREMIUMS— Premiums  paid 
for  insurance  against  professional  losses  are  de- 
ductible. This  includes  insurance  against  dam- 
ages for  alleged  malpractice,  against  liability  for 
injuries  to  a physician’s  automobile  while  in  use 
for  professional  purposes,  and  against  loss  from 
theft  of  professional  equipment,  and  damage  to 
or  loss  of  professional  equipment  by  fire  or  other- 
wise. Premiums  paid  on  life  insurance  are  not 
deductible  nor  is  interest  on  indebtedness  incurred 
in  connection  with  the  purchase  or  carrying  of 
annuities. 

LEGAL  EXPENSE — Expense  incurred  in  the 
defense  of  a suit  for  alleged  malpractice  is  de- 
ductible as  business  expense.  However,  expense 
incurred  in  the  defense  of  a criminal  action  is  not 
deductible. 

CONTRIBUTIONS — It  is  permissible  to  deduct 
from  gross  income  contributions  when  made  to 
charitable,  religious,  educational  and  scientific 
organizations,  to  an  amount  not  to  exceed  15%  of 
the  net  income,  exclusive  of  such  contributions. 

NORMAL  TAX  RATE 

As  explained  previously,  the  normal  tax  rate 
on  1932  income  is  4%  on  the  first  $4,000  in 
excess  of  exemptions  and  credits  and  8%  on  the 
remainder  of  such  excess. 

SURTAX  RATES 

In  addition  to  the  normal  tax  as  computed 
above,  a surtax  is  levied  upon  net  income  as 
follows: 


First  $6,000,  no  tax;  $6,000  to  $10,000,  1%; 

$10,000  to  $12,000,  2%;  $12,000  to  $14,000,  3%; 

$14,000  to  $16,000,  4%;  $16,000  to  $18,000,  5%; 

$18,000  to  $20,000,  6%;  $20,000  to  $22,000,  8%; 

$22,000  to  $24,000,  9%;  $24,000  to  $26,000,  10%; 
$26,000  to  $28,000,  11%;  $28,000  to  $30,000,  12%; 
$30,000  to  $32,000,  13%;  $32,000  to  $36,000,  15%, 
and  an  additional  1%  surtax  on  each  $2,000  in- 
crease in  net  incomes  up  to  $100,000.  Net  incomes 
between  $100,000  and  $150,000  are  surtaxed  at 
48%;  those  from  $150,000  to  $200,000  at  49%; 
$200,000  to  $300,000;  50%;  $300,000  to  $400,000, 
51%;  $400,000  to  $500,000,  52%;  $500,000  to 
$750,000  53%;  $750,000  to  $1,000,000,  54%,  and 
more  than  $1,000,000,  55%. 

HOW  COMPUTATIONS  ARE  MADE 

An  example  of  how  computations  are  made 
is  given  here  for  the  information  of  physicians. 
Suppose,  for  example,  a married  physician  with 
no  dependents  and  who  rents  his  home  and  office, 
had  a gross  income  during  1932  of  $20,000  and 
ordinary  expenses.  He  would  submit  the  follow- 
ing data  in  his  return  and  compute  his  tax  as 
follows : 

GROSS  INCOME 

Income  from  professional 

services $15,000.00 

Income  from  other  sources: 

Rent  from  apartment 

house 4,000.00 

Taxable  interest  and  divi- 
dends   1,000.00 


Total  gross  income $20,000.00 

EXPENSES,  CREDITS,  ETC. 

Depreciation  of  office  fix- 
tures, etc  $ 400.00 

Office  help,  etc.  1,500.00 

Telephone,  heat,  light,  etc.  ...  400.00 

Auto  cost  and  depreciation  ...  800.00 

Drugs,  bandages,  medicine, 

etc.  2,500.00 

Dues,  insurance,  etc 300.00 

Traveling  expenses  to  medi- 
cal conventions  200.00 

Office  rent  1,000.00 

Taxes  on  apartment,  over- 
head, etc.  2,600.00 

Interest  on  mortgage,  etc 200.00 

Miscellaneous  expense  100.00 


Total  expenses  

Net  income  (gross  income  less  total 

expenses)  

Personal  exemption .. 

Income  subject  to  normal  tax...  $ 7,500.00 

COMPUTATION  OF  NORMAL  TAX  AND 
SURTAX 

Taxable  at  4%  ($4,000) $160.00 

Taxable  at  8%  ($3,500) 280.00 

Surtax  on  net  in  excess  of 

$6,000  to  $10,000  at  1%....  40.00 

Total  normal  tax  and  surtax $ 480.00 

DISTRICTS  AND  COLLECTORS 

Any  physician  failing  to  receive  an  income  tax 
blank  should  apply  to  the  Collector  of  Internal 
Revenue  for  his  district.  These  districts,  together 


$10,000.00 

10,000.00 

2,500.00 


February,  1933 


State  News 


127 


with  the  name  and  address  of  the  Collector,  and 
counties  comprising  such  districts  follow: 

For  the  Columbus  District  (Ohio  11th)  Collec- 
tor of  Internal  Revenue  Newton  M.  Miller,  Post- 
office  Building,  Third  and  State  Sts.,  Columbus, 
Ohio;  comprising  the  following  counties: 

Adams,  Athens,  Coshocton,  Delaware,  Fairfield, 
Franklin,  Gallia,  Guernsey,  Hocking,  Jackson, 
Knox,  Lawrence,  Licking,  Madison,  Marion, 
Meigs,  Morgan,  Morrow,  Muskingum,  Noble, 
Perry,  Pickaway,  Pike,  Ross,  Scioto,  Union, 
Vinton  and  Washington. 

For  the  Cleveland  District  (Ohio  18th)  Collec- 
tor of  Internal  Revenue  C.  F.  Routzahn,  262  Fed- 
eral Building,  Cleveland,  Ohio;  comprising  the 
following  counties: 

Ashland,  Ashtabula,  Belmont,  Carroll,  Colum- 
biana, Cuyahoga,  Geauga,  Harrison,  Holmes, 
Jefferson,  Lake,  Lorain,  Mahoning,  Medina,  Mon- 
roe, Portage,  Richland,  Stark,  Summit,  Trumbull, 
Tuscarawas  and  Wayne. 

For  the  Cincinnati  District  (Ohio  1st)  Collec- 
tor of  Internal  Revenue  L.  J.  Huwe,  Custom 
Building,  Cincinnati,  Ohio;  comprising  the  follow- 
ing counties: 

Brown,  Butler,  Clarke,  Clermont,  Clinton, 
Fayette,  Greene,  Hamilton,  Highland,  Miami, 
Montgomery,  Preble  and  Warren. 

For  the  Toledo  District  (Ohio  10th)  Collector 
of  Internal  Revenue  Wm.  B.  Guitteau,  Toledo, 
Ohio;  comprising  the  following  counties: 

Allen,  Auglaize,  Champaign,  Crawford,  Darke, 
Defiance,  Erie,  Fulton,  Hancock,  Hardin,  Henry, 
Huron,  Logan,  Lucas,  Mercer,  Ottawa,  Paulding, 
Putnam,  Sandusky,  Seneca,  Shelby,  Van  Wert, 
Williams,  Wood  and  Wyandot. 

State  Personal  Property  Tax  Returns 
Due  Between  February  15  and  March  31 

Every  member  of  the  State  Association  should 
bear  in  mind  the  present  Ohio  tax  law  which  re- 
quires that  sometime  between  February  15  and 
March  31,  1933,  he  must  file  with  the  auditor  of 
his  county,  a return  listing  the  tangible  and  in- 
tangible personal  property  in  his  possession  as  of 
January  1,  1933. 

Such  returns  must  be  filed  in  duplicate.  Fail- 
ure to  receive  a proper  form  for  making  the  re- 
turn will  not  be  accepted  as  an  excuse  for  failure 
to  make  a return  dui’ing  the  filing  period.  Forms 
for  making  returns  may  be  obtained  from  the 
county  auditor. 

As  pointed  out  in  an  article  in  the  December, 
1931,  issue  of  The  Journal,  analyzing  some  of  the 
provisions  of  the  Ohio  Personal  Property  Tax 
Law  (enacted  at  the  1931  session  of  the  Ohio 
Legislature),  the  statute  is  intricate  and  compli- 
cated. This  makes  it  imperative  that  every 
physician  be  extremely  careful  in  making  his  re- 
turn and  obtain  competent  advice  in  case  of  doubt 
as  to  the  meaning  of  any  requirements  of  the  law. 

One  of  the  most  confusing  provisons  of  the 


Ohio  law  is  that  involving  the  listing  of  credits 
which  are  taxable  at  3 mills  on  the  dollar.  This 
is  particularly  complicated  for  a physician  since 
it  involves  the  computation  of  accounts  receivable. 

As  defined  by  Section  5327  of  the  law,  credits 
means  “the  excess  of  the  sum  of  all  current  ac- 
counts receivable  and  prepaid  items  when  added 
together  estimating  every  such  account  and  item 
at  its  true  value  in  money,  over  and  above  the 
sum  of  current  accounts  payable,  other  than  taxes 
and  assessments”.  The  same  section  states  that 
“ ‘current  accounts’  includes  items  receivable  or 
payable  within  one  year,  however  evidenced”. 

As  the  first  step  in  making  his  return  under  the 
section  relating  to  credits,  a physician  should 
estimate  by  his  best  judgment  the  ACTUAL 
VALUE  of  his  current  accounts  receivable  (the 
amount  that  can  probably  be  collected). 

In  listing  his  current  accounts  receivable,  the 
physician  should  note  after  each  account  what  he 
considers  the  value  of  the  account.  If  he  believes 
the  account  can  be  collected  in  full,  it  should  be 
listed  as  its  full  face  value.  Otherwise,  it  should 
be  listed  at  75%,  50%,  25%,  10%,  etc.,  of  its  full 
face  value,  or  of  “no  value”  in  case  that  is  consid- 
ered the  “actual  value”  of  the  account.  The  total 
of  these  estimates  is  the  total  to  be  enterd  as  “cur- 
rent accounts  receivable”  and  used  in  computing 
credits. 

This  procedure  permits  the  physician  to  charge 
off  bad  debts,  since  in  his  1933  return  he  would 
be  permitted  to  return  as  of  “no  value”  accounts 
receivable  which  he  listed  in  1932  but  no  part  of 
which  was  collected  during  the  past  year.  More- 
over, it  permits  the  physician  to  depreciate  the 
actual  value  of  accounts  returned  in  1932  but 
which  have  decreased  in  actual  value  during  the 
past  year. 


Tiffin — Dr.  E.  H.  Porter  spoke  on  “Medicine 
and  Surgery  as  a Profession”  at  the  second  of  a 
series  of  meetings  on  “Choosing  Your  Career”, 
held  under  the  auspices  of  the  local  Y.M.C.A. 

Canton — Dr.  George  B.  Hansel  has  been  ap- 
pointed physician  at  the  Stark  County  Home. 

Van  Wert — Dr.  J.  P.  Sampsell  was  injured  in 
an  automobile  accident  near  Delaware. 

Dayton — Dr.  Alfred  G.  Farmer  has  been  re- 
appointed a lieutenant  colonel  in  the  medical  re- 
serve corps. 

Hamilton — Dr.  Vernon  Roden  has  been  ap- 
pointed county  physician  by  the  Butler  County 
Commissioners. 

Chillicothe — Dr.  John  Baird,  for  the  past  seven 
years  clinical  director  in  the  U.  S.  Veterans’  Hos- 
pital here,  has  been  appointed  associate  to  Dr. 
George  Rowland,  chief  of  the  neuro-psychiatric 
division  of  the  Veterans’  Administi-ation,  Wash- 
ington, D.  C.  Dr.  Rowland  formerly  was  director 
of  the  Chillicothe  Veterans’  Hospital. 


Health  and  Welfare  Budgets  for  1933^34  Biennimn 
Submitted  to  Legislature 


Budgets  for  the  1933-1934  biennium  of  the 
State  Department  of  Health  and  the  State  De- 
partment of  Public  Welfare  were  in  the  hands  of 
the  State  Director  of  Finance  and  being  studied 
by  him  preliminary  to  submitting  recommenda- 
tions to  the  Legislature  on  appropriations  for  op- 
erating the  state  government  during  1933  and 
1934. 

The  budget  submitted  by  State  Director  of 
Health  H.  G.  Southard  asks  for  funds  totalling 
$1,106,124.60  for  this  year  and  1934,  separated  as 
follows:  $554,450.10  for  1933  and  $551,674.50  for 

1934. 

In  1932,  the  State  Department  of  Health  ex- 
pended funds  totalling  $470,743.86  and  in  1931, 
$552,429.04,  making  a total  expenditure  of  $1,023,- 
172.90  for  the  1931-1932  biennium. The  department 
spent  $1,227,889.80  during  the  1929-1930  bien- 
nium, $597,329.60  being  spent  in  1929  and  $630,- 
560.20  in  1930. 


The  1933-34  budget  of  the  State  Department  of 
Health  requests  these  funds  for  the  following 
purposes: 


1933 

Salaries  $192,662.50 

Other  personal  services,-.  5,000.00 
Maintenance  356,787.60 


1934 

$192,662.50 

5,000.00 

354,012.00 


Total $554,450.10  $551,674.50 


A statement  by  Dr.  Southard  accompanying  the 
budget  points  out  that  a savings  amounting  to 
$156,337  was  made  by  the  Department  during  the 
1931-32  biennium  in  funds  appropriated  by  the 
Legislature  and  that  the  request  of  the  Depart- 
ment for  the  1933-34  biennium  is  approximately 
$250,000  less  than  the  amount  appropriated  for 
the  biennium  which  just  closed. 

Included  in  the  Department’s  budget  under 
“Maintenance”  is  a request  for  $300,000  for  each 
year  of  the  1933-34  biennium  to  be  paid  out  as 
subsidy  to  the  various  local  health  districts.  The 
same  request  was  made  in  the  budget  submitted 
at  the  beginning  of  the  1931-32  biennium  but  the 
amount  was  cut  by  the  Legislature  to  $400,000  for 
the  two-year  period. 


Welfare  Budget  $17,000,000 

Requests  of  the  State  Department  of  Public 
Welfare  for  the  1933-34  biennium  total  $17,- 
156,262,  compared  to  actual  expenditures  of 
$16,513,169  for  the  1931-32  biennium  and  $20,- 
738,347  in  1929  and  1930. 

The  1933-34  budget  of  the  Department  of  Wel- 
fare requests  these  funds  for  the  following  pur- 
poses : 


1933  1934 

Salaries  $3,203,831  $3,303*831 

Other  personal  services 169,500  169,500 

Maintenance  4,269,800  4,448,300 

Additions  and  betterments..  1,591,500  

Total  $9,234,631  $7,921,631 

If  appropriated  by  the  Legislature,  the  $1,591,- 
500  requested  for  additions  and  betterments  will 
be  expended  at  the  following  state  institutions: 

Athens  State  Hospital,  $279,000;  Apple  Creek 
Institution  for  Feeble-Minded,  $250,000;  Boys’ 
Industrial  School,  Lancaster,  $11,000;  Cleveland 
State  Hospital,  $33,000;  Columbus  State  Hospital, 
$37,500;  Columbus  Institution  for  the  Feeble- 
Minded,  $10,600;  Dayton  State  Hospital,  $334,- 
000;  Hawthornden  Farm,  Cleveland,  $260,000; 
Longview  State  Hospital,  $131,000;  Lima  State 
Hospital,  $21,500;  Massillon  State  Hospital, 
$44,000;  State  Hospital  for  Epileptics,  Gallipolis, 
$44,050 ; Orient  Institution  for  Feeble-Minded, 
$7,500;  Toledo  State  Hospital,  $67,800;  Girls’  In- 
dustrial School,  $17,000;  Ohio  Reformatory, 
$18,250;  Ohio  Reformatoi’y  for  Women,  $7,000; 
London  Prison  Farm,  $5,000;  Ohio  State  Sani- 
tarium, Mt.  Vernon,  $1,200;  Ohio  Soldiers’  and 
Sailors’  Orphans’  Home,  $11,300. 


Canton — Officers  have  been  opened  here  by  Dr. 
Harold  Schmuck  following  a year  of  post-grad- 
uate work. 

Troy — Changes  in  medical  education  during  the 
past  century  were  reviewed  by  Dr.  Warren  Cole- 
man in  an  address  before  the  Troy  Rotary  Club. 

Lisbon — Dr.  James  C.  Gruber  has  been  re- 
appointed physician  at  the  county  home. 

Toledo — Dr.  Norman  Fisher  was  kidnaped  by 
three  bandits  and  forced  to  drive  them  into  the 
country  where  they  robbed  him  of  $15  and  took 
his  machine. 

Lima — Dr.  R.  E.  Bushong,  Milwaukee,  formerly 
connected  with  the  Toledo  State  Hospital  and  the 
Athens  State  Hospital,  has  been  appointed  by 
State  Welfare  Director  John  McSweeney  as 
superintendent  of  the  Lima  State  Hospital  for  the 
Criminal  Insane,  succeeding  the  late  Dr.  W.  H. 
Vorbau. 

Columbus — Dr.  Fred  E.  Hall  sustained  a frac- 
tured arm  when  he  fell  on  an  icy  pavement. 

Akron — Dr.  R.  E.  Amos  has  been  named  sur- 
geon in  the  police  department,  succeeding  Dr. 
Oscar  Hayes,  new  Summit  County  coroner. 

Auburn — Dr.  M.  H.  Mitchell  has  moved  here 
from  Somerset  and  opened  offices  for  the  practice 
of  general  medicine. 


128 


Health  Department  Orders  Requiring  Adequate  Sewage 

Disposal  Upheld  By  Court 


Orders  of  the  State  Director  of  Health,  acting 
for  the  Public  Health  Council,  issued  pursuant  to 
general  laws  to  compel  political  subdivisions  to 
provide  ways  and  means  for  the  purification  or 
disposal  of  sewage  and  other  wastes  for  the  pro- 
tection of  public  health  or  to  safeguard  public 
water  supplies,  are  mandatory  and  must  be  com- 
plied with;  and  funds  for  such  purposes  must  be 
provided  out  of  current  expenses  if  no  other  funds 
are  available,  the  Ohio  Supreme  Court  held  in  a 
recent  decision  in  the  case  of  State  of  Ohio,  ex 
rel  Southard,  State  Director  of  Health,  v.  The 
City  of  Van  Wert. 

The  decision,  handed  down  December  21,  1932, 
is  the  final  chapter  of  a long  skirmish  between 
the  State  Department  of  Health  and  a half  a 
dozen  or  more  municipalities  and  villages  of  Ohio 
relative  to  the  power  of  the  State  Department  of 
Health  to  force  political  subdivisions  to  carry  out 
the  department’s  orders,  regardless  of  the  finan- 
cial condition  of  the  subdivisions.  The  Van  Wert 
case  was  submitted  to  the  court  as  a test  case. 

Briefly,  the  history  of  the  case  is  as  follows: 

In  1920,  the  State  Director  of  Health,  acting 
for  the  Public  Health  Council,  ordered  the  city  of 
Van  Wert  to  install  a sewage  disposal  plant  to 
correct  pollution  of  Town  Creek.  The  city  took 
no  steps  to  comply  with  the  order  until  November, 
1931,  when  it  submitted  to  the  voters  a proposi- 
tion for  the  issuing  of  bonds  and  making  a levy 
of  taxes  outside  the  15-mill  limitation  to  obtain 
funds  to  comply  with  the  order.  The  proposal  lost 
at  the  polls. 

Defeated  in  its  attempt  to  float  additional 
bonds  or  borrow  money  to  commence  the  sewage 
disposal  project,  the  city  made  no  further  effort 
to  comply  with  the  order  of  the  State  Department 
of  Health. 

To  force  the  issue,  the  State  Department  of 
Health  filed  a writ  of  mandamus  to  compel  the 
City  of  Van  Wert  to  comply  with  its  order.  An 
answer  was  filed  by  the  city  in  which  the  defense 
was  set  up  that  all  funds  the  city  is  able  to  secure 
from  all  sources  are  needed  and  necessary  for 
paying  operating  expenses  and  to  retire  already 
existing  debts ; that  the  voters  defeated  the  city’s 
proposal  to  borrow  money  and  levy  a special  tax 
for  the  purpose,  and  that  under  the  provisions  of 
Section  2,  Article  12,  of  the  Constitution,  and 
Section  5625-2,  General  Code,  the  city  is  not  per- 
mitted to  borrow  money  and  issue  bonds,  without 
the  consent  of  the  electorate,  for  such  borrowing 
would  create  an  additional  debt  which  could  not 
be  retired  by  levy  of  taxes  within  the  15-mill 
limitation. 

A demurrer  to  the  city”s’  answer  was  filed  by 


the  attorney  general  in  behalf  of  the  State  De- 
partment of  Health. 

In  sustaining  the  State’s  demurrer,  the  court 
pointed  out  that  the  order  issued  by  the  State 
Department  of  Health  is  mandatory  and  must  be 
complied  with,  and  that  if  no  other  way  is  open, 
the  city  must  provide  money  from  funds  for  cur- 
rent expenses  to  carry  out  the  order. 

“Current  expenses,”  the  court  stated,  “must  be 
secondary  to  levies  to  meet  mandatory  require- 
ments such  as  discharge  of  bonded  indebtedness, 
interest  thereon,  and  also  compliance  with  the 
orders  of  the  State  Department  of  Health  issued 
under  general  state  laws  which  we  hold  to  be 
mandatory.  If  current  expenses  of  the  muirci- 
pality  cannot  be  provided  within  the  15-mill  limi- 
tation and  provision  made  for  payment  of  bonds 
required  to  be  issued  in  order  to  comply  with 
orders  of  the  State  Department  of  Health,  then 
current  expenses  must  yield.  . . .” 

As  a remedy  for  the  deficit  which  would  be 
created  in  funds  for  operating  expenses  by  use 
of  a part  of  such  funds  for  the  sewage  disposal 
plant,  the  court  cited  Section  5625-15,  General 
Code,  which  section  permits  the  taxing  authority 
of  any  subdivision  by  a vote  of  two-thirds  of 
such  body  to  declare  that  the  amount  of  taxes 
which  may  be  raised  within  the  15-mill  limitation 
will  be  insufficient  to  provide  an  adequate  amount 
for  the  necessary  requirements  of  the  subdivision 
and  that  it  is  necessary  to  levy  a tax  in  excess  of 
the  15-mill  limitation  for  certain  purposes,  one  of 
which  is  current  expenses  of  the  subdivision. 

In  other  words,  the  City  of  Van  Wert  and  other 
subdivisions  against  which  mandatory  orders  have 
been  issued  by  the  State  Department  of  Health, 
must,  under  the  terms  of  the  court’s  decision, 
take  money  from  the  operating  expense  funds  of 
the  subdivision,  if  necessary,  to  comply  with  said 
orders  and  rely  on  the  authority  granted  them  in 
Section  5625-15,  General  Code,  to  obtain  addi- 
tional funds  necessary  to  meet  current  expenses 
of  the  subdivision. 


Columbiana — Dr.  F.  W.  Trader  addressed  the 
local  Rotary  Club  on  “Cancer”. 

Cleveland — A banquet,  honoring  Dr.  John  P. 
Sawyer,  for  44  years  on  the  medical  faculty  at 
Western  Reserve  University  and  for  37  years  on 
the  staff  at  Charity  Hospital,  was  given  recently 
at  the  Union  Club  by  Dr.  Sawyer’s  associates  and 
friends.  Toasts  to  his  long  and  active  career  were 
made  by  Dr.  Frederick  C.  Waite,  Dr.  W.  G.  Leut- 
ner,  acting  president  of  the  University,  Dr.  John 
Dickenson,  Rev.  C.  H.  LeBlond,  and  Dr.  Torald 
Sollmann. 


129 


Supreme  Court  Decision  Strengthens  Law  Enforcement  in 
Prosecution  of  Violators  of  Medical  Practice  Act 


In  a decision  handed  down  January  11,  the 
Ohio  Supreme  Court  removed  one  of  the  most 
serious  obstacles  to  law  enforcement  generally  in 
Ohio,  especially  in  misdemeanor  cases,  and  clearly 
and  conclusively  interpreted  certain  Ohio  statutes 
pertaining  thereto,  which,  undoubtedly,  will  have 
a beneficial  effect  in  the  prosecution  of  violators 
of  the  Medical  Practice  Act. 

The  court’s  ruling,  in  the  case  of  The  Muni- 
cipal Court  of  Toledo  and  Leonard  Donovan,  a 
judge  of  the  Municipal  Court  of  Toledo  vs.  State, 
ex  rel.,  H.  M.  Platter  (Secretary  of  the  State 
Medical  Board),  clears  up  various  controversial 
questions  relative  to  the  suspension  of  sentences 
in  criminal  cases.  It  provides  the  state  with  the 
necessary  legal  ammunition  to  combat  the  exces- 
sive tendency  on  the  part  of  some  courts  to  as- 
sume an  attitude  of  extreme  leniency  toward 
violators  of  the  Medical  Practice  Act. 

As  pointed  out  in  an  article  in  the  May,  1932, 
issue  of  The  Journal,  pages  386  and  387,  review- 
ing lower  court  decisions  in  the  case,  enforcement 
of  the  Medical  Practice  Act  has  been  hampered 
considerably,  especially  during  the  past  few  years, 
by  a lukewarm  attitude  on  the  part  of  some  courts 
toward  strict  enforcement  of  the  act  and  by  the 
practice  of  suspending  the  execution  of  sentences 
imposed  against  those  found  guilty  of  violating 
the  provisions  of  the  statutes  regulating  the  prac- 
tice of  medicine  and  its  limited  branches. 

The  Supreme  Court’s  decision  in  the  Toledo 
case  will  have  the  effect  of  putting  an  end  to  this 
uncooperative  attitude  on  the  part  of  some 
courts,  the  court  stating  in  definite  terms  that 
“the  trial  courts  of  this  state  do  not  have  the  in- 
herent power  to  suspend  execution  of  a sentence 
in  a criminal  case  and  may  order  such  suspension 
only  as  authorized  by  statute  and  where  a court 
has  suspended  execution  of  sentence  without  law- 
ful authority  to  do  so,  its  order  of  suspension  may 
be  treated  as  a nullity  and  void,  and  the  original 
sentence  carried  into  execution  even  after  the 
term  in  which  the  order  suspending  the  execution 
of  sentence  was  made.’” 

Briefly,  the  history  of  the  case  is  as  follows: 

On  or  about  March  16,  1930,  and  August  4, 
1931,  affidavits  were  filed  by  Former  Attorney 
General  Gilbert  Bettman  and  his  assistant,  Isa- 
doi-e  Topper,  on  behalf  of  the  State  Medical 
Board,  in  the  Municipal  Court  of  Toledo  against 
29  unlicensed  chiropractors,  charging  them  with 
violation  of  the  provisions  of  Section  12694  of  the 
General  Code,  making  it  unlawful  to  practice 
medicine  or  surgery,  or  any  of  its  limited 
branches,  and  to  advertise  or  announce  such  with- 
out obtaining  a certificate  from  the  State  Medical 
Board. 

The  defendants  were  found  guilty  and  sen- 
tenced to  pay  a fine  of  $25.00  each  and  to  stand 


committed  until  the  fine  was  paid  by  Municipal 
Judge  Leonard  Donovan.  Subsequently,  Judge 
Donovan  ordered  the  fine  and  costs  imposed  on 
each  defendant  suspended.  The  judgment  of  the 
Municipal  Court  was  reversed  by  the  Court  of 
Common  Pleas.  The  Common  Pleas  Court  de- 
cision was  reversed  and  the  Municipal  Court  judg- 
ment sustained  by  the  Court  of  Appeals.  A peti- 
tion of  error  filed  by  the  defendants  with  the 
Supreme  Court  was  dismissed  and  the  judgment 
against  the  defendants  ordered  carried  out. 

Unable  to  obtain  execution  of  the  sentences  by 
the  Municipal  Court  of  Toledo,  the  Attorney  Gen- 
eral and  Special  Counsel  Topper  filed  a writ  of 
mandamus  in  the  Court  of  Appeals,  seeking  to 
require  the  Municipal  Court  of  Toledo  to  vacate 
the  orders  of  suspension  of  execution  of  the  sen- 
tences and  to  order  enforcement  of  the  sentences. 
The  Court  of  Appeals  rendered  a judgment  in 
favor  of  the  state,  ordering  the  Municipal  Court 
of  Toledo  to  enforce  execution  of  the  sentences. 

Thereupon,  the  case  was  carried  to  the  Supreme 
Court  a second  time  on  error  proceedings,  which 
petition  in  error  was  dismissed  by  the  Supreme 
Court  in  its  decision  of  January  11  and  judgment 
rendered  in  favor  of  the  State  Medical  Board. 

In  addition  to  deciding  that  a criminal  court 
does  not  have  the  inherent  power  to  suspend  the 
execution  of  a sentence  in  a criminal  case  other 
than  for  error  proceedings,  which  was  not  the 
reason  for  suspension  in  the  Toledo  case,  the 
Supreme  Court  held  that  “a  court  does  not  lose 
jurisdiction  to  enforce  a sentence  in  a criminal 
case  by  an  unauthorized  attempt  to  suspend  it” 
and  that  it  has  the  power  on  its  own  motion  to 
set  aside  at  any  time  a void  order  suspending 
execution  of  a sentence  in  a criminal  case.  The 
Municipal  Court  of  Toledo  and  Judge  Donovan 
contended  that  they  had  lost  jurisdiction  of  the 
convicted  chiropractors  by  virtue  of  the  fact  that 
the  term  of  court  in  which  the  sentences  were  im- 
posed and  illegally  suspended  had  passed. 

Moreover,  the  Supreme  Court  approved  the 
action  taken  by  the  state  in  attempting  to  have 
the  sentences  enforced  by  holding  that  “where  a 
court  has  made  an  unlawful  order  of  suspension 
of  execution  of  a sentence  in  a criminal  case, 
mandamus  is  a proper  remedy  by  which  to  compel 
such  court  to  set  aside  and  vacate  such  order  and 
compel  execution  of  the  original  sentence”. 

The  court  pointed  out  that  there  must  be  a dis- 
tinction between  “imposition”  of  sentence  and 
“execution”  of  sentence,  holding  that  imposition 
of  sentence  may  be  suspended  for  the  purpose  of 
probation  and  that  conditional  sentence  may  be 
imposed  in  misdemeanors,  but  that  execution  of 
a sentence  once  imposed  may  be  suspended  only 
for  the  purpose  of  permitting  a person  convicted 
of  a bailable  offense  for  a pei'iod  which  will  give 
him  sufficient  time  to  institute  error  proceedings. 


130 


Horace  N.  Allen,  M.D.,  Toledo;  Miami  Medical 
College,  Cincinnati,  18S3;  aged  74;  died  December 
11  following  a two-year  illness  of  diabetes.  Dr. 
Allen,  retired,  was  a grand-nephew  of  Ethan 
Allen  of  Revolutionary  War  fame.  Following  his 
graduation  from  medical  school,  Dr.  Allen  went 
to  the  Orient  where  he  served  as  a medical  mis- 
sionary until  1897  when  he  was  appointed  min- 
ister resident  and  counsel-general  for  the  United 
States  in  Korea.  Later  he  was  promoted  to  min- 
ister which  office  he  held  until  1905  when  he  re- 
tired and  took  up  his  residence  in  Toledo.  He 
leaves  his  widow  and  two  sons. 

William  E.  Bright , M.D.,  North  Hampton;  Ohio 
Medical  University,  Columbus,  1897;  aged  66; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  December  13  of  heart  disease.  Dr. 
Bright,  a native  of  Christianburg,  Ohio,  began  the 
practice  of  medicine  at  New  Lebanon  but  during 
his  first  year  of  practice  he  moved  to  North 
Hampton  where  he  resided  until  his  death.  Dr. 
Bright  was  a member  of  the  visiting  staff  of  the 
Springfield  City  Hospital;  Masonic  Lodge, 
Pythian  Lodge  and  the  Junior  Order,  U.  A.  M. 
Surviving  are  his  mother,  one  son  and  one 
brother. 

Ellen  F.  Hawkins,  M.D.,  Oberlin;  Cleveland 
University  of  Medicine  and  Surgery,  1896;  aged 
87;  died  December  16  of  influenza.  Dr.  Hawkins 
had  resided  in  Oberlin  since  1892.  She  was  a 
member  of  the  Congregational  Church.  Surviving 
are  two  sons  and  three  sisters. 

Charles  E.  Kerney,  M.D.,  Dayton;  University 
of  Michigan,  School  of  Medicine,  1891;  aged  67; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  January  3 following  an  extended  illness. 
Dr.  Kerney  practiced  in  Delaware  for  seven  years 
before  moving  to  Dayton  in  1898.  He  leaves  his 
widow,  one  son  and  two  sisters. 

John  Lauf ersweiler , M.D.,  Minster;  Ohio  State 
University,  College  of  Medicine,  1924;  aged  32; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  December  20  of  a throat  infection.  Dr. 
Laufersweiler,  a native  of  Minster,  practiced  for 
a short  time  in  Lancaster  before  establishing  an 
office  in  his  home  town.  He  was  a member  of  the 
Auglaize  County  Board  of  Health.  Surviving  are 
his  widow,  one  son,  two  brothers  and  six  sisters. 

John  B.  McBride,  M.D.,  Zanesville;  Cleveland 


University  of  Medicine  and  Surgery,  1896;  aged 
66;  died  January  3 following  an  extended  illness. 
Dr.  McBride  had  been  a resident  of  Zanesville 
since  1901.  Since  1929  he  had  been  registrar  of 
vital  statistics  for  the  district  and  city  poor 
physician.  Dr.  McBride  leaves  his  widow,  three 
daughters,  two  sons,  one  brother  and  five  sisters. 

John  J.  Mory,  M.D.,  St.  Henry;  Jefferson  Medi- 
cal College,  1869 ; aged  86 ; former  member  of  the 
Ohio  State  Medical  Association  and  of  the  Amer- 
ican Medical  Association;  died  December  28  of 
obstruction  of  the  bowels.  Dr.  Mory  had  practiced 
in  St.  Henry  and  that  vicinity  for  the  past  55 
years.  He  is  survived  by  two  granddaughters. 

David  C.  Peters,  M.D.,  Zanesville;  Medical  Col- 
lege of  Ohio,  1866;  aged  90;  died  December  28  of 
pneumonia.  Dr.  Peters  was  a native  of  Zanesville 
and  after  retiring  from  the  practice  of  medicine 
was  in  the  drug  business  there.  He  was  at  one 
time  president  of  the  Ohio  Pharmaceutical  Asso- 
ciation. He  leaves  one  daughter. 

Watson  G.  Scurlock,  M.D.,  Jackson;  Starling 
Medical  College,  Columbus,  1900;  aged  57;  mem- 
ber of  the  Ohio  State  Medical  Association  and  the 
American  Medical  Association;  died  January  5 of 
angina  pectoris.  Dr.  Scurlock  retired  in  1927  after 
practicing  25  years  in  Jackson  and  Columbus.  He 
leaves  his  widow,  one  son,  one  brother  and  three 
sisters. 

Zalmon  O.  Sherwood,  M.D.,  Geneva;  Western 
Reserve  University,  School  of  Medicine,  1911; 
aged  46;  member  of  the  Ohio  State  Medical  Asso- 
ciation and  a Fellow  of  the  American  Medical  As- 
sociation; died  December  13  of  pneumonia.  Dr. 
Sherwood,  the  fifth  generation  of  his  family  to 
practice  medicine,  has  spent  most  of  his  profes- 
sional career  in  Geneva.  During  the  World  War 
he  served  as  a captain  in  the  medical  corps.  Sur- 
viving are  his  widow,  one  son  and  one  daughter. 

Morris  C.  Tarr,  M.D.,  Wellsville;  New  York 
University  Medical  College,  1881;  aged  79;  mem- 
ber of  the  Ohio  State  Medical  Association  and  a 
Fellow  of  the  American  Medical  Association;  died 
December  1.  Dr.  Tarr,  a native  of  Columbiana 
County,  settled  in  Wellsville  47  years  ago.  Re- 
cently he  completed  the  50th  anniversary  of  his 
entrance  into  the  practice  of  medicine.  Dr.  Tarr 
is  survived  by  his  widow,  one  daughter,  one  son, 
and  two  sisters. 

Rolla  L.  Thomas,  M.D.,  Cincinnati;  Eclectic 
Medical  College,  Cincinnati,  1880;  aged  75;  died 
December  28  following  an  extended  illness.  Dr. 


131 


132 


The  Ohio  State  Medical  Journal 


February,  1933 


Thomas  had  been  associated  with  the  Eclectic 
Medical  College  of  Cincinnati  since  1887,  serving 
as  professor  of  medicine,  dean  of  the  college  and 
vice  president  of  the  board  of  trustees.  Dr. 
Thomas  was  active  in  the  Methodist  Episcopal 
Church.  Surviving  are  his  widow,  one  son  and 
two  sisters. 

Henry  Voile,  M.D.,  Reading;  Eclectic  Medical 
College,  Cincinnati,  1891;  aged  79;  died  Decem- 
ber 9.  Dr.  Voile  was  a native  of  Germany  and 
had  resided  in  Reading  for  almost  40  years.  He 
leaves  one  son  and  three  daughters. 

Edwin  B.  Herrington,  M.D.,  Findlay;  New 
York  University  Medical  College,  1889  and  Louis- 
ville Medical  College,  1896;  member  of  the  Ohio 
State  Medical  Association  and  the  American 
Medical  Association;  died  January  12  as  a result 
of  injuries  l’eceived  from  a fall  on  the  ice  a month 
ago.  Dr.  Herrington,  who  had  practiced  in  Find- 
lay for  30  years,  was  active  in  medical  circles  in 
Northwestern  Ohio.  He  was  a member  of  the 
Methodist  Episcopal  Church  and  the  Elks’  Lodge. 
He  leaves  his  widow  and  one  daughter. 

Joseph  Wagner,  M.D.,  Mt.  Vernon;  licensed  in 


1896;  aged  90;  died  December  31  of  infirmities  of 
age.  He  had  practiced  in  Knox  County  since  1879. 
He  leaves  two  sons,  two  daughters,  two  sisters 
and  two  brothers. 

Arnold  G.  Webb,  M.D.,  Cincinnati;  Medical  Col- 
lege of  Ohio,  Cincinnati,  1900 ; aged  57 ; died  De- 
cember 23  of  heart  disease.  Dr.  Webb  leaves  his 
widow,  two  brothers  and  three  sisters. 

Walter  V.  Havens,  M.D.,  near  New  Albany; 
Starling  Medical  College,  Columbus,  1886;  aged 
73;  died  December  18  of  heart  disease.  He  had 
practiced  for  many  years  in  Columbus  and  Frank- 
lin County.  Surviving  are  his  widow,  one  son,  one 
daughter,  and  two  brothers. 

KNOWN  IN  OHIO 

Louis  D.  Chabut,  M.D.,  Jackson,  Michigan; 
Jefferson  Medical  College,  1890;  aged  72.  Dr. 
Chabut,  a native  of  France,  came  to  this  country 
in  1885.  For  30  years  he  practiced  in  Youngs- 
town, retiring  six  years  ago  and  moving  to  Jack- 
son,  Michigan,  to  reside  with  his  son,  Dr.  Hector 
Chabut.  Surviving  are  his  widow,  one  daughter, 
three  sons,  two  brothers  and  one  sister. 


New^ 

County  Socif 

N|g|s  From 

ities  &jjid  Academies  j 

First  District 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(George  B.  Topmoeller,  M.D.,  Secretary) 

January  9 — General  Session.  Program:  “Head- 
ache”, Dr.  Max  Dreyfoos;  discussions  by  Dr. 
Louis  A.  Lurie  and  Dr.  Charles  C.  Jones;  “A  New 
Type  of  Encephalitis”,  Dr.  Howard  D.  McIntyre, 
based  on  observations  of  18  cases  of  a peculiar 
form  of  encephalitis  in  the  vicinity  of  Cincinnati 
during  the  past  six  months ; discussions  by  Dr.  A. 
R.  Vonderahe  and  Dr.  C.  E.  Shinkle. 

January  16 — General  Session.  Program:  “Hodg- 
kin’s Disease”,  Dr.  Curtis  F.  Burnam,  Baltimore. 

January  23 — General  Session.  Program:  “Renal 
Tuberculosis”,  Dr.  Gordon  McKim;  discussion, 
Dr.  E.  O.  Smith;  “Stuttering:  Discussion  of 

Cause  and  Treatment”,  Dr.  E.  A.  North;  discus- 
sions, Dr.  A.  T.  Childers  and  Dr.  Charles  E. 
Kiely. 

January  30 — General  Session.  Program:  “The 
Relationship  of  the  Coroner’s  Office  to  Medical- 
Legal  Problems”,  Dr.  M.  Scott  Kearns;  discus- 
sions, Dr.  Richard  A.  Austin  and  Dr.  J.  N.  Pat- 
terson; “Achlorydria”,  Dr.  Leon  Schiff;  discus- 
sions, Dr.  H.  W.  Bettman  and  Dr.  C.  C.  Fihe. 

Adams  County  Medical  Society  met  December 


21  at  the  courthouse  at  West  Union.  No  program 
was  presented,  the  meeting  being  devoted  to  a dis- 
cussion of  organization  and  business  matters. — 
News  Clipping. 

Butler  County  Medical  Society  held  its  regular 
meeting  January  10  at  the  Mercy  Hospital,  Ham- 
ilton. Guest  speakers  were  Dr.  Harold  F.  Down- 
ing and  Dr.  James  Price,  both  of  Cincinnati. — • 
News  Clipping. 

Clinton  County  Medical  Society  held  a general 
discussion  on  “Protein”,  at  its  regular  meeting 
January  3 at  Wilmington.  There  was  a good  at- 
tendance.—News  Clipping. 

Fayette  County  Medical  Society  held  a well-at- 
tended meeting  January  5 at  the  Y.M.C.A.  build- 
ing, Washington  C.  H.  Dr.  Charles  J.  Shepard, 
Columbus,  made  an  interesting  talk  on  “Skin 
Diseases”,  illustrated  with  lantern  slides.  The 
report  of  the  Committee  on  the  Costs  of  Medical 
Care  was  discussed  by  the  membership.  It  was 
decided  to  discuss  the  question  further  at  the  next 
meeting. — James  F.  Wilson,  M.D.,  Secretary. 

Highland  County  Medical  Society  was  addressed 
by  Dr.  H.  H.  Lowe,  Leesburg,  at  its  regular  meet- 
ing on  December  7 at  the  Hotel  Parker,  Hillsboro. 
Dr.  Lowe  spoke  on  the  subject  “The  Value  of  a 


February,  1933 


State  News 


133 


Medical  Society  to  the  Community”. — News  Clip- 
ping. 

Second  District 

Champaign  County  Medical  Society  at  its  meet- 
ing on  December  8 at  Urbana,  selected  the  fol- 
lowing officers  for  the  ensuing  year:  President, 
Dr.  N.  M.  Rhodes,  Urbana;  president-elect,  Dr.  J. 
D.  O’Gara,  Urbana;  secretary-treasurer,  Dr.  L.  A. 
Woodburn,  Urbana;  legislative  committeeman, 
Dr.  E.  R.  Earle,  Urbana;  medical  defense  com- 
mitteeman, Dr.  Mark  Houston,  Urbana;  delegate, 
Dr.  E.  W.  Ludlow,  Urbana;  alternate,  Dr.  J.  W. 
Norman,  St.  Paris. — L.  A.  Woodburn,  M.D., 
Secretary. 

Clark  County  Medical  Society  elected  the  fol- 
lowing officers  at  its  meeting  on  December  28  at 
the  Springfield  City  Hospital : President,  Dr.  C. 
W.  Evans,  Springfield;  vice  president,  Dr.  E.  P. 
Greenawalt,  Springfield;  secretary,  Dr.  Rodger 
Marquart,  Springfield;  treasurer,  Dr.  F.  P.  An- 
zinger,  Springfield;  legislative  committeeman,  Dr. 
Anzinger;  medical  defense  committeeman,  Dr.  C. 
L.  Minor;  delegate,  Dr.  Edgar  Long,  South 
Vienna. 

At  the  regular  meeting  of  the  society  on  Decem- 
ber 14,  Dr.  H.  M.  Platter,  Columbus,  president  of 
the  State  Association,  spoke.  Dr.  Platter  dis- 
cussed the  report  of  the  Committee  on  the  Costs 
of  Medical  Care,  urging  the  society  to  study  the 
reports  carefully  as  well  as  the  action  of  the 
Council  of  the  State  Association  relative  to  the 
investigation. — News  Clipping. 

Darke  County  Medical  Society  at  its  regular 
session  December  9 at  Greenville  elected  the  fol- 
lowing officers  for  the  ensuing  year:  President, 
Dr.  W.  T.  Fitzgerald,  Greenville;  vice  president, 
Dr.  J.  0.  Starr,  Greenville;  secretary-treasurer, 
Dr.  W.  D.  Bishop,  Greenville;  legislative  com- 
mitteeman, Dr.  J.  E.  Hunter,  Greenville;  medical 
defense  committeeman,  Dr.  0.  P.  Wolverton, 
Greenville;  delegate,  Dr.  C.  I.  Stephen,  Ansonia; 
alternate,  Dr.  J.  E.  Gillette,  Versailles.  Dr.  E.  J. 
Gordon,  Columbus,  the  guest  speaker,  presented  a 
paper  on  “Periodic  Health  Examinations”. — 
News  Clipping. 

Green  County  Medical  Society  was  addressed 
by  Dr.  Vernon  Hart,  Dayton,  at  its  meeting  on 
January  5 at  Xenia.  Dr.  Hart  spoke  on  “Common 
Fractures  About  the  Elbow  Joint”,  illustrating 
his  address  with  lantern  slides.  Luncheon  was 
sei'ved  following  the  program. 

At  a special  meeting  of  the  society  on  Decem- 
ber 13,  Dr.  W.  C.  Breidenbach,  Stillwater  Sani- 
tarium, Dayton,  spoke  on  “Medical  Economics”. 
He  also  discussed  the  chest  clinic  being  held  in 
Xenia. — H.  C.  Schick,  M.D.,  Secretary. 

Miami  and  Shelby  County  Medical  Societies 
held  their  annual  joint  dinner  meeting  on  Jan- 
uary 6 at  the  Stouder  Memorial  Hospital,  Troy. 
Following  the  dinner,  Dr.  B.  N.  Carter,  assistant 


professor  of  surgery,  University  of  Cincinnati, 
spoke  on  “The  Surgical  Treatment  of  Pulmonary 
Tuberculosis”. — Bulletin. 

Montgomery  County  Medical  Society  met  Jan- 
uary 6 at  the  Fidelity  Medical  Building,  Dayton. 
The  program  was  presented  by  Dr.  F.  W.  Cox 
and  Dr.  T.  H.  Dickinson.  Dr.  Cox  read  a paper  on 
“The  Colon”  and  Dr.  Dickinson  one  on  “Colitis 
and  Other  Conditions  as  Abnormal  Cause  of  In- 
testinal Mucous  Secretion  in  Infants  and  Chil- 
dren”.— Bulletin. 

Preble  County  Medical  Society  elected  the  fol- 
lowing officers  at  its  meeting  December  15  at  the 
Seven  Mile  Tavern  near  Eaton:  President,  Dr.  C. 
M.  Treffinger,  Eaton;  vice  president,  Dr.  C.  E. 
Newbold,  Eaton;  secretary -treasurer,  Dr.  C.  J. 
Brian,  Eaton;  legislative  committeeman,  Dr.  J.  C. 
Ryder,  Eaton;  medical  defense  committeeman, 
Dr.  A.  C.  Hunter,  West  Alexandria;  delegate,  Dr. 
J.  J.  Nisbet;  alternate,  Dr.  Newbold. — News 
Clipping. 

Third  District 

Hancock  County  Medical  Society  met  in  regular- 
session  January  5 at  the  Elks’  Club,  Findlay.  The 
guest  speaker  was  Dr.  F.  M.  Douglass,  Toledo, 
who  spoke  on  “Diagnosis  and  Treatment  of  Biliary 
Obstruction”.  The  interesting  paper  was  illus- 
trated with  lantern  slides.— H.  0.  Crosby,  M.D., 
Secretary. 

Hardin  County  Medical  Society  in  regular  ses- 
sion December  15  at  Kenton  elected  the  following 
officers:  President,  Dr.  T.  M.  Elliott,  Ada;  vice 
president,  Dr.  C.  R.  Blosser,  Dunkirk;  secretary- 
treasurer,  Dr.  W.  N.  Mundy,  Forest;  legislative 
committeeman,  Dr.  E.  S.  Protzman,  Kenton;  medi- 
cal defense  committeeman,  Dr.  J.  S.  Hedrick, 
Dunkirk;  delegate,  Dr.  R.  G.  Schutte,  Kenton; 
alternate,  Dr.  Protzman.  Dr.  Frank  W.  Harrah, 
Columbus,  the  guest  speaker,  read  a paper  on 
“The  Significance  of  Abdominal  Pains”.— W.  N. 
Mundy,  M.D.,  Secretary. 

Logan  County  Medical  Society  was  addressed 
by  Dr.  S.  H.  Mulholland,  Springfield,  at  a dinner 
meeting  on  January  3 at  the  Hotel  Ingalls,  Belle- 
fontaine.  He  spoke  on  “Renal  Infections”. — - 
News  Clipping. 

Marion  Academy  of  Medicine  was  addressed  by 
Dr.  G.  S.  Shibley,  Cleveland,  on  January  3 at  the 
Marion  City  Hospital.  The  subject  of  the  address 
was  “The  Common  Cold”,  in  which  he  described 
many  of  his  laboratory  investigations  on  the  ques- 
tion of  colds. — News  Clipping. 

Mercer  County  Medical  Society  elected  the  fol- 
lowing officers  at  a meeting  December  8 at  Celina : 
President,  Dr.  M.  B.  Fishbaugh,  Celina;  vice  pres- 
ident, Dr.  T.  H.  Will,  Coldwater;  secretary-ti’eas- 
urer  Dr.  Frank  E.  Ayers,  Celina;  legislative  com- 
mitteeman, Dr.  M.  L.  Downing  Rockford;  medical 
defense  committeeman,  Dr.  L.  M.  Otis,  Celina; 


134 


The  Ohio  State  Medical  Journal 


February,  1933 


delegate,  Dr.  R.  E.  Riley,  Celina ; alternate,  Dr. 
Downing.  Follow' ng  the  dinner  and  business  ses- 
sion, Dr.  W.  N.  Taylor,  Columbus,  presented  a 
paper  on  “Kidney  Diseases”,  illustrated  with  lan- 
tern slides. — News  Clipping. 

Van  Wert  County  Medical  Society  was  ad- 
dressed by  Dr.  Ernest  Carlo,  Fort  Wayne,  Ind.,  at 
its  meeting  January  3 at  the  Van  Wert  County 
Hospital.  Dr.  Carlo  spoke  on  “Pediatrics”. — 
News  Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO 
AND  LUCAS  COUNTY 

(A.  P.  HancufT,  M.D.,  Secretary) 

January  6 — Annual  banquet  and  business  meet- 
ing, Elks’  Club.  Annual  address  of  Dr.  E.  B. 
Gillette,  the  retiring  president.  Reports  of  officers 
and  committees.  Installation  of  incoming  presi- 
dent, Dr.  Louis  R.  Effler.  Election  of  new  officers 
as  follows:  President-elect,  Dr.  M.  D.  Haag; 

secretary,  Dr.  A.  P.  Hancuff ; board  of  trustees, 
Dr.  E.  B.  Gillette;  member  of  Council,  Dr.  B.  W. 
Patrick.  Following  the  business  meeting,  a brief 
memorial  service  was  held  for  members  of  the 
academy  who  died  during  the  past  year. 

January  13— Section  of  Pathology,  Experimen- 
tal Medicine  and  Bacteriology.  Program:  “Toru- 
lus,  Yeast-Like  Organisms  and  Coccidioides  in 
Human  Patients”,  Dr.  R.  M.  Crumrine;  discus- 
sion, Dr.  S.  S.  Hindman;  “Diabetes  Insipidus — 
Presentation  of  a Case”,  Dr.  Theodore  Zbinden ; 
discussion,  Dr.  H.  F.  Howe. 

January  20 — Medical  Section.  Program:  “The 
Medical  Aspects  of  Arthritis”,  Dr.  Carl  S. 
Mundy;  “Demonstration  of  a Case  of  Infectious 
Arthritis  With  Special  Reference  to  the  Results 
of  Physical  Therapy”,  Dr.  J.  V.  Rae;  “Bacter- 
iology and  Immunology  in  Arthritis”,  Dr.  Theo- 
dore Zbinden. 

January  27 — Surgical  Section.  Program:  “Dis- 
sussion  and  Surgical  Treatment  of  the  Parathy- 
roids”, Dr.  Max  Ballin,  Detroit. 

Defiance  County  Medical  Society  at  its  regular 
meeting  on  December  6 at  Defiance  elected  the 
following  officers  for  the  ensuing  year:  President, 
Dr.  S.  E.  DeMuth,  Hicksville;  vice  president,  Dr. 
J.  U.  Fauster,  Defiance;  secretary-treasurer,  Dr. 
D.  J.  Slosser  Defiance;  correspondent,  Dr.  J.  U. 
Fauster,  Jr.,  Defiance;  legislative  committeeman, 
Dr.  J.  J.  Reynolds,  Defiance;  medical  defense  com- 
mitteeman Dr.  Reynolds;  delegate,  Dr.  Slosser; 
alternate,  Dr.  P.  B.  Newcomb,  Defiance, — D.  J. 
Slosser,  M.D.,  Secretary. 

Fulton  County  Medical  Society,  meeting  at  the 
Community  Hall,  Delta,  on  December  9,  elected 
the  following  officers  for  the  ensuing  year:  Presi- 
dent, Dr.  P.  S.  Bishop,  Delta;  vice  president,  Dr. 
G.  R.  Salsberry,  Lyons;  secretary-treasurer,  Dr. 


George  McGuffin,  Pettisville;  correspondent,  Dr. 
Bishop;  legislative  committeeman,  Dr.  Sals- 
berry; medical  defense  committeeman.  Dr.  W.  H. 
Maddox,  Wauseon;  delegate,  Dr.  C.  E.  Patterson, 
Fayette. — George  McGuffin,  M.D.,  Secretary. 

Henry  County  Medical  Society  met  December 
28  for  its  annual  election  of  officers.  Those 
elected  were:  President,  Dr.  T.  P.  Delventhal, 

Napoleon;  vice  president,  Dr.  C.  G.  Hissong, 
Hamler;  secretary-treasurer.  Dr.  F.  M.  Harrison, 
Napoleon;  legislative  committeeman,  Dr.  H.  F. 
Rohrs,  Napoleon;  medical  defense  committeeman, 
Dr.  Thomas  Quinn,  Napoleon;  delegate,  Dr. 
Quinn;  alternate,  Dr.  Delventhal. — F.  M.  Har- 
rison, M.D.,  Secretary. 

Putnam  County  Medical  Society  met  January 
12  at  Ottawa  with  Dr.  E.  C.  Yingling,  Lima,  as 
the  guest  speaker.  The  program  was  preceded  by 
a dinner  at  the  Hotel  DuMont. — News  Clipping. 

Sandusky  County  Medical  Society  held  its  an- 
nual election  of  officers  on  December  29  at  a meet- 
ing at  Fremont.  Those  elected  were:  President, 

Dr.  D.  W.  Philo,  Fremont;  vice  president,  Dr.  C. 
A.  Kingman,,  Bellevue;  secretary-treasurer,  Dr. 
J.  C.  Boyce,  Fremont;  legislative  committeeman, 
Dr.  L.  N.  Bates,  Fremont;  medical  defense  com- 
mitteeman, Dr.  H.  K.  Shumaker,  Bellevue;  dele- 
gate, Dr.  C.  J.  Egger,  Woodville;  alternate,  Dr. 
C.  R.  Pontius,  Fremont.  The  program  consisted 
of  a discussion  on  Cabot  case  records. — J.  C. 
Boyce,  M.D.,  Secretary. 

Wood  County  Medical  Society  was  addressed 
December  15  by  Dr.  R.  S.  Gillette  and  Dr.  E.  B. 
Gillette,  both  of  Toledo,  on  “Radium  Against  Sur- 
gery in  the  Treatment  of  Cancer”,  and  “The  Man- 
agement of  the  Patient  With  Gastric  or  Duodenal 
Ulcer”,  respectively.  At  the  business  meeting  of 
the  society,  the  following  officers  were  elected: 
President,  Dr.  F.  L.  Sterling,  Bowling  Green;  vice 
president,  Dr.  C.  S.  Cavett,  Noi'th  Baltimore; 
secretary-treasurer,  Dr.  R.  N.  Whitehead,  Bowl- 
ing Green;  correspondent,  Dr.  R.  E.  Rasor,  Bloom- 
dale;  legislative  committeeman,  Dr.  E.  A.  Powell, 
North  Baltimore;  medical  defense  committeeman, 
Dr.  0.  S.  Canright,  Haskins;  delegate,  Dr.  F.  V. 
Boyle,  Bowling  Green ; alternate,  Dr.  J.  W.  Cham- 
bers, Rudolph. — R.  N.  Whitehead,  M.D.,  Secre- 
tary. 

Fifth  District 

ACADEMY  OF  MEDICINE  OF  CLEVELAND 

(C.  H.  Heyman,  M.D.,  Secretary^ 

December  16 — Annual  meeting  and  election  of 
the  following  new  directors  for  three-year  terms : 
Dr.  M.  A.  Blankenhorn,  Dr.  C.  D.  Christie,  Dr. 
John  Dickenson,  Dr.  L.  J.  Karnosh  and  Dr.  T.  P. 
Shupe.  At  a meeting  of  the  Board  of  Directors  on 
December  23,  the  following  officers  for  the 
Academy  were  elected : President,  Dr.  H.  V. 

Paryzek;  vice  president,  Dr.  A.  A.  Jenkins,  and 


February,  1933 


State  News 


135 


secretary,  Dr.  C.  H.  Heyman.  Dr.  J.  E.  Tucker- 
man  was  reappointed  legislative  nad  medical  de- 
fense committeeman. 

January  3 — Dinner  meeting  of  the  Ophthalmo- 
logical  and  Oto-laryngological  Section  at  the 
Hotel  Statler.  No  formal  program. 

January  6 — Clinical  and  Pathological  Section. 
Program : “Mikulicz  Disease  of  the  Parotid 

Gland”,  Dr.  J.  G.  Jones;  “Embolism  of  the  Cen- 
tral Retinal  Artery”,  Dr.  M.  E.  Cans;  “Myotonia 
Congenita — 12  Cases  in  Three  Generations  of  One 
Family”,  Dr.  M.  D.  Friedman;  “Congenital  Ab- 
sence of  the  Sternum,  Motion  Pictures”,  Dr.  M.  I. 
Marks;  A Case  of  Double  Vagina,  Cervix  and 
Uterus”,  Dr.  L.  H.  Biskind;  “Spirochetal  Pul- 
monary Gangrene”,  medical  aspects,  Dr.  S.  S. 
Berger;  surgical  aspects,  Dr.  M.  E.  Blahd;  path- 
ology, Dr.  B.  S.  Kline. 

January  13 — Joint  meeting  of  the  Experimental 
Medicine  Section  and  the  Cleveland  Section  of 
the  Society  for  Experimental  Biology  and  Medi- 
cine. Program:  “Effect  of  Male  Sex  Hormone  on 
Rats  Following  Complete  Removal  of  the  Pitui- 
tary Gland”,  D.  Roy  McCullagh,  Ph.D. ; “Relation 
of  Dental  Caries  to  Pregnancy”,  F.  M.  Kinney, 
D.D.S.,  J.  W.  Mull,  Ph.D.,  and  Dr.  A.  H.  Bill; 
Variations  in  Serum  Calcium  and  Phosphorus 
During  Pregnancy”,  J.  W.  Mull,  Ph.D.,  and  Dr. 
A.  H.  Bill;  “Determination  of  Iron  in  Biological 
Material”,  R.  F.  Hanzal,  Ph.D.;  “Changes  in  the 
Iron  Content  of  the  Liver  in  the  Rat”,  E.  Munt- 
wyler,  Ph.D.,  and  R.  F.  Hanzal,  Ph.D.;  “Further 
Studies  on  the  Utilization  of  Parenterally  Ad- 
ministered Iron”,  F.  C.  Bing,  Ph.D.,  M.  W. 
Eveleth,  M.S.,  and  V.  C.  Myers,  D.Sc.;  “Obser- 
vations on  a Case  of  Renal  Disease  Covering  a 
Period  of  Three  Years”,  Dr.  C.  T.  Way,  E.  Munt- 
wyler,  Ph.D.,  and  E.  Pomerene,  Ph.D. 

Ashtabula  County  Medical  Society  met  in  regu- 
lar session  December  20  at  the  Hotel  Ashtabula. 
The  guest  speaker  was  Dr.  Frederick  Herrick, 
Cleveland,  who  presented  an  interesting  and  in- 
structive paper  on  “Peptic  Ulcer”.  Dr.  M.  R. 
Martin,  Geneva,  was  elected  to  membership  at  the 
business  session  of  the  society  and  the  following 
officers  for  the  ensuing  year  were  elected:  Presi- 
dent, Dr.  J.  F.  Docherty,  Conneaut;  vice  presi- 
dent, Dr.  E.  H.  Merrell,  Geneva;  secretary-treas- 
urer, Dr.  A.  M.  Mills,  Ashtabula ; censor,  Dr.  O. 
A.  Dickson,  Jefferson;  legislative  committeeman, 
Dr.  R.  B.  Wynkoop,  Ashtabula;  delegate,  Dr. 
Wynkoop;  alternate,  Dr.  P.  J.  Collander,  Ashta- 
bula.—E.  H.  Merrell,  M.D. 

Lake  County  Medical  Society  in  regular  ses- 
sion December  27  at  Painesville  elected  Dr.  G.  0. 
Hedlund,  Painesville,  president  for  the  ensuing 
year.  Other  officers  elected  were:  Vice  president, 
Dr.  J.  M.  York,  Painesville;  secretary-treasurer, 
Dr.  B.  T.  Church,  Painesville;  legislative  commit- 
teeman, Dr.  W.  P.  Ellis,  Painesville;  delegate, 


Dr.  V.  N.  Marsh,  Painesville. — B.  T.  Church, 
M.D.,  Secretary. 

Lorain  County  Medical  Society  held  a dinner 
meeting  at  the  Antlers  Hotel,  Lorain,  on  Decem- 
ber 13.  Following  the  dinner  and  an  address  by 
Dr.  Frederick  C.  Herrick,  Cleveland,  the  follow- 
ing officers  were  elected:  President,  Dr.  H.  C. 

Stevens,  Elyria;  vice  president,  Dr.  David 
Thomas,  Lorain;  secretary-treasurer,  Dr.  W.  E. 
Hart;  legislative  committeeman,  Dr.  S.  V.  Bur- 
ley, Lorain;  delegate,  Dr.  Burley;  alternate,  Dr. 
Thomas. — W.  E.  Hart,  M.D.,  Secretary. 

The  January  meeting  of  the  society,  held  on 
January  10,  was  addressed  by  Dr.  Benjamin 
Carlson,  Cleveland.  Dr.  Carlson  reviewed,  with 
lantern  slides,  many  cases  of  pneumonia  observed 
at  the  Cleveland  City  Hospital. — W.  E.  Hart, 
M.D.,  Secretary. 

Medina  County  Medical  Society,  meeting  at  the 
Evanon  Inn  on  December  15  was  addressed  by 
Dean  Edward  Spease  of  the  School  of  Pharmacy, 
Western  Reserve  University,  on  “The  Relation 
Between  Medicine  and  Pharmacy”.  Gueste  of  the 
society  were  E.  H.  Deibel,  representative  from 
Medina  County  to  the  90th  General  Assembly, 
and  P.  H.  Rogers,  representative  from  Lorain 
County. — News  Clipping. 

Trumbull  County  Medical  Society  was  addressed 
by  Dr.  Richard  Dexter,  Cleveland,  on  “Abscess  of 
the  Lungs”,  at  its  meeting  on  December  15  at  the 
Trumbull  County  Country  Club.  Following  the 
program,  the  following  officers  were  elected: 
President,  Dr.  E.  P.  Adams,  Warren;  vice  presi- 
dent, Dr.  J.  H.  Caldwell,  Warren;  secretary- 
treasurer,  Dr.  R.  H.  McCaughtry,  Warren. — R. 
H.  McCaughtry,  M.D.,  Secretary. 

Sixth  District 

The  Union  Medical  Association  of  the  Sixth 
Councilor  District  held  its  225th  session  January 
11  at  the  Mayflower  Hotel,  Akron.  The  following 
program  was  presented,  as  arranged  by  Dr. 
Charles  A.  LaMont,  Canton,  president  of  the 
association;  Dr.  J.  H.  Seiler,  Akron,  secretary, 
and  Dr.  H.  S.  Davidson,  Akron,  councilor  of  the 
district:  “Progress  in  Medicine  During  1932”, 

Dr.  A.  P.  Ormond,  Akron;  discussion,  Dr.  Fred- 
erick Smith,  Akron;  “Progress  in  Preventive 
Medicine  During  1932”,  Dr.  R.  H.  Markwith, 
Akron;  “Progress  in  Eye,  Ear,  Nose  and  Throat 
in  1932”,  Dr.  V.  C.  Malloy,  Akron;  discussion, 
Dr.  Marshall  Pierson,  Akron;  “Progress  in  Sur- 
gery in  1932”,  Dr.  R.  T.  Allison,  Akron;  discus- 
sion, Dr.  Harvey  Musser,  Akron;  “Bone  Tumors”, 
Dr.  C.  F.  Geschickter,  Baltimore;  “Malignancy”, 
illustrated,  Dr.  Geschickter. 

Following  the  program,  a business  session  was 
held.  Dr.  A.  E.  Brant,  Youngstown,  was  elected 
president  and  Dr.  J.  H.  Seiler,  Akron,  was  re- 
elected secretary-treasurer.  Dr.  C.  L.  Cummer, 
Cleveland,  president-elect  of  the  Ohio  State  Medi- 


136 


The  Ohio  State  Medical  Journal 


February,  1933 


cal  Association,  attended  the  meeting  and  spoke 
briefly  on  organization  matters. 

Ashland  County  Medical  Society  met  in  regular 
session  at  the  Samaritan  Hospital,  Ashland,  on 
December  9.  Case  reports  were  given  by  Dr.  L. 
G.  Sheets  on  “Dermatitis  Exfoliativa  Following 
the  Use  of  Neoarsphenamine”;  and  “Melena 
Neonatorum”.  Dr.  M.  J.  Thomas  presented  a re- 
port on  a case  of  pituitary  disturbance  in  a girl, 
aged  16,  which  was  treated  successfully  with 
whole  pituitary  gland  extract.  At  the  business 
session,  the  following  officers  were  elected: 
President,  Dr.  H.  M.  Gunn,  Ashland;  vice  presi- 
dent, Dr.  0.  J.  Powell,  Ashland,  and  Dr.  Paul  E. 
Kellogg,  secretary-treasurer. 

The  society  held  its  annual  Ladies’  Night  Ban- 
quet at  Loudonville  on  Friday  evening,  January 
13.  Dinner  was  served  to  35  doctors  and  wives  at 
the  Highway  Restaui-ant.  After  the  dinner,  the 
group  went  to  Dr.  J.  M.  Hedye’s  new  home  in 
Loudonville,  where  a lantern  slide  lecture  was 
given  by  Dr.  Henry  J.  John,  Cleveland,  on  “The 
Diabetic  Child”.  After  the  lecture,  the  meeting 
was  thrown  open  to  general  discussion  and  ques- 
tions. Refreshments  wei'e  served. — Paul  E.  Kel- 
logg, M.D.,  Secretary. 

Mahoning  Comity  Medical  Society,  meeting  De- 
cember 20  at  the  Youngstown  Club,  elected  Dr.  J. 
P.  Harvey  president  for  the  ensuing  year.  Other 
officers  elected  were:  President-elect,  Dr.  J.  B. 

Nelson;  vice  president,  Dr.  E.  C.  Goldcamp;  sec- 
retary, Dr,  William  M.  Skipp;  treasurer,  Dr.  W. 
X.  Taylor;  correspondent,  Dr.  W.  M.  Neidus; 
legislative  committeeman,  Dr.  M.  E.  Hayes;  medi- 
cal defense  committeeman,  Dr.  E.  W.  Coe;  dele- 
gates, Dr.  Joseph  Rosenfeld  and  Dr.  L.  G.  Coe; 
alternates,  Dr.  P.  J.  Fuzy  and  Dr.  0.  J.  Walker. 
— W.  M.  Skipp,  M.D.,  Secretary. 

Portage  County  Medical  Society  elected  officers 
for  the  year  at  a meeting  held  January  5 at  the 
home  of  Dr.  E.  M.  Kauffman,  Kent.  Those  elected 
were:  President,  Dr.  S.  U.  Sivon,  Ravenna;  vice 
president,  Dr.  Harris  S.  Wendorf,  Ravenna;  sec- 
retary-treasurer, Dr.  E.  J.  Widdecombe,  Kent; 
Legislative  committeeman,  Dr.  George  J.  Wag- 
goner, Ravenna;  medical  defense  committeeman, 
Dr.  W.  B.  Andrews,  Kent.  A general  discussion 
on  the  report  of  the  Committee  on  the  Costs  of 
Medical  Care  was  opened  by  Dr.  B.  H.  Nichols. 
Dr.  Sivon  described  some  of  the  work  done  at  the 
post-graduate  school  of  Johns  Hopkins  University 
Hospital. — E.  J.  Widdecombe,  M.D.,  Secretary. 

Richland  County  Medical  Society  held  its  an- 
nual meeting  December  26  and  elected  the  follow- 
ing officers:  President,  Dr  C.  H.  Bell,  Mansfield; 
vice  president,  Dr.  P.  A.  Stoodt,  Mansfield;  secre- 
tary-treasurer, Dr.  Mabel  Emery,  Mansfield;  as- 
sistant secretary-treasurer,  Dr.  W.  D.  Abrams, 
Mansfield;  legislative  committeeman,  Dr.  Charles 
R.  Keller,  Mansfield;  medical  defense  committee- 


man, Dr.  Keller;  delegate,  Dr.  S.  C.  Schiller, 
Mansfield. — Mabel  Emery,  M.D.,  Secretary. 

Stark  County  Medical  Society  was  addressed 
by  Dr.  George  F.  Zinninger  and  Dr.  Charles  A. 
LaMont  at  its  annual  meeting,  held  January  10, 
at  the  Elks’  Club,  Canton.  Dr.  Zinninger  spoke  on 
“Recent  Advances  in  Pernicious  Anemia”  and  Dr. 
LaMont  on  “Diabetes — Comments  on  a Few 
Selected  Cases”. 

At  its  meeting  on  December  20,  the  society  was 
addressed  by  Dr.  Geo.  Edw.  Follansbee,  Cleveland, 
on  the  report  of  the  Committee  on  the  Costs  of 
Medical  Care.  Dr.  Follansbee  was  a member  of 
the  committee  and  signed  the  minority  report. — 
Bulletin. 

Summit  County  Medical  Society  at  its  annual 
dinner  meeting  at  the  Mayflower  Hotel,  Akron, 
December  8 installed  its  new  president,  Dr.  J.  H. 
Selby,  and  elected  the  following  officers  for  the 
ensuing  year:  President-elect,  Dr.  Roy  G.  Wer- 
ner; secretary-treasurer,  Dr.  A.  S.  McCormick; 
legislative  committeeman,  Dr.  J.  G.  Blower;  dele- 
gates, Drs.  F.  C.  Potter,  R.  E.  Amos  and  C.  R. 
Steinke;  alternates,  Drs.  W.  A.  Hoyt,  L.  E.  Brown 
and  J.  H.  Weber.  Dr.  McCormick  is  serving  his 
19th  year  as  secretary  of  the  society  and  his  15th 
year  as  its  treasurer.  Following  the  business 
session,  the  Doctors’  Orchestra  presented  a splen- 
did program. 

Wayne  County  Medical  Society  met  in  regular 
session,  January  6 at  Hygeia  Hall,  Wooster.  The 
Costs  of  Medical  Care  report  was  discussed  by  Dr. 
J.  G.  Wishard  and  Dr.  A.  C.  Smith,  following 
which  a round-table  discussion  of  the  report  was 
held.  The  following  officers,  elected  at  the  annual 
meeting  of  the  society,  were  installed:  President, 
Dr.  E.  H.  McKinney,  Doylestown;  vice  president, 
Dr.  W.  A.  Morton,  Wooster;  secretary -treasurer, 
Dr.  R.  C.  Paul,  Wooster;  legislative  committee- 
man, Dr.  F.  E.  Snyder,  Rittman;  medical  defense 
committeeman,  Dr.  W.  B.  Turner,  Wooster;  dele- 
gate, Dr.  Paul;  alternate,  Dr.  A.  C.  Smith. — R. 
C.  Paul,  M.D.,  Secretary. 

Seventh  District 

Belmont  County  Medical  Society  held  its  first 
meeting  of  1933  on  January  5 at  the  Kilkenny 
Inn.  A round-table  discussion  on  the  report  of 
the  Committee  on  the  Costs  of  Medical  Care  was 
held.  The  new  officers  of  the  society  were  seated. 
They  are:  President,  Dr.  G.  L.  Ramsey,  Pow- 

hatan; president-elect,  Dr.  C.  H.  Cale,  Neffs; 
secretary-treasurer,  Dr.  C.  W.  Kirkland,  Bellaire; 
correspondent,  Dr.  F.  R.  Dew,  St.  Clairsville; 
legislative  committeeman,  Dr.  R.  H.  Wilson,  Mar- 
t;ns  Ferry;  medical  defense  committeeman,  Dr. 
C.  B.  Messerly,  Martins  Ferry;  delegate,  Dr. 
Kirkland;  alternate,  Dr.  E.  C.  Cope,  Barton. — C. 
W.  Kirkland,  M.D.,  Secretary. 

Columbiana  County  Medical  Society  held  its 


February,  1933 


State  News 


137 


Exclusively  Engaged 
in  providing 


Thirty-four  Tears 


Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

360  North  Michigan  Avenue  i Chicago,  Illinois 


138 


The  Ohio  State  Medical  Journal 


February,  1933 


January  meeting  on  January  10  at  Lisbon.  Officers 
for  the  ensuing  year  were  installed  and  the  ad- 
dresses of  the  retiring  president,  Dr.  G.  E.  Byers, 
Salem,  and  the  incoming  president,  Dr.  J.  W. 
Robinson,  Lisbon,  were  presented.  The  guest 
speaker  was  Dr.  J.  H.  Barach,  Pittsburgh,  who 
spoke  on  “Hypertension”.  The  paper  was  dis- 
cussed by  Drs.  Trader,  Miskall  and  Hartford. — 
Bulletin. 

Coshocton  County  Medical  Society  elected  Dr. 
Floyd  W.  Craig  as  president  for  the  ensuing  year 
at  its  regular  meeting  held  December  16  at 
Coshocton.  Other  officers  elected  were:  Vice 

president,  Dr.  Samuel  Kistler;  secretary-treas- 
urer, Dr.  J.  D.  Lower;  legislative  committeeman, 
Dr.  J.  W.  Shaw;  medical  defense  committeeman, 
Dr.  D.  M.  Criswell;  delegate,  Dr.  J.  G.  Smailes; 
alternate,  Dr.  Criswell.  Dr.  S.  D.  Cohen  pre- 
sented a paper  on  “Gastric  Ulcers”. — J.  D.  Lower, 
M.D.,  Secretary. 

Harrison  County  Medical  Society  elected  the 
following  officers  at  its  annual  meeting  held  De- 
cember 6:  President,  Dr.  A.  C.  Groves,  Jewett; 
vice  president,  Dr.  R.  P.  Rusk,  Cadiz ; secretary- 
treasurer,  Dr.  W.  C.  Wallace,  Hopedale;  legis- 
lative committeeman,  Dr.  Joseph  McElhattan, 
Freeport;  medical  defense  committeeman,  Dr.  H. 
C.  Koepke,  Cadiz;  delegate,  Dr.  Groves;  alternate, 
Dr.  Wallace.— W.  C.  Wallace,  M.D.,  Secretary. 

Jefferson  County  Medical  Society  meeting  De- 
cember 29,  elected  the  following  officers  for  the 
ensuing  year:  President,  Dr.  S.  A.  Harris,  Steu- 
benville; vice  president,  Dr.  Carl  Goehring,  Steu- 
benville; secretary-treasurer,  Dr.  John  Y.  Bevan, 
Steubenville;  legislative  committeeman,  Dr.  A. 
Jacoby,  Steubenville;  medical  defense  committee- 
man, Dr.  C.  B.  Terwillegar,  Steubenville;  dele- 
gate, Dr.  Fred  H.  Riney,  Mingo  Junction;  alter- 
nate, Dr.  M.  H.  Rosenblum,  Steubenville. — John 
Y.  Bevan,  M.D.,  Secretary. 

Eighth  District 

Athens  County  Medical  Society  was  addressed 
by  Dr.  George  T.  Harding,  III,  Columbus,  on 
January  9 at  Athens.  Dr.  Harding  spoke  on 
“Psychoneurosis”.  Members  of  the  Hocking 
County  Medical  Society  were  guests. — News 
Clipping. 

Fairfield  County  Medical  Society  was  addressed 
by  Dr.  R.  B.  Drury,  Columbus,  at  its  regular 
meeting  December  13  at  the  home  of  Dr.  W.  B. 
Taylor,  Pickerington. 

At  the  November  meeting  of  the  society,  the 
following  officers  were  elected:  President,  Dr.  E. 
B.  Roller,  Lithopolis;  vice  president,  Dr.  H.  R. 
Plum,  Lancaster;  secretary-treasurer,  Dr.  Carl 
W.  Brown,  Lancaster;  legislative  committeeman, 
Dr.  C.  G.  Axline,  Lancaster;  medical  defense  com- 
mitteeman, Dr.  B.  H.  Biddle,  Sugar  Grove;  dele- 
gate, Dr.  Ralph  Smith,  Lancaster;  alternate,  Dr. 


C.  H.  Hamilton,  Lancaster. — Carl  W.  Brown, 
M.D.,  Secretary. 

Guernsey  County  Medical  Society  was  addressed 
on  January  5 at  the  Romance  Restaurant,  Cam- 
bridge, by  Dr.  Howard  Phillips,  Wheeling,  West 
Va.  He  presented  an  illustrated  address  on  “Skin 
Diseases”. 

The  annual  banquet  and  installation  of  officers 
were  held  by  the  society  on  December  19  at  the 
Shenandoak  Tea  Room,  Old  Washington.  Wives 
of  the  members  were  guests.  Officers  installed 
were:  President,  Dr.  C.  C.  Headley,  Cambridge; 
vice  president,  Dr.  W.  C.  McCormick,  Senecaville; 
secretary- treasurer,  Dr.  E.  F.  Hunter,  Cam- 
bridge; correspondent,  Dr.  A.  C.  Ormond,  Byes- 
ville;  legislative  committeeman,  Dr.  A.  G.  Ringer, 
Cambridge;  medical  defense  committeeman,  Dr. 
G.  F.  Swan,  Cambridge;  delegate,  Dr.  H.  R.  Nee- 
land,  Cambridge;  alternate,  Dr.  W.  L.  Denny, 
Cambridge. — E.  F.  Hunter,  M.D.,  Secretary. 

Muskingum  County  Academy  of  Medicine  met 
in  regular  session  January  4 at  the  Zane  Hotel, 
Zanesville.  The  guest  speaker  was  Dr.  W.  D.  Por- 
ter, Cincinnati,  who  presented  a paper  on 
“Caesarian  Section”. — Bulletin. 

Perry  County  Medical  Society  met  December  19 
at  the  Park  Hotel,  New  Lexington.  Following  an 
address  by  Dr.  R.  W.  Miller,  Hemlock,  officers  for 
the  ensuing  year  were  elected  as  follows:  Presi- 
dent, Dr.  James  Miller,  Corning;  vice  president, 
Dr.  H.  F.  Minshull,  New  Lexington;  secretary- 
treasurer,  Dr.  F.  J.  Crosbie,  New  Lexington; 
legislative  committeeman,  Dr.  J.  H.  Clouse, 
Somerset;  medical  defense  committeeman,  Dr.  R. 
W.  Miller,  Hemlock;  delegate,  Dr.  J.  G.  McDougal, 
New  Lexington;  alternate,  Dr.  R.  W.  Miller,  Hem- 
lock.— F.  J.  Crosbie,  M.D.,  Secretary. 

Washington  County  Medical  Society  elected  Dr. 
W.  W.  Sauer,  Marietta,  president  for  the  en- 
suing year  at  its  regular  meeting  December  14. 
Other  officers  elected  were:  Vice  president,  Dr. 
Hugh  Amos,  Waterford;  secretary-treasurer,  Dr. 
G.  M.  James,  Marietta.  The  program  presented 
consisted  of  case  reports. — G.  M.  James,  M.D., 
Secretary. 

Ninth  District 

Gallia  County  Medical  Society  met  in  regular 
session  December  7 and  elected  the  following 
officers:  President,  Dr  O.  A.  Vornholt,  Gallipolis; 
vice  president,  Dr.  Ella  G.  Lupton,  Gallipolis; 
secretary-treasurer,  Dr.  Milo  Wilson,  Gallipolis; 
legislative  committeeman,  Dr.  R.  A.  Howell,  Gal- 
lipolis; medical  defense  committeeman,  Dr. 
Howell;  delegate,  Dr.  Mary  L.  Austin,  Gallipolis; 
alternate,  Dr.  Leo  C.  Bean.  The  program  con- 
sisted of  a discussion  of  immunization  against 
diphtheria  and  scarlet  fever. — Milo  Wilson,  M.D., 
Secretary. 

Hocking  County  Medical  Society  has  elected  the 


February,  1933 


State  News 


139 


Edward  Reinert 


Ph.G.,  M.D. 


247  East  State  Street 


Columbus,  Ohio 


Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 


FRANK  GALLEN,  M.D., 

Dermatology 

Tel.  Main  1537 


LEE  A.  HAYS,  M.D., 

Roentgenology 

University  5842 


W.  H.  MILLER,  M.  D. 


328  East  State  St. 

Office  Telephone,  MAin  3743 


Columbus,  Ohio 
Residence,  EVergreen  5644 


(L^g) 


Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

Prompt  and  Full  Report 


140 


The  Ohio  State  Medical  Journal 


February,  1933 


POSTGRADUATE  COURSE 

For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

CLASSES  LIMITED  TO  SIX 


LABORATORY  COURSE 

For  Nurses  and  Graduates  of  High  School 

CLASSES  LIMITED  TO  SIX 


150  clinical  patients  daily  provide  material  for  classes.  Technicians  trained  for  group  doctors. 

Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 

• For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


THE  UNIVERSITY  OF  MICHIGAN  MEDICAL  SCHOOL 

and  THE  MICHIGAN  STATE  MEDICAL  SOCIETY 

Intensive  Courses  for  1933 


Pulmonary  Tuberculosis  March  20-24 

Diseases  of  Metabolism  March  27-31 

Diseases  of  the  Heart  April  3-7 

Ophthalmology  and  Otolaryngology — April  24-29 

Serology  and  Clinical  Microscopy Throughout  the  year 

Registration  limited.  Normal  fees. 

Director,  Department  of  Post-Graduate  Medicine 


Proctology  —May  15-27 

Practitioners’  Course  June  19-July  1 

Gynecology  and  Obstetrics - June  19-July  1 

Roentgenology  I — June  26-August  4 

Physical  Therapy  Throughout  the  year 

For  further  information  _ address: 
University  Hospital,  Ann  Arbor,  Michigan. 


following  officers  for  the  ensuing  year : President, 
Dr  H.  M.  Boocks,  Logan;  secretary-treasurer,  Dr. 
M.  H.  Cherrington,  Logan;  legislative  committee- 
man, Dr.  J.  S.  Cherrington,  Logan;  medical  de- 
fense committeeman,  Dr.  J.  S.  Cherrington;  dele- 
gate, Dr.  0.  V.  Donaldson,  Gore;  alternate,  Dr.  J. 

S.  Cherrington. — M.  H.  Cherrington,  M.D.,  Secre- 
tary. 

Tenth  District 

COLUMBUS  ACADEMY  OF  MEDICINE 

(John  H.  Mitchell,  M.D.,  Secretary) 

January  9 — Annual  Meeting.  Reports  of  stand- 
ing committees  and  Board  of  Trustees.  Medical 
progress  committee  reports  by  Dr.  Carl  Postle 
and  Dr.  C.  A.  Doan.  Address  of  Dr.  James  H. 
Warren,  the  retiring  president.  Installation  of 
the  following  officers  for  the  year  1933 : President, 
Dr.  Jonathan  Forman;  vice  president,  Dr.  George 

T.  Harding,  III;  secretary-treasurer,  Dr.  John  H. 
Mitchell;  trustee,  Dr.  L.  H.  VanBuskirk;  delegate, 
Dr.  John  B.  Alcorn;  legislative  committeeman,  Dr. 
John  M.  Thomas. 

January  18 — General  Session.  Program:  “The 
Value  of  Prenatal  Care”,  Dr.  Andrews  Rogers; 
“Diet  and  Metabolism  in  Pregnancy”,  Dr.  Roy 
Krigbaum;  “The  Cost  of  Medical  Education”,  Dr. 
J.  H.  J.  Upham. 

January 23 — General  Practitioners’  Section. 
Program:  “Psychoanalysis”,  Dr.  B.  W.  Abram- 
son. Discussion  by  Dr.  E.  J.  Emerick,  Dr.  Isa- 
belle Bradley,  Dr.  H.  M.  Brundage  and  Dr.  George 
T.  Harding. 

January  30 — General  Session.  Program:  “Ar- 
terio-Venous Aneurysm”,  Dr.  Dean  Lewis,  Balti- 
more, president-elect  of  the  American  Medical 
Association. 

Knox  County  Medical  Society  at  its  December 
meeting  elected  the  following  officers:  President, 
Dr.  S.  0.  Gantt,  Centerburg;  vice  president.  Dr. 
E.  V.  Ackerman,  Fredericktown ; secretary-treas- 
urer, Dr.  Robert  L.  Eastman,  Mt.  Vernon;  dele- 
gate, Dr.  F.  C.  Anderson,  Mt.  Vernon;  alternate, 
Dr.  Gantt. — Robert  L.  Eastman,  M.D.,  Secretary. 


Ross  County  Medical  Society  was  addressed  by 
Dr.  George  Curtis,  Columbus,  at  its  regular  meet- 
ing January  5 at  the  Warner  Hotel,  Chillicothe. 
He  spoke  on  “Some  Unusual  Forms  of  Goiter”. 

At  the  December  meeting  of  the  society,  the 
following  officers  were  elected:  President,  Dr.  Glen 
Nisley;  vice  president,  Dr.  H.  R.  Brown;  secre- 
tary-treasurer, Dr.  W.  C.  Breth;  legislative  com- 
mitteeman, Dr.  H.  R.  Brown;  medical  defense 
committeeman,  Dr.  L.  T.  Franklin;  delegate,  Dr. 
O.  P.  Tatman;  alternate,  Dr.  A.  E.  Merkle. — 
W.  C.  Breth,  M.  D.,  Secretary. 

Union  County  Medical  Society  at  its  annual 
meeting  December  13,  elected  the  following  offi- 
cers: President,  Dr.  E.  J.  Marsh,  Broadway;  vice 
president,  Dr.  R.  H.  Martin,  Magnetic  Springs; 
secretary-treasurer,  Dr.  Angus  Maclvor,  Marys- 
ville; correspondent,  Dr.  J.  D.  Boylan,  Milford 
Center;  legislative  committeeman,  Dr.  F.  C.  Cal- 
laway, Marysville;  medical  defense  committeeman, 
Dr.  C.  D.  Mills,  Marysville;  delegate,  Dr.  Boylan; 
alternate,  Dr.  Maclvor. — Angus  Maclvor,  M.D., 
Secretary. 


Thirty  New  Physicians  Licensed  in  Ohio 

Officers  for  the  ensuing  year  were  elected  and 
licenses  issued  to  30  who  took  the  medical  and 
surgical  examinations  in  December  at  a meeting 
of  the  State  Medical  Board  in  Columbus  on 
January  9. 

Dr.  J.  H.  J.  Upham,  Columbus,  was  elected 
president;  Dr.  J.  F.  Wuist,  Dayton,  vice  presi- 


CLASSIFIED  ADVERTISEMENTS 

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Assistance  to  Medical  Writers — Abstracts,  Translations, 
Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  PL,  Chicago,  111. 


February,  1933 


State  News 


141 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 


LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Association. 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Coup,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


(fiank  If ou  Doctor 


The  baby  is  doing  splendidly  and  Tom  and  I are  so 
pleased. 

When  you  first  told  me  that  Junior  would  have  to  have 
bottle  feedings  I thought  I was  due  for  a lot  of  trouble 
and  work  because  I remembered  what  a time  my  sister  had 
when  her  baby  was  on  the  bottle.  She  sent  for  a formula 
that  was  advertised  to  be  recommended  by  many  authorities, 
but  something  was  wrong.  She  used  to  spend  hours  in  her 
kitchen  mixing  this,  that  and  the  other  thing.  And  in  spite 
of  all  her  trouble,  her  baby  fretted  and  cried  and  didn’t 
gain  properly. 

This  S.M.A.  you  have  prescribed  for  my  baby  is  a new 
one  to  me.  In  fact,  I have  never  seen  it  advertised.  But, 
believe  me,  it  works  like  a charm  and  it  is  so  simple  to  pre- 
pare— no  fuss  or  bother  at  all. 

Junior  reaches  to  take  the  bottle  right  out  of  my  hands 
and  drinks  it  all  up.  And  he’s  the  best  child.  Always  happy 
when  he’s  awake,  and  sleeps  the  whole  night  through. 

And  talk  about  a picture  of  health!  I believe  he  would 
take  first  prize  in  any  baby  contest. 

I'm  going  to  bring  him  down  to  your  office  Wednesday 
as  you  suggested.  That  S.M.A.  folder  you  gave  me  says 
even  a breast  fed  baby  should  be  under  the  supervision  of 
a physician  and  I think  myself  that  it’s  better  to  keep  the 
baby  well  than  to  wait  until  trouble  starts. 

We  certainly  want  to  thank  you  for  bringing  our  baby 
along  so  well.  Doctor.  It  increases  our  confidence  in  you  as 
our  family  physician.  Tom  has  already  "said  it  with  dollars”, 
but  I wanted  to  thank  you  personally,  too. 

And  I’m  going  to  persuade  Mrs.  Brown, — that’s  my 
neighbor  with  the  baby  that’s  not  gaining — to  come  along 
on  Wednesday  so  you  can  prescribe  the  proper  diet  for 
him  too.  


Trial  supply  of  S.M.A.  Because  S.M.A.  has  won  favor  un- 
offered  'without  charge  der  typical  conditions  we  are  quite 
willing  that  you  should  try  it  in  your  own  practice  and 
under  your  own  control.  To  make  this  easy 
we  offer  you  a generous  trial  supply  without 
charge  or  obligation.  Simply  attach  the  cou- 
pon  to  your  prescription  blank  or  letterhead. 


S.M.A.  Corporation,  4614  Prospect  Avenue,  Cleveland,  Ohio 
Please  send  me: 

1 I Trial  supply  of  S.M.A.  Q New  S.M.A.  prescription  pad. 

I I Fourth  revised  edition  of  "Milk  Allergy”  Booklet,  a resume  of 
current  literature  on  milk  allergy  with  information  concerning 
Smaco  Hypo-Allergic  Milks. 


Attach  coupon  to  If  blank  or  letterhead. 


41-23 


142 


The  Ohio  State  Medical  Journal 


February,  1933 


dent;  Dr.  Lee  Humphrey,  Malta,  treasurer,  and 
Dr.  H.  M.  Platter,  Columbus,  secretary. 

Miss  Clara  Brouse  was  appointed  chief  ex- 
aminer of  the  Nurse  Examining  Committee  and 
Professor  S.  E.  Rasor  was  named  entrance 
examiner. 

Certificates  to  practice  were  issued  to  three 
osteopaths,  one  electro-therapist,  one  cosmetic- 
therapist,  and  11  masseurs. 

The  following  were  granted  licenses  to  practice 
medicine  and  surgery:  Dora  F.  Sonnenday,  Cin- 
cinnati, University  of  Cincinnati;  Edward  Reno, 
Canton,  Georgetown  University;  Robert  Boswell, 
Dayton,  George  Washington  University;  Joseph 
Dobkin,  Toledo,  George  Washington  University; 
Harold  Erlenbach,  Cleveland,  Hahnemann  Medi- 
cal College;  Earl  Leyrer,  Hamilton,  Hahnemann 
Medical  College;  Samuel  Bishko,  Cleveland,  Jef- 
ferson Medical  College;  William  Brown,  St. 
Clairsville,  Jefferson  Medical  College;  Louis  Sin- 
ger, Cleveland,  Loyola  University;  Alton  Cum- 
mings, Atwater,  New  York  Homeopathic  Medical 
College  and  Flower  Hospital;  John  Davis,  Cleve- 
land, New  York  Homeopathic  Medical  College  and 
Flower  Hospital;  Roswell  Lowry,  Cleveland,  New 
York  Homeopathic  Medical  College  and  Flower 
Hospital;  Mercer  Bailey,  Columbus,  Northwestern 
University  Medical  School;  Carter  Pitcher,  La- 
Rue,  Northwestern  University  Medical  School; 
Walter  Webb,  Dayton,  Northwestern  University 
Medical  School;  Elmer  Caskey,  New  Galilee,  Pa., 
Rush  Medical  College;  Gene  Haber,  Akron,  Rush 
Medical  College;  Herbert  Wildman,  Wooster, 
Rush  Medical  College;  William  Althoff,  Dayton, 
St.  Louis  University;  Deane  Hartman,  Wapa- 
koneta,  St.  Louis  University;  William  Mishler, 
Cleveland,  St.  Louis  University;  William  Pit- 
tinger,  Jr.,  Akron,  St.  Louis  University;  Carl 
Dreyer,  Toledo,  Temple  University;  Emil  Ober- 
son,  Cleveland,  Temple  University;  Isaac  Sieber, 
Jr.,  Cleveland,  Temple  University;  Corrin  Hodg- 
son, Cincinnati,  University  of  Minnesota;  God- 
frey Beaumont,  New  Cumberland,  W.  Va.,  Uni- 
versity of  Pennsylvania;  Cecil  Hickam,  Cincin- 
nati, University  of  Pennsylvania;  Louis  Bubna, 
Cleveland,  University  of  Rochester;  Emery  Kyle, 
Youngstown,  Medical  College  of  Virginia. 


Middletown — Dr.  J.  C.  Stratton  has  been  re- 
elected president  of  the  city  board  of  education. 


Medina — Dr.  E.  L.  Crum,  Lodi,  has  been  ap- 
pointed physician  for  the  County  Home. 

Coumbus — Dr.  Evan  C.  Brock  is  convalescing 
from  a recent  serious  illness. 

Rockford — Dr.  Paul  E.  Rex,  formerly  of 
Youngstown,  has  opened  officecs  here,  taking  over 
the  quarters  formerly  occupied  by  the  late  Dr.  J. 
P.  Symons. 

Columbus — Dr.  Warren  G.  Harding,  II,  is  in 
Edinburgh,  Scotland,  taking  the  examinations  for 
membership  in  the  Royal  College  of  Surgery  of 
Edinburgh.  Dr.  Harding  will  soon  become  asso- 
ciated with  the  Waroongha  Sanitarium  at  Sidney, 
Australia,  which  will  include  medical  missionary 
work  on  the  South  Sea  Islands. 

Oberlin — Dr.  Raymond  W.  Bradshaw,  physician 
at  Oberlin  College,  attended  the  annual  meeting 
of  the  American  Student  Health  Association  at 
New  York  City. 

Akron — Dr.  S.  J.  Michaels  is  in  Vienna  taking 
post-graduate  work  in  surgery. 

Piqua — Dr.  B.  E.  Hyde  has  been  reappointed 
physician  at  the  county  home  and  county  jail. 

Nor'rood — The  Norwood  Kiwanis  Club  was  ad- 
dressed recently  by  Dr.  Joseph  Bolin  on  “The 
Costs  of  Medical  Care”. 


lV/if/  Physicians 
PREFER  KNOX  GELATINE 
for  Nutritional  Therapy 

When  gelatine  is  prescribed,  an  unmodified, 
unsweetened,  unflavored  brand — 100%  gelatine — 
is  required! 

Patients’  dieto-therapy  must  be 
directed  in  detail  for  effective 
systemic  results. 

Knox  Gelatine  is  U.  S.P.  Gela- 
tine fulfilling  the  doctor’s  every 
requirement  for  prescription. 

Knox  Gelatine  is  indicated  in 
nutritional,  metabolic  and  hemor- 
rhagic problems  of  young  and  old. 


This  is  the  Real 
Gelatine 
A U.  S.  P.  Food 
Sold  only 
by  Grocers 


Cincinnati — The  1933  meeting  of  the  Western 
Surgical  Association  will  be  held  here. 


On  request,  the  Knox  Gelatine  Laboratories,  434  Knox 
Ave.,  Johnstown,  N.  Y.,  will  send  you  facts  on  Gelatine 
r,  * i , in  the  Diet,  prepared  by  accredited  authorities,  and  free 

C.  Alexander  has  been  ap-  diet  recipe  Vooks  to  giv*  to  patient8. 


Castalia — Dr.  E 
pointed  medical  examiner  for  war  veterans  in 
Erie  County. 

Bamesville — The  local  Chamber  of  Commerce 
was  addressed  recently  by  Dr.  M.  S.  Lawrence, 
Quaker  City,  former  president  of  the  Guernsey 
County  Medical  Society. 


Prescribe 

KNOX  GELATINE 

in  Nutritional  Therapy 


February,  1933 


State  News 


143 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 


OBSTETRICS,  GYNECOLOGY 

and 

ALLIED  SUBJECTS 


For  Information  Address 

MEDICAL  EXECUTIVE  OFFICER 

345  West  50th  Street  NEW  YORK  CITY 


COOK  COUNTY  GRADUATE  SCHOOL  OF  MEDICINE 

(In  affiliation  with  COOK  COUNTY  HOSPITAL) 

INTENSIVE  TWO  WEEKS  COURSE  IN  MEDICINE,  MARCH  6 TO  18  INC. 

THE  NAME  OF  THE  PROFESSOR  HOLDING  EACH  CLINIC  IS  GIVEN 

FIRST  WEEK 


Mon. 

Tues. 

Wed. 

Thurs. 

Fri. 

Sat. 

9-11  Luetic 

Essential 

Cardiac 

Nephro- 

Peptic 

Ulcerative 

heart 

hyper- 

irregular- 

sclerosis 

Ulcer 

colitis 

disease 

tension 

ities 

Dr.  Scupham 

Dr.  Singer 

Dr.  Goldsmith 

Dr.  A.  Arkin 

Dr.  Tice 

Dr.  Brams 

11-1  Hyper- 

Angina 

Electro- 

Pathology 

Gastric 

Diabetes 

tensive 

pectoris 

cardi- 

Dr. Jaffe 

carcinoma 

Dr.  McMullen 

Heart 

Dr.  S.  Strauss 

ography 

Dr.  S.  Portis 

Disease 
Dr.  Volini 

Dr.  Maher 

2-4  Arterio 

Subacute 

Glomerulo- 

Arthritis 

Gastritis 

Carcinoma  of 

sclerotic 

bacterial 

nephritis 

Dr.  Traut 

Dr.  J.  Meyer 

intestines 

heart 

endocar- 

Dr. W.  C.  Buchbinder 

Dr  .L.  C.  Gatewood 

disease 

ditis 

Dr.  Sutton 

Dr.  Trace 

4-6  Rheumatic 

Acute 

Liver 

Therapy  of 

X-Ray  of 

Lung 

heart 

vascular 

diseases 

heart 

G.  I. 

abscess 

disease 

diseases 

Dr.  E.  F.  Foley 

disease 

Tract 

Dr.  Pilot 

Dr.  Isaacs 

Dr.  Sloan 

SECOND 

Dr.  Hines 

WEEK 

Dr.  Warfield 

Mon. 

Tues. 

Wed. 

Thurs. 

Fri. 

Sat. 

9-11  Pulmonary 

Hodgkin’s 

Mediastinal 

Leukemias 

Auricular 

Cirrhosis 

neoplasms 

disease 

tumors 

Dr.  Pilot 

Fibrillation 

Dr.  Sloan 

Dr.  A.  ArkinDr.  Tice 

Dr.  Volini 

Dr.  Volini 

11-1  Bronchial 

Coronary 

Obesity 

Pathology 

Pericarditis 

Choleli- 

Asthma 

thrombosis 

Dr.  Lusk 

Dr.  Jaffe 

Dr.  Brams 

thiasis 

Dr.  Unger 

Dr.  Isaacs 

Dr.  Quigley 

2-4  Allergic 

Intestinal 

Deficiency 

Acute 

Amebic 

diseases 

obstruction 

diseases 

abdomen 

dysentery 

Dr.  Feinberg 

Dr.  Portis 

Dr.  Traut 

Dr.  Singer 

Dr.  Goldsmith 

4-6  Cor. 

Pancreas 

Pernicious 

Thyreo- 

Jaundice 

Pulmonale 

carcinoma 

Anaemia 

toxicosis 

differential 

Dr.  Trace 

Dr.  McMullen 

Dr.  L.  C.  Gatewood 

Dr.  J.  Meyer 

diagnosis 
Dr.  Scupham 

TUITION — $75.00  For  information,  address  Registrar: 427  South  Honore  St.,  Chicago 


144 


The  Ohio  State  Medical  Journal 


February,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

John  B.  Alcorn,  Chairman,  (1933) 


Columbus 

J.  H.  J.  Upham  (1934) Columbus 

C.  W.  Stone  (1935) Cleveland 

H.  M.  Platter,  (ex-officio) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

D.  C.  Houser,  (special) Urbana 

C.  W.  Waggoner,  (special) Toledo 

A.  H.  Freiberg,  (special) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

A.  B.  Denison,  (1933) Cleveland 


Gilbert  Micklethwaite,  (1935)... .Portsmouth 

MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

W.  H.  Snyder,  (1933) Toledo 

F.  P.  Anzinger,  (1935) Springfield 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) Toledo 

R.  H.  Birge,  (1935) Cleveland 

MEDICAL  ECONOMICS 

J.  Craig  Bowman,  Chairman,  (1933) 

Upper  Sandusky 

A.  B.  Brower,  (1934) Dayton 

E.  O.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 

V.  C.  Rowland,  Chairman Cleveland 

Jonathan  Forman Columbus 

Beatrice  T.  Hagen Zanesville 

R.  R.  Hendershott Tiffin 

C.  I.  Stephen Ansonia 

MILITARY  AND  VETERANS’  AFFAIRS 

C.  W.  Stone,  Chairman Cleveland 

Fred  K.  Kislig ..Dayton 

A.  E.  Brant . Youngstown 

COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

S.  J.  Goodman,  Chairman Columbus 

John  A.  Caldwell Cincinnati 

I.  P.  Seiler__ Piketon 

ARRANGEMENTS  1933  ANNUAL  MEETING 

H.  S.  Davidson,  Chairman Akron 

E.  M.  Huston Dayton 

E.  B.  Shanley New  Philadelphia 

PROGRAM  1933  ANNUAL  MEETING 

C.  L.  Cummer,  Chairman Cleveland 

B.  J.  Hein._ Toledo 

E.  R.  Brush Zanesville 


SECTION  OFFICERS  FOR  1932-1933 


MEDICINE 

Carll  S.  Mundy Chairman 

125  16th  St.,  Toledo 

Cecil  Striker Secretary 

700  Provident  Bank  Bldg.,  Cincinnati 
SURGERY 

Carl  R.  Steinke  Chairman 

1027  Second  Natl.  Bldg.,  Akron 

Norris  Gillette Secretary 

320  Michigan  St.,  Toledo 

OBSTETRICS  AND  PEDIATRICS 

B.  H.  Carroll Chairman 

240  Michigan  St.,  Toledo 

Edward  A.  Wagner Secretary 

2560  Grandin  Rd.,  Cincinnati 


EYE,  EAR,  NOSE  AND  THROAT 


W.  V.  Mullin Chairman 

Euclid  at  93rd  St.,  Cleveland 

Ivor  G.  Clark Secretary 

188  E.  State  St.,  Columbus 

NERVOUS  AND  MENTAL  DISEASES 

J.  Fremont  Bateman Chairman 

Box  36,  Elmwood  Place 

Henry  C.  Schumacher Secretary 

2625  Euclid  Ave.,  Cleveland 

PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 

R.  H.  Markwith Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 


J.  P.  DeWitt,  11933)  Canton 

C.  E.  Kiely,  (1933) , Cincinnati 

C.  W.  Waggoner,  (1933) Toledo 

Wells  Teachnor,  Sr.,  (1934) Columbus 

Ben  R.  McClellan,  (1934) , Xenia 

E.  R.  Brush,  (1934) Zanesville 

C.  W.  Stone,  (1934) Cleveland 


ALTERNATES 


G.  F.  Zinninger,  (1933) Canton 

L.  H.  Schriver,  (1933) Cincinnati 

John  Sprague,  (1933) Athens 

D.  H.  Morgan,  (1934) Akron 

A.  C.  Messenger,  (1934) Xenia 

A.  Howard  Smith,  (1934) . Marietta 

C.  L.  Cummer,  (1934) : Cleveland 


Eighty-Seventh  Annual  Meeting,  Akron,  May  2-3,  1933 


PUBLIC  H®  ALTM  - SOCIAL  WE LFAM 
MEDICAL  ECONOMICS 


Ulith  Editorial  Comment  by  D.K.M. 


Practically  snowed  under  with  an  assortment  of 
more  than  1000  legislative  proposals,  most  of 
which  have  little  or  no  merit,  the  Ohio  General 
Assembly  has  entered  the 
crucial  period  of  its  activity. 

During  the  next  few 
weeks,  the  Legislature  will 
be  forced  to  decide  whether 
to  heed  the  advice  of  the 
Governor  and  of  its  own  leaders  to  hold  a short, 
economical  session  and  confine  its  work  to  con- 
sideration of  taxation  relief,  balanced  budget  and 
a few  other  major  problems;  or  whether  to  waste 
valuable  time  and  effort  and  considerable  of  the 
taxpayers’  money  in  wrangling  over  unnecessary 
and  controversial  measures  and  giving  uncalled 
for  consideration  to  silly  and  destructive  pro- 
posals sponsored  by  faddists  and  special-interest 
groups. 

Although  the  General  Assembly  got  off  to  a 
doubtful  start  by  throwing  into  the  hopper  a 
record  number  of  foolish  and  dangerous  bills, 
many  of  which  are  old  wheezes  and  chestnuts  of 
former  sessions,  supplemented  by  new-fangled 
ideas  alleged  to  be  panaceas  for  economic  and 
social  ills,  it  is  not  too  late  for  it  to  distinguish 
itself  by  killing  off  promptly  all  unnecessary  and 
doubtful  proposals,  and  settling  down  to  the  task 
of  solving  the  pressing  major  issues  confronting 
it. 

Unless  the  dependable  members  of  both  the 
House  and  the  Senate,  supported  by  strong  public 
sentiment,  apply  pressure  promptly  and  put  an 
end  to  the  growing  tendency  on  the  part  of  some 
of  the  membership  to  waste  their  time  on  foolish 
and  destructive  proposals,  the  Assembly  is  liable 
to  go  “hay-wire”,  leaving  the  final  outcome  of  the 
session,  from  the  standpoint  of  public  benefit,  in 
doubt. 

Faddists,  cultists  and  special-interest  groups 
have  taken  advantage  of  the  general  confusion 
which  exists  in  both  houses,  aggravated  by  the 
inability  of  the  membership  to  agree  on  some  of 
the  major  issues.  These  groups  have  set  up  large 
and  active  lobbies  in  Columbus  and  are  resorting 
to  log-rolling,  wire-pulling  and  trading  to  promote 
the  measures  in  which  they  are  interested.  Some 
of  the  members  of  the  Legislature  with  special 
axes  to  grind  are  flirting  with  these  destructive 
groups  in  an  effort  to  win  votes  for  their  own 
“pet”  proposals. 

It  is  vital  that  the  medical  profession  of  Ohio 


realize  the  seriousness  of  the  legislative  situation. 
Many  of  the  bills  now  pending  before  both  the 
House  and  the  Senate  have  medical  and  health 
angles.  Some  of  them  are  malicious  attempts  to 
destroy  the  high  standards  of  medical  practice 
and  medical  education.  Others  are  deliberate  at- 
tacks on  the  safeguards  which  have  been  estab- 
lished to  protect  the  public  health.  In  addition, 
there  are  dozens  of  proposals  which  are  the 
brain-children  of  theorists,  social-engineers  and 
uplifters,  calling  for  various  types  of  super-regu- 
lation and  socialized  programs. 

There  is  grave  danger  that  legislation  inimical 
to  good  medical  practice  and  effective  public 
health  administration  will  be  enacted  unless  the 
physicians  of  Ohio  and  others  similarly  interested 
in  such  matters  use  the  proper  influence  at  their 
command  to  create  among  the  personnel  of  the 
General  Assembly  an  overwhelming  sentiment  in 
favor  of  maintaining  existing  sound  and  con- 
structive medical  and  health  laws. 

Activities  at  the  General  Assembly  are  being 
followed  closely  and  constantly  by  the  Committee 
on  Public  Policy  of  the  State  Association  and  the 
state  headquarters  staff.  The  State  Association 
has  been  officially  represented  at  committee  hear- 
ings on  proposals  in  which  the  medical  profession 
is  interested.  Many  members  of  the  Legislature 
have  been  contacted  while  in  Columbus.  Frequent 
bulletins  have  been  issued  by  the  Policy  Commit- 
tee through  our  state  headquarters  to  the  legis- 
lative committee-chairman  of  the  component 
county  societies  and  academies  of  medicine  to  in- 
form them  about  happenings  at  the  Capitol. 
Various  proposals  with  health  and  medical  angles 
have  been  analyzed  in  these  bulletins  and  the 
policy  of  the  State  Association  concerning  them 
summarized  for  the  guidance  of  the  legislative 
committeemen  in  their  contacts  with  the  legis- 
lators over  the  week-ends.  The  Policy  Committee 
will  continue  to  keep  in  close  and  active  touch 
with  activities  at  the  Legislature  and  will  do  all 
within  its  power  to  protect  the  interests  of  the 
profession  and  the  health  of  the  public. 

However,  the  Policy  Committee  cannot  be  suc- 
cessful unless  it  has  the  support  and  active  co- 
operation of  the  membership  generally.  The  pri- 
mary responsibility  rests  on  the  shoulders  of  local 
physicians,  especially  the  legislative  committee- 
men and  officers  of  the  local  medical  societies,  who 
must  initiate  and  direct  local  legislative  activities. 
Of  course,  the  legislative  committeemen  and 


Tlhe  Ohio 

Legislative 

Situation! 


161 


162 


The  Ohio  State  Medical  Journal 


March,  1933 


officers  of  the  local  societies  should  not  be  ex- 
pected to  shoulder  the  entire  burden  of  establish- 
ing contacts  with  members  of  the  Legislature 
when  home  on  week-ends  and  of  keeping  them  in- 
formed as  to  the  correct  medical  and  health  view- 
point on  pending  legislation.  They  must  have  the 
support  and  cooperation  of  all  the  members  of 
their  respective  societies  and  their  active  assist- 
ance when  necessary. 

The  most  effective  method  of  creating  favor- 
able sentiment  on  medical  and  health  legislation 
is  through  the  establishment  of  local  contacts, 
supplemented  by  frequent  interviews  and  con- 
ferences between  local  physicians  and  their  repre- 
sentatives. The  great  majority  of  the  members 
of  the  General  Assembly  ai-e  willing  and  anxious 
to  receive  information  and  advice  from  their  con- 
stituents. They  should  be  encouraged  to  look  to 
the  physicians  of  their  home  communities  for  cor- 
rect information  and  counsel  on  medical  and 
health  questions.  Unless  frequent  contacts  are 
made  between  local  physicians  and  their  represen- 
tatives, there  is  a danger  that  the  legislators  will 
not  be  fully  supplied  with  the  correct  information 
on  pending  medical  and  health  proposals.  More- 
over, there  is  the  possibility  that  some  legislators 
may  get  the  erroneous  idea  that  their  physician 
constituents  are  not  interested  in  such  questions 
and  care  nothing  about  the  attitude  of  their 
representatives  in  the  Legislature  concerning 
medical  and  health  legislation. 

It  is  of  pi’imary  importance  that  the  local  legis- 
lative committeemen  give  their  wholehearted  and 
constant  cooperation  to  the  Committee  on  Public 
Policy  in  its  legislative  activities.  They  should 
keep  the  committee  informed  of  the  outcome  of 
interviews  with  members  of  the  Legislature,  sum- 
marizing the  comments  made  to  questions  asked 
by  the  legislators  during  their  conversation.  It 
is  vital  that  the  Policy  Committee  have  complete 
information,  if  possible,  relative  to  the  attitude 
and  views  of  members  of  the  General  Assembly 
on  pending  measures  so  that  it  can  carry  on  its 
activities  in  Columbus  in  a more  efficient  and 
effective  manner.  Unless  the  committee  has 
prompt,  frequent  and  complete  information  based 
on  contacts  made  “back  home”  by  physicians 
known  to  and  personal  friends  of  the  respective 
legislators,  it  is  considerably  handicapped  in  its 
work  and  is  unable  to  function  effectively. 

If  the  legislative  activities  of  the  State  Associa- 
tion are  to  be  successful,  there  must  be  first  of  all 
active  cooperation  between  the  legislative  commit- 
teemen and  the  members  of  each  county  society 
and  academy  in  the  matter  of  interviewing  and 
advising  their  respective  representatives  in  the 
General  Assembly.  Secondly,  there  must  be  con- 
stant cooperation  between  the  legislative  commit- 
teemen and  the  Committee  on  Public  Policy. 

Now  is  an  appropriate  time  for  the  medical 
profession,  a conservative  group  and  one  which 
always  has  been  a supporter  of  constructive 
legislation  and  sound  governmental  activities,  to 


throw  its  entire  strength  behind  the  movement  to 
create  a sti'ong  public  sentiment  in  favor  of  a 
minimum  of  new  legislation  by  the  90th  General 
Assembly  and  the  enactment  of  only  those  pro- 
posals which  can  be  proved  to  be  of  general  pub- 
lic benefit  and  importance. 

Inactivity  and  delay  on  the  part  of  the  phy- 
sicians of  Ohio  in  taking  an  active  part  in  the 
present  legislative  battle  may  prove  disastrous. 
As  intimated  previously,  the  present  legislative 
situation  is  so  complicated  that  vigorous  activity 
on  the  part  of  individuals  and  groups  interested 
in  sound  and  constructive  legislation  and  in  the 
maintenance  of  existing  medical  and  health  laws 
will  be  necessai’y  to  prevent  the  enactment  of 
laws  which  would  be  detrimental  to  the  public’s 
interests  and  welfare,  and  the  destruction  of 
present  medical  and  health  safeguards. 


Various  committees  of  the  Summit  County 
Medical  Society  are  hard  at  work  completing 
local  arrangements  and  details  for  the  87th  An- 
nual Meeting  of  the  Ohio 
State  Medical  Association 
to  be  held  in  Akron,  May 
2 and  3. 

_ The  personnel  of  the 

Akron  committees  is  as 

follows : 


Executive — Dr.  E.  A.  Weeks,  general  chairman; 
Dr.  J.  H.  Selby,  President  of  the  Summit  County 
Medical  Society,  and  Dr.  H.  S.  Davidson,  Coun- 
cilor of  the  Sixth  District  and  chairman  of  the 
Council  Committee  on  Arrangements  for  the  1933 
Annual  Meeting. 

Registration  and  Information — Dr.  E.  A.  Free- 
man, chairman;  Dr.  M.  D.  Ailes,  Dr.  H.  R.  Bare- 
more,  Dr.  R.  S.  Friedley,  Dr.  J.  G.  Gage,  Dr.  R. 
F.  Jolley,  Dr.  A.  W.  Jones,  and  Dr.  C.  H.  Kent. 

Halls  and  Meeting  Places — Dr.  R.  E.  Amos, 
chairman;  Dr.  G.  E.  Black,  Dr.  M.  B.  Crafts,  Dr. 
H.  E.  Groom,  Dr.  G.  M.  Logan,  Dr.  W.  D.  Lyon, 
Dr.  G.  K.  Parke,  Dr.  R.  E.  Pinkerton  and  Dr.  U. 
D.  Seidel. 


Projection  Apparatus — Dr.  G.  A.  Ferguson, 
chairman;  Dr.  H.  E.  Blass,  Dr.  M.  F.  Bossart,  Dr. 

R.  A.  Breckinridge,  Dr.  P.  C.  Doran,  Dr.  K.  H. 
Harrington,  Dr.  I.  L.  Houghton,  Dr.  V.  C.  Mal- 
loy, Dr.  T.  J.  Murphy,  Dr.  J.  P.  Sauvageoit  and 
Dr.  R.  P.  Vivian. 

Reception — Dr.  J.  G.  Blower,  chairman;  Dr.  L. 
L.  Bottsford,  Dr.  L.  E.  Brown,  Dr.  G.  M.  Camp- 
bell, Dr.  H.  I.  Cozad,  Dr.  R.  F.  Drury,  Dr.  E.  B. 
Dyson,  Dr.  L.  C.  Eberhard,  Dr.  G.  E.  Gardner, 
Dr.  C.  E.  Held,  Dr.  Carrie  A.  Herring,  Dr.  C.  T. 
Hill,  Dr.  T.  D.  Hollingsworth,  Dr.  W.  McK.  John- 
ston, Dr.  B.  E.  Miller,  Dr.  D.  H.  Morgan,  Dr.  A. 

S.  McCormick,  Dr.  S.  E.  McMaster,  Dr.  J.  H. 
Seiler,  Dr.  J.  R.  Shoemaker,  Dr.  H.  L.  Small- 
man,  Dr.  A.  H.  Stall,  Dr.  E.  R.  Stumpf,  Dr.  R. 
F.  Thaw,  Di\  M.  C.  Tuholske,  Dr.  R.  G.  Wemer, 
Dr.  L.  A.  Witzeman  and  Dr.  S.  St.  J.  Wright. 


March,  1933 


Editorial 


163 


Entertainment — Dr.  J.  S.  Millard,  chairman; 
Dr.  D.  C.  Brennan,  Dr.  B.  H.  Gillespie,  Dr.  W. 
McD.  Johnston,  Dr.  J.  G.  Kramer,  Dr.  R.  V.  Luce, 
Dr.  T.  K.  Moore,  Dr.  S.  Morgenroth,  Dr.  R.  G. 
Pearce,  Dr.  J.  E.  Springer,  Dr.  Elizabeth  M. 
Weaver  and  Dr.  J.  N.  Weller. 

Banquet — Dr.  J.  H.  Weber,  chairman;  Dr.  E. 
C.  Banker,  Dr.  R.  Barnwell,  Dr.  R.  H.  Cather, 
Dr.  S.  B.  Conger,  Dr.  H.  R.  Conn,  Dr.  C.  E.  Jelm, 
Dr.  A.  A.  Kohler,  Dr.  J.  G.  Lemmon,  Dr.  J.  E. 
Monnig,  Dr.  D.  M.  McDonald,  Dr.  J.  L.  McEvitt, 
Dr.  G.  K.  Parke,  Dr.  W.  A.  Parks,  Dr.  M.  J. 
Pierson,  Dr.  F.  C.  Potter,  Dr.  H.  V.  Sharp,  Dr. 
J.  D.  Smith,  Dr.  G.  R.  Taylor,  Dr.  J.  M.  Ulrich 
and  Dr.  C.  E.  Updegraff. 

Scientific  Exhibits — Dr.  P.  A.  Davis,  chairman; 
Dr.  R.  T.  Allison,  Dr.  A.  E.  Davis,  Dr.  P.  C. 
Langan,  Dr.  R.  H.  Markwith,  Dr.  A.  P.  Ormond, 
Dr.  A.  S.  Robinson,  Dr.  E.  L.  Saylor  and  Dr.  F. 
A.  Smith. 

Commercial  Exhibits — Dr.  C.  H.  Franks,  chair- 
man; Dr.  C.  R.  Anderson,  Dr.  0.  J.  Chaney,  Dr. 
M.  G.  Gibans  and  Dr.  W.  L.  Hogue. 

Clinics — Dr.  W.  A.  Hoyt,  chairman;  Dr.  J.  G. 
Blower,  Dr.  C.  L.  Hyde,  Dr.  D.  B.  Lowe,  Dr.  H. 
H.  Musser  and  Dr.  F.  B.  Roberts. 

Publicity— Dr.  C.  C.  Pinkerton,  chairman;  Dr. 
W.  S.  Chase,  Dr.  C.  M.  Clark,  Dr.  H.  J.  Gordon, 
Dr.  R.  H.  Markwith,  Dr.  F.  E.  Read  and  Dr.  C. 
R.  Steinke. 

Several  features  augmenting  the  official  pro- 
gram for  the  two-days  meeting  are  being  ar- 
ranged. As  usual,  the  Ohio  State  Medical  Golfers’ 
Association  will  hold  its  annual  tournament  on 
Monday,  May  1,  the  day  preceding  the  opening  of 
the  meeting.  This  year’s  event  will  be  staged  at 
the  Portage  Country  Club,  one  of  the  finest  lay- 
outs in  the  state.  Additional  information  concern- 
ing the  tournament  will  be  found  elsewhere  in  this 
issue  of  The  Journal. 

A Scientific  Exhibit  will  be  held.  The  excellent 
display  shown  at  last  year’s  annual  meeting  at 
Dayton  was  one  of  the  features  of  the  1932  meet- 
ing and  the  Akron  committee  headed  by  Dr.  P.  A. 
Davis  is  determined  not  to  let  themselves  be  out- 
done by  their  Dayton  colleagues  in  arranging  this 
feature  of  the  meeting. 

A banquet  will  be  given  on  Tuesday  evening, 
May  3,  by  the  Summit  County  Medical  Society,  at 
which  the  President  and  President-elect  of  the 
State  Association  will  present  their  annual  ad- 
dresses. Details  concerning  the  banquet  and  en- 
tertainment which  will  follow  will  be  published  in 
subsequent  issues  of  The  Journal. 

The  Akron  physicians  also  are  arranging  for  a 
fine  program  of  medical  and  surgical  clinics  at 
the  various  Akron  hospitals.  The  program  of 
clinics  will  be  published  in  The  Journal  as  soon  as 
it  has  been  completed. 

Members  of  the  State  Association  who  are 
planning  to  attend  the  Akron  meeting — every 
member  who  possibly  can  should  arrange  to  be 


there — should  make  their  hotel  reservations  as 
soon  as  possible.  A list  of  Akron  hotels,  together 
with  their  accommodations  and  rates,  will  be 
found  elsewhere  in  this  issue  of  The  Journal. 

The  official  program  for  the  two-days  gathering 
has  been  completed  except  for  one  or  two  minor 
details.  It  will  be  published  in  its  entirety  in  the 
April  issue  of  The  Jomual  so  that  every  member 
will  have  plenty  of  time  to  digest  it  and  plan  to 
attend  the  addresses  and  demonstrations  in  which 
he  is  especially  interested. 

Additional  information  concerning  the  Akron 
meeting  will  be  published  in  later  issues  of  The 
Journal.  At  present,  the  prospects  are  bright  for 
one  of  the  most  interesting  and  beneficial  meetings 
ever  held  by  the  State  Association. 


In  a recent  decision  in  a suit  against  a phy- 
sician for  alleged  malpractice,  the  Supreme  Court 
of  Connecticut  placed  a new  and  significant  in- 
terpretation on 

Degree  of  Skill  the  universally 

Required  fey  Doctors  Jhat^physicffin 

Interpreted  fey  Court  in  the  treatment 

of  patients 

should  exercise  the  average  degree  of  skill,  care 
and  diligence  exercised  by  members  of  his  pro- 
fession in  the  same  and  similar  localities. 

The  Connecticut  court  in  its  opinion  declared 
that  it  is  not  unreasonable  to  require  that  the 
physician  have  and  exercise  the  skill  of  physicians 
and  surgeons  in  similar  localities  in  the  same 
general  neighborhood,  and  that,  “under  modem 
conditions  there  is  perhaps  less  reason  than 
formerly  for  the  restriction  of  the  skill  required 
to  that  possessed  by  physicians  and  surgeons  in 
the  same  locality,  since  there  is  no  lack  of  oppor- 
tunity for  the  physician  or  surgeon  in  smaller 
communities  to  keep  abreast  of  the  advances  made 
in  his  profession  and  to  be  familiar  with  the  latest 
methods  arid  practices  adopted”. 

Excluding  entirely  the  legal  angles,  this  dictum 
touches  on  one  of  the  essential  factors  in  the  ad- 
vancement and  maintenance  of  the  high  standards 
of  medical  practice  generally. 

For  years,  leaders  in  medicine  have  empha- 
sized the  importance  of  constant  and  continuous 
effort  on  the  part  of  members  of  the  medical  pro- 
fession themselves  to  increase  their  knowledge  of 
scientific  medicine  and  their  skill  in  the  practice 
of  medicine.  It  has  been  said  that  when  the 
physician  ceases  to  try  to  learn  more  about  the 
intricacies  of  modern  scientific  medicine  and  to 
improve  his  skill  in  application  of  that  knowledge, 
he  has  reached  a point  where  retirement  from 
active  practice  is  indicated. 

As  the  Connecticut  tribunal  has  pointed  out, 
under  modern  conditions  there  is  little,  if  any, 
excuse  for  any  physician  not  availing  himself  of 
the  numerous  opportunities  offered  for  keeping 
abreast  of  the  advances  and  progress  of  medicine. 


164 


The  Ohio  State  Medical  Journal 


March,  1933 


He  owes  it  to  his  clientele,  as  well  as  himself  and 
his  profession,  to  take  advantage  of  the  various 
ways  offered  to  increase  his  knowledge  and  im- 
prove his  skill. 

The  fact  that  the  courts — at  least  this  one — 
have  begun  to  recognize  that  the  difference  be- 
tween good,  bad  and  mediocre  medical  service  is 
not  to  any  great  extent  a matter  of  geography  is 
evidence  that  those  outside  the  medical  profession 
are  not  unaware  of  the  fact  that  the  average 
physician  can,  if  he  has  the  desire,  progress  and 
keep  abreast  of  medical  advancement.  Moreover, 
it  indicates  that  the  public  more  and  more  is  be- 
ginning to  discriminate  between  the  physician 
who  shows  a willingness  to  increase  his  knowl- 
edge and  improve  his  skill  and  the  one  who  does 
not. 

This  awakening  on  the  part  of  the  public,  as 
exemplified  by  the  Connecticut  decision,  should  be 
an  added  stimulus  to  every  physician  to  utilize 
every  means  offered  to  make  himself  a better 
physician  and  incidentally  become  a greater  asset 
to  the  community  he  serves.  Incidentally,  the  phy- 
sician who  is  consistently  active  in  medical  or- 
ganization, who  attends  medical  meetings  and 
participates  in  scientific  discussions,  is  usually 
most  active  in  keeping  abreast  of  scientific  ad- 
vances. It  is  usually  the  non-member  who  is  a 
laggard. 


Many  of  the  recommendations  for  removing  the 
Federal  Government  from  competition  with  priv- 
ate business  and  services,  contained  in  the  recent 


Unwarranted 

Governmental 

Competition 


report  of  the  special 
House  of  Representatives 
Committee,  known  as  the 
“Shannon  Committee”, 
and  submitted  to  Con- 
gress, are  significant  and 


thought-provoking. 

Data  collected  by  the  committee  show  that  ap- 
proximately 230  items  of  trade,  industry,  and 
personal  and  professional  service  are  affected  by 
governmental  competition,  evidencing  a radical 
departure  by  the  Federal  Government  from  the 
fundamental  purposes  for  which  it  was  estab- 
lished. 


In  the  preamble  of  its  report,  the  Shannon 
Committee  sets  forth  a series  of  general  prin- 
ciples which  in  the  opinion  of  the  committee 
should  control  governmental  policy,  the  most  im- 
portant of  which  is  as  follows: 

“The  Government,  as  it  now  exists,  was  con- 
ceived and  organized  for  political  and  social  con- 
trol and  activity.  It  was  not  vested  with  any 
economic  functions  beyond  those  essential  to  the 
proper  exercise  of  its  own  functions  in  coining 
money,  collecting  and  disbursing  revenue,  emitting 
credit,  operating  post  offices  and  carrying  mails, 
and  in  developing  and  maintaining  military  estab- 
lishments for  the  protection  of  the  lives  and 
property  of  its  citizens.  It  was  primarily  designed 
to  promote  the  general  welfare  and  to  conserve 
to  its  citizens  the  rights  of  ‘life,  liberty,  and  the 
pursuit  of  happiness’.  The  entrance  of  the  gov- 


ernment into  commercial  and  industrial  undertak- 
ings, backed  by  public  credit  and  resources  and 
its  military  and  civilian  personnel,  for  the  pur- 
pose of  competing  with  the  business  establish- 
ments and  the  opportunities  of  livelihood  of  its 
citizens,  is,  therefore,  in  general  repugnant  to 
our  fundamental  democratic  institutions  and 
aspirations  ....  no  constitutional  authority  ex- 
ists whatsoever  which  would  permit  the  Govern- 
ment deliberately  to  engage  in  business  in  any 
form  which  competes  with  and  impairs  the  private 
business  of  its  citizens,  except  for  reasons  of 
economy  or  fiscal  and  military  expediency.” 

Among  the  items  considered  by  the  Committee 
was  that  of  competition  of  the  Federal  Govern- 
ment with  individuals  and  institutions  engaged  in 
rendering  medical,  hospital,  dental  and  nursing 
services,  etc.,  on  a private  competitive  basis. 
Special  mention  is  made  of  the  elaborate  system 
of  medical  and  hospital  services  which  the  Fed- 
eral Government  has  established  for  the  care  of 
World  War  veterans  and  those  of  former  wars. 

Dealing  specifically  with  this  question,  the  Com- 
mittee declared: 

“The  committee  recommends  to  the  Veterans’ 
Administration  that  the  ends  of  economy  would 
be  best  served  by  using  private,  municipal,  and 
other  hospitals  for  patients,  rather  than  provide 
additional  new  governmental  hospitalization  at 
greater  outlays.” 

With  reference  to  competition  of  the  Govern- 
ment with  physicians,  dentists,  etc.,  in  private 
practice,  the  Committee  stated: 

“Consistent  with  the  general  recommendation 
of  the  committee  for  decentralization  of  hospital 
treatment  for  veterans,  we  recommend  that  local 
physicians,  surgeons  and  dentists  be  employed  in 
their  treatment  in  so  far  as  practicable.” 

It  is  somewhat  of  a disappointment  that  the 
Shannon  Committee  did  not  go  a bit  deeper  into 
the  veterans’  problem  and  include  in  its  recom- 
mendations the  suggestion  that  the  Federal  Gov- 
ernment should  consider  seriously  the  matter  of 
limiting  medical  and  hospital  care  at  government 
expense  solely  to  veterans  suffering  from  service- 
connected  disabilities. 

Perhaps  the  Shannon  Committee  felt  that  this 
particular  phase  of  the  veterans’  question  was 
outside  its  field  of  investigation.  Nevertheless, 
some  mention  of  the  necessity  for  modification  of 
the  present  policy  which  makes  no  distinction  be- 
tween veterans  with  service-connected  and  those 
with  non-service-connected  disabilities  might  have 
added  impetus  to  growing  demands  that  the  Fed- 
eral Government  confine  benefits  under  the  World 
War  Veterans’  Act  to  those  with  service-con- 
nected disabilities  and  the  dependents  of  those 
who  died  from  service  disabilities. 

At  any  rate,  the  information  and  recommenda- 
tions contained  in  the  report  of  the  Shannon  Com- 
mittee should  prove  valuable  to  other  committees 
and  agencies  now  engaged  in  studying  the 
veterans’  question  and  other  problems  which  in- 
volve the  paternalistic  and  bureaucratic  activities 
of  the  Federal  Government,  unsound  in  principle 
and  unfair  to  those  engaged  in  private  com- 
petitive business  and  services. 


Ernest  Scott,  M.D.,  and  C.  J.  Delor,  B.A.,  Columbus,  Ohio 


ABERDHALDEN  in  1900  demonstrated  for 
the  first  time  that  laboratory  animals  fed  a 
sole  milk  diet  develop  unmistakable  evi- 
dences of  anemia.  Bunge,  a year  later,  showed 
that  milk  was  notably  low  in  iron  content.  The 
fact  that  hemoglobin  contains  iron,  together  with 
previous  observations  of  anemia,  has  led  to  re- 
peated attempts  to  demonstrate  the  therapeutic 
value  of  iron  in  anemias  of  various  etiology.  The 
results,  however,  have  never  been  completely 
satisfactory.  Following  these  first  attempts  for  a 
solution  of  the  anemia  produced  experimentally 
with  a sole  milk  diet,  there  was  nothing  further 
of  interest  until  the  problem  was  reopened  by 
Hart  and  his  co-workers  in  1925  at  the  University 
of  Wisconsin.  They  have  reported  remission  of 
milk  anemia  in  rats  by  the  addition  of  iron  and 
copper  to  the  diet,  though  iron  alone  was  ineffec- 
tive.1 

The  therapeutic  value  of  iron  in  the  treatment 
of  nutritional  anemia  has  been  a matter  of  some 
controversy.  Beard  and  Myers,2  after  a series  of 
experiments  with  metallic  iron,  electrolytic  iron 
and  H2S  iron,  found  that  .25  mg.  of  Fe  daily  was 
the  necessary  supplement  to  a whole  raw  milk  diet 
to  produce  hemoglobin  recovery  in  six  weeks  and 
red  corpuscle  recovery  in  four  weeks.  By  increas- 
ing the  dosage  of  the  iron  up  to  2 mg.  the  time 
for  recovery  was  reduced  to  one  and  eight-tenths 
weeks. 

This  is  in  agreement  with  the  results  obtained 
by  Mitchell  and  Schmidt,3  Drabkin  and  Wag- 
goner,4 and  Keil  and  Nelson.5  Hart  and  his  asso- 
ciates,6' 7 Lewis,8  and  Krauss,”  do  not  agree  that 
pure  iron  will  cui'e  nutritional  anemia.  The  ex- 
tensive work  of  Beard  in  obtaining  pure  iron 
would  seem  to  indicate  that  unless  contamination 
occurred  during  consumption,  any  effect  received 
therefrom  must  be  due  to  the  iron  alone.  Hart 
maintains,  however,  that  either  there  must  have 
been  contamination,  or  else  impurities  of  copper 
were  present  in  the  iron  salts  used.  Steenbock15 
found  that  the  smallest  amount  of  copper  neces- 
sary Was  .0025  mg.  daily.  He  says  that  this  must 
have  been  present  as  a contamination  in  Beard’s 
and  Myers’  materials.  Myers  and  Beard11  main- 
tain that  they  found  .01  mg.  of  copper  and  .5  mg. 
of  iron  not  sufficient  to  reduce  the  time  of  re- 
covery from  nutritional  anemia  to  less  than  six 
weeks,  which  is  the  time  for  recovery  with  iron 
alone.  When,  however,  the  copper  was  added  in 
greater  amounts,  .025  mg.  and  upward,  the  period 
of  recovery  was  cut  down  to  two  or  three  weeks. 
Other  inorganic  substances  found  that  would  also 
catalize  erythropoiesis  were  daily  doses  of  .05  mg. 

Read  before  the  Third  General  Session,  Ohio  State  Medical 
Association,  at  the  86th  Annual  Meeting*,  Dayton,  May  3-4, 
1932. 

Department  of  Patholog*y,  The  Ohio  State  University. 


Ni,  .4  mg.  Ge,  .01  mg.  As,  .1  mg.  zinc,  (.5  mg.  Zn 
depressed  hemopoiesis)  .5  mg.  Hg,  while  Cobalt, 
Magnesium  and  Aluminum  were  ineffective. 
Myers13  in  commenting  on  the  presence  of  suffi- 
cient copper  in  the  milk  itself  says,  “It  does  not 
seem  to  us  that  when  essentially  the  same  effects 
were  obtained  with  a number  of  other  inorganic 
supplements  in  addition  to  copper,  their  action  can 
be  explained  so  simply”. 

Supplee,  Dow,  Flanigan  and  Kahlenberg13  found 
that  milk  takes  up  iron  from  the  container  in  the 
process  of  drying.  The  milk  used  by  Beard  and 
Myers14  in  their  experiments  was  whole  raw  milk 
obtained  with  special  precautions  against  iron  or 
copper  contamination.  Beard  says  that  in  the 
milk  they  were  feeding,  75  cc.  contained  .33  mg. 
copper.  The  animals  used  Were  weaned  from 
mothers  receiving  lettuce,  which  is  rich  in  iron 
and  copper,  and  yet  these  young  rats  developed 
nutritional  anemia  on  a whole  milk  diet,  showing 
that  there  was  no  storage  of  iron  or  copper  in 
their  bodies. 

Hill15  says  that  nutritional  anemia  is  a de- 
ficiency disease,  “depending  upon  a lack  of  ii-on 
and  possibly  a pigment  in  the  diet”. 

Agents  other  than  inorganic  elements  have  been 
found  which  favorably  influence  erythropoiesis. 
Furniss16  found  that  ultraviolet  light  stimulated 
hemopoietic  function.  Osato  and  Tanaka,11  using 
a General  Electric  Sunlight  Lamp,  found  the  same 
effects  as  Furniss.  It  is  evident  then  that  the 
irradiation  of  experimental  animals  on  a whole 
raw  milk  diet  with  the  subsequent  prevention  of 
nutritional  anemia  would  indicate  that  Vitamin 
D was  concerned,  while  Moore  states  that  Vitamin 
D is  essential  for  the  action  of  carotin  in  pro- 
ducing normal  rat  growth  on  a milk  diet. 

It  is  thus  seen  that  the  addition  of  Fe  and  Cu 
to  the  diet  of  the  anemic  rat  is  not  on  an  entirely 
established  basis,  that  different  experimentors 
have  obtained  varying  results,  that  essentially  the 
same  effects  may  be  obtained  with  a number  of 
other  inorganic  supplements,  that  the  ultra-violet 
light,  the  carbon  mercury  lamp  and  irradiation 
have  all  accomplished  a definite  erythropoiesis. 

It  is  generally  granted  that  the  iron  and  other 
inorganic  elements  in  milk  cannot  be  increased  by 
increasing  their  amount  in  the  feed  of  the  cow. 
This  is  not  true,  however,  for  many  other  sub- 
stances, it  having  been  recently  proved  that  the 
vitamin  content  of  milk  is  directly  and  entirely  de- 
pendent upon  the  quality  of  the  food  consumed. 

One  of  the  most  recent  and  striking  proofs  of 
this  is  the  work  of  Thomas  and  MacLeod10  and  of 
Krauss  and  Bethke,20  who  have  proved  that  the 
anti-rachitic  Vitamin  D is  greatly  increased  in 
the  milk  of  cows  fed  upon  irradiated  yeast  or 
irradiated  ergosterol.  Thomas  and  MacLeod  find 


165 


166 


The  Ohio  State  Medical  Journal 


March,  1933 


that  Vitamin  D can  be  increased  in  the  milk  as 
much  as  sixteen  times  in  this  manner. 

Hess21  and  his  co-workers  have  utilized  this 
fact  clinically  and  report  many  advantages  in 
both  the  prevention  and  treatment  of  rachitis  by 
the  feeding  of  “anti-rachitic  cow’s  milk”,  stating 
that  when  rachitic  infants  were  fed  upon  such 
milk,  definite  calcification  was  brought  about 
Within  thirty  days. 

Roessler22  in  experimenting  along  similar  lines 
found  that  “the  milk  of  cows  on  a green  fodder 
diet  had  the  same  effect  as  ergosterol,  but  that 
winter  milk  did  not  possess  this  property.” 

Hunt  and  Krauss23  have  proved  that  the  milk 
from  cows  on  green  pasture  has  a higher  Vitamin 
G content  than  cows  on  dry  feed,  and  that  cows 
on  pasture  during  a vigorous  plant  growth  pro- 
duce milk  with  higher  Vitamin  G content  than 
those  on  pasture  that  is  over-mature.  These 
authors  also  state  that  Vitamin  B is  influenced  in 
the  same  manner  but  to  a less  degree.  Ernst34 
states  that  both  quality  and  quantity  of  milk  are 
dependent  upon  the  quality  of  the  cow’s  food,  and 
also  that  the  texture  and  quality  of  butter  are  de- 
termined by  the  diet  of  the  animal.  Brown  and 
Sutton15  have  proved  that  the  administration  of 
Manhadon  (fish)  oil  to  producing  cows  not  only 
“lowers  production,  but  also  the  percentage  of 
butter  fat  and  the  total  amount  of  butter  fat”. 

Daniels®  found  that  vitamins  are  present  in  the 
milk  only  in  the  proportions  existing  in  the  diet 
of  the  animals  producing  it. 

Lachet2'  indicates  the  growing  belief  among  in- 
vestigators that  carotin,  the  yellow  coloring  ma- 
terial of  plants,  is  definitely  correlated  with  the 
physiological  activity  of  the  fat  soluble  Vitamin 
A.  Bugi,30  from  an  extensive  experimental  series, 
states  that  chlorophyll  is  “the”  or  at  least  one  of 
the  growth  factors  and  is  either  Vitamin  A or 
absorbs  it.  Zih37  in  feeding  rabbits  observed  an 
erythropenic  effect,  not  controlled  by  Vitamin  B 
or  C,  when  dry  or  chlorophyll-free  food  was  used. 
The  addition  of  chemically  pure  chlorophyll  or  of 
green  food  to  the  diet  caused  a rapid  return  to  a 
normal  red  blood  count.  He  postulates  that  the 
hemopoietic  effect  of  chlorophyll  is  due  to  its  re- 
duction products  which  are  thought  to  be  related 
to  those  of  hemoglobin  and  to  have  the  same 
action  on  the  blood-forming  elements  of  the  bone 
marrow.  Hart28  states  that  we  now  know,  or  think 
we  know,  that  carotin  is  the  precursor  of  Vitamin 
A “and  that  Vitamin  A is  more  abundant  in  the 
milk  of  pasture  fed  cows  than  those  stall  fed.” 

Olcott  and  McCann29  have  very  recently  added 
the  necessary  proof  of  this  statement  by  combin- 
ing the  liver  tissue  of  a rat  suffering  from  severe 
Vitamin  A deficiency  with  carotin  and  allowing 
them  to  incubate  over  night.  When  upon  examina- 
tion they  were  able  to  demonstrate  a spectroscopic 
band  for  Vitamin  A which  was  previously  absent 
in  both  the  liver  and  the  carotin,  these  workers 
further  proved  that  by  heating  the  liver  tissues 


before  the  addition  of  the  carotin,  no  Vitamin  A 
band  appeared.  This  is  of  interest  in  the  present 
connection  because  of  the  fact  that  carotin  in 
association  with  chlorophyll  is  the  pigment  which 
gives  the  characteristic  green  color  to  the  grass 
and  to  the  leaves  of  trees  and  plants.  Chemists 
inform  us  that  the  chlorophyll  of  the  green  grass 
and  vegetables  is  almost  identical  in  chemical 
composition  with  the  hemoglobin  of  the  blood, 
apparently  performing  much  the  same  function 
in  the  plant  as  does  the  hemoglobin  in  the  animal 
body,  the  only  essential  difference  being  that  the 
structural  units  of  chlorophyll  are  linked  together 
by  magnesium,  while  those  of  hemoglobin  are 
linked  by  iron.32  As  has  already  been  indicated,  it 
is  the  actively  growing  green  grass  and  the  hay 
that  maintains  its  green  color  that  give  high 
vitamin  potency  to  milk. 

A further  interesting  obseiwation  along  this 
same  line  is  that  of  Koessler  and  Maurer,30  who 
assert  that  Vitamin  A is  essential  for  normal 
blood  regeneration,  and  that  there  is  a definite  re- 
lationship between  a state  of  chronic  Vitamin  A 
deficiency  and  certain  anemias  of  man. 

EXPERIMENTS 

In  a comprehensive  series  of  experiments 
previously  reported,3*  it  was  demonstrated  that 
the  milk  of  cattle  fed  upon  a diet  consisting  of  a 
warm  malted  and  hydrolized  hay  and  grain  mix- 
ture (the  hay  being  a first  grade  alfalfa)  to 
which  a complex  mineral  formula  was  added, 
proved  to  be  an  entirely  adequate  diet  for  white 
rats  to  whom  it  was  given  as  an  exclusive  diet. 
A diet  consisting  exclusively  of  milk  from  cattle 
fed  upon  the  usual  winter  dairy  ration,  proved  to 
be  inadequate,  the  rats  rapidly  becoming  anemic. 

In  a subsequent  series  of  experiments  the 
animals  used  were  weanling  rats  who  had  never 
tasted  food  other  than  the  mother’s  milk.  These 
rats  were  divided  into  groups  of  six  each.  The 
first  group  was  the  control,  receiving  a normal 
diet  of  grain,  vegetables,  and  bread.  The  second 
group  received  the  herd  milk  unheated,  the  thii’d 
group  was  fed  the  milk  of  the  same  herd  after  it 
had  been  heated  to  145°  for  30  minutes.  A fourth 
group  of  rats  was  fed  upon  the  milk  of  cattle 
which  were  receiving  the  usual  dry  “winter  feed” 
and  had  no  grass  or  other  green  food  during  the 
time  of  the  experiment.  The  fifth  group  of  ani- 
mals in  this  series  was  given  the  fresh  milk  of 
cows  who  were  upon  official  test  and  who  were 
producing  from  90-100  pounds  per  day  during  the 
period  of  observation. 

This  experiment  was  of  comparatively  brief 
duration,  extending  over  a period  of  only  eleven 
weeks,  yet  in  this  short  time  rather  striking  re- 
sults were  obtained.  The  rats  used  as  experi- 
mental animals  were  all  bom  within  a period  of 
three  days  and  all  closely  approximated  42.5 
grams  in  weight  and  a blood  count  of  5,300,000 
red  corpuscles  when  weaned.  During  the  period 
of  the  experiment  the  following  results  were 


March,  1933 


Nutritional  Anemia — Scott  and  Delor 


167 


Fig.  I.  Chart  illustrating  the  red  blood  count  and  weight 
records  of  a group  of  rats  changed  from  the  milk  of  cows 
on  special  feed  to  the  milk  of  those  fed  the  usual  dairy 
ration. 

noted:  The  control  group  gained  113  grams  in 
weight  and  4,700,000  red  blood  cells.  The  group 
upon  unheated  herd  milk  gained  100  grams  in 
weight  and  2,340,000  red  blood  cells.  The  group 
receiving  the  herd  milk  heated  gained  66.5  grams 
and  lost  2,340,000  red  blood  cells.  The  group  fed 
upon  milk  from  the  cows  upon  winter  feed  gained 
only  12  grams  in  weight  and  lost  2,480,000  red 
blood  cells,  while  those  fed  upon  the  milk  of  the 
cows  upon  official  test  gained  only  9.5  grams  in 
weight  and  lost  3,600,000  red  blood  cells. 

The  herd  from  which  the  milk  used  in  this 
series  of  experiments  was  obtained  was  a Hol- 
stein herd  that  was  fed  the  warm  hydrolized 
ground  alfalfa  hay  and  grain  diet  similar  to  that 
used  in  the  series  of  experiments  previously  re- 
ported. Mineral  mixture,  however,  was  omitted  as 
was  the  fish  meal.  The  cows  upon  “winter  feed” 
received  a dry  grain  mixture  of  corn,  oats,  oil 
meal,  and  cotton  seed  meal  with  a poor  quality  of 
brown  hay  (timothy  and  clover)  and  a small 
amount  of  silage.  The  cows  upon  official  test  were 
fed  the  warm  ground  feed  as  used  in  the  general 
herd  but  were  fed  to  their  capacity.  The  animals 
fed  upon  the  milk  from  these  test  cattle  showed 
very  early  lack  of  growth  and  vitality  and  at  the 
end  of  six  weeks  three  of  the  group  died.  The 
other  groups  of  this  series  showed  rather  wide 
variation  in  weight  and  in  the  red  blood  count. 
The  control  group  and  the  group  fed  upon  the  un- 
heated portion  of  the  general  herd  milk  developed 
in  an  entirely  normal  manner,  while  those  upon 
the  heated  portion  of  the  milk  from  the  general 
herd  and  those  fed  upon  the  milk  from  the  portion 
of  the  herd  kept  upon  “winter  feed”  presented 
well  marked  anemia. 

At  the  conclusion  of  this  experiment  the  rats  of 
groups  three,  four,  and  five,  or  those  which  had 
received  the  heated  herd  milk,  the  milk  of  the 
cows  upon  the  winter  feed,  and  the  rat  that  had 
been  rendered  anemic  by  the  use  of  the  milk  from 
the  high  producing  cows,  were  removed  to  another 
laboratory  and  placed  upon  a diet  consisting  of 
the  milk  from  a herd  that  was  receiving  a 


Fig.  II.  The  upper  photograph  shows  a representative 
of  the  group  fed  an  exclusive  diet  of  milk  from  a herd  re- 
ceiving the  “special”  feed.  The  center  photograph  shows  a 
litter  mate  of  the  above,  which  had  received  for  the  same 
period,  the  milk  of  cows  of  the  same  herd  but  which  were 
fed  only  the  “winter”’  ration.  The  lower  photograph  pic- 
tures the  same  animal  as  that  in  the  center  after  it  had 
been  fed  for  40  days  upon  the  milk  of  cows  which  were  on 
an  abundant  bluegrass  pasture. 

liberal  dry  grain  ration  plus  minerals  and  fish 
meal,  supplemented  by  an  abundant  green  blue- 
grass  pasture.  To  this  changed  diet  the  experi- 
mental rats  showed  a quick  response  and  within 
a thirty-day  period  showed  the  following  gains: 
The  group  pi’eviously  on  heated  milk  gained  in 
weight  an  average  of  51  grams  and  an  increase 
of  5,000,000  red  blood  cells.  Those  formerly  fed 
on  milk  from  “winter  fed”  cows  made  an  average 
gain  of  63  grams  and  an  increase  in  red  blood 
cells  of  5,500,000.  The  rat  from  the  group  fed 
upon  the  milk  of  the  test  cattle  gained  108  grams 
and  6,700,000  red  blood  cells  in  71  days  upon  a 


168 


The  Ohio  State  Medical  Journal 


March,  1933 


diet  of  this  special  milk,  with  lettuce  occasionally 
during  the  first  30  days. 

In  a still  later  experiment  in  which  the  same 
general  methods  of  procedure  were  followed  as  to 
animals,  cages,  and  food  of  the  experimental 
animals  (rats)  were  carefully  maintained,  very 
different  results  were  obtained.  This  experiment 
was  started  on  October  17,  1931,  and  the  milk 
used  was  from  the  same  herd  that  had  given  such 
excellent  results  during  the  preceding  month  of 
August.  During  the  progress  of  this  test,  how- 
ever, the  rats  failed  to  respond  in  growth  and 
showed  both  loss  of  erythrocytes  and  hemoglobin. 
This  condiiton  became  more  noticeable  during  No- 


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Fig.  III.  Chart  illustrating  the  rapid  remission  of  the 
anemia  in  groups  maintained  upon  the  same  basic  diet  but 
with  hemopoietic  substances  in  the  form  of  alfalfa  extract, 
halibut  liver  oil,  milk  from  cows  upon  “special”  feed  and 
mixed  food  added  to  the  diet. 

vember  and  was  quite  marked  during  December. 
In  seeking  an  explanation,  it  was  found  that  the 
herd  producing  the  milk  had  been  upon  a failing 
pasture  supply  during  October,  and  November 
and  that  in  December  they  were  entirely  upon  a 
ration  of  dry  grain,  a mineral  mixture,  fish  meal, 
and  silage.  The  hay,  however,  which  was  thought 
to  be  first  quality  alfalfa  had  heated  in  the  mow 
and  was  bleached  and  brown.  This  result  was  in 
all  regards  similar  to  that  obtained  from  the  milk 
of  the  so-called  “winter  fed”  group  of  the  previous 
experiment  and  corresponds  closely  with  the  re- 
sults of  Krauss,  Erb  and  Washburn.33 

Changes  were  instituted  in  the  feeding  of  the 
herd  producing  this  milk.  A first  grade  furnace 
dried  alfalfa  meal  was  obtained,  the  silage  was 
withdrawn,  and  the  hay  was  hydrolized  and  malted 
as  in  the  earlier  experiments.  The  grain  and 
mineral  rations  were  not  changed.  With  this 
change  of  feed  the  milk  of  these  cattle  soon  re- 
gained its  growth  and  hemopoietic  properties, 
and  rats  that  were  already  anemic  gained  2,000,- 
000  red  blood  cells  and  43  per  cent  hemoglobin  in 
a period  of  26  days.  Again  in  this  experiment  it 
is  strongly  indicated  that  the  factor  in  milk  con- 
cerned with  growth  and  hemopoiesis  is  entirely 
dependent  upon  the  food  and  the  feeding  methods, 


especially  with  the  quality  and  pigment  content 
of  the  hay,  rather  than  the  heating  of  the  milk. 

In  association  with  this  last  series  a number  of 
what  may  be  termed  purely  laboratory  experi- 
ments have  been  conducted  in  order  to  find  if 
possible  what,  if  any,  substance  might  duplicate 
the  action  of  this  unknown  factor  of  milk  which 
stimulates  blood  regeneration.  Carotin,  because 
of  its  close  chemical  relationship  to  hemoglobin 
was  chosen  first,  and  a sample  of  this  material 
was  obtained  through  the  courtesy  of  the  Di- 
gestive Ferments  Co.  of  Detroit.  This  substance 
used  alone  in  the  milk  in  doses  of  0.1  mg.,  later 
increased  to  1.0  mg.  per  rat  per  day,  was  at  first 
thought  not  to  be  giving  the  expected  results,  but 
more  prolonged  investigation  of  its  properties  in- 
dicates that,  while  somewhat  slow  in  its  reaction, 
it  ultimately  gives  satisfactory  results,  in  our 
series  giving  a count  of  7,000,000  corpuscles  and 
90  per  cent  hemoglobin  in  90  days. 

Following  the  work  of  Olcott  and  McCann,  who 
have  so  recently  proved  that  carotin  is  converted 
into  Vitamin  A by  enzymatic  action  of  the  liver, 
it  was  decided  to  add  as  nearly  as  possible  a pure 
Vitamin  A to  the  deficient  milk  diet  of  already 
anemic  rats.  The  material  used  in  this  experi- 
ment was  the  pure  Halibut  liver  oil  to  which  no 
Vitamin  D had  been  added.  This  preparation  was 
kindly  furnished  us  by  the  Research  Department 
of  the  Parke-Davis  Co.  This  material  was  used 
in  amounts  of  2 to  3 drops  per  rat  per  day  and 
has  given  marked  results,  increasing  the  number 
of  red  blood  cells  2,500,000  cells  with  a gain  of 
46  per  cent  hemoglobin  in  a period  of  24  days. 

To  another  group  of  anemic  rats  there  was 
added  an  alcoholic  extract  of  furnace  dried  al- 
falfa hay.  This  extract  had  been  evaporated  to 
dryness  and  redissolved  in  olive  oil.  This  extract 
was  given  in  doses  of  5 drops  per  rat  per  day  and 
was  estimated  to  represent  3 grams  of  the 
original  hay.  Chemical  analysis  of  this  alfalfa 
extract  shows  that  the  daily  dose  of  iron  was 
.00171  mg.,  that  of  copper  .00135  mg.  Beard  and 
Myers2,  11  state  that  the  minimum  dose  of  iron 
necessary  to  stimulate  hemopoiesis  is  .25  mg.,  plus 


Fig.  IV.  Chart  illustrating  the  gain  in  hemoglobin  con- 
tent of  the  blood  of  the  same  animals  as  shown  in  Chart  III. 


March,  1933 


Nutritional  Anemia— Scott  and  Delor 


169 


Fig.  V.  Chart  showing  the  erythrocytic  response  to 
dietary  changes  in  the  same  herd  of  cattle  which  were 
changed  from  grass  to  winter  feed  with  poor  hay  and  later 
placed  upon  the  “special”  feed. 

.025  mg.  of  copper.  It  may  be  seen,  therefore,  that 
the  dosage  of  iron  and  copper  in  the  extract  is 
far  from  sufficient  to  supply  the  minimum 
amounts  established  by  these  workers.  In  this 
group  of  experimental  rats  again  there  was  ob- 
served very  rapid  regeneration  of  both  hemo- 
globin and  erythrocytes,  these  animals  showing 
an  increase  of  3,000,000  cells,  and  a 41  per  cent 
gain  in  hemoglobin  in  26  days,  while  the  group 
that  was  placed  upon  the  basic  (or  control)  diet 
in  the  same  period  of  time  gained  1,700,000  cells 
and  46  per  cent  hemoglobin. 

Other  substances  are  being  tested,  but  thus  far 
none  have  given  such  favorable  results  as  those 
mentioned. 

The  results  of  the  work  done  in  this  laboratory 
tend  to  confirm  the  conclusions  of  Guha,31  who 
states  that: 

Both  milk  and  yeast  contain  a factor  that  is 
required  for  the  normal  growth  of  rats. 

That  the  factor  present  in  milk  is  different 
from  other  known  vitamins,  A,  C,  D,  E. 

That  the  milk  factor  cannot  be  corrected  by 
lactalbumin  or  amino  acids. 

The  milk  factor  is  thermolabile  at  high  tem- 
perature which  argues  against  its  inorganic 
nature. 

The  factor  is  present  in  egg,  spinach,  grass  and 
alfalfa. 

Carotin  and  chlorophyll  do  not  replace  the  milk 
factor  in  the  diet. 

CONCLUSIONS 

1.  Experimental  proof  is  presented  that  the 
nutritional  anemia  of  the  white  rat  may  be  re- 
lieved by  either  (a)  the  feeding  of  the  milk  from 
cows  fed  in  the  manner  described,  or  (b)  by  the 
addition  of  an  iron  and  copper  free  extract  of 
alfalfa,  or  (c)  by  the  addition  of  a liver  oil  high 
in  Vitamin  A to  the  deficient  milk  diet. 


Appreciation  is  expressed  to  Professor  Oscar  Erf  for  his 
supervision  of  the  feeding  of  the  cattle  from  which  the 
special  milk  used  in  these  experiments  was  obtained. 


2.  This  growth  promoting  factor  is  absent  or 
insufficient  in  the  milk  of  cattle  fed  upon  the 
usual  winter  dairy  ration. 

3.  This  factor,  when  present  in  milk  following 
the  special  feeding  of  the  cattle,  is  thermolabile. 

4.  Further  evidence  has  been  obtained  of  the 
very  intimate  relationship  existing  between  the 
feed  of  the  cow  and  the  hemopoietic  factor  or 
factors  in  the  milk. 

5.  Milk,  to  be  of  the  highest  nutritive  value, 
must  contain  the  factors  resulting  from  the 
presence  of  the  vegetable  pigments  in  the  food  of 
the  cow. 

6.  The  rapidly  growing  belief  in  the  close  asso- 
ciation between  the  vegetable  pigments,  carotin 
and  chlorophyll,  and  Vitamin  A or  its  associated 
factors  is  strengthened  by  these  experiments. 

BIBLIOGRAPHY 

1.  Editorial,  J.A.M.A.,  98:320  (Jan.  23),  1932. 

2.  Beard,  H.  H.  and  Myers,  V.  C. : J.  Bioehem.,  94:73-75, 
(Nov.),  1931. 

3.  Mitchell,  H.  A.  and  Schmidt,  L. : J.  Bioehem.,  70 : 

471,  1926. 

4.  Drablcin,  D.  L.  and  Waggoner,  C.  S. : J.  Bioehem., 

89:51,  1930. 

5.  Keil,  H.  and  Nelson,  V.  E. : Proc.  Soc.  Exp.  Biol, 

and  Med.,  .28:392,  1931. 

6.  Hart,  E.  B.  et  ah:  J.  Bioehem.,  77:777,  1928. 

7.  Hart,  E.  B.  et  al. : Ibid,  77 :797,  1928. 

8.  Lewis,  G.  T. : Proc.  Soc.  Exp.  Biol,  and  Med.,  27  :329, 

1929-1930. 

9.  Krauss,  W.  E. : J.  Bioehem.,  90  :767,  1931. 

10.  Steenbock,  H.  J. : J.  Bioehem.,  85  :451,  1929. 

11.  Myers,  V.  C.  and  Beard,  H.  H. : J.  Bioehem,  94: 

91-99  (Nov.),  1931. 

12.  Myers,  V.  C.  and  Beard,  H.  H. : J.  Bioehem.,  94  :105, 

(Nov.),  1931. 

13.  Supplee,  G.  C.,  Dow,  O.  D.,  Flanigan,  G.  E.,  and 

Kahlenberg,  O.  J. : J.  Nutr.,  2 :451,  1930. 

14.  Beard,  H.  H.  and  Myers,  V.  C. : J.  Bioehem.,  94: 
83-85,  Nov.),  1931. 

15.  Hill,  L.  W. : New  England  Med.  Jour.,  70:761, 

1929. 

16.  Furniss,  S. : Am.  J.  Physic.  Therapy,  7 :465,  1931. 

17.  Osato,  S.  and  Tanaka,  S. : Z.  Ges.  Exp.  Med.,  63 : 

6921,  1929. 

18.  Moore,  T. : Bioehem.  Jour. : 24  :692,  1930. 

19.  Thomas,  B.  H.  and  MacLeod,  F.  L. : Science  N.S., 

73,  1901:618,  (June  5),  1931. 

20.  Krauss,  W.  E.  and  Bethka,  R.  M. : Meeting  of  Assn. 

Biol.  Chem.,  (April),  1931,  cited  by  Hess,  A.  F.,  J.A.M.A., 
Vol.  97,  No.  6,  (Aug.  8),  1931. 

21.  Hess,  A.  F.,  Lewis,  J.  M.,  MacLeod,  F.  L.  and 

Thomas,  B.  H. : J.A.M.A.,  97:370,  (Aug.  8),  1931. 

22.  Roessler,  G. : Arch.  Exp.  Path  and  Pharmac.,  155 : 

144-58,  1930. 

23.  Hunt,  C.  H.  and  Krauss,  W.  E. : J.  Biol.  Chem., 

92:3-631,  (Aug.),  1931. 

24.  Ernst,  William : Trans,  by  Mohler  Eickhorn. 

25.  Brown,  J.  B.  and  Sutton,  T.  S. : Jour.  Dairy  Science, 
14:2-125,  (March),  1931. 

26.  Daniels,  Amy  L.  : Proc.  Amer.  Assn.  Medical  Milk 

Com.,  169-173,  1930. 

27.  Lachet.  L.  L. : Jour.  Chem.  Edue.,  8 :875-83,  1931. 

28.  Hart,  E.  B. : Certified  Milk,  65  :5,  No.  6,  1931. 

29.  Olcott,  D.  S.  and  McCann,  H.  S. : J.  Bioehem., 

94:185-193,  (Nov.), '1931. 

30.  Koessler,  K.  F.  and  Maurer,  S:  J.A.M.A.,  89:768, 

1927. 

31.  Guha,  B.  C. : Bioehem.  Jour.,  25 :970,  1931. 

32.  Thatcher,  R.  W. : The  Chemistry  of  Plant  Life,  p. 

110,  McGrow-Hill  Book  Co.,  N.  Y. 

33.  Krauss,  W.  E.,  Erb,  J.  H.  and  Washburn,  R.  G.  : 
Bimonthly  Bulletin  Ohio  Experiment  Station,  Jan.-Feb., 
1932,  No.  154. 

34.  Scott,  E.  and  Erf,  L.  A. : Proc.  Am.  Assn.  Med. 

Milk  Com.,  1930. 

35.  Scott,  E.  and  Erf,  L.  A. : Proc.  International  Assn. 

Dairy  and  Milk  Inspectors,  1931. 

36.  Burgi,  Emil:  Klin.  Wochschr.,  9:789-90,  1930,  C. 

A.  25  :3380. 

37.  Zih,  A.  : Archiv.  f.d.  gesamt.  Physiol,  von  Pfluger, 
225  :728-736. 


5111 


imt 


Walter  G.  Stern,  M.D.,  Cleveland,  Ohio 


AFTER  the  temporary  period  of  convales- 
cence and  rehabilitation  is  over;  after 
orthopedic  surgery  and  vocational  rehabil- 
itation have  finished  in  their  work  of  restoring  the 
injured  individual  so  that  he  can  be  returned,  if 
possible,  back  into  useful  industry,  comes  the  in- 
definite period  of  permanent  disability,  either 
total  or  partial,  which  in  this  modern  age  of 
sociological  development,  usually  calls  for  ad- 
ditional compensation  or  indemnity.  The  actual 
payment  of  money  by  an  indemnifying  board  is  in 
itself  a comparatively  simple  process,  for  prac- 
tically all  have  adopted  fixed  schedules  of  loss  for 
certain  fixed  anatomical  conditions  and  deformi- 
ties, and,  whether  such  indemnity  is  paid  in  one 
lump  sum  or  upon  a weekly  basis,  it  is  usually 
computed  from  an  anatomical  standpoint  and  paid 
accord:ng  to  some  fixed  formula,  whether  set 
down  by  law  or  by  a board  of  actuaries. 

But  whilst  laws  and  tables  may  differ  widely, — 
for  instance  in  New  Mexico,  the  loss  of  the  whole 
of  the  major  arm  is  rated  only  as  29  per  cent  of  a 
permanent  total  disability,  while  Iowa  allows  56 
per  cent, — the  disabilities  themselves  are  constant 
and  under  similar  conditions  of  labor  constitute 
anywhere  the  same  relative  loss  of  use  to  the  in- 
dividual. So  in  practice,  all  compensating  bodies 
must  depend  upon  physicians  for  the  exact  in- 
formation concerning  the  amount  and  nature  of 
the  disability  before  their  schedules  of  indemni- 
ties can  be  put  into  effect.  Thus,  we  find  that  the 
entire  medical  profession  may  at  times  be  called 
upon  to  express  opinions  as  to  the  nature  and  ex- 
tent of  injuries  and  disability.  Such  reports 
should  be  based  upon  a common  understanding  of 
the  problem  and  should  furthermore  be  couched  in 
terms  readily  understandable  by  all  compensating 
bodies,  upon  whatever  nature  their  schedule  is 
based. 

In  order  to  have  a common,  readily  understood 
standard,  it  has  been  proposed  by  the  Inter- 
national Association  of  Industrial  Accident  Boards 
and  Commissioners  to  have  the  amount  of  dis- 
ability expressed  not  merely  with  the  anatomic 
extent  of  the  loss,  but  rather  in  percentages  of 
Permanent  Total  Disability  (P.T.D.),  which  is 
intei  preted  as  100  per  cent  of  unfitness  for  future 
industrial  usefulness.* * 

In  estimating  permanent  disability  the  follow- 
ing must  be  kept  in  mind: 


ivr,J^e?ld  b~?Ie  ^Section  on  Public  Health  and  Industria 
Medieme  Oh10  State  Medical  Association,  at  the  86th  An 
nual  Meeting,  Dayton,  May  3-4,  1932. 

*Taken  from  the  report  of  Committee  appointed  by  th 
Central  States  Clinical  Orthopedic  Society  on  “Estimatioi 
of  Percentages  of  Disability  in  Injury  of  the  Lower  Ex 
tremity ’. 


1.  Compensation  paid  for  permanent  disability 
is  that  paid  after  temporary  disability 
ceases — that  is,  for  the  loss  of  earning 
power  after  healing  has  taken  place. 

2.  Compensation  for  such  permanent  disability 
should  be  valued  on  disability  for  a lifetime. 
Only  13  states  allow  this — others  have  a 
time  or  money  limitation. 

3.  Permanent  disability  should  be  based  on  a 
table  of  fixed  ratings,  modified  by  important 
variable  factors.  These  latter  are: — 

a.  Age.  A man  of  sixty  is  greatly  more 

disabled  by  the  loss  of  an  arm 
than  a man  of  thirty-five.  There 
are  five  distinct  breaks  in  the  line 
representing  age: 

1.  15-25  years  is  the  experimental 
age  when  average  boy  is  learn- 
ing his  trade,  etc. 

2.  25-30  years  show  decided 
change,  usually  has  learned 
trade,  social  status — changed  by 
marriage,  etc. 

3.  30-50  greatest  productive  age. 
At  40,  usually  starts  on  decline. 
Trade  is  fixed,  hard  to  adapt  to 
new  one,  etc.,  accentuating  any 
disability. 

4.  50-60  above  factors  are  even 
more  accentuated. 

5.  60  above — age  is  less  important. 
At  the  end  of  industrial  activity. 

b.  The  type  of  occupation.  There  is  a dis- 
tinct and  unique  relation  to  the  amount 
of  disability  arising  from  a given  injury. 
The  United  States  Veterans  Bureau  uses 
a most  comprehensive  and  detailed  table 
of  occupations  with  a variant  ratio  rang- 
from  1 to  9,  the  lightest  occupation 
usually  rating  the  lowest. 

The  type  of  work  must  always  be  borne 
in  mind.  For  instance,  a seamstress 
working  with  thin  silk  must  be  able  to 
take  a firm  grasp  of  her  materials  with 
the  left  hand. 

Disabled  people  are  often  able  to  do  much 
heavier  types  of  work  while  working  for 
themselves, — and  from  the  nature  of 
things,  resting  whenever  a painful  spasm 
arises, — than  they  could  for  an  unsym- 
pathetic foreman  who  might  drive  them 
beyond  the  limit  of  their  endurance. 

The  type  of  light  work  that  any  individ- 
ual can  do  is  usually  not  specified.  This 
leaves  such  partial  disability  cases  at  the 
mercy  of  the  unsympathetic  foreman  who 
wishes  to  relieve  his  department  of  the 
burden  of  keeping  crippled  employees; 
and  thus,  in  one  of  the  cases  I have  in 
mind,  light  work  for  a crippled  man 
with  a crippled  ankle,  consisted  in  carry- 
ing two  pails  full  of  cutting  liquid  all 
day  long  up  three  flights  of  stairs,  a task 


170 


March,  1933  Disability  From  an  Orthopedic  Standpoint — Stern 


171 


TABLE  I. 


PERCENTAGES  OF  DISABILITY  FOR  PERMANENT  PARTIAL  DISABILITIES  AT  VARIOUS  AGES 


Nature  of  Injury 

15  and 
under  20 

25 

30 

35 

40 

45 

50 

55 

60 

65 

70  & 
over 

Major  arm  at  shoulder 

40. 

42.5 

45. 

50. 

52.5 

55. 

60. 

65. 

72.5 

80. 

82.5 

85. 

Minor  arm  at  shoulder  

38. 

40.375 

42.75 

47.5 

49.875 

52.25 

57. 

61.75 

68.875 

76. 

78.375 

80.75 

Major  arm  at  or  above 

elbow 34. 

36.125 

38.25 

42.5 

44.625 

46.75 

51. 

55.25 

61.625 

68. 

70.125 

72.25 

Minor  arm  at  or  above 

elbow 32.3 

34.3 

36.3 

40.376  42.4 

44.4 

48.45 

52.49 

58.54 

64.6 

66.61 

68.64 

Major  hand  at  or  above  wrist-  26-1 

28-5 

30. 

33-5 

35. 

36-£ 

40. 

43-3 

48-3 

53-3 

55. 

56-1 

Minor  hand  at  or  above 

wrist-  25.3 

26.9 

28.6 

31-1 

33.25 

34/8 

38. 

41.2 

49.9 

50-5 

52.25 

53.8 

Thumb  . 

8. 

8.5 

9. 

10. 

10.5 

11. 

12. 

13. 

14.5 

16. 

16.5 

17. 

Index  finger  

4. 

4.25 

4.5 

5. 

5.25 

5.5 

6. 

6.5 

7.25 

8. 

8.25 

8.5 

Middle  finger  

. 3.2 

3.4 

3.6 

4. 

4.2 

4.4 

4.8 

5.2 

5.8 

6.4 

6.6 

6.8 

Ring  finger  

— 2.4 

2.55 

2.7 

3. 

3.15 

3.3 

3.6 

3.9 

4.35 

4.8 

4.95 

5.1 

Little  finger  . . - 

2.4 

2.55 

2.7 

3. 

3.15 

3.3 

3.6 

3.9 

4.35 

4.8 

4.95 

5.1 

Leg  at  Hip 

40. 

42.5 

45. 

60. 

62.5 

55. 

60. 

65. 

72.5 

80. 

82.5 

85. 

Leg  at  or  above  knee 

34. 

36.125 

38.25 

42.5 

44.625 

46.75 

51. 

55.25 

61.625 

68. 

70.125 

72.25 

Leg  at  or  above  ankle  — 

20. 

21.25 

22.5 

25. 

26.25 

27.5 

30. 

32.5 

36.25 

40. 

41.25 

42.5 

Great  Toe  

..... 3.2 

3.4 

3.6 

4. 

4.2 

4.4 

4.8 

5.2 

5.8 

6.4 

6.6 

6.8 

Other  Toes 

.8 

.85 

.9 

1. 

1.05 

1.1 

1.2 

1.3 

1.45 

1.6 

1.65 

1.7 

Eye  

16. 

17. 

18. 

20. 

21. 

22. 

24. 

26. 

29. 

32. 

33. 

34. 

Hearing,  one  ear 

4. 

4.25 

4.5 

5. 

5.25 

5.5 

6. 

6.5 

7.25 

8. 

8.25 

8.5 

Hearing,  both  ears  

26-| 

28-5 

30. 

33-5 

35. 

36-g 

40. 

43-3 

48-3 

53-3 

55. 

56-  S 

Report  of  Committee  of  International  Association  of  Industrial  Accident  Boards. 


which  nobody,  except  when  in  the  pink 
of  health  and  strength,  could  do. 

c.  The  will  to  work.  The  mental  attitude  of 
the  patient  greatly  influences  his  ability 
to  carry  out  the  work  which  his  dis- 
ability, age  and  occupation  should  war- 
rant his  performance.  Malingery  and 
deliberate  exaggeration  must  always  be 
summarily  condemned,  but  genuine  psy- 
choneurosis must  at  least  be  viewed  in  a 
sympathetic  manner.  Some  states,  the 
latest  being  Iowa  and  Nebraska,  actually 
pay  compensation  for  such  conditions 
(J.A.M.A.,  April  2,  1932). 

An  examining  physician  must  at  all  times 
be  on  his  guard  against  the  obvious  fal- 
lacy of  calling  every  hidden  and  unex- 
plainable condition  a neurosis  or  exag- 
geration, and  it  is  the  writer’s  opinion 
and  his  constant  practice,  never  to  make 
a diagnosis  of  neurosis  until  after  re- 
peated examinations  have  fully  demon- 
strated the  lack  of  objective  corrobo- 
rative evidence  of  the  actual  existence  of 
disability.  Often  actual  disability  of  a 
minor  grade  and  psycho-neurosis  co- 
exist. The  compensating  board  situated 
at  a distance  and  seeing  only  the  cold, 
formal  report,  cannot  be  expected  to 
evaluate  these  conditions  as  can  the  ob- 
serving examining  physician. 

d.  The  presence  of  pain,  be  it  ever  so  slight, 
is  a most  disturbing  factor,  and  one  ex- 
tremely difficult  to  evaluate.  In  some 
regions,  as  the  shoulder  and  spine,  the 
presence  of  pain  can  be  estimated  by  the 
muscle  spasm  which  accompanies  painful 
motion;  but  pain  in  a neighboring  joint 
absolutely  destroys  any  values  given  to 
the  fixed  disability  ratings  of  existing 
deformities,  as  given  in  the  tables  herein 
submitted.  Especially  in  partial  anky- 
losis or  fractures  near  a joint  it  is  my 
belief  that  a stiff  and  painless  joint  is 
far  preferable  to  a movable  joint  which 
produces  pain.  Tender  scars  or  amputa- 
tion stumps  add  1 per  cent  to  fixed  dis- 
ability rating. 


e.  Pre-existing  disease  which  has  been  ren- 
dered active,  painful  and  disabling  by 
the  injury,  or  disease  which  has  resulted 
from  the  trauma,  must  always  be  given 
due  consideration.  For  instance,  tabetic 
arthropathy — Charcot’s  Joint — is  often 
seen  following  fractures,  the  first  .X-rays 
of  which  were  entirely  negative  except 
for  the  fracture  and  the  condition  ob- 
served to  have  developed  month  by 
month.  Osteo-arthritis  which  had  hither- 
to been  painless  and  symptomless  can  be 
made  painful  and  disabling,  etc. 

The  writer,  however,  does  not  agree  with 
the  commonly  expressed  opinions  of 
Coley  and  Geshickter  that  sarcoma  of 
the  bone  can  arise  from  a single  injury. 
Neither  one  of  these  two  authors  offers 
any  proof  of  this  claim  beyond  the  his- 
tory of  an  injury.  One  could  readily 
understand  how  an  infection,  such  as 
tuberculosis,  might  crop  out  of  a locus 
minoris  resistentia  from  trauma,  but 
how,  for  instance  a giant  cell  tumor  deep 
in  the  interior  of  a condyle  of  a femur 
should  rise  from  a single  bruise  which 
does  not  even  break  the  tissues  of  the 
soft  parts  or  disarrange  the  lamellae  of 
the  cortex,  is  beyond  the  writer’s  con- 
ception. My  own  experience,  however, 
contains  several  positive  refutations  of 
this  theory. 

I would  like  to  put  on  record  a case  of  a motor- 
cycle patrolman  from  the  city  of  Erie,  Pennsyl- 
vania, who,  nine  years  before  my  observation,  re- 
ceived a severe  trauma  to  the  upper  leg,  with  sev- 
eral crack  fractures  into  the  upper  part  of  the 
tibia.  An  uneventful  convalescence  took  place,  but 
about  three  months  later,  a swelling  formed, 
which  was  incised  and  a straw  colored  fluid 
evacuated.  The  records  show  that  on  the  average 
of  once  every  three  to  six  months  from  that  time 
on,  he  consulted  one  or  other  of  the  local  sur- 
geons for  a new  painful  swelling  in  and  about 
this  region,  most  of  which  were  either  incised  or 


172 


The  Ohio  State  Medical  Journal 


March,  1933 


disappeared  under  rest  and  hot  applications.  His 
Wassermann  was  negative,  but  the  condition  was 
usually  diagnosed  as  a luetic  periostitis,  yet  no 
X-ray  proof  of  this  was  ever  offered. 

Finally,  he  noticed  a swelling  of  the  tibia  which 
would  not  go  down  under  incision  and  hot  appli- 
cations, and  finally  the  upper  portion  of  the  tibia 
started  to  enlarge  enormously.  I saw  him  two 
months  after  this  last  swelling  began,  and  as  he 
put  it,  there  was  five  times  more  swelling  and  en- 
largement of  the  upper  end  of  the  shin  in  the  last 
two  months  than  there  had  been  in  all  the  pre- 
ceding nine  years;  and  the  X-ray  showed  a large, 
central,  destructive  lesion  in  the  upper  end  of  the 
tibia  which  had  broken  through  the  cortex,  and 
which  I diagnosed  as  osteolytic  sarcoma  of  the 
tibia,  although  a giant  cell  tumor  with  perforation 
of  the  cortex  was  not  ruled  out.  The  leg  was 
amputated.  The  pathological  report  was  round 
cell  sarcoma  of  the  tibia,  and  this  was  accepted  by 
the  Sarcoma  Commission  of  the  American  College 
of  Surgeons  with  only  one  dissenting  voice, — that 
of  Ewing  of  New  York. 

If  there  was  ever  a case  of  bone  sarcoma  due 
to  a distinct,  well  proved  and  undeniable  injury, 
with  a tightly  forged  and  well  proven  chain  of 
medical  events — here  it  was. 

Four  months  after  the  amputation  the  patient 
developed  metastases  of  the  lungs  and  died.  The 
autopsy  showed  a tumor  of  the  right  suprarenal 
with  metastases  in  the  lungs,  and  microscopic 
sections  from  the  right  suprarenal  and  lungs  were 
typical  of  malignant  hypernephroma,  which  cor- 
roborated the  objection  raised  to  the  acceptance  of 
this  case  as  a primary  bone  sarcoma,  by  Ewing  of 
New  York,  who,  of  all  the  pathologists  to  whom 
the  sections  had  been  submitted,  called  the  case  a 
secondary  carcinoma  rather  than  a primary 
osteolytic  sarcoma. 

f.  Atrophy  or  soft  part  injury  which  is 
judged  permanent  due  to  nerve  injury, 
circulatory  changes,  etc.,  add  5 to  15  per 
cent  to  loss  of  function. 

g.  Swelling  of  limb  adds  5-15  per  cent  to 
loss  of  function,  when  due  to  permanent 
circulatory  change. 

h.  Tendon  injuries  are  estimated  according 
to  resultant  loss  of  function  of  neighbor- 
ing joints. 

i.  Nerve  injuries  give  a combination  of 
disabilities.  These  are  estimated  accord- 
ing to  the  loss  of  function  in  joints  in- 
volved, plus  an  estimated  per  cent  for 
atrophy,  trophic  changes  and  pain. 

j.  Ununited  fractures  rate  as  % of  an 
amputation  at  site  of  non-union  except 
in  cases  of  patella  and  hip,  where  it 
rates  100  per  cent.  Flail  joints  rate  as 
% of  loss  of  joint. 

FIXED  RATING  OF  DISABILITIES 

Forty  states  and  the  U.  S.  Compensation  Board 
for  Federal  Employees  now  have  compensation 
boards.  Practically  all  of  them  have  adopted 


fixed  schedules  of  percentage  of  loss  for  a certain 
number  of  fixed  disabilities,  usually  amputations 
of  various  members,  and  from  them  the  following 
tables  and  estimates  have  been  made.  The  amount 
of  the  disability  should  be  measured  from  the 
percentage  of  the  loss  of  function  in  the  part.* 

Example:  The  loss  of  a major  arm  at  the 
shoulder  by  a common  laborer  at  the  age  of  30 
(100  per  cent  loss  of  member)  is  rated  at  50  per 
cent  of  a Permanent  Total  Disability.  The  loss  of 
a leg  at  the  hip  (100  per  cent  loss  of  limb)  is 
given  the  same  rating;  viz. — 50  per  cent  P.T.D. 

Partial  loss  of  a member  is  figured  first  in  per- 
centage of  the  practical  loss  of  limb  function  and 
then  its  final  percentage  in  terms  of  P.T.D.;  as 
for  instance  the  loss  of  the  leg  at  the  ankle  is  con- 
sidered as  one-half  of  the  loss  of  the  limb  or  25 
per  cent  P.T.D.  Multiple  disabilities  of  an  ex- 
tremity are  computed  on  the  same  plan  as  are 
multiple  discounts  in  business,  but  the  maximum 
cannot  exceed  the  complete  loss  of  the  extremity. 

Example:  Flexion-contraction  of  hip  plus  loss 
of  little  finger.  Sixty  degrees  of  flexion  remaining 
in  the  hip  equals  53.6  per  cent  of  the  loss  of  the 
entire  amount  of  possible  flexion,  which  is  equal 
to  13.4  per  cent  P.T.D.  The  loss  of  the  little 
finger  is  equal  to  2%  per  cent  P.T.D.  Patient’s 
total  loss,  therefore,  would  be  computed  thus: 
first  subtract  percentage  of  disability  for  loss  of 
hip  = 86.6  per  cent  ability  remaining.  Two  per 
of  remaining  86.6  per  cent  (proportionate  loss  for 
finger)  equals  2.17  per  cent.  Subtract  this  from 
first  remainder  gives  final  disability  as  100 — 84.43 
per  cent  equal  to  15.57  per  cent  P.T.D. 

Note:  When  an  amputation  is  so  close  to  joint 
that  the  use  of  that  joint  is  impractical, — less 
than  3 inches — amputation  rating  is  reckoned  as 
above  the  joint. 


UPPER  EXTREMITY 

The  upper  extremity  includes  the  shoulder 
girdle.  Total  loss  of  the  upper  extremity  is  usual- 
ly defined  by  local  state  law;  average  is  50  per 
cent  P.T.D. 


I.  Sterno-clavicular  joint. 


a.  Ankylosis  f 

b.  Chronic  -J 

dislocation  [ 

II.  Clavicle. 

a.  Complete  loss  f 

b.  Non-union 

c.  Mal-union  ! 


rate  according  to  result- 
ing loss  of  active  shoul- 
der joint  motion 


rate  according  to  result- 
ing loss  of  active  shoul- 
der joint  motion 


III.  Acromi-clavicular  joint. 

a.  Ankylosis — as  above 

b.  Dislocation 

1.  Incomplete  (conoid  and  trapezoid  liga- 
ments intact) — 5 per  cent  P.T.D. 


*For  the  latest  and  most  comprehensive  schedule  of  in- 
demnity based  upon  disability  rating  adopted  by  any 
political  subdivision,  see  Bulletin  of  U.  S.  Dept,  of  Labor, 
Labor  Review  for  Dec.,  1931,  giving  the  new  workmen’s 
compensation  law  of  Mexico  which  went  into  effect  August 
28,  1931. 


March,  1933  Disability  From  an  Orthopedic  Standpoint — Stern 


173 


2.  Complete  (conoid  and  trapezoid  liga- 
ments torn) — rate  according  to  result- 
ing loss  of  active  shoulder  joint  motion. 

IV.  Scapula. 

a.  Malunion  f rate  according  to  result- 

b.  Loss  of  blade  j ing  loss  of  shoulder 

or  body  [ joint  motion 

V.  Shoulder. 

a.  Flail — 40  per  cent  loss  of  extremity— 
which  equals  20  per  cent  P.T.D.  (unless 
rating  for  loss  of  motion  exceeds  this,  in 
which  case  rate  on  loss  of  motion) 

b.  Ankylosis — in  Jones  position  (20  degrees 
in  front  of  coronal  plane,  50  degrees  ab- 
duction)— -30  per  cent  P.T.D. 

c.  Ankylosis  in  bad  position — if  operable 

37.5  per  cent  P.T.D.  (may  be  total  loss  of 
extremity  if  inoperable;  i.e.,  patient  a 
poor  operative  risk) 

d.  Loss  of  Motion 

1.  Loss  of  elevation  (useful  arc  normally 
90  degrees  from  shoulder  level  to  ver- 
tical)— -17.5  per  cent  P.T.D. 

2.  Loss  of  abduction  (useful  arc  normally 
90  degrees  from  side  to  shoulder  level) 
— -40  per  cent.  Arc  refers  to  any  plane 
and  rotation  is  necessarily  limited  in 
proportion  and  covered  in  arc  loss 
rating. 

VI.  Arm. 

a.  Amputation — at  or  above  elbow=loss  of 
extremity — 50  per  cent  P.T.D. 

b.  Amputation — 4 inches  or  more  below 
elbow  (permitting  use  of  elbow  in 
prosthesis) — 35  per  cent  P.T.D. 

c.  Shortening — nil  unless  actually  disabling 
or  seriously  disfiguring. 

VII.  Elbow. 

a.  Flail — Same  as  ankylosis  in  good  posi- 
tion plus  rating  for  loss  of  motion 

b.  Ankylosis  in  Jones  position  (at  an  angle 
of  110  degrees) — 20  per  cent  P.T.D. 

c.  Ankylosis  in  bad  position — 

1.  Acute  angle — if  inoperable  total  of 
arm.  If  operable,  60  per  cent  of  loss 
of  use  of  arm,  which  equals  30  per 
cent  P.T.D. 

2.  Obtuse  angle  of  110  degrees  to  155 
degrees — 25  per  cent  P.T.D. 

3.  Obtuse  angle  of  155  degrees  to  180 
degrees — 37.5  per  cent  P.T.D. 

d.  Distortion  of  carrying  angle  of  elbow 

(15  degrees  valgus) — 10  per  cent 
maximum  in  heavy  workers. 

e.  Loss  of  Motion 

1.  Loss  of  flexion  beyond  acute  angle  of 
80  degrees — not  compensable 

2.  Loss  of  motion  (useful  arc  normally 
80  degrees  to  175  degrees) — rated  on 
percentage  loss  of  this  range  up  to 

37.5  per  cent 

f.  1.  Loss  of  pronation-supination  alone 

(in  Jones  position;  i.e.,  midway  be- 
tween pronation -supination — 10  per 
cent 

2.  Loss  of  pronation-supination  alone  in 
bad  position — -15  per  cent 


3.  Loss  of  pronation-supination  alone  in 
Jones  position  when  combined  with 
disabilities  of  wrist  or  elbow  con- 
stitutes an  additional  10  per  cent  dis- 
ability. 

4.  Loss  of  pronation-supination  in  bad 
position  when  combined  with  disabili- 
ties of  wrist  or  elbow  constitutes  an 
additional  20  per  cent  disability. 

VIII.  Wrist. 

a.  Flail — -Same  as  ankylosis  in  good  posi- 
tion plus  rating  for  loss  of  motion  up  to 

37.5  per  cent  maximum 

b.  Ankylosis  (in  Jones  position;  i.e.,  at  an 
angle  of  135  degrees) — 12.5  per  cent 

c.  Ankylosis  in  bad  position  (i.e.,  straight 
or  in  volar  flexion) — if  operable  15-25 
per  cent — (may  be  loss  of  hand  if  in- 
operable) 

d.  Loss  of  Motion — percentage  loss  of  arc 
total  loss  equals  25  per  cent  P.T.D. 

1.  Flexion-extension  (75  per  cent  of 
wrist  joint  motion) — 18.5  per  cent 
loss  of  extremity  equal  to  9.5  per  cent 
P.T.D.  (useful  arc  normally  is  165 
degrees) 

2.  Radial  and  ulnar  abduction  (25  per 
cent  of  wrist  joint  motion) — 5 per 
cent.  (Useful  arc  is  normally' 30  de- 
grees each) 

IX.  Hand — Total  loss — 70  per  cent  of  extremity 
(includes  forearm  loss  to  4 inches 
below  elbow)  or  35  per  cent  P.T.D. 

Partial  loss — rated  on  loss  of  finger  func- 
tion. 

1.  Thumb 

a.  Total  loss — 20  per  cent  of  extremity 
equals  10  per  cent  P.T.D. 

b.  Ankylosis  in  good  position  (extended 
in  apposition) — 7.5  per  cent  P.T.D. 

c.  Ankylosis  in  bad  position — same  as 
total  loss  if  inoperable,  if  operable  5 
per  cent 

d.  Loss  of  terminal  phalanx — 5 per  cent 

P.T.D. 

e.  Loss  of  metacarpo-phalangeal  joint 
motion — 7.5  per  cent 

f.  Loss  of  interphalangeal  joint  motion 
- — percentage  of  loss  of  arc  of  motion 
(normal  range  90  degrees) — 5 per 
cent.) 

2.  Index  Finger 

a.  Total  loss — -10  per  cent  of  extremity 
equals  5 per  cent  P.T.D. 

b.  Loss  of  one  and  a half  or  more 
phalanges — 5 per  cent  P.T.D. 

c.  Loss  of  terminal  phalanx — 2%  per 
cent  P.T.D. 

d.  Loss  of  interphalangeal  joint  motion 
or  ankylosis 

(1)  Distal  joint— percentage  of  loss 
of  arc  of  motion  based  on  2% 
per  cent 

(2)  Proximal  joint  — percentage  of 
loss  of  arc  of  motion  based  on  5 
per  cent 

3.  Middle  finger  (second  finger) 

a.  Total  loss — 5 per  cent  P.T.D. 

b.  Other  ratings  same  proportion  of  5 
per  cent  as  in  index  finger 


174 


The  Ohio  State  Medical  Journal 


March,  1933 


TABLE  III. 

LOSS  OF  FLEXION  MOTION 


70  degrees 

flexion  ankylosis 

a a 

equals 

100% 

60 

a 

90% 

50 

a a 

u 

80% 

40 

i(  it 

a 

70% 

30 

a a 

a 

60% 

20 

a u 

a 

50% 

loss  of  function  equals  50%  P.  T.  D. 
“ “ “ 45%  P.  T.  D. 

“ “ “ 40%  P.  T.  D. 

“ “ “ 35%  P.  T.  D. 

“ “ “ 30%  P.  T.  D. 

“ “ “ 25%  P.  T.  D. 


Note:  a 10  to  20  degree  flexion  is  probably  better  than  an  ankylosis  in  complete 
extension. 


0 degrees 

of 

flexion 

equals 

100.0% 

TABLE 

loss  of 

IV— Loss  of  Motion  of  Knee 

flexion  equals  75.0%  loss  of  function  of 

leg 

equals 

31.8% 

P. 

T. 

D. 

10 

“ 

92.8% 

69.6% 

29.5% 

P. 

T. 

D. 

20 

85.7% 

“ 

64.2% 

27.2% 

P. 

T. 

D. 

30 

78.5% 

58.8% 

24.9% 

P. 

T. 

D. 

40 

“ 

71.3% 

53.4% 

22.6% 

P. 

T. 

D. 

50 

64.2% 

“ 

48.0% 

20.3% 

P. 

T. 

D. 

60 

“ 

57.1% 

“ “ 

42.6% 

18.0% 

P. 

T. 

D. 

70 

50.0% 

37.2% 

15.9% 

P. 

T. 

D. 

80 

42.9% 

31.8% 

13.6% 

P. 

T. 

D. 

90 

35.8% 

26.4% 

11.3% 

P. 

T. 

D. 

100 

28.7% 

“ 

21.0% 

9.0% 

P. 

T. 

D. 

110 

21.6% 

“ 

15.6% 

6.7% 

P. 

T. 

D. 

120 

14.4% 

“ 

10.2% 

4.4% 

P. 

T. 

D. 

130 

7.2% 

“ “ 

4.8% 

44 

2.2% 

P. 

T. 

D. 

140 

“ 

0 % 

“ “ 

0 % 

44 

0 % 

P. 

T. 

D. 

Problem : 

10 

degrees 

equals 

130/140ths  of 

100 

equals  92.8% 

equals  69.7  % loss 

of 

function 

equals 

29.5% 

P.  T. 

D. 

10  degrees  loss  flexion  equals  92.8%  loss  flexion  equals  7.2%  of  75%  or  5.3i%,  the  percentage  of  decrease 
in  loss  of  function  in  the  leg  for  each  10  degrees  of  movement.  Complete  loss  of  leg  at  knee  equals 
42.5%  loss  of  function  of  leg  equals  75%.  42.5%  of  75%  equals  31.8%,  or  the  P.  T.  D. 

Example:  Loss  of  leg  at  knee  by  amputation  equals  42.5%  P.  T.  D.  P.  T.  D.  in  certain  states  is  62-2/3%  of  wage  for 

400  weeks. 

42.5%  P.  T.  D.  would  equal  percentage  of  wage  for  170  weeks. 

75%  loss  of  function  in  leg  would  equal  127  weeks. 

31.8%  P.  T.  D.  would  likewise  equal  127  weeks. 


4.  Ring  finger  (third  finger 

a.  Total  loss — 5 per  cent 

b.  Other  ratings  same  proportion  of  10 
per  cent  as  in  index  finger 

5.  Little  finger  (fourth  finger) 

a.  Total  loss — -2%  per  cent 

b.  Other  ratings  same  proportion  of 
2%  per  cent  as  in  index  finger. 

The  accrued  rating  for  loss  of  use  of  more  than 
one  finger  should  not  exceed  the  total  loss  of  a 
hand  as  provided  above. 

SPINE 

Since  most  state  laws  give  no  definite  ratings 
fob  disabilities  of  spine,  no  attempt  has  been  made 
to  rate  the  spine  or  the  spinal  portion  of  the 
pelvis.  Ratings  on  pelvis  are  covered  in  this 
schedule  only  as  the  disability  limits  hip  motion, 
shortening  of  extremities,  or  both. 

LOWER  EXTREMITY 

I.  Thigh. 

a.  Amputation 

1.  Stump  of  less  than  6 inches — 100  per 
cent  loss  of  leg,  equal  to  50  per  cent 
P.T.D. 

2.  Useful  stump  6 inches  below  hip- 
42. 5 per  cent 


3.  Amputation  3 inches  or  more  below 
knee  (useful  stump) — 33  per  cent 

4.  Amputation  of  foot  without  loss  of 
ankle  motion — 25  per  cent 

b.  Shortening  ** 

1.  One  inch — no  disability 

2.  One  inch  to  2 inches — 5-10  per  cent 

3.  Two  inches  to  3 inches— 10-20  per 
cent 

4.  More  than  3 inches — 25-30  per  cent 

Just  as  in  shoulder  joint,  so  in  the  hip  joint, 
motions  are  considered  with  reference  to  pelvic 
girdle  as  a whole;  whereas  scapular  motion  com- 
pletes the  upper  extremity  to  some  extent,  this 
does  not  play  so  great  a part  in  the  lower  ex- 
tremity, except  in  some  fractures  of  the  pelvis, 
especially  of  the  acetabulum.  However,  the 
mobility  of  the  hip  joint  is  so  great  that  the 
authors  deemed  it  wise  to  classify  these  motions 
with  specific  values  for  each,  so  that  the  total 
disability  present  could  be  readily  ascertained. 

II.  Hip  Joint. 

a.  Ankylosis  in  optimum  position  (15  de- 
grees flexion — 10  degrees  abduction  and 
slight  external  rotation  or  a proportion- 
ate increase  in  abduction  dependent  on 
shortening**) — 50  per  cent  loss  of  ex- 
tremity equal  to  25  per  cent  P.T.D. 


**  Optimum  position  depends  on  amount  of  shortening. 
See  table  of  abduction,  Jones  & Lovett,  page  138. 


March,  1933  Disability  From  an  Orthopedic  Standpoint — Stern 


175 


b.  Ankylosis  in  bad  position  equals  30  per 

cent  to  50  per  cent  P.T.D.  if  inoperable 

c.  Loss  of  Motion 

1.  Flexion-extension  disability  propor- 
tionate to  loss  of  motion  (useful  arc 
normally  120  degrees  of  which  flexion 
is  105  degrees — extension  15  degrees. 
Total  loss  of  motion  with  flexion 
ankylosis  equals  100  per  cent  loss  of 
function  of  limb,  equals  50  per  cent 
P.T.D. 

2.  Abduction-adduction — useful  arc  nor- 
mally 90  degrees  of  which  abduction 
is  45  degrees — adduction  45  degrees. 
Total  loss  of  abduction-adduction 
equals  25  per  cent  loss  of  function  of 
limb,  equals  12.5  per  cent  P.T.D. 

3.  Internal  and  external  rotation — use- 
ful arc  normally  90  degrees  of  which 
internal  rotation  is  45  degrees — ex- 
ternal rotation  45  degrees.  Total  loss 
of  rotation  equals  10  per  cent  loss  of 
function  of  limb,  equals  5 per  cent 
P.T.D. 

Formula:  The  proportionate  loss  of  flexion  (25 
per  cent) , plus  the  proportionate  loss  of  abduc- 
tion (12%  per  cent),  plus  the  proportionate  loss 
of  rotation  (5  per  cent),  equals  the  disability. 

III.  Knee. 

a.  Flail — 40  per  cent  P.  T.  D. 

b.  Ankylosis  in  good  position  (at  an  angle 
of  170  degrees  to  150  degrees) — 30  per  cent 

c.  Ankylosis  in  bad  position  (at  an  angle  of 
less  than  140  degrees — if  inoperable)  — 


d.  Subastragalar  ankylosis  in  good  position 
— 7%  per  cent 

e.  Partial  ankylosis  of  subastragalar  joints 
(always  painful) — 17  to  25  per  cent  if 
inoperable. 

f.  Loss  of  Motion 

1.  Dorsi-flexion  (valued  at  12  per  cent 
P.T.D.)  useful  arc  90  degrees  to  70 
degrees 

2.  Plantar  flexion  (valued  at  8 per  cent 
P.T.D.)  useful  arc  90  degrees  to  125 
degrees. 

(Formula:  The  proportionate  part  of  dorsi- 
flexion  (12  per  cent)  plus  the  proportionate  part 
of  plantar  flexion  (8  per  cent)  equals  the  dis- 
ability in  ankle  motions,  the  proportionate  loss  of 
dorsi-flexion  is  considered  as  that  proportion  of 
12  per  cent,  and  added  to  the  proportionate  loss  of 
plantar  flexion  which  is  represented  by  a total 
value  of  8 per  cent) . 

g.  Loss  of  the  foot. 

1.  With  loss  of  ankle  joint  motion — 25 
per  cent  P.T.D. 

2.  Amputation  proximal  to  heads  of 
metatarsals  (loss  of  weight  bearing) 
25  per  cent. 

(In  our  experience  such  amputations 
usually  require  rating  as  for  amputa- 
tions above  the  ankle  or  loss  of  ankle 
motion) 

3.  Loss  of  metatarsals  rated  as  the  pro- 
portionate loss  of  weight  bearing 
(which  if  total  is  specified  in  para- 
graph 2 as  25  per  cent) 


60  degree  flexion  ankylosis  equals 


50 

40 

30 

20 

10 


it 

ii 

a 

a 

a 


ii 

a 

a 

a 

ii 


100  % loss  of  function  equals  42.5%  P.  T.  D 


93.3%  “ “ 

86.6%  “ “ 

79.9%  “ “ 

73.2%  “ “ 

66.5%  “ “ 


39.7%  P.  T.  D. 
36.9%  P.  T.  D. 
34.1%  P.  T.  D. 
31.3%  P.  T.  D. 
28.5%  P.  T.  D. 


Note:  The  leg  fixed  in  a 10  degree  of  flexion  ankylosis  gives  a better  functional  result 
than  the  leg  completely  ankylosed  in  full  extension.  This  is  definitely  shown  by  the 
above  table. 


d.  Loss  of  Motion. 

1.  Flexion-extension — useful  arc  normal- 
ly 180  degrees  to  75  degrees 

(Formula:  The  proportionate  loss  of  arc  valued 
at  31.8  per  cent  P.T.D.)  See  Table  IV. 

2.  Extension  limited  to  less  than  160  de- 
grees — same  as  ankylosis  in  bad 
position. 

3.  Abnormal  lateral  mobility — 10  per 
cent  to  30  per  cent  depending  on 
function. 

4.  Relaxation  of  either  or  both  crucial 
ligaments  and  other  internal  derange- 
ments— 10  per  cent  to  40  per  cent. 

IV.  Ankle. 

a.  Flail — 25  per  cent  (P.  T.  D.) 

b.  Ankylosis  in  good  position — 12%  per 
cent 

c.  Ankylosis  in  bad  position  (calcaneus  or 
over  20  degrees  plantar  flexion) — if  in- 
operable— 25  per  cent 


4.  Great  Toe. 

a.  Amputation  at  metatarso-phalan- 
geal  joint — 5 per  cent 

b.  Amputation  at  interphalangeal 
joint — -2  per  cent 

c.  Loss  of  motion  (hallux  rigidus)  — 
4 per  cent 

5.  Other  toes 

a.  Total  loss — 1 per  cent 

b.  Partial  loss — % per  cent 

6.  Ankylosis  between  tarsal  bones — 5 
per  cent 

7.  Ankylosis  of  subastragaloid  joint  (as- 
tragalus and  os  calcis) — 8 per  cent 

8.  The  “Frozen  Foot”,  i.e.,  atrophied, 
ankylosed  in  practically  all  the  joints, 
lowered  circulation  with  tendency  to 
trophic  changes  and  usually  painful 
should  be  allowed  the  same  disability 
as  the  total  loss  of  the  member:  viz. 
- — -25  per  cent. 

1304  Hanna  Building. 


The  Management  of  the  Acute  Abdomen  With  Special 
Reference  to  the  Use  of  Spinal  Anesthesia 

Robert  C.  Austin,  M.D.,  F.A.C.S.,  and  H.  H.  Wagner,  M.D.,  Dayton,  Ohio 


THERE  are  three  pathological  conditions,  the 
acute  appendix,  the  perforated  intestinal 
ulcer  and  intestinal  obstruction,  which  are 
largely  responsible  for  the  surgical  mortality  of 
the  acute  abdomen. 

In  the  spectacular  development  of  surgery  dur- 
ing the  past  three  decades,  the  mortality  of 
stomach,  gall  bladder,  thyroid  and  pelvic  surgery 
has  been  diminished  to  an  incredible,  almost  irre- 
ducible rate.  But  in  the  acute  abdomen  there  con- 
tinues to  be  an  appalling  death  rate;  varying  lit- 
tle from  the  records  of  a quarter  of  a century 
ago. 

The  present  day  acute  appendicitis  mortality 
taken  from  various  hospital  records  is  approxi- 
mately 8 to  12  per  cent.  There  has  been  an  oc- 
casional surgeon  who  has  been  able  to  report  an 
improved  mortality  record  of  3,  4,  or  5 per  cent. 

In  intestinal  obstruction,  particularly,  there 
has  been  a notorious  failure  to  improve  results. 
In  1900  Gibson  reported  1000  cases  of  obstruction 
with  a mortality  of  43  per  cent,  and  twenty-five 
years  later  Van  Buren  and  Smith  collected  1089 
cases  with  a mortality  of  41.8  per  cent.  Jeff  Mil- 
ler more  recently  has  published  a report  of  347 
cases  with  a mortality  of  55  per  cent. 

In  perforated  ulcer  the  death  incidence  is  con- 
servatively stated  at  25  to  40  per  cent. 

It  is  obvious  that  the  above  percentages  are 
those  of  the  larger  institutions  and  probably  of 
the  more  experienced  surgeons. 

Are  such  mortality  figures  acceptable? 

The  reason  for  the  high  mortality  of  these 
acute  conditions  is  not  difficult  to  discover.  They 
are  diseases  in  which  the  death  rate  increases 
with  each  hour  that  surgical  relief  is  deferred. 
It  is  obvious  then,  that  the  accountability  is  that 
of  the  patient,  the  physician  and  the  surgeon. 

The  responsibility  of  the  public  is  no  small 
factor.  While  the  life  of  the  patient  depends  upon 
the  promptness  with  which  he  is  given  relief, 
physical  salvation  cannot  be  given  him  until  he 
applies  for  it  and  accepts  it.  There  is  still  a sur- 
prisingly large  group  whom  one  would  credit 
with  more  common  sense,  who  are  “opposed  to 
operations”  and  listen  with  avidity  to  tales  of 
surgical  horrors.  Also,  the  laity  is  particularly 
inclined  to  ascribe  an  abdominal  pain  to  an 
‘indigestion”  and  to  take  a cathartic  which  is 
likely  to  cause  a rupture  in  an  appendix  and  add 
to  the  possibilities  of  a peritonitis.  Jeff  Miller  in 
studying  239  deaths  from  acute  appendicitis,  col- 
lected from  two  New  Orleans  hospitals,  found 

Read  before  the  Surgical  Section,  Ohio  State  Medical 
Association,  at  the  86th  Annual  Meeting,  Dayton,  May  3-4, 


that  50.5  per  cent  of  the  patients  gave  a history 
of  having  taken  purgatives  and  that  12.6  per  cent 
additional  had  taken  cathartics  on  the  advice  of 
their  physician. 

Why  do  physicians  delay?  In  a certain  group 
of  cases  the  classical  clinical  symptoms  are  not 
pronounced  and  the  physician  awaits  the  develop- 
ment of  signs  which  permits  him  to  make  a cor- 
rect anatomical  diagnosis.  Unfortunately,  when 
this  has  been  accomplished  the  patient’s  life  has 
been  jeopardized.  While  one’s  diagnostic  batting 
average  will  be  improved  by  such  a course,  his 
mortality  records  will  be  greatly  increased.  The 
hypodermic  of  morphine  contributes  considerably 
to  the  deferring  of  surgery.  It  is  the  relief  from 
pain  which  the  patient  seeks  and  the  hours  of 
comfort  which  he  finds  as  a result  of  morphine  are 
frequently  the  golden  hours  which  have  been  lost. 
Again  the  fear  of  making  a mistaken  diagnosis 
prompts  the  physician  to  await  unmistakable 
symptoms.  These  unmistakable  symptoms  are  too 
often  the  signs  of  grave  complications.  A tenta- 
tive diagnosis  with  the  suggestion  that  a con- 
sultant is  desired  or  that  the  patient  should  be 
sent  to  the  hospital  for  investigation  will  obviate 
censure.  Not  to  know  is  no  disgrace,  but  not  to 
try  to  find  out  is  unpardonable. 

There  is  sometimes  the  lack  of  virility  on  the 
part  of  the  physician  whose  indecisiveness  per- 
mits the  patient  to  have  doubts  about  the  correct- 
ness of  the  diagnosis  and  the  wisdom  of  the  course 
which  he  suggests. 

The  surgeon  is  not  blameless.  He,  too,  some- 
times delays  because  he  has  been  unable  to  make 
an  irrefutable  diagnosis.  Deaver  well  states  that 
it  is  no  time  for  a hair  line  diagnosis  which  rarely 
gets  a patient  anywhere  except  into  the  grave  and 
it  is  more  important  to  recognize  that  an  acute 
surgical  condition  exists.  Further,  the  best  au- 
thorities are  agreed  that  exploration  in  suspected 
surgical  conditions  is  always  less  harmful  than 
delay  and  that  a few  unnecessary  incisions  into 
live  patients  ai'e  infinitely  better  than  a single 
autopsy  on  a dead  one. 

In  the  earlier  stages  of  appendicitis  a beginner 
in  surgery  may  handle  it,  but  when  it  has  passed 
beyond  its  first  stages  it  offers  problems  of  judge- 
ment and  technique  which  tax  to  the  utmost  the 
resources  of  expert  surgeons. 

The  remedy  then  is  simple.  The  laity  must  be 
educated  out  of  its  pernicious  habit  of  self-medi- 
cation and  also  that  abdominal  pain  is  the  most 
urgent  of  all  indications  for  refraining  from  pur- 
gation. The  laity  and  profession  alike,  must  be 
taught  that  the  major  factor  in  the  mortality  of 


176 


March,  1933 


Acute  Abdomen — Austin  and  Wagner 


177 


the  acute  abdomen  is  delay  and  that  only  by  the 
reduction  of  the  interval  between  the  onset  of 
symptoms  and  the  institution  of  surgical  relief, 
can  mortality  be  reduced  to  within  reasonable 
limits. 

PRE-OPERATIVE  MANAGEMENT 

The  almost  universal  habit  of  immediately 
transporting  the  patient  to  the  operative  room 
where  he  is  subjected  to  anesthesia  and  surgery, 
may  be  a factor  contributing  to  his  death.  In 
serious  risk  patients  where  dehydration,  acidosis 
or  alkalosis  are  marked,  an  hour  or  so  of  delay 
that  will  permit  of  administration  of  normal 
saline  and  glucose  intravenously  or  subcutanously 
will  contribute  to  a safer  surgical  course. 

INTESTINAL  OBSTRUCTION 

The  three  factors  which  contribute  largely  to 
late  diagnosis  in  acute  intestinal  obstruction  are 
(1)  absence  of  local  physical  findings  (2)  im- 
proper appraisal  of  enemata  as  a diagnostic 
criterion  and  (3)  irrational  administration  of 
morphine. 

Intestinal  obstruction  is  one  of  the  few  acute 
conditions  which  does  not  present  local  symptoms 
of  tenderness  or  rigidity.  The  passage  of  gas  or 
faeces  per  enema  must  not  be  accepted  as  evidence 
of  an  absence  of  obstruction.  The  distal  gut  is 
normal  and  why  should  not  patients  with  a fairly 
high  obstruction  pass  gas  with  an  enema;  and  if 
the  obstruction  is  partial,  gas  will  be  expelled  as 
long  as  enemas  are  given.  Only  in  low,  complete 
obstruction,  is  early  information  obtained  through 
rectal  irrigations. 

The  occurrence  of  intermittent,  erampy,  colicky 
abdominal  pains,  with  nausea  and  vomiting,  un- 
attended by  local  rigidity  and  tenderness,  suggests 
bowel  obstruction;  if  the  stethoscope  reveals  in- 
testinal noises  synchronous  with  pain,  and  if  the 
M-ray  reveals  gas  in  the  small  intestine,  the 
diagnosis  of  intestinal  obstruction  may  confidently 
be  made. 

PERFORATED  ULCER 

Symptoms  of  acute  perforated  ulcer  should 
rarely  be  mistaken.  The  onset  is  so  dramatic  and 
the  symptoms  and  signs  so  evident  that  although 
the  physician  or  surgeon  may  not  always  be  able 
to  make  a diagnosis  of  a perfoi'ated  ulcer,  he 
should  recognize  the  acute  surgical  condition  of 
the  abdomen.  The  patient  is  suddenly  seized  with 
an  unendurable  epigastric  pain  that  spreads  to  the 
entire  abdomen  and  even  to  the  thorax  and 
shoulders.  He  is  prostrated,  pale,  haggard  and 
perspiring.  His  knees  are  flexed  in  a protective 
position,  his  pulse  is  slow  and  the  temperature  is 
often  subnormal.  There  is  usually  nausea  and 
vomiting.  Of  great  diagnostic  significance  is  the 
characteristic  board-like  rigidity.  An  hour  or  so 
later  the  face  becomes  flushed,  the  pulse  rate  in- 
creases and  the  temperature  slightly  exceeds 
normal.  Liver  dullness  is  often  absent  and  the 
roentgen  ray  reveals  pneumoperitoneum.  Morphia 


eases  but  does  not  relieve  and  rigidity  persists. 
The  patient  gradually  becomes  worse  and  within 
twenty-four  hours,  unless  surgery  intervenes, 
there  are  signs  of  early  peritonitis. 

THE  ACUTE  APPENDIX 

It  is  the  atypical  appendix  that  so  frequently 
presents  a difficult  diagnostic  problem.  The  re- 
trocecal appendix  is  prone  to  present  a minimum 
tenderness  and  an  absence  of  rigidity.  It  is  in  this 
type  that  the  severity  of  infection  is  apt  to  be 
appraised  inaccurately  until  a complication  occurs. 
The  blood  count  is  too  infrequently  made  in  the 
early  stages. 

The  history  of  pain,  usually  epigastric,  with 
nausea  and  vomiting,  the  absence  of  temperature 
and  acceleration  of  pulse  rate,  the  localization  of 
tenderness  in  the  right  lower  quadrant,  together 
with  a leukocytosis,  will  usually  permit  the  ar- 
rival at  an  early  diagnosis. 

POST  OPERATIVE  CURE 

While  the  discussion  of  post-operative  care 
seems  academic,  several  recent  experiences  in 
which  I was  called  as  a consultant  prompts  me  to 
emphasize  again  some  salient  points.  In  intes- 
tinal obstruction  the  maintenance  of  a water, 
chloride  and  sugar  balance  by  administration  of 
normal  saline  and  glucose  intravenously  or  sub- 
cutaneously; in  acute  appendicitis,  in  addition  to 
the  maintenance  of  a water  and  sugar  balance,  the 
elimination  of  fluids  by  mouth,  the  immobilization 
of  the  abdomen  by  frequent  doses  of  morphine, 
the  avoidance  of  enemata  during  the  first  48  to  72 
hours  and  the  non-use  of  cathartics  until  the 
acute  stage  is  over. 

SPINAL  ANESTHESIA 

The  success  of  the  emergency  operation  for  an 
acute  abdominal  condition  may  depend  on  the 
ability  of  the  surgeon  to  create  the  most  favorable 
conditions  for  operative  interference.  The  selec- 
tion of  the  type  of  anesthetic  to  be  used  is  im- 
portant. 

I know  of  no  single  anesthetic  that  may  be  re- 
garded as  the  ideal  anesthetic  or  that  may  be 
used  appropriately  in  all  surgical  procedures.  The 
surgeon  should  have  in  his  armamentarium  the 
several  types  of  anesthesia  that  the  anesthetic 
may  be  adapted  to  the  patient,  rather  than  adapt- 
ing the  patient  to  the  anesthetic. 

In  my  opinion,  spinal  anesthesia  is  a valuable 
adjunct  in  surgery  of  the  acute  abdomen.  The 
flaccid  abdominal  wall  and  contracted  intestinal 
tract  obtained  in  spinal  anesthesia,  make  adequate 
exposure  possible  with  a minimum  amount  of 
trauma.  The  ease  with  which  exposure  is  ob- 
tained is  no  little  factor  in  the  successful  manage- 
ment of  acute  abdominal  conditions.  Exposure 
gained  after  a struggle  with  surrounding  tissue 
reduces  the  recovery  margin  of  the  patient  in 
proportion  to  the  insult  imposed.  Spinal  anesthe- 
sia permits  of  a toilet  to  the  abdominal  cavity  in 


178 


The  Ohio  State  Medical  Journal 


March,  1933 


terms  of  drainage  of  a localized  infection  without 
disseminating  it;  it  simplifies  the  release  of  an  in- 
testinal obstruction  or  the  removal  of  a gan- 
grenous or  ruptured  appendix. 

From  the  patient’s  standpoint,  it  has  been  our 
experience  that  nausea,  vomiting,  distention  and 
gas  pains  are  lessened  and  morbidity  and  mortal- 
ity are  reduced. 

COMPLICATION 

In  a study  of  the  post-operative  course  of  a 
fairly  large  group  of  my  personal  patients,  com- 
plications have  been  rare.  The  incidence  of  two1 
pneumonia  deaths  in  82  appendectomies  compared 
to  five  pneumonias  in  a like  number  of  a previous 
group  that  were  given  general  anesthesia.  There 
were  no  intestinal  obstructions  and  the  mortality 
was  2.75  per  cent  as  compared  with  9 per  cent  in 
a like  previous  group.  The  two  deaths  were  due 
to  pneumonia  and  it  is  almost  incredible  that  in 
this  group  there  was  not  a case  of  a general 
peritonitis.  One  patient  who  had  a general  per- 
itonitis and  a pneumonia  was  refused  operation. 

McKietrich,  McClure  and  Sweet  and  other 
writers  have  stated  that  the  incidence  of  pul- 
monary complications  have  not  been  decreased 
and  in  some  instances  have  been  increased.  Lin- 
coln Brown  states  that  this  may  be  explained  by 
the  fact  that  the  viscosity  of  the  respiratory 
secretions  is  increased  and  that  the  force  and 
depth  of  respiratory  movements  is  inhibited.  The 
administration  of  carbon  dioxide  and  oxygen  post- 
operatively  has  been  routinely  employed  in  this 
group  of  cases  and  I believe  that  it  may  con- 
tribute to  a lessened  incidence  of  pulmonary  com- 
plications. 

PHYSIOLOGICAL  FACTORS 

The  pitfalls  of  spinal  anesthesia  are  associated 
with  vasomotor  depression.  Functional  severance 
of  the  motor  nerves  to  over  half  the  skeletal  mus- 
cles, paralysis  of  the  intercostal  nerves  and  of  the 
vasoconstrictor  nerves  of  the  skin,  are  factors 
lending  toward  a greater  or  lesser  circulatory  de- 
pression and  an  anoxemia.  Lundy  anesthetized 
dogs  completely,  gave  them  adequate  ventilation 
and  found  that  the  pulse  rate  and  blood  pressure 
were  not  changed.  Seevers  and  Walters  state  that 
as  a result  of  their  animal  experimentation  the 
vasomotor  depression  is  largely  associated  with 
the  falling  out  of  thoracic  respiration  and  the 
anoxemia  resulting  therefrom. 

Therefore  a technique  that  controls  vasodilata- 
tion and  the  accurate  level  of  anesthesia  is  one 
that  will  permit  of  a high  degree  of  safety  to  the 
patient  and  satisfaction  to  the  surgeon. 

The  “volume  control”  technique  of  Stout  has 
been  most  satisfactory  in  our  hands.  It  seems  to 
me  that  the  criticism  that  has  been  directed  to- 
ward spinal  anesthesia  has  been  the  result  of  im- 
proper technique,  lack  of  knowledge  and  disre- 
gard of  the  physiological  principles  involved. 

The  aim  of  the  anesthetist  should  be  to  main- 


tain the  physiological  processes  of  the  body  at  a 
normal  state.  The  proper  use  of  ephedrine,  carbon 
dioxide  and  oxygen  inhalation  and  the  posture  of 
the  patient  will  control  variations  in  blood  pres- 
sure. Carbon  dioxide  and  oxygen  inhalations  are 
valuable  post-operatively  in  causing  adequate  ven- 
tilation of  the  lungs  and  oxygenation  of  the  tis- 
sues. 

It  is  pertinent  to  remember  two  facts.  In  the 
first  place,  spinal  anesthesia  greatly  facilitates 
abdominal  surgery.  In  the  second  place,  the  sur- 
gical mortality  is  always  so  much  higher  than 
anesthetic  mortality  that  a reduction  in  surgical 
mortality  will  greatly  outweigh  anything  but  a 
marked  increase  in  the  anesthetic  mortality. 

I further  believe  that  it  is  reasonable  to  con- 
clude that  spinal  anesthesia  is  an  anesthesia  of 
potential  danger;  that  it  is  unsuitable  for  indis- 
criminate use;  but  that  it  greatly  facilitates  sur- 
gery and  that  it  may  be  so  effectively  safe- 
guarded that  in  the  hands  of  careful  and  ex- 
perienced men  it  becomes  the  anesthesia  of  choice 
for  the  acute  abdomen. 

540  Fidelity  Building. 

discussion 

J.  F.  Baldwin,  M.D.,  Coumbus:  A few  months 
ago,  in  commencing  the  preparation  of  a paper  on 
appendicitis  which  appeared  in  the  May,  1932, 
Annals  of  Surgery,  I took  occasion  to  go  through 
the  literature  on  appendicitis  for  the  ten  years 
from  1900  to  1910,  as  it  appeared  in  the  A.M.A. 
Journal,  during  which  time  the  Ochsner  treat- 
ment was  attracting  a great  deal  of  general  at- 
tention, owing  to  the  high  standing  of  Dr.  Ochs- 
ner and  his  persistence.  That  perusal  impressed 
upon  me  the  fact  that  the  present  generation  of 
surgeons  has  apparently  little  or  no  knowledge  of 
the  Ochsner  treatment.  In  England  I find  it  more 
in  vogue,  and  it  is  greatly  emphasized  in  Volume 
I of  the  recent  work  on  Emergency  Surgery  by 
Hamilton  Bailey.  In  that  country,  Ochsner’s 
name  is  hyphenated  with  that  of  the  English  sur- 
geon Sherren,  who  evidently  was  the  first  to  em- 
phasize its  importance  in  that  country.  When 
Ochsner  published  his  first  article,  I made  the 
statement  to  surgical  friends  that  if  he  had  pub- 
lished his  paper  only  to  experienced  surgeons  it 
would  do  a great  deal  of  good,  but  publishing  it 
broadcast  to  the  general  practitioner  as  well  would 
result  in  many  unnecessary  fatalities;  and  un- 
questionably my  statement  was  correct,  as  many 
physicians,  although  called  promptly  to  cases  of 
appendicitis  and  promptly  recognizing  their  char- 
acter, would  assure  the  friends  that  they  would 
“adopt  the  Ochsner  treatment,”  and  consequently 
would  delay  the  case  until  a fatal  issue  was  al- 
most inevitable. 

In  the  treatment  of  an  acute  abdomen,  the 
surgeon  when  in  doubt  should  sometimes  give  the 
patient  the  benefit  of  that  doubt  by  an  explora- 
tion. The  symptomatology  of  an  acute  perfora- 
tion is  usually,  as  Dr.  Austin  has  pointed  out,  ab- 
solutely distinct  and  positive;  but  it  may  not 
necessarily  be  so.  Thus,  in  one  of  my  earliest 
cases,  the  patient  was  seen  late  at  night  with 
simply  a little  abdominal  discomfort,  but  with  no 
evidence  of  anything  seriously  wrong.  He  was  a 
prominent  business  man,  and  I came  over  again 
early  the  next  morning  to  see  him.  I found  him 


March,  1933 


Evaluating  Remissions  in  General  Paralysis 


179 


in  bed  cocked  up  with  pillows,  reading  the  morn- 
ing paper,  and  still  with  no  vomiting  and  little  or 
no  discomfort.  The  abdomen  was  soft,  and  I 
could  press  it  in  without  difficulty.  I had  a blood 
count  made  at  once,  then  went  to  the  operating 
room,  and  a few  hours  later,  and  before  I had 
assumed  my  street  clothes,  went  to  his  room, 
where  a second  blood  count  had  just  been  made, 
and  while  he  was  still  comfortable  and  with  no 
muscular  rigidity  nor  vomiting,  I found  the  white 
cells  mounting,  but  the  same  conditions  still  in  the 
upper  abdomen;  I frankly  advised  him  on  general 
principles  to  have  an  exploration.  He  consented 
promptly,  and  on  opening  the  abdomen  a perfora- 
tion of  the  stomach  was  found  which  would  al- 
most have  admitted  a pencil.  This  was  closed  in 
the  usual  way,  and  he  made  a prompt  and  perma- 
nent recovery. 

We  should  not  place  too  much  stress  on  blood 
counts  in  cases  of  acute  abdomen.  We  should  re- 
member the  advice  of  the  late  Dr.  Ochsner  who, 
when  asked  in  regard  to  taking  blood  counts,  said, 
“Yes,  take  them  always;  but  don’t  look  at  them 
until  after  you  have  operated.”  We  should  also 


remember  that  Dr.  Cabot,  of  Boston,  in  his  book 
on  “Diagnosis,”  in  referring  to  certain  clinic 
cases  in  which  there  had  been,  without  any  as- 
signable cause,  a high  leukocytosis,  remarked  to 
the  class  present  that  that  was  “one  of  the  wild, 
untamed  facts  frequently  found  in  well-kept  his- 
tories.” In  a recent  report  from  the  Mayo  Clinic, 
the  statement  was  made  that  a few  minutes 
vigorous  flexing  of  the  arms  would  give  a marked 
leukoctosis,  while  running  a short  distance 
might  give  a leukocytosis  of  40,000,  which 
would  require  an  hour  or  so  for  its  disappearance. 
Recently  a professor  of  su rgery  in  one  of  the 
eastern  colleges  made  the  statement  that  when  he 
was  called  to  the  telephone  late  in  the  evening 
from  the  hospital  and  was  told  that  a patient  with 
appendicitis  had  been  brought  in,  he  inquired  as 
to  the  leukocytosis,  and  if  it  was  under  15,000  he 
unhesitatingly  directed  that  the  patient  be  pre- 
pared for  operation  in  the  morning.  Many  of  us,  I 
think,  have  had  cases  of  gangrenous  appendicitis 
come  in  with  a leukocytosis  of  only  8,000,  so  that 
some  of  us  at  least  would  differ  from  the  professor 
in  his  reliance  on  a low  leukocytosis. 


Graphic  Methods  of  Evaluating  Remissions  In  General 


Richard  E.  Stout,  M.D.,  Cleveland,  Ohio 


IF  a general  paralytic  after  therapeutic  ma- 
laria becomes  able  to  return  to  his  home  and 
support  his  family  at  his  old  or  at  some 
similar  occupation  he  is  usually  said  to  be  in  good 
remission.  This  criterion  fails  to  detect  such 
stigmata  of  an  incomplete  cure  as  euphoria,  im- 
pairment of  memory,  and  retardation  of  compre- 
hension. It  fails  to  measure  the  effect  of  thera- 
peutic malaria  upon  very  early  cases  without 
marked  mental  symptoms,  and  upon  the  so-called 
asymptomatic  neurosyphilitics.  Neither  does  im- 
provement in  the  spinal  fluid  findings  accurately 
reflect  changes  in  symptomatology.  A desire  to 
study  more  carefully  incipient  cases  of  general 
paralysis  has  led  to  a search  for  more  accurate 
standards  for  determining  improvement. 

A study  of  the  speech,  handwriting,  and  tremor 
of  110  general  paralytics  in  the  Cleveland  City 
Hospital  and  Out-patient  Department  has  been 
made;  the  rate  and  degree  of  improvement  fol- 
lowing malaria,  and  the  degree  of  synchronism 
between  this  improvement  and  improvement  in 
the  mental  and  emotional  status  have  been  noted. 
Thirty-five  of  these  patients  were  first  examined 
before  malaria,  and  twelve  in  the  immediate  con- 
valescent period.  Sixty-three  patients  whose  con- 
valescent period  had  exceeded  six  months  were 
classified  as  in  good,  fair,  or  poor  clinical  re- 
mission, on  the  basis  of  ability  to  make  a good 
home  adjustment,  ability  to  work  and  accept  re- 
sponsibility, residual  irritability,  euphoria,  emo- 
tional instability,  memory  defect,  and  ataxia. 

Read  by  invitation,  before  the  Section  on  Nervous  and 
Mental  Diseases,  Ohio  State  Medical  Association,  at  the 
86th  Annual  Meeting,  Dayton,  May  3-4,  1932. 


Dysarthria,  or  incoordination  of  motor  speech 
was  greatly  diminished  in  all  our  cases  success- 
fully treated  by  malaria.  Improvement  was  some- 
times noted  within  a month,  and  absence  of 
dysarthria  in  four  to  nine  months.  A slight  resi- 
due may  remain  in  about  30  per  cent  of  cases  in 
good  clinical  remission,  but  it  is  evident  from  the 
following  table  that  a marked  or  moderate  degree 
of  dysarthria  must  be  considered  a stigma  of 
an  incomplete  remission. 


Table  I,  Dysarthria 


Condition  of 

Patient 

Marked 

Moderate  Slight 

None 

Untreated  

- 51% 

27% 

11% 

n% 

Poor  Clinical 

Remission 

- 59% 

35% 

6% 

Fair  Clinical 

Remission 

- 20% 

28% 

32% 

20% 

Good  Clinical 

Remission 

30% 

70% 

The  handwriting  of  general  paralytics  reliably 
reflects  motor  incoordination,  and  often  by  its 
content  also  incoordination  of  thought.  Char- 
acteristic of  this  handwriting  are  ataxic  lines  and 
dots,  retraced  letters,  elision  of  syllables  and 
omission  of  words  and  letters,  and  a slow,  heavy 
writing  attempting  to  compensate  for  the  tremor. 

A moderate  degree  of  improvement  in  hand- 
writing accompanies  or  closely  follows  clinical  re- 
mission in  most  cases,  and  is  evident  in  from 
three  to  nine  months  after  malaria.  It  is  as  yet 
impossible  to  say  when  the  maximum  improve- 
ment is  reached.  Many  persons  who  make  a good 
remission  regain  a nearly  normal  script,  but  in 
the  majority  of  cases  some  residue  is  left.  Illiter- 
ate patients  who  are  able  to  write  only  their  own 


180 


The  Ohio  State  Medical  Journal 


March,  1933 


names  do  not  accurately  reflect  clinical  improve- 
ment in  their  handwriting.  Very  early  paralytics 
may  have  a nearly  normal  handwriting  before 
treatment,  and  in  them  the  prognosis  seems  ex- 
cellent. 

Tremor  is  a most  constant  finding  among  gen- 
eral paralytics,  being  grossly  evident  in  about  85 
per  cent  of  cases.  More  accurate  methods  have 
disclosed  pathological  involuntary  movements  in 
every  patient  who  was  examined  before  malarial 
treatment.  Mott1  defined  tremors  in  1904  as 
“rhythmical  involuntary  oscillations  of  the  body, 
or  of  its  separate  parts,  around  their  position  of 
equilibrium”. 

The  present  studies,  by  means  of  a mechanical 
tremograph,  as  well  as  those  of  Beall2,  by  means 
of  a tremograph  utilizing  reflected  light,  show 
that  the  so-called  organic  tremor  of  general 
paralysis  is  grossly  arhythmic,  and,  therefore  not 
a true  tremor  such  as  is  found  in  paralysis  agi- 
tans,  but  is  an  ataxia.  It  is  an  incoordination  of 
muscle  balance  of  cortical  origin,  akin  to  dysar- 
thria or  incoordination  of  motor  speech,  and  to 
incoordination  of  thought,  which  is  responsible 
for  so  much  of  the  symptomatology  of  general 
paralysis.  It  is,  therefore,  entirely  logical  that 
improvement  in  the  physiological  condition  of  the 
cortex  following  malaria  should  be  reflected  by  a 
concurrent  improvement  in  the  confusion,  memory, 
and  emotional  state,  and  in  ataxia  and  dysarthria. 


Fig.  1.  Whipple’s  steadiness  tester. 


By  means  of  Whipple’s  steadiness  tester"  a 
record  of  the  involuntary  movements  of  general 
paralytics  can  easily  and  quickly  be  made,  and 
the  progress  of  the  remission  can  be  graphically 
charted.  This  instrument  consists  of  a metal 
plate  inclined  at  an  angle  of  about  45  degrees, 


and  pierced  by  nine  perforations  of  diminishing 
diameter.  It  is  placed  in  series  with  an  electric 
stylus  and  counting  clock.  Whipple’s  technique 
has  been  modified  somewhat,  in  the  interests  of 
simplicity  and  cooperation.  The  stylus  has  been 
marked  at  a point  % inch  from  the  end.  The 
patient  is  seated  with  his  forearm  resting  on  the 
table  in  order  that  movements  of  the  shoulder 


and  arm  might  be  largely  eliminated,  and  after 
the  object  of  the  test  has  been  explained  to  him, 
is  told  to  insert  the  stylus  successively  into  each 
aperture  as  far  as  the  mark,  and  to  withdraw  it, 
being  careful  not  to  touch  the  sides  of  the  aper- 
tures. This  procedure  is  repeated  five  times,  and 
an  average  made  of  the  number  of  errors  on  each 
aperture. 

Twenty-five  members  of  the  professional  staff 
of  the  hospital  were  subjected  to  this  test  and 
made  remarkably  consistent  records.  An  average 
normal  record  contains  only  an  occasional  error 
on  the  first  four  apertures,  one  or  less  error  per 
attempt  on  the  fifth,  sixth,  and  seventh,  and  about 
three  on  the  eighth  and  seven  on  the  ninth. 

Thirty-five  general  paralytics  studied  before 
malaria  represented  all  stages  of  the  disease  from 
the  nearly  asymptomatic  to  the  most  advanced; 
and  as  was  expected,  made  widely  varying  rec- 
ords, but  not  one  that  could  be  considered  as 


March,  1933 


Evaluating  Remissions  in  General  Paralysis 


181 


normal  or  nearly  normal.  Nearly  all  were  sur- 
prisingly cooperative  and  anxious  to  make  a good 
record.  In  a few  cases  lack  of  comprehension  or 
cooperation  prevented  execution  of  the  test  before 
malaria,  and  in  them  the  test  was  deferred  until 
after  the  treatment.  Advanced  optic  atrophy  is  a 
definite  contraindication  to  this  type  of  examina- 
tion. 

Seventeen  general  paralytics  in  poor  clinical  re- 
mission or  unimproved  showed  records  almost 
identical  with  the  untreated  series.  Only  one 
showed  a normal  curve. 

Twenty  general  paralytics  in  good  clinical  re- 
mission made  very  consistent  records  in  the  nearly 
normal  range.  A few  patients  made  entirely  nor- 
mal records  and  only  one  made  a markedly  ab- 
normal record. 

The  twenty-five  patients  classified  as  in  fair 
clinical  remission  showed  wide  variation  in  their 
records.  Improvement  was  evident  only  in  the 
larger  apertures?  and  their  records  were  in  some 


Fig.  3,  Case  1.  Ataxia  records  and  handwriting  before 
and  after  malaria.  Twelve  malarial  paroxysms,  Oct.  8- 
Oct.  19,  1931.  Patient  is  making  rapid  clinical  improvement. 


instances  worse  than  those  of  untreated  patients 
in  the  smaller  apertures.  It  was  a constant  ob- 
servation that  as  the  oscillation  of  the  fingers 
decreased  in  amplitude,  the  rate  increased.  A 
final  stage  in  the  improvement  was  a decrease  in 


Fig.  4,  Case  2.  Ataxia  records  and  handwriting  before 
and  after  malaria.  Nine  malarial  paroxysms  Oct.  20-Oct.  29, 
1931.  Patient  made  no  clinical  improvement. 


the  number  of  oscillations.  Only  two  or  three 
patients  made  records  comparable  to  those  of  per- 
sons in  good  clinical  remission. 

Case  1.  W.  R.,  a 29  year  old  white  general 
paralytic  on  admission  manifested  confusion, 
memory  defect,  euphoria,  tremor,  dysarthria,  and 
occasional  delusional  ideas. 

His  ataxia  record  before  malaria  is  shown  by 
the  solid  line  in  Fig.  3. 

One  and  one-half  months  after  malaria  (Dec.  3, 
1931)  he  had  recovered  his  acuity  of  memory,  lost 
his  confusion  and  delusions,  and  much  of  his 
euphoria,  but  retained  some  dysarthria  and  an 
unsteady  handwriting.  He  was  discharged  from 
the  hospital  at  this  time. 

Five  months  after  malaria  (March  24,  1932) 
he  was  asymptomatic  except  for  a moderate  de- 
gree of  dysarthria,  and  a very  slight  euphoria. 
His  handwriting  is  imperfect,  but  improved.  His 
tremor  record  is  approximating  normal.  He  has 
had  part-time  employment  at  his  old  occupation 
as  a steel  worker. 

Case  2,  L.  L.,  a forty-one  year  old  colored  man 
on  admission  was  grandiose,  euphoric,  irritable, 
very  confused  and  dysarthric,  and  had  a very 
marked  tremor,  which  is  indicated  by  the  solid 
line  in  Fig.  4. 

Three  weeks  after  malarial  treatment  (Nov.  17, 
1931)  he  showed  a slight  exacerbation  of  motor 
symptoms  and  was  much  more  irritable. 

Four  months  after  malaria  (March  6,  1932)  he 


182 


The  Ohio  State  Medical  Journal 


March,  1933 


Fig.  5,  Ataxia  records  of  Case  3 before  and  after  malaria. 
Eleven  malarial  paroxysms  Nov.  14-Dec.  3,  1931.  Rapid 
clinical  improvement. 


remains  clinically  unimproved.  He  is  very 
euphoric,  irritable,  confused,  and  deluded ; he 
cannot  be  persuaded  that  his  mother  is  dead. 
His  tremor  and  dysarthria  remain  essentially  un- 
improved; his  script  is  still  nearly  illegible. 

Case  3,  C.  G.,  a 38  year  old  white  man  sought 
medical  advice  because  of  drowsiness  and  forget- 
fulness of  minor  details  in  his  work  as  a bank 
teller.  He  exhibited  no  dysarthria  and  no  visible 
tremor,  but  his  record  on  the  steadiness  tester 
(solid  line  Fig.  5)  was  distinctly  abnormal. 

Two  weeks  after  malaria  (Dec.  16,  1931)  his 
tremor  record  was  unchanged,  but  he  had  lost  his 
drowsiness  and  forgetfulness,  was  asymptomatic 
except  for  a slight  euphoria,  and  was  discharged 
from  the  hospital.  The  first  specimen  of  his  hand- 
writing was  taken  at  this  time. 

Nearly  four  months  after  malaria  (March  31, 
1932)  his  euphoria  had  decreased,  and  his  tremor 
was  approaching  normal. 

Case  4,  0.  M.,  a very  irritable,  violently 
maniacal,  grandiose  tabo-paretic  was  admitted  on 
July  2,  1926.  He  was  filthy,  vulgar,  confused,  and 
had  absent  patellar,  Achilles,  biceps,  triceps,  and 
periosteoradial  reflexes,  and  a marked  tremor. 
He  had  a good  course  of  malaria  in  July,  1926, 
but  made  a slow  remission.  He  was  sent  to  the 
Cleveland  State  Hospital  on  October  19,  1926, 
and  was  discharged  from  that  hospital  on  proba- 
tion on  November  16,  1926. 

Since  that  time  he  has  been  continuously  em- 
ployed at  his  former  occupation  as  a salesman. 
He  has  exhibited  no  irritability,  violence,  con- 
fusion, euphoria,  or  delusions.  His  ataxia  record 


is  entirely  normal,  nearly  six  years  after  malarial 
ti’eatment. 

Ataxia  Record  of  Case  4 
Aperture  123456  78  9 

November  5,  1931 — 

0.0  0.0  0.0  0.0  0.0  0.2  1.0  2.0  7.8 

February  25,  1932 — 

0.0  0.0  0.0  0.0  0.2  0.4  1.4  2.0  6.2 

Average  Normal  Record— 

0.0  0.0  0.1  0.2  0.8  0.6  1.2  2.8  6.5 

These  typical  cases  of  remission  and  non-re- 
mission  illustrate  the  close  correlation  between 
clinical  improvement  and  loss  of  acro-ataxia, 

which  must  be  considered  a symptom  of  coidical 
disease.  Of  twenty  patients  intensively  studied 
during  the  progress  of  satisfactory  remissions, 
motor  improvement  occurred  concomitantly  with 
clinical  improvement  in  40  per  cent,  preceded  it 
in  35  per  cent,  and  followed  it  in  25  per  cent. 
Very  early  cases  may  lose  most  of  their  acro- 
ataxia  within  three  months;  others  continue  to 
manifest  improvement  at  nine  months,  and  oc- 
casionally beyond  a year.  Immediate  improvement 
was  noted  in  the  motor  symptoms  of  45  per  cent 
of  our  patients  following  malaria,  25  per  cent 
were  unchanged  during  the  first  month.  In  30 
per  cent  of  cases  an  exacerbation  of  the  motor 
symptoms  was  manifested  immediately  following 
malaria  and  during  the  first  month  of  convales- 
cence. This  is  consistent  with  the  observation  of 
Wilson4,  that  paralytics  who  died  during  this 
period  showed  a marked  intensification  of  the 
meningeal  and  cortical  inflammatory  and  pro- 
liferative reaction. 

Patients  with  evidence  of  mental  deterioration 
showed  a slower  recovery  of  motor  coordination 
than  eai’ly  cases.  We  have  obtained  no  evidence 
that  would  indicate  that  a marked  degree  of  in- 
voluntary movement  prognosticates  against  a 
good  clinical  remission. 

CONCLUSIONS 

I.  Earlier  diagnosis  of  general  paralysis,  and 
the  adaptation  of  therapeutic  malaria  to  asymp- 
tomatic neurosyphilis  urges  the  clinican  to  adopt 
additional  standards  to  determine  the  degree  of 
improvement  in  these  cases. 

II.  Improvement  in  the  objective  neurological 
signs  of  general  paralysis,  especially  in  those  due 
to  cortical  disease,  is  a most  reliable  sign  of  im- 
provement in  the  physiological  state  of  the  cortex. 

III.  Improvement  in  dysarthria,  involuntary 
movement,  and  in  the  mental  and  emotional  status 
of  general  paralytics  becomes  evident  concur- 
rently following  therapeutic  malaria. 

IV.  The  spontaneous  handwriting  of  general 
paralytics,  discloses  not  only  involuntary  move- 
ment, but  also  by  its  content  incoordination  of 
thought.  Improvement  both  in  form  and  in 
thought  content  occurs  following  malaria,  and  is 
evidence  of  clinical  remission. 

V.  By  means  of  Whipple’s  steadiness  tester  in- 


March,  1933 


Imperforate  Anus — Curtis 


183 


voluntary  movements  can  be  recorded  and  graphi- 
cally compared.  This  affords  a very  reliable  ob- 
jective test  for  the  degree  of  recovery. 

VI.  Advanced  optic  atrophy,  and  profound  de- 
mentia have  been  the  only  contraindications  to 
this  type  of  examination. 

City  Hospital. 


BIBLIOGRAPHY 

1.  Mott,  F.  W.,  The  Practitioner,  Sept.,  1904,  p.  293. 

2.  Beall,  C.  G.,  Arch  Neurol,  and  Psychiatry  14  :751,  1925. 

3.  Griffitts,  C.  H.,  Fundamentals  of  Vocational  Psych- 
ology, p.  219. 

Wallin,  J.  E.  W.,  Clinical  and  Abnormal  Psychology, 

p.  505. 

4.  Wilson,  R.  B.,  Brain,  51  :440,  1928. 


Imperforate  Anus 

George  M.  Curtis,  Ph.D.,  M.D.,  F.A.C.S.,  and  F.  E.  Kredel,  S.B.,  M.D.* 


IMPERFORATE  anus  may  or  may  not  be  ac- 
companied by  atresia  of  the  lower  rectum. 
There  may  even  be  an  associated  agenesis  of 
the  entire  distal  colon.  It  is  manifestly  of  con- 
sequence to  know  in  advance  how  much  of  the 
lower  bowel  is  present  before  planning  any  opera- 
tive correction.  This  may  be  determined  by  the 
X-ray,  since  the  bowel  of  the  newborn  infant  con- 
tains gas.  We  wish  to  present  at  this  time  a case 
in  which  the  preoperative  diagnosis  was  thus 
made,  and  also  to  emphasize  the  prevention  of 
stenosis  following  the  proctoplasty. 

This  patient,  a premature  male  infant  of  35 
weeks,  was  bom  in  the  Chicago  Lying-In  Hos- 
pital on  January  24,  1932.  Delivery  was  normal 
and  the  post-natal  revival  was  prompt.  The  in- 
fant weighed  2900  grams.  Examination  revealed 
an  imperforate  anus.  No  other  associated  abnor- 
malities were  seen  on  external  examination,  ex- 
cept a right  hydrocele.  The  circulation  was  excel- 
lent. A catheter  passed  easily  into  the  stomach. 
The  infant  was  placed  in  an  incubator  and  given 
one-half  ounce  of  water  by  mouth  every  three 
hours.  The  urine  was  clear  and  contained  no 
meconium. 

An  X-ray  of  the  abdomen,  with  the  baby  in- 
verted, was  taken  fifteen  hours  after  delivery 
(Fig.  1).  A considerable  amount  of  gas  was  evi- 
dent in  the  stomach,  the  small  and  large  intes- 
tines. The  gas  in  the  rectum,  however,  ended 
sharply  (Fig.  1,  B)  at  the  upper  margin  of  the 
pelvis,  3 cm.  from  a lead  marker  (Fig.  1,  A) 
placed  on  the  skin  over  the  anal  dimple. 

This  X-ray  evidence,  together  with  the  fact  that 
an  impulse  could  not  be  felt  in  the  perineum  when 
the  infant  cried  or  strained,  established  the  diag- 
nosis of  atresia  of  the  lower  rectum.  Since  the 
mortality  for  inguinal  colostomy  in  such  cases  is 
extremely  high  and  the  functional  result  most  un- 
satisfactory, repair  by  the  perineal  route  was  de- 
cided upon. 

Proctoplasty  was  done  33  hours  after  delivery, 
with  the  infant  in  an  exaggerated  lithotomy  posi- 
tion. Local  infiltration  anesthesia  was  employed 
using  one-half  per  cent  novocaine.  A mid-line  in- 
cision was  made  from  the  anal  dimple  posteriorly 
to  the  coccyx.  Dissection  was  carefully  carried 
out  in  the  mid-line  close  to  the  sacrum,  in  order 

*From  the  Departments  of  Surgery  of  the  University  of 
Chicago  and  of  Ohio  State  University. 


to  avoid  injury  to  the  urethra.  A small  fibrous 
cord,  evidently  the  vestige  of  the  lower  rectum, 
was  encountered.  This  was  followed  into  an  in- 
tact levator  ani  muscle,  which  formed,  with  the 
coccygeus,  a complete  pelvic  diaphragm.  When  the 
muscle  was  split,  the  blind  end  of  the  rectum 
(Fig.  1,  B)  was  found  directly  above.  Aspiration 
with  a large  bored  needle  revealed  meconium. 
The  rectum  was  readily  mobilized  by  blunt  dis- 
section, brought  down  to  the  perineum,  opened, 
and  sutured  to  the  skin  at  the  anterior  half  of  the 
incision.  Closure  of  the  posterior  portion  of  the 
incision  in  the  mid-line  reestablished  the  con- 
tinuity of  the  external  sphincter  fibres,  which 
were  present.  A large  rubber  tube  (F.  30 


Figure  1.  X-ray,  taken  15  hours  post  partum,  showing 
the  marked  anal  site,  A,  and  the  blindly  ending  rectum,  B. 


184 


The  Ohio  State  Medical  Journal 


March,  1933 


catheter)  was  then  sutured  into  the  lumen  of  the 
rectum. 

The  postoperative  course  was  smooth,  save  for 
some  difficulty  in  voiding.  This  lasted  for  three 
days.  Catheterization  was  required  during  the 
first  twenty-four  hours.  During  the  second  and 
third  days  urine  was  expressed  by  firm  pressure 
in  the  suprapubic  region.  Normal  spontaneous 
urination  began  on  the  fourth  day. 

Continued  dilation  of  the  newly  made  anal 
opening  was  maintained  for  an  extended  period 
to  prevent  subsequent  stenosis.  Fluid  meconium 
passed  readily  through  the  tube  inserted  at  the 
time  of  operation.  Five  days  later  the  tube  began 
to  be  expelled  during  passage  of  a stool.  For 
three  weeks  the  tube  was  replaced  immediately 
after  stool.  During  the  next  four  weeks  a large 
tube  was  inserted  for  a half-hour  every  four 
hours.  When  the  patient  was  discharged,  at  the 
age  of  seven  weeks,  the  mother  was  instructed  to 
keep  the  anal  opening  dilated  with  a 30  French 
catheter.  This  instruction  was  indifferently  fol- 
lowed and  some  stenosis  resulted,  so  that  it  be- 
came necessary  at  the  age  of  nine  weeks  to  dilate 
the  rectal  opening  up  to  the  tube  size  with  Hegar 
dilators.  The  infant,  when  last  seen,  was  five 
months  old.  There  was  no  stricture  and  the  F.  30 
catheter  passed  readily.  Daily  dilation  was  being 
practiced.  There  was  some  evidence  of  sphincter 
action.  The  infant  was  growing  normally. 

The  embryology  of  this  condition  has  been  dis- 
cussed by  Keith1  who  points  out  that  sphincter 
fibres  develop  in  the  perineum  independently  of 
the  proctodeum,  and  that  an  adequate  sphincter 
is  present  in  most  cases  of  anal  atresia.  In  a 
series  of  sixty-one  cases  reported  by  Brenner2  the 
mortality  from  perineal  operations  was  24  per 
cent,  while  that  of  inguinal  colostomy  was  67  per 
cent.  The  perineal  approach  is  the  method  of 
choice  when  a patent  rectum  can  be  mobilized  and 
brought  down.  The  determination  of  the  extent 
of  rectal  atresia  by  means  of  the  X-ray,  with  the 
patient  inverted,  has  recently  been  described  by 
Wangensteen  and  Rice.3  This  is  an  important 
diagnostic  procedure.  In  their  second  case,  as  in 
ours,  gas  was  present  in  the  rectum  during  the 
first  twenty-four  hours  of  life. 

REFERENCES 

1.  Keith,  A. : Brit.  Med.  Jour.,  2,  1736,  1908. 

2.  Brenner  E.  C. : Surg.  Gyn.  and  Obst.,  20,  579,  1915. 

3.  Wangensteen,  O.  H.,  and  Rice,  C.  O. : Ann.  Surg., 

92,  77,  1930. 

A Large  Proportion  of  Nurses,  Outnum- 
bering Physicians,  Are  in  Public  Health 
and  Institutional  Service 

More  than  half  of  the  nursing  profession,  domi- 
nated by  women,  are  engaged  in  private  duty, 
while  the  remainder  is  about  equally  distributed 
among  public  health  work,  institutional  service, 
and  other  types  of  service,  according  to  Walter  J. 
Greenleaf,  specialist  in  higher  education,  United 
States  Office  of  Education.  There  are  at  the  pres- 
ent time  throe  JU  rses  to  every  two  physicians. 


Nursing  within  a quarter  of  a century  has  risen 
to  the  status  of  a profession.  Now  regarded  as  a 
definite  health  service,  96  per  cent  of  those  en- 
gaged in  nursing  are  women. 

Many  changes  in  the  last  thirty  years  in  medi- 
cine, surgery,  dentistry,  hygiene  and  preventive 
measures  have  taken  it  from  the  bedside  to  many 
occupations  associated  with  health. 

Nursing  is  now  divided  into  four  large  groups. 
It  is  either  practiced  as  a private  duty,  an  insti- 
tutional duty,  in  the  form  of  public  health  service, 
or  as  a government  service. 

When  practiced  privately  it  is  performed  for 
private  persons  in  hospitals  or  homes.  As  an  in- 
stitutional occupation,  it  is  practiced  in  hospitals, 
charitable  homes,  reformatories  and  various  insti- 
tutions. A hospital  may  include  staff  nurses,  su- 
perintendents, educational  directors,  principals, 
instructors,  supervisors,  head  nurses,  operating 
room  nurses,  general  duty  nurses,  dietitians,  an- 
esthetists, laboratory  assistants,  technicians  and 
even  occupational  therapy  aids  and  hospital  social 
service  workers. 

Public  health  nursing  is  subdivided  into  many 
phases.  There  may  be  district  nurses  (visiting 
nurses)  to  call  at  the  homes,  municipal  nurses 
and  others.  Public  health  nurses  are  employed 
by  state  departments  of  health  and  education, 
state  tuberculosis  associations,  visiting  nurse  as- 
sociations, infant  welfare  associations  and  vari- 
ous social  organizations. 

Over  5,000  nurses  are  now  employed  in  the 
public  and  private  schools  of  the  nation.  There 
are  rural  nurses  for  the  remote  areas  and  indus- 
trial nurses  for  the  factories  of  the  cities.  Mis- 
sionary nurses  are  found  throughout  the  world. 
Red  Cross  nurses  act  in  emergencies  at  the  re- 
quest of  the  surgeon  general.  Over  200,000  were 
supplied  during  the  World  War. 

Government  service  in  its  many  ramifications 
has  attracted  many  nurses.  There  are  public 
health  nurses,  veterans’  bureau  nurses,  navy  and 
army  nurses. 

Nurses  are  generally  paid  from  $35  to  $45  a 
week.  Average  earnings  amount  to  about  $1,300 
yearly.  Income  varies  according  to  the  special 
skill  of  the  nurse  and  the  nature  of  her  employ- 
ment. In  government  service  the  salaries  vary  in 
the  army  from  $70  to  $130  per  month  with  main- 
tenance, to  $2,700  annually  as  chief  nurses  in  the 
Public  Health  Service  less  deductions  for  room, 
board  and  laundry  in  respect  to  the  latter. 

Education  is  stressed  more  than  formerly. 
About  54  per  cent  of  the  graduate  nurses  have 
had  four  years  of  high  school  training  while  15 
per  cent  have  been  to  college.  Of  the  1,884  nurs- 
ing schools,  accredited  by  state  boards  of  nurse 
examiners,  1,137  are  nonsectarian,  228  Protestant, 
343  Roman  Catholic  and  176  under  other  types 
of  control.  Nevada  is  the  only  state  in  the 
United  States  without  a nurses’  training  school. 


March,  1933 


Discourse  on  Higher  Learning 


185 


III. 


Higher 


By  Socrates  Asklepian 


— We  discover  you  looking  sad,  Socrates. 

— A grievous  fault,  Theocritus  and  Janus,  that 
any  of  our  number  should  so  reveal  the  soul  in 
the  facies. 

— Is  it  a matter  of  your  soul  then,  Socrates? 
We  had  hoped  that  it  was  but  too  much  wine  last 
evening. 

— I did  partake  too  freely  for  I was  with  Kal- 
lius  and  his  friends  but  in  sober  judgment  it  was 
not  what  they  fed  my  body  but  what  they  fed  my 
soul  that  now  is  depressing  me. 

— Will  you  not  speak  out  to  us? 

— I do  so  gladly,  though  I find  it  difficult  to 
formulate  in  few  words  the  subject  of  what  we 
discussed  last  evening. 

— Did  it  not  concern  teaching,  Socrates,  for  all 
men  ply  you  with  questions  in  that  matter. 

— It  did  concern  teaching,  but  they  did  not  use 
that  single  word — speaking  constantly  of  higher 
teaching. 

— What  said  they,  Socrates? 

- — It  was  Kallius  himself  who  spake  first  and  of 
his  sons.  He  sought  advice  regarding  Cleon. 
Should  he  enter  him  as  novitiate  to  serve  Askle- 
pios  or  to  worship  under  another  god? 

— What  answered  you,  Socrates,  since  none 
knows  the  physician’s  calling  better  than  you? 

— I bade  him  to  inquire  of  the  son  himself  did 
he  desire  the  life  of  one  of  our  kind  and  to  ap- 
prentice him  or  not  to  the  worship  of  Asklepios 
according  to  his  answer. 

— Had  Kallius  not  already  settled  the  matter  in 
this  fashion  since  he  is  himself  a physician  of 
long  practice? 

— That  he  had  not,  for  he  did  cite  the  larger 
pecuniary  rewards  that  come  to  the  followers  of 
other  gods. 

— But  did  he  not  perceive  that  the  purpose  of 
life  is  the  attainment  of  happiness  and  that  a 
hundred  drachmas  under  Asklepios  might  buy 
more  than  a thousand  under  Hermes? 

—He  seemed  not  convinced  in  that  matter  for 
he  did  counter  such  reasoning  by  telling  me  of  the 
happiness  of  his  other  son,  Praxagora. 

— Where  pray  does  he  play  apprentice? 

— He  is  not  like  you,  Janus,  or  you,  Theocritus, 
the  follower  of  one  teacher  only.  He  will  be  the 
product  of  many  men,  the  product  of  what  they 
call  a school.  He  does  not  receive  such  simple 
direction  in  discourse  and  reason  and  faith  as  you 
are  content  to  take  from  me  but  a whole  regiment 
works  with  him.  Kallius  calls  it  the  system  of 
higher  learning. 

• — Mean  you  that  Kallius’  son  is  no  longer  a 


peripatetic  but  in  one  of  the  sessile  schools  of 
thought  that  some  men  call  the  university? 

I 

— Kallius  calls  it  an  institute.  And  the  son  is 
entered  in  the  Institute  of  Hotel  Management. 

— Where  in  the  realms  of  logic  or  ethics  does 
such  an  institute  find  place,  Socrates? 

— I asked  regarding  that  point.  In  fact  I sug- 
gested that  the  institute  could  only  be  a portion  of 
a school  of  education  or  engineering  or  business 
or  agriculture,  but  I was  wrong.  This  institute 
is  a unit. 

— What  do  the  masters  teach  there? 

— I can  only  repeat  the  words  that  followed  my 
inquiry  on  this  point.  Kallius  and  I were  eating 
cheese  toast  with  our  wine.  ‘Consider  my  son’,  he 
said,  ‘he  did  come  home  last  week  to  confound  my 
mind.  Father,  he  asked,  how  many  kinds  of  toast 
are  there.  I ventured  the  classes,  dry,  buttered 
and  milk,  at  which  he  laughed  upon  my  stupidity.’ 
It  seems  that  in  the  higher  learning,  Janus,  they 
know  of  more  than  fifty  kinds. 

— What  other  treasures  of  the  mind  brought  he 
home? 

— I can  remember  but  three  more.  They  have 
one  intensive  week  in  swine  butchering.  The  son 
had  himself  dissected  a sow. 

— And  the  others? 

— There  is  an  intensive  course  also  in  draperies, 
wall  papers  and  bed  furnishings. 

—And—? 

— A very  thorough  practice  in  the  new  science 
of  numbers. 

— Does  not  this  self-proving  art  of  logic  give 
joy  to  you,  Socrates? 

— It  should,  Theocritus. 

— Then  why  be  cast  down  because  your  rivals 
choose  to  emphasize  weight  when  you  emphasize 
power ; without  both  there  would  not  be  that  lever 
which  is  life. 

— You  are  wiser  than  your  master,  Theocritus. 
My  desire  is  for  musk  and  without  the  buck.  I 
acknowledge  the  weakness  of  my  stand — but  I am 
still  not  cheered. 


Next  written  examination  of  the  American 
Board  of  Obstetrics  and  Gynecology  will  be  held 
April  1,  1933.  A general  clinical  examination  will 
be  held  by  the  board  on  Tuesday,  June  13,  im- 
mediately preceding  the  annual  session  of  the 
American  Medical  Association  in  Milwaukee.  In- 
formation concerning  both  examinations  may  be 
obtained  from  Dr.  Paul  Titus,  secretary,  1015 
Highland  Building,  Pittsburgh. 


The  Presidents  P&qe 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


Candor  is  a priceless  quality.  It  serves  to  cement  and  perpetuate  friendship. 
Frank  discussions  do  not  leave  misunderstandings.  Recently  one  colleague  has  re- 
ferred to  articles  on  this  page  as  just  another  page  while  another  has  complimented  me. 
Neither  the  criticism  nor  the  commendation  has  served  to  depress  or  exalt  the  author; 
rather  they  have  had,  a salutary  effect  in  constantly  reminding  me  that  I am  of  the 
rank  and  file.  Such  observations  as  have  appeared  on  this  page  I thought  to  be  in  line 
with  the  purposes  of  the  Association  which  are  defined  to  be  the  promotion  of  the 
science  and  art  of  medicine,  and  the  protection  of  jrublic  health. 

I have  sought  to  stimulate  your  interest  in  our  profession  by  emphasizing  the  need 
of  membership  and  attendance  at  the  meetings  of  your  county  society,  to  promote  a 
fraternal  spirit  among  the  members,  and  to  emphasize  the  broadening  of  the  field  of 
medical  practice  to  include  prevention  as  well  as  treatment  of  disease. 

Without  membership  you  can  not  do  your  part  in  the  modern  program.  You  may 
attain  eminence  without  it,  but  the  chances  are  that  without  this  stimulation  you  will 
degenerate  and  certainly  you  withhold  from  your  profession  a duty  and  an  obligation 
which  you  assumed  when  your  diploma  was  granted  to  you. 

Effective  organization  is  the  only  weapon  we  possess  to  make  ourselves  heard  and 
felt  in  these  uncertain  times.  Reports  indicate  a gratifying  response  to  appeals  of  our 
officers  that  society  membership  and  interest  be  maintained. 

But  above  intellectual  equipment  and  professional  interest  character  stands  as 
the  basis  of  true  professional  attainment.  Without  character  an  educated  man  is  dan- 
gei’ous.  County  societies  to  measure  up  to  the  requirements  of  the  Code  must  purge 
themselves  of  such  members  or  guard  against  their  admission.  The  formula  which 
Oliver  Wendell  Holmes  prescribed  for  the  patient  in  the  choice  of  his  physician  still 
applies: 

“Choose  a man  who  is  personally  agreeable,  for  a daily  visit  from  an  intelligent, 
amiable,  pleasant,  sympathetic  person  will  cost  you  no  more  than  one  from  a sloven  or 
a boor,  and  his  presence  will  do  more  for  you  than  any  prescription  the  other  will 
order. 

“Let  him  be  a man  of  recognized  good  sense  in  other  matters,  and  the  chance  is 
that  he  will  be  sensible  as  a practitioner. 

“Let  him  be  a man  who  stands  well  with  his  professional  brethren,  whom  they 
approve  as  honest,  able,  courteous.” 

With  a membership  composed  of  such  men  we  need  have  no  fear  from  a thorough 
discussion  of  state  medicine  or  socialization  of  medical  practice. 


186 


Hotel  Reservations  Should  Be  Made  Immediately  for  the 
Coming  Annual  Meeting  in  Akron 


Hotel  reservations  should  be  made  immediately 
by  Ohio  physicians  who  are  contemplating  attend- 
ing the  87th  Annual  Meeting  of  the  Ohio  State 
Medical  Association  at  Akron,  Tuesday  and  Wed- 
nesday, May  2 and  3,  and  the  golf  tournament 
and  clinics  on  Monday,  May  1. 

Requests  for  hotel  reservations  should  be  made 
direct  to  the  management  of  the  hotel  selected. 
Verification  of  the  reservation  should  be  re- 
quested. 

The  Mayflower,  Akron’s  new  hotel  and  one  of 
the  finest  in  Ohio,  has  been  selected  as  the  head- 
quarters hotel.  It  will  house  the  commercial  and 
scientific  exhibits  and  the  registration  headquar- 
ters. It  will  be  the  meeting  place  for  all  of  the 
general  sessions  and  most  of  the  scientific  section 
sessions. 

Akron  is  liberally  supplied  with  hotels  but  in 
order  to  secure  good  accommodations  readily  ac- 
cessible to  the  annual  meeting  hotel,  physicians 
who  are  expecting  to  attend  the  gathering  should 
not  delay  in  making  their  reservations.  Follow- 
ing is  a list  of  Akron  hotels,  their  rates  and  con- 
veniences: 

THE  MAYFLOWER 
Headquarters  Hotel 
Main  and  Market  Streets 

450  rooms,  all  with  bath;  single  room,  $2.50 
to  $4.50;  room  with  double  bed,  $3.50  to  $6.00; 
room  with  twin  beds,  $5.50  to  $6.50;  suites,  $10.00, 
$12.00  to  $21.00. 

THE  PORTAGE 
Main  and  Market  Streets 

320  rooms;  59  rooms  with  lavatory  and  toilet, 
$1.50  single,  $2.50  double;  35  rooms  with  lavatory 
and  toilet,  single,  $2.00,  double,  $3.00;  30  rooms 

with  bath,  $2.00  single,  $3.00  double;  65  rooms 

with  bath,  $2.50  single,  $3.50  double;  49  rooms 

with  bath,  $3.00  single,  $4.00  double;  12  rooms 

with  bath  and  twin  beds,  $4.00;  44  rooms  with 
bath  and  twin  beds,  $4.50. 

THE  ANTHONY  WAYNE 
314  South  Main  Street 

150  rooms;  single  room  with  bath,  $2.00  to 
$2.50;  double,  $3.00  to  $3.50. 

THE  AKRON 

East  Market  Street  and  Broadway 

200  rooms;  single  room  with  bath,  $2.50  to 
$3.00;  double  room  with  bath,  $3.50  and  $4.00; 
room  with  bath  and  twin  beds,  $4.00;  two-room 
suites  with  connecting  bath,  $2.00  per  room. 

THE  HOME 
11  South  Main  Street 

175  rooms;  single  room  with  bath,  $1.50  to 
$2.50;  double  room  with  bath,  $3.00  to  $3.50;  sin- 
gle room  without  bath,  $1.00  to  $1.25;  double  room 
without  bath,  $2.00. 


THE  MARNE 

South  Main  Street  near  State  Street 
175  rooms;  single  room  with  connecting  shower, 
$1.50;  double  room  with  connecting  shower,  $2.00; 
single  room  with  tub  bath,  $2.50;  double  room 
with  tub  bath,  $3.00. 

THE  TAYLOR 
8 East  Market  Street 

185  rooms;  35  rooms  with  bath,  $1.50;  35  rooms 
with  bath  and  radio,  $2.00;  15  rooms  with  twin 
beds  and  bath,  $3.50  to  $4.00 ; 100  rooms  with 
running  water,  $1.00  to  $2.00. 


Pathologists  Hold  Annual  Meeting- 

Twelfth  Annual  Session  of  the  Ohio  Society  of 
Clinical  and  Laboratory  Diagnosis  was  held  in 
Columbus  on  the  Ohio  State  University  campus, 
January  21.  The  following  program  was  pre- 
sented: “Prognostic  Value  of  the  Corpuscular 

Constants  in  Mitral  Stenosis”,  Dr.  R.  S.  Fidler, 
Columbus;  “Experience  with  Detoxified  Autogen- 
ous Vaccines”,  Dr.  C.  E.  Roderick,  Battle  Creek, 
Michigan;  “Torulus,  Yeast-Like  Organisms  and 
Coccidioides  in  Human  Patients”,  Dr.  R.  M. 
Crumrine,  Toledo;  “The  Relation  of  the  Patho- 
logist to  the  Embalmer”,  Dr.  Jonathan  Forman, 
Columbus;  “Neoplasms  of  the  Testes”,  Dr. 
Thomas  L.  Ramsey,  Toledo;  “The  Tumors  of  the 
Hypophyseal  Duct”,  Dr.  Ernest  Scott  and  Mary 
H.  Oliver,  M.A.,  Columbus;  “Pathological  Physi- 
ology of  Insulin  Reactions”,  Dr.  W.  M.  Sheppe, 
Wheeling,  West  Virginia.  In  addition  a clinical 
pathological  conference  was  held  on  the  subject, 
“Tuberculosis  and  Syphilitic  Meningitis”.  The 
annual  banquet  was  held  in  the  evening  at  the 
Faculty  Club. 

At  the  business  session,  Dr.  R.  S.  Fidler,  Co- 
lumbus, was  elected  president;  Dr.  A.  H.  Schade, 
Toledo,  was  re-elected  secretary-treasurer,  and 
Dr.  F.  C.  Payne,  Dayton,  a member  of  the  ex- 
ecutive committee. 

The  society  authorized  the  committee  headed  by 
Dr.  Jonathan  Forman,  Columbus,  which  has  been 
cooperating  with  a special  committee  from  the 
Ohio  Society  of  Embalmers  relative  to  autopsies, 
to  continue  with  its  activities  on  a permanent 
basis.  Dr.  Forman  announced  that  an  effoi-t  will 
be  made  to  extend  the  scope  of  the  committee’s 
activities  to  include  cooperation  with  coroners 
and  hospitals.  It  was  agreed  that  the  committee 
should  act  as  a grievance  committee  for  Ohio  em- 
balmers to  which  complaints  arising  from  autop- 
sies may  be  filed  for  the  purpose  of  clearing  up 
misunderstandings  between  embalmers  and  phy- 
sicians and  educating  physicians  concerning  the 
rights  of  embalmers  in  cases  where  autopsies 
have  been  performed.  A business  session  of  the 
society  will  be  held  on  Tuesday,  May  2,  the  first 
day  of  the  annual  meeting  of  the  Ohio  State  Medi- 
cal Association  in  Akron. 


187 


Interesting  Decision  by  Judicial  Council,  A.M,  A.  Sets  a 
Precedent  in  Megard  to  Types  of  Contract  Practice 


Numerous  new  ventures  in  changing  the  nature 
and  methods  of  medical  practice  have  been 
launched  during  the  past  two  or  three  years  but 
probably  none  of  these  revolutionary  experiments 
has  gained  such  momentum  and  been  accorded 
such  widespread  publicity  as  those  commonly 
known  as  contract  practice  schemes  for  marketing 
medical  service  to  limited  groups  of  individuals  or 
the  public  at  large. 

Contract  practice  is  not  a new  development  in 
medical  care.  It  has  been  carried  on  for  years  in 
different  sections  of  the  country.  In  many  in- 
stances, especially  under  certain  conditions  and  in 
certain  communities,  contract  practice  set-ups 
have  been  deemed  ethical. 

However,  with  the  onset  of  the  present  economic 
depression,  numerous  and  varied  new  forms  of 
contract  practice  were  established.  In  these  new 
experiments  medical  ethics  and  the  fundamental 
principles  underlying  good  medical  practice  and 
competent  medical  care  are  accorded  little,  if  any, 
consideration.  For  the  most  part,  they  are  com- 
mercial rackets  which  exploit  the  services  of  the 
physician  under  contract;  advance  the  financial 
interests  of  those  promoting  the  venture;  pre- 
clude the  free  choice  of  physician;  operate  in  un- 
fair competition  with  other  physicians  of  the  com- 
munity; sacrifice  quality  of  medical  service  for 
commercial  expediency;  encourage  bargaining, 
solicitation  of  patients  and  underbidding;  create 
dissentions  within  the  ranks  of  the  medical  pro- 
fession, and  stimulate  other  activities  which  dis- 
rupt the  relationship  between  physician  and  pa- 
tient and  break  down  the  practice  of  medicine  on 
an  ethical,  altruistic  and  professional  basis. 

All  physicians  who  have  kept  themselves  in- 
formed concerning  recent  trends  and  develop- 
ments in  the  field  of  medicine  are  familiar  with 
the  mode  of  operation  of  many  of  these  new 
types  of  medical  practice  and  with  their  inherent 
dangers,  both  from  the  standpoint  of  the  public 
and  the  medical  profession. 

In  all  probability,  the  question  in  the  minds  of 
the  majority  of  members  of  the  profession  con- 
cerning this  development,  now  threatening  to  in- 
jure the  individual  independent  practice  of  medi- 
cine, is: 

“What  are  we  going  to  do  about  it?” 

A partial  answer  to  this  question  has  been  fur- 
nished by  the  Dallas  County  (Texas)  Medical 
Society  whose  fearless  action  against  a contract 
practice  scheme  operating  in  the  City  of  Dallas 
has  blazed  the  way  for  similar  action  by  other 
county  medical  societies  and  has  the  official  and 
final  judgment  of  the  Judicial  Council  of  the 
American  Medical  Association  to  back  it  up. 

Early  in  1932,  the  Dallas  County  Medical  So- 


ciety, by  official  act,  suspended  eighteen  of  its 
members  who  were  practicing  medicine  as  a group, 
because  of  their  refusal  to  abandon  certain  con- 
tracts which  the  society  believed  were  inimical 
to  the  welfare  of  their  confreres  and  subversive  of 
sound  public  policy. 

The  case  was  appealed  through  the  councilor 
of  the  district  to  the  Council  of  the  Texas  State 
Medical  Association.  This  body,  acting  as  a court 
of  appeals,  sustained  the  Dallas  County  Medical 
Society  and  directed  that  the  suspension  of  the 
appellants  should  be  relieved  immediately  that 
they  abandon  the  contracts  complained  of. 

From  this  decision  appeal  was  taken  to  the 
Judicial  Council  of  the  American  Medical  Asso- 
ciation which,  as  stated  before,  recently  sustained 
the  suspension. 

Prosecution  of  the  case  was  based  primarily 
upon  Section  2,  Article  6,  of  the  Principles  of 
Medical  Ethics  of  the  American  Medical  Associa- 
tion, which  reads  as  follows : 

“It  is  unprofessional  for  a physician  to  dispose 
of  his  services  under  conditions  that  make  it  im- 
possible to  render  adequate  service  to  his  patient 
or  which  interfere  with  reasonable  competition 
among  the  physicians  of  a community.  To  do  this 
is  detrimental  to  the  public  and  to  the  individual 
physician,  and  lowers  the  dignity  of  the  pro- 
fession.” 

In  addition,  the  Council  of  the  Texas  State 
Medical  Association  in  rendering  its  decision  sus- 
taining the  action  of  the  Dallas  County  Medical 
Society,  relied  upon  the  following  interpretative 
analyses  of  unethical  contract  practice  made  by 
the  Judicial  Council  of  the  A.  M.A. : 

“1.  When  the  compensation  received  is  inade- 
quate, based  on  the  usual  fees  paid  for  the  same 
kind  of  service  by  the  doctors  in  the  same  com- 
munity. 

“2.  When  the  compensation  is  so  low  as  to 
make  it  impossible  for  competent  service  to  be  ren- 
dered. 

“3.  When  there  is  competitive  bidding  in  order 
to  secure  the  contract. 

“4.  When  a free  choice  of  physicians  is  denied. 

“5.  Solicitation  of  patients,  directly  or  indi- 
reetly.” 

The  contract  complained  of,  and  upon  which 
the  procedure  was  based  and  the  eighteen  mem- 
bers suspended,  read  in  part  as  follows: 

CONTRACT  NO.  1 

“For  the  consideration  herein  stated,  the  clinic 
agi’ees  to  render  all  necessary  surgical  and  medi- 
cal treatment  for  members  of  the  Association, 
such  members  to  be  composed  of  white  employees, 
male  and  female,  of  the  Dallas  Railway  Company 
and  Texas  Interurban  Railway,  through  physi- 
cians connected  with  the  Dallas  Medical  and  Sur- 
gical Clinic,  the  Clinic  agreeing  to  appoint  a com- 
petent person,  graduate  in  medicine  and  surgery 
as  Chief  Physician  and  the  Clinic  agreeing  to  fur- 
nish consultation  service  and  active  assistance 


188 


March,  1933 


State  News 


189 


when  necessary  so  as  to  fully  cooperate  in  the  per- 
formance of  the  services  herein  contemplated. 

“An  office  shall  be  furnished  and  equipped  by 
the  Association,  at  a place  selected  by  it,  where- 
on each  day,  except  Sundays  and  holidays,  at  any 
hour  to  be  designated  by  the  Association,  the 
Chief  Physician  of  the  Clinic  as  hereinabove  pro- 
vided, shall  hold  a clinic  or  sick  call  period  for 
ambulatory  cases  among  the  Association  mem- 
bers. 

“The  Association  shall  likewise  employ  at  its 
own  expense,  a nurse  mutually  satisfactory  to  the 
Association  and  the  Clinic. 

“The  physicians  and  surgeons  of  the  Clinic  will 
render  attention  either  at  the  clinical  office  here- 
inabove referred  to,  or  at  the  homes  of  the  mem- 
bers. 

“The  services  agreed  to  be  performed  by  the 
Clinic,  through  its  physicians  and  surgeons,  shall 
include  medical  and  surgical  attention  of  every 
character,  including  also,  eye,  ear,  nose  and  throat 
and  oral  surgery,  but  shall  not  include  ordinary 
filling  and  dental  work,  or  venereal  diseases. 

“X-ray  service  and  special  treatments  shall  be 
furnished  by  the  Clinic  to  the  Association  mem- 
bers at  actual  cost  to  the  Clinic,  which  cost  shall 
be  paid  to  the  Clinic  by  the  individual  members 
of  the  Association,  and  it  is  not  agreed  to  be  paid 
by  the  Association  itself. 

“As  a consideration  of  the  services  above  ren- 
dered, the  Association  agrees  to  pay  the  Clinic 
seventy-five  (75c)  per  member  per  month,  the 
collection  of  such  fees  to  be  made  by  the  Associa- 
tion, and  remittance  of  such  amount,  together 
with  an  accounting  and  statement  thereof,  shall 
be  made  to  the  Clinic  not  later  than  the  tenth  of 
each  month,  such  remittance  and  accounting  to 
cover  fees  for  the  preceding  calendar  month. 

“The  contract  and  agreement  shall  take  effect 
from  and  after  the  first  day  of  August,  1924,  and 
continue  for  the  period  of  one  year  from  such 
date,  and  thereafter  indefinitely,  unless  termi- 
nated by  either  of  the  parties,  such  termination  to 
be  written  notice  served  upon  the  other  party 
thirty  (30)  days  before  the  time  of  termination.” 

CONTRACT  NO.  2 

“Upon  the  payment  of  $200.00  per  month,  the 
services  of  your  staff  are  available  to  the  officers 
and  employees  of  this  bank  for  consultation,  ex- 
amination, and  treatment  of  minor  cases  of  illness, 
in  our  building  when  necessary.  However,  em- 
ployees are  not  required  to  accept  this  service,  but 
are  free  to  employ  the  services  of  their  family 
physician  at  their  expense  if  they  so  desire. 

“Any  treatments  given  our  employes  at  the 
clinic  and  all  home  visits  are  made  at  the  request 
of  the  employee,  without  any  knowledge  or  lia- 
bility on  the  part  of  this  bank,  and  we  presume 
the  charges  made  in  such  instance  are  in  accord- 
ance with  the  economic  standing  of  such  em- 
ployee.” 

The  decision  of  the  Judicial  Council  of  the 
American  Medical  Association  in  confirming  the 
suspension  of  the  Dallas  physicians  was  in  part 
as  follows: 

“The  fundamental  issue  in  dispute  in  this  case 
is  the  ethical  character  of  certain  contracts  held 
by  the  appellants  to  give  medical  service  to  groups 
of  people  on  a monthly  per  capita  plan  of  pay- 
ment. No  essential  facts  of  the  contracts  wex’e  in 
dispute. 

“It  is  contended  by  the  appellants  that  these 
contracts  were  not  in  violation  of  all  or  any  of 
five  conditions  which  the  Judicial  Council  has  de- 


clared at  various  times  are  conditions,  which  ob- 
taining, made  a contract  unethical.  The  Dallas 
County  Medical  Society  which  sentenced  these  ap- 
pellants to  suspension  contended  that  these  con- 
tracts violated  all  five  of  these  conditions.  When, 
in  its  constitutional  function  as  authority  over 
ethical  matters,  the  Judicial  Council  expounds 
the  subject  of  contract  practice  and  lays  down 
certain  principles  which,  when  present,  create  an 
unethical  contract  it  is  not  to  be  assumed  that 
those  are  the  only  principles  which  may  have  that 
effect.  A fundemental  of  medical  ethics  is  that 
anything  which  in  effect  is  opposed  to  the  ultimate 
good  of  the  people  at  large  is  against  sound  pub- 
lic policy  and  therefore  unethical.  On  the  five 
points  mentioned  the  appellants  presented  a 
strong  argument  which  might  be  convincing  if  a 
narrow  or  local  view  only  is  considered.  Never- 
theless the  Judicial  Council  is  of  the  unanimous 
opinion  that  this  type  of  contract  is  unethical  on 
the  basis  of  being  contrary  to  sound  public  policy. 

“The  appellants  were  at  the  same  time  con- 
victed of  violation  of  a by-law  of  the  society  for- 
bidding the  holding  of  certain  contracts  and 
pleaded  error  in  the  trial  on  a technical  procedure. 
This  phase  of  the  appeal  was  not  pressed  by 
either  side,  but  from  such  records  as  were  sub- 
mitted to  the  Council,  it  is  of  the  opinion  that  no 
reversible  error  was  proven. 

“The  action  of  the  Board  of  Councilors  of  the 
State  Medical  Association  of  Texas  is  con- 
firmed.” 

Although  only  touching  the  high  spots  of  the 
Dallas  case,  the  facts  summarized  in  the  fore- 
going paragraphs  may  set  a pi'ecedent  for  solu- 
tion of  similar  px’oblems  confronting  other  county 
medical  societies. 

Obviously,  local  situations  and  circumstances 
will  vary  greatly.  Each  will  have  to  be  con- 
sidered as  an  individual,  isolated  problem.  How- 
ever, the  broad,  general  and  fundamental  prin- 
ciples upon  which  action  can  be  based  will  apply 
in  many  cases. 

Commenting  on  the  case  and  the  decision  of  the 
Judicial  Council,  Dr.  Holman  Taylor,  editor  of 
the  Texas  State  Journal  of  Medicine,  made  the 
following  observations : 

“No  matter  how  the  problem  is  approached, 
solution  must  begin  in  the  society,  and  chances 
are  that  for  the  most  part  it  will  remain  there. 
Only  in  the  instance  new  issues  are  raised  in 
similar  cases  will  there  likely  be  appeal,  the  case 
here  discussed  serving  adequately  as  a precedent 
in  the  character  of  contracts  considered. 

“It  is  difficult  to  see  how  any  gx-oup  could  lay 
down  hard  and  fast  rules  for  the  control  of  con- 
tract practice  under  the  vai’ying  conditions  eon- 
fi’onting  practitioners  throughout  this  country. 
It  is  easily  possible,  and  it  should  be  doxxe,  and 
soon,  to  expand  the  five  points  advanced  by  the 
Judicial  Council  and  above  quoted,  into  rnox’e 
specific  provisions,  although  still  of  a general 
nature,  suppox’ted  by  case  x'eports,  as  it  wex’e,  both 
actual  and  hypothetical.  In  the  meantime,  it  is 
up  to  the  county  medical  society  to  deal  with  the 
situation. 

“It  would  seem  quite  evident  that  the  trend  of 


190 


The  Ohio  State  Medical  Journal 


March,  1933 


practice  under  even  the  modest  form  of  contracts 
complained  of  in  this  case,  to  towards  the  de- 
velopment of  groups  of  a large  variety,  based 
upon  many  and  different  factors  but  all  for  the 
purpose  of  securing  medical  service  at  a reduced 
rate,  and  it  is  in  the  ultimate  result  of  this  de- 


velopment, under  the  very  complex  organization 
of  society  at  this  time  and  in  the  face  of  the  ten- 
dency toward  the  socialization  of  not  only  medi- 
cine, but  other  vocations,  that  is  to  be  feared,  not 
only,  as  we  have  already  said,  by  the  medical  pro- 
fession but  by  the  public  as  well.” 


=vfom 

‘d  Academies 


First  District 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(George  B.  Topmoeller,  M.D.,  Secretary) 

February  6 — General  Session.  Program:  “Some 
Causes  of  Death  in  Gallbladder  Surgery”,  by  Dr. 
Dudley  W.  Palmer;  discussions  by  Drs.  Roger  S. 
Morris  and  C.  A.  Langdale.  “Recognition  and 
Treatment  of  Cardiac  Irregularities”,  by  Dr. 
Johnson  McGuire;  discussions  by  Drs.  Alfred 
Friedlander  and  Clifford  J.  Straehley,  Jr. 

February  13 — General  Session.  Program:  “A 
Consideration  of  Some  Phases  of  the  Surgery  of 
the  Colon”,  by  Dr.  Fred  W.  Rankin,  Rochester, 
Minnesota. 

February  20  — General  Session.  Program: 
“Nephritis  in  Children”,  by  Dr.  A.  Graeme 
Mitchell;  discussions  by  Drs.  Edward  A.  Wagner 
and  George  Guest.  “History  of  Cancer”,  by  Dr. 
William  M.  Millar. 

February  27 — General  Session.  Program : “Is 
Group  Practice  of  Medicine  and  Group  Health  In- 
surance Desirable?”  by  Dr.  L.  Howard  Schriver. 
“Report  of  a Study  of  Lymphogranuloma  In- 
guinale and  Rectal  Strictures”,  by  Drs.  R.  W. 
Staley  and  Henry  Lee;  discussion  by  Dr.  Henry 
B.  Freiberg. — Bulletin. 

Second  District 

Clark  County  Medical  Society  met  Wednesday 
evening,  January  18,  in  the  dining  room  of  the 
City  Hospital,  with  physicians  from  surrounding 
towns  as  guests.  About  60  physicians  attended 
the  banquet,  and  inspected  the  new  hospital.  An 
illustrated  lecture  on  the  subject,  “Surgical  Re- 
search and  the  Thyroid”  was  presented  by  Dr. 
George  M.  Curtis,  professor  of  surgical  research 
at  Ohio  State  University,  College  of  Medicine. 
The  committee  in  charge  of  the  banquet  and  pro- 
gram was  composed  of  Drs.  A.  C.  Link,  H.  B. 
Elliott  and  R.  D.  Am.  Dr.  C.  W.  Evans,  presi- 
dent of  the  Society,  presided. — News  Clipping. 

Darke  County  Medical  Society  held  its  regular 
meeting  in  the  basement  of  the  Christian  Church, 
Greenville,  on  Friday  evening,  January  13.  Din- 
ner at  6:30,  was  followed  by  a paper  on  “Eclamp- 
sia”, presented  by  Dr.  G.  C.  Gilfillen  of  Dayton, 
in  which  he  outlined  some  new  phases  of  treat- 
ment. Dr.  R.  D.  Hostetter,  also  of  Dayton,  dis- 


cussed the  subject  of  “Some  Pediatric  Problems 
of  Interest  to  the  Practitioner”. — News  Clipping. 

Greene  County  Medical  Society  met  in  their  room 
at  the  Court  House,  Xenia,  Thursday,  February  2. 
After  the  routine  business  was  transacted,  an 
open  forum  discussion  was  held  on  the  subject, 
“Costs  of  Medical  Care”.  There  was  no  definite 
action  taken  except  a committee  appointed  to 
study  the  question  and  act  in  an  advisory  capacity 
in  all  matters  relative  to  the  public.  Meeting  ad- 
journed with  luncheon. — H.  C.  Schick,  M.D., 
Secretary. 

Miami  County  Medical  Society  held  its  February 
meeting  on  Friday  afternoon,  the  3rd,  at  Piqua 
Memorial  Hospital.  Dr.  A.  H.  Bausman  of  Piqua, 
presented  a paper  on  “Borderline  Cases  in  Sur- 
gery”, in  which  he  outlined  methods  of  recognizing 
sub-standard  surgical  risks,  as  well  as  differen- 
tiating operative  from  non-operative  cases.  Dis- 
cussion was  opened  by  Dr.  Warren  Coleman,  of 
Troy.  Dinner  was  served  at  6:00  P.  M. — Bulletin. 

Montgomery  County  Medical  Society  at  its  reg- 
ular meeting  at  the  Fidelity  Building,  Dayton, 
Friday  evening,  January  20,  devoted  the  session 
to  a symposium  on  “The  Common  Cold”,  pre- 
sented as  follows:  “Etiology”,  by  Dr.  A.  W.  Mc- 
Cally;  “Treatment”,  by  Dr.  H.  B.  Harris;  “Com- 
plications”, by  Dr.  H.  V.  Dutrow.  Discussions  by 
Drs.  Cassell,  Olch  and  Haley. 

Regular  meeting,  Friday  evening,  Februai’y  3, 
in  the  Fidelity  Building,  Dayton,  was  addressed 
by  Dr.  Samuel  Brown  of  Cincinnati.  His  subject, 
“Abdominal  Tumors,  a Radiological  Study”,  was 
illustrated  with  lantern  slides.  Discussion  was  led 
by  Drs.  Price,  Jones  and  Burnett. 

Dinner  meeting,  Thursday  evening,  February 
16,  was  held  at  St.  Elizabeth  Hospital,  Dayton. 
Dr.  Carl  A.  Hedblom,  Associate  Professor  of  Sur- 
gery of  the  University  of  Illinois,  College  of  Medi- 
cine, Chicago,  gave  an  illustrated  lecture  on  “The 
Surgical  Treatment  of  Pulmonary  Tuberculosis”, 
using  lantern  slides  and  motion  pictures. — Bul- 
letin. 

Preble  County  Medical  Society  held  its  regular 
meeting  on  Thursday  evening,  January  27,  at 
Seven  Mile  Tavern,  Eaton.  Dinner  at  7 o’clock 
was  followed  by  two  instructive  papers  on 
“Arthritis”,  by  Dr.  A.  B.  Brower,  Dayton  Clinic, 


March,  1933 


State  News 


191 


and  Dr.  Vernon  L.  Hart  of  the  University  of 
Michigan. — News  Clipping. 

Third  District 

Allen  County  Academy  of  Medicine  met  at  the 
City  Hospital,  Lima,  Tuesday  evening,  January 
10,  with  more  than  40  members  present.  Moving 
pictures  concerning  the  heart  and  blood  pressure 
were  shown,  and  the  newly-elected  president,  Dr. 
Burt  Hibbard,  delivered  his  inaugural  address. — 
News  Clipping. 

Hancock  County  Medical  Society  held  its  regu- 
lar monthly  meeting  Thursday  evening,  February 
2,  at  the  Elks’  Club,  Findlay.  The  guest  speaker 
was  Dr.  H.  M.  Sage  of  Columbus,  who  gave  a 
very  interesting  paper  on  “Sinusitis”.  His  paper 
was  discussed  by  Dr.  E.  H.  Porter  of  Tiffin. — H. 
0.  Crosby,  Secretary. 

Hardin  County  Medical  Society  met  Thursday 
evening,  January  19,  at  the  Kenton  Cafe,  for  their 
regular  dinner.  An  illustrated  lecture  was  pre- 
sented by  Dr.  George  M.  Curtis,  professor  of  re- 
search surgery,  Ohio  State  University  College  of 
Medicine. — -News  Clipping. 

Seneca  County  Medical  Society  held  a dinner 
meeting,  Friday  evening,  January  20,  at  Tiffin. 
At  the  business  session,  the  following  were 
elected  to  membership  in  the  society:  Dr.  Edward 
J.  Amberg,  New  Riegel,  Dr.  G.  H.  W.  Brugge- 
mann,  Fostoria,  and  Dr.  Wade  Chamberlain, 
Tiffin. — News  Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO 
AND  LUCAS  COUNTY 

(A.  P.  Hancuff,  M.D.,  Secretary) 

February  3 — General  Meeting,  Academy  Build- 
ing, 8:30  P.  M.  Program:  “Parasitology — A 

Study  of  Animal  Parasites”,  with  lantern  slide 
demonstration,  by  Dr.  Thomas  B.  Magath,  Mayo 
Clinic,  Rochester,  Minnesota. 

February  10 — Section  of  Pathology,  Experimen- 
tal Medicine  and  Bacteriology.  Program:  “Agra- 
nulo  Cytosis— Atypical  Cases”,  by  Dr.  J.  L.  Stifel. 
“Agranulo  Cytosis  due  to  Benzol  Poisoning” — A 
Report  of  Four  Cases,  by  Dr.  Robert  H.  Elrod; 
discussion  opened  by  Dr.  J.  Lester  Kobacker. 

February  17 — Medical  Section.  Junior  Medical 
Forum.  Program  participants : Drs.  H.  G.  Bruss, 
Bemart  Botsch,  Matthew  Ginsburg,  W.  W.  Green, 
Rollin  Kuebbeler,  A.  N.  Johns,  Rees  Klopfenstein, 
C.  G.  Lynch,  E.  E.  Lyons,  and  M.  L.  Mclnnes.  A 
variety  of  individual  medical  presentations  of 
general  interest,  followed  by  open  discussions. 

February  2U — Surgical  Section.  Program : “Cal- 
cinosis Universalis”,  with  case  report  and  lantern 
slide  demonstration,  by  Dr.  B.  J.  Hein.  “Surgery 
of  and  around  the  Hip  Joint”,  with  lantern  slide 
demonstration,  by  Dr.  B.  G.  Chollett. — Bulletin. 

Four  County  Medical  Society  held  its  regular 
meeting  Thursday  afternoon,  January  26,  in  De- 
fiance, with  36  members  present.  The  program  in- 
cluded the  following : “Common  Skin  Diseases”,  by 


Dr.  W.  W.  Duemling  of  Fort  Wayne,  Indiana;  and 
“Vaginal  Bleeding”,  by  Dr.  R.  W.  Wilkins,  also  of 
Fort  Wayne.  Members  participated  in  a general 
discussion  of  the  papers.  The  meeting  and  topics 
were  timely,  and  the  essayists  were  well  received 
and  many  practical  points  were  carried  home. 
Dinner  followed  at  the  Kettering  Golf  Club 
House,  where  the  program  was  carried  out. — D. 
J.  Slosser,  M.D.,  Secretary. 

Putnam  County  Medical  Society  met  at  Hotel 
Dumont,  Ottawa,  on  Tuesday  evening,  February 
7.  Dr.  R.  O.  Ruch,  of  Lima,  gave  a talk  and  pre- 
sented lantern  slides  on  “Skin  Diseases”.  The  talk 
was  very  instructive  and  many  points  of  interest 
and  value  to  the  general  practitioner  were  brought 
out.  Discussion  followed  in  which  many  of  the 
doctors  present  took  part.  Acne,  psoriasis, 
eczema  and  syphilis  were  especially  stressed.  Dr. 
Ruch  has  spent  considerable  time  in  Cleveland 
Clinic,  giving  special  attention  to  the  study  of 
skin  diseases.  We  were  very  fortunate  in  hav- 
ing him  with  us  for  this  session. — J.  R.  Echel- 
barger,  M.D.,  Correspondent. 

Sandusky  County  Medical  Society  held  its  regu- 
lar monthly  meeting  at  the  City  Hall,  Fremont, 
on  Thursday  evening,  January  26.  The  speaker 
was  Dr.  Burt  G.  Chollett,  of  Toledo,  who  dis- 
cussed the  subject  of  “Diseases  and  Operations  of 
the  Hip”,  using  lantern  slide  illustrations.  Dr.  C. 
R.  Pontius,  of  Fremont,  also  presented  several  in- 
teresting lantern  slides  on  bone  diseases.  The 
meeting  was  one  of  the  largest  in  recent  years. — 
News  Clipping. 

Williams  County  Medical  Society  met  at  Mont- 
pelier, Thursday  evening,  Januai'y  12,  and  elected 
the  following  officers  for  the  current  year:  Presi- 
dent, Dr.  B.  C.  Bly;  vice  president,  Dr.  A.  E. 
Snyder,  and  secretary-treasurer,  Dr.  H.  R.  May- 
berry, all  of  Bryan,  Ohio. — News  Clipping. 

Wood  County  Medical  Society  held  its  first 
meeting  of  1933  in  the  Woman’s  Club  at  Bowling 
Green,  Thursday  evening,  January  26,  with  Dr. 
F.  L.  Sterling  of  Bowling  Green,  presiding.  Dr. 
Carll  S.  Mundy  of  Toledo,  gave  a fine  paper  on 
“Arthritis”,  illustrated  with  lantern  slides.  Petro- 
lagar  Laboratories,  presented  some  scientific  talk- 
ing films. — Ralph  E.  Rasor,  M.D.,  Correspondent. 

Fifth  District 

ACADEMY  OF  MEDICINE  OF  CLEVELAND 

(C.  H.  Heyman,  M.D.,  Secretary) 

Febmary  3 — Clinical  and  Pathological  Section 
— City  Hospital,  8:15  P.  M.  Program:  “Surgical 
Aspects  of  Obstructive  Jaundice”,  by  Dr.  S.  O. 
Freedlander;  “Demonstration  of  Interesting 
Medical  Cases”,  by  Dr.  H.  H.  Brittingham; 
“Demonstration  of  Dermatological  Cases”,  by  Dr. 
H.  N.  Cole;  “Post  Purpural  Hemiplegia”,  by  Dr. 
Richard  Stout;  “A  Case  of  Syphilis  of  the  Lung”, 
by  Drs.  Eugene  Freedman  and  C.  S.  Higley. 

February  8 — Obstetrical  and  Gynecological  Sec- 
tion, 8:15  P.  M.  Program:  Symposium  on  Septic 


192 


The  Ohio  State  Medical  Journal 


March,  1933 


Abortions:  “Treatment  of  Septic  Abortion”,  by 

Dr.  Theodore  Miller;  discussion  opened  by  Dr.  A. 
J.  Skeel.  “Septic  Abortion — Radical  versus  Con- 
servative Treatment”,  by  Dr.  Marion  Douglass; 
discussion  opened  by  Dr.  W.  H.  Weir.  “Com- 
plications and  Sequelae  of  Septic  Abortion  and 
their  Treatment”,  by  Dr.  J.  L.  Bubis. 

Febmary  10 — Joint  meeting  of  the  Experi- 
mental Medicine  Section  of  the  Academy  of  Medi- 
cine and  the  Cleveland  Section  of  the  Society  for 
Experimental  Biology  and  Medicine.  Program 
arranged  by  the  Department  of  Physiology.  “The 
Circulatory  Effects  of  Acute  Polycythemic  Hyper- 
volemia”, by  D.  E.  Gregg,  Ph.D.  “The  Physiologic 
Basis  for  the  Anoxemia  of  Polycythemia”,  by  G. 
B.  Ray,  Ph.D.,  C.  I.  Thomas,  A.B.,  and  J.  E. 
Strong,  A.B.  “Uterine  Motility  in  Hypophysec- 
tomized  and  Pregnant  Rabbits”,  by  S.  R.  M.  Rey- 
olds,  Ph.D  “Circulatory  Effects  of  Hyperthermia 
Induced  by  Short  Radio  Waves”,  by  C.  J.  Wiggers, 
M.D.,  O.  Orias,  M.D.,  R.  W.  Heinle,  A.B.  and  K. 

R.  Phelps,  B.S.  “Determination  of  Propulsive 
Activity  of  the  Small  Intestine  by  the  Bolus 
Method.  Effect  of  Certain  Drugs  on  Intestinal 
Propulsion”,  by  J.  P.  Quigley,  Ph.D. 

February  15 — Industrial  Medicine  and  Ortho- 
pedic Section.  St.  Luke’s  Hospital,  8:15  P.  M. 
Program:  “Acute  Joint  Injuries”,  by  Dr.  E.  J. 
Brown;  “Ununited  Fractures  of  the  Neck  of  the 
Femur”,  by  Dr.  T.  A.  Willis;  “Some  Unusual 
Sequelae  of  Bone  Injury  from  the  U-ray  Stand- 
point”, by  Dr.  R.  J.  May;  “Repair  of  Traumatic 
Skin  Defects”,  by  Drs.  D.  M.  Glover  and  A.  F. 
Sydow.  “Traumatic  Urology”,  by  Dr.  C.  A. 
Bowers. 

February  17 — Regular  Academy  Meeting,  Medi- 
cal Librai'y  Auditorium,  8:15  P.  M.  Program: 
“Surgical  Treatment  of  Peptic  Ulcer”,  by  Dr.  M. 
E.  Blahd;  “Appendicitis  in  Childhood”,  by  Dr. 
Wm.  E.  Gallie,  Professor  of  Surgery,  University 
of  Toronto. 

February  21 — Pediatric  Section.  Babies’  and 
Children’s  Hospital,  8:15  P.  M.  Presentation  of 
cases  by  staff. 

February  2U — Ophthalmological  and  Oto-Laryn- 
gological  Section.  Dinner  meeting  at  University 
Club,  6:00  P.  M.  Program:  “Lateral  Sinus 

Thrombosis”,  by  Dr.  W.  H.  Evans,  of  Youngs- 
town; discussion  opened  by  Dr.  Fred  Dixon. 
“Perisinus  Abscess”,  by  Dr.  Ivan  F.  Weidlein; 
discussion  opened  by  Dr.  Harry  Rosenberger. 
“Eye  Manisfestations  of  Lateral  Sinus  Path- 
ology”, by  Dr.  A.  D.  Ruedemann;  discussion 
opened  by  Dr.  H.  H.  Wyand. — Bulletin. 

Ashtabula  County  Medical  Society  held  its  reg- 
ular meeting  at  the  Ashtabula  General  Hospital 
Nurses’  Home  on  Tuesday  evening,  January  17. 
Dr.  Clarence  T.  Risley  of  Conneaut,  was  elected 
to  membership  in  the  Society.  A committee  was 
appointed  to  arrange  for  a dinner  dance,  Feb- 
ruary 9.  Following  the  business  session,  Dr.  W. 

S.  Weiss,  County  Health  Commissioner,  gave  a 


digest  of  the  report  of  the  Committee  on  the  Costs 
of  Medical  Care.  It  was  voted  unanimously  that 
the  society  go  on  record  as  ratifying  the  report 
of  the  Minority  Committee. — A.  M.  Mills,  M.D., 
Secretary. 

Sixth  District 

Mahoning  County  Medical  Society  held  its  an- 
nual banquet  on  Tuesday  evening,  January  17,  at 
the  Youngstown  Club.  The  guest  speaker  was  Dr. 
Fielding  H.  Garrison,  noted  author  of  “The  His- 
tory of  Medicine”,  who  spoke  on  “Geographical 
Medicine  and  Medical  Geography”.  The  following 
physicians  (elected  December  20)  were  installed 
as  officers  of  the  society:  President,  Dr.  J.  P. 
Harvey;  president-elect,  (a  new  innovation  in  the 
history  of  the  society)  Dr.  J.  B.  Nelson;  vice- 
president,  Dr.  E.  C.  Goldcamp;  secretary,  Dr.  W. 
M.  Skipp;  treasurer,  Dr.  Wm.  X.  Taylor.  The 
society  in  the  past  year  has  made  splendid  prog- 
ress in  spite  of  the  times.  Its  membership  is 
steadily  growing  in  number.  Plans  are  under 
way  for  the  establishment  of  a permanent  home 
and  exchange  for  the  society. — M.  W.  Neidus, 
M.D.,  Correspondent. 

Portage  County  Medical  Society  met  at  Robin- 
son Memorial  Hospital,  Ravenna,  on  Thursday 
evening,  February  2.  Dr.  A.  C.  Ernstene,  cardi- 
ologist at  Cleveland  Clinic,  presented  a paper  on 
“Coronary  Thrombosis  and  Agina  Pectoris”,  illus- 
trating his  talk  with  lantern  slide  tracings.  Dr. 

E.  H.  Knowlton,  Mantua,  presented  a thirteen 
year  old  boy  with  rheumatic  heart. — E.  J.  Widde- 
combe,  M.D.,  Secretary. 

Richland  County  Medical  Society  held  a dinner 
meeting  at  the  Leland  Hotel,  Mansfield,  Thurs- 
day evening,  January  26.  Speakers  for  the  eve- 
ning were  Dr.  Harry  S.  Davidson,  Akron,  coun- 
cilor of  the  Sixth  District,  whose  discussion  cov- 
ered organization  matters,  and  Dr.  James  Gard- 
ner of  the  Cleveland  Clinic,  who  spoke  on 
“Cerebral  Injuries”.  Dr.  C.  H.  Bell,  president  of 
the  society,  presided. 

Stark  County  Medical  Society  met  at  the  Can- 
ton Elks’  Club,  Tuesday  evening,  January  10.  The 
following  officers  were  elected  for  1933:  Presi- 
dent, Dr.  H.  Welland,  Canton;  vice-president,  Dr. 
H.  L.  Weaver,  Alliance;  secretary-treasurer,  Dr. 

F.  S.  Van  Dyke,  Canton  (re-elected)  ; Legislative 
committeeman,  Dr.  J.  M.  Van  Dyke,  Canton; 
Delegates  to  State  Meeting,  Drs.  Perry  King, 
Alliance  and  J.  P.  DeWitt,  Canton;  alternates, 
Drs.  G.  F.  Zinninger,  Canton,  and  B.  C.  Barnard, 
Alliance.  Annual  report  was  presented  by  Dr.  F. 
S.  Van  Dyke,  secretary-treasurer.  Following  the 
business  session,  papers  were  presented  by  Dr. 
George  F.  Zinninger  on  “Recent  Advances  in 
Pernicious  Anemia”,  and  by  Dr.  Charles  A.  La- 
Mont  on  “Diabetes  and  Comments  on  a Few 
Selected  Cases”.  Dr.  LaMont  illustrated  his  talk 
with  stereopticon  slides. — News  Clipping. 

The  February  meeting  of  the  society  was  held 
at  the  Elks’  Club,  Canton,  Tuesday  evening,  Feb- 


March,  1933 


State  News 


193 


ruary  14.  “The  Difficulties  Encountered  in  the 
Diagnosis  and  Treatment  of  Peptic  Ulcer”,  was 
the  subject  of  an  address  by  Dr.  A.  J.  Beams,  as- 
sociate professor  of  medicine,  Western  Reserve 
University,  Cleveland. — Bulletin. 

Summit  County  Medical  Society  held  its  regu- 
lar meeting  on  Tuesday  evening,  February  7,  at 
the  Mayflower  Hotel,  Akron.  The  following  pro- 
gram was  presented:  “Important  Variations  in 
Blood  Cells”.  Demonstration  by  Dr.  E.  L.  Saylor. 
“Important  Variables  in  Blood  Cells”,  case  his- 
tories, by  Drs.  E.  H.  McKinney,  S.  Morgenroth,  J. 
P.  Sauvageoit,  F.  A.  Smith,  J.  E.  Springer,  G.  R. 
Welland;  discussion  by  Dr.  J.  N.  Weller. — Bul- 
letin. 

Wayne  County  Medical  Society  met  in  Hygeia 
Hall,  College  Campus,  Wooster,  Tuesday  evening, 
February  14.  “Childhood  Tuberculosis  and  Diag- 
nosis”, was  the  subject  of  an  address  by  Dr.  E.  B. 
Pierce  of  Molly  Stark  Sanatorium,  Canton. 
“Pneumothorax  and  Results  at  Molly  Stark”,  was 
the  subject  of  a paper  by  Dr.  Elizabeth  C.  Brun- 
ton.  Dr.  B.  C.  Barnard,  Alliance,  discussed  the 
subject  of  “Surgical  Treatment  of  Pulmonary 
Tuberculosis”.— R.  C.  Paul,  M.D.,  Secretary. 

Seventh  District 

Belmont  County  Medical  Society  held  its  regu- 
lar meeting  on  Thursday  afternoon,  February  2, 
at  Kilkenny  Inn,  Bellaire.  The  dinner  was  pre- 
ceded by  an  address  on  “Some  Aspects  of  the  Costs 
of  Medical  Care”,  by  Dr.  D.  A.  McGregor  of 
Wheeling,  West  Virginia. — Bulletin. 

Columbiana  County  Medical  Society  met  in  the 
office  of  Dr.  Seward  Harris  in  Lisbon,  Tuesday 
evening,  February  7.  A symposium  on  “Low  Back 
Pain”,  was  presented.  Dr.  Theodore  Baker  of 
Pittsburgh,  discussed  the  subject  from  the  view- 
point of  the  genito-urologist;  Dr.  J.  M.  King,  from 
the  viewpoint  of  the  pedologist;  Dr.  M.  D.  Mc- 
Cutcheon,  of  the  roentgenologist,  and  Dr.  Gail 
Roose,  of  the  gynecologist.- — Bulletin. 

T-uscarawas  County  Medical  Society,  at  its 
meeting  Thursday  evening,  January  12,  at  the 
Buckeye  Hotel,  Uhrichsville,  featured  a debate  on 
“Resolved,  That  the  Recent  Recommendations  of 
the  Committee  on  Costs  of  Medical  Care  Should 
be  Adopted  and  Means  Taken  to  Put  them  in 
Force”.  Dr.  H.  A.  Coleman  and  Attorney  Clayton 
Renner  presented  one  side  of  the  discussion  and 
Dr.  E.  D.  Moore  and  Attorney  James  Patrick, 
argued  the  other  side  of  the  plan.  No  decision  was 
reached  in  the  interesting  pro  and  con  discussion. 
— NeWs  Clipping. 

Eighth  District 

Fairfield  County  Medical  Society  held  a lunch- 
eon and  business  meeting  on  Tuesday,  January 
10,  at  the  U.  B.  Church  in  Baltimore.  Twenty-one 
members  were  present.  Short  talks  followed  the 
business  session. — News  Clipping. 

Guernsey  County  Medical  Society  was  addressed 


by  Mayor  Frank  Arnold  of  Cambridge,  at  a 
luncheon  meeting  held  Thursday,  January  19.  at 
the  Romance  restaurant.  Twenty-two  members 
were  present.  Mr.  Arnold  discussed  medical  fees 
for  services  rendered  to  indigents.  The  society 
voted  to  cooperate  with  the  city  welfare  depaiff- 
ment,  and  appointed  Drs.  E.  F.  Hunter,  H.  R. 
Neeland  and  Fred  Lane  as  members  of  a com- 
mittee to  confer  with  the  mayor. 

The  society  met  at  the  Romance  restaurant, 
Thursday,  February  2,  for  a luncheon.  The  guest 
speaker  was  Dr.  Hugh  Dorr,  chief  medical  ex- 
aminer of  the  Industrial  Commission  of  Ohio, 
Columbus. — News  Clipping. 

Perry  County  Medical  Society  held  its  regular 
monthly  meeting,  Monday,  January  16,  at  the 
Park  Hotel,  New  Lexington.  Following  the  dinner. 
Dr.  W.  D.  Porterfield  of  Junction  City,  spoke  on 
the  subject  “Physiology  of  the  Heart”. — News 
Clipping. 

Washington  County  Medical  Society,  meeting  at 
Memorial  Hall,  Marietta,  January  9,  passed  reso- 
lutions opposing  the  principle  of  competitive  bid- 
ding for  positions  that  have  been  filled  in  the  past 
in  county  institutions  by  appointment  by  county 
commissioners. — News  Clipping. 

Scioto  County — Hempstead  Academy  of  Medi- 
cine held  its  regular  meeting,  Monday  evening, 
January  9,  at  the  Nurses’  Home,  Portsmouth, 
with  Dr.  George  Lyons  of  Huntington,  West  Vir- 
ginia, as  guest  speaker.  “Meningitis  in  Children”, 
was  the  subject  of  his  discussion.  Following  the 
program,  a buffet  luncheon  was  served  to  mem- 
bers in  attendance. — News  Clipping. 

Tenth  District 

COLUMBUS  ACADEMY  OF  MEDICINE 

(John  H.  Mitchell,  M.D.,  Secretary) 

February  6 — Columbus  Public  Library,  8:30  P. 
M.  Program:  “Preventive  Medicine  During  the 
First  Two  Years  of  Life”,  by  Dr.  E.  G.  Horton; 
discussion  by  Dr.  J.  P.  Farson  and  Dr.  Orville 
Baldwin.  “The  Life  of  John  Hunter”,  by  Dr. 
Harry  Reinhart. 

February  13 — At  the  Library,  8:30  P.  M.  Pro- 
gram: “Research  into  the  Etiology  of  Goiter”,  by 
Dr.  Andre  Crotti. 

February  20 — At  University  Hospital,  8:30  P. 
M.  Clinic  by  the  staff. 

Febmary  27 — At  the  Library,  8:30  P.  M.  Gen- 
eral Practitioners’  Section.  Program:  “Chronic 

Arthritis  and  the  Rheumatic  State”,  by  Dr.  Wil- 
lard C.  Stoner,  chief  of  the  medical  division,  St. 
Luke’s  Hospital,  Cleveland. — Bulletin. 

Crawford  County  Medical  Society  held  its  regu- 
lar monthly  meeting  on  Monday  evening,  Feb- 
ruary 6,  in  the  Second  National  Bank  Building, 
Bucyrus.  The  guest  speaker  was  Dr.  H.  M.  Plat- 
ter, Columbus,  President  of  the  Ohio  State  Medi- 
cal Association,  who  discussed  “Socialization  of 
Medicine”. — Bulletin. 


Oran  P.  Andrews,  M.D.,  East  Liverpool;  Co- 
lumbia University  College  of  Physicians  and  Sur- 
geons, New  York  City,  1893;  aged  63;  former 
member  of  the  Ohio  State  Medical  Association; 
died  January  6 of  pneumonia.  Dr.  Andrews  had 
practiced  in  East  Liverpool  for  37  years.  He 
served  as  a first  lieutenant  in  the  Medical  Corps, 
stationed  at  Fort  Oglethorpe,  Georgia,  during  the 
World  War.  Military  funeral  services  were  con- 
ducted by  the  American  Legion  of  East  Liverpool, 
of  which  he  was  a charter  member.  Surviving  him 
are  his  widow  and  one  sister. 

Albert  James  Brainard,  M.D.,  Dayton;  Cleve- 
land-Pulte  Medical  College,  Cleveland,  1899;  aged 
57;  died  February  1 at  the  National  Military 
home,  Dayton,  where  he  had  served  as  assistant 
surgeon  for  the  past  ten  years.  He  is  survived  by 
his  widow,  two  sons,  one  daughter,  and  one  sister. 

Charles  Kinsey  Conard,  M.D.,  Mt.  Vernon; 
Cleveland  University  of  Medicine  and  Surgery, 
1890;  aged  67;  member  of  the  Ohio  State  Medical 
Association  and  the  American  Medical  Associa- 
tion; died  January  7.  For  42  years  he  had  prac- 
ticed in  Mt.  Vemon  until  failing  health  forced 
him  to  retire  a short  time  ago.  He  leaves  a 
daughter,  and  a son,  Dr.  Carroll  D.  Conard. 

William  Alexander  Daugherty,  M.D.,  Massillon; 
Kentucky  School  of  Medicine,  Louisville,  1904; 
aged  72;  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  January  5.  Dr.  Daugherty  practiced  in  Chi- 
cago and  Cleveland  before  taking  up  his  residence 
in  Massillon  25  years  ago.  He  is  survived  by  his 
widow,  two  sisters  and  a brother. 

Alexander  Christy  Dempster,  M.D.,  Uhrichs- 
ville;  Ohio  Medical  University,  Columbus,  1896; 
aged  66;  member  of  the  Ohio  State  Medical  Asso- 
ciation and  Fellow  of  the  American  Medical  Asso- 
ciation; died  February  8,  of  pulmonary  edema. 
Dr.  Dempster  was  born  in  Uhrichsville  and  had 
resided  in  the  vicinity  all  his  life.  He  started  his 
medical  career  at  Tuscarawas  where  he  practiced 
for  five  years  before  locating  in  Uhrichsville. 
For  ten  years  he  was  a member  of  the  city  coun- 
cil. He  was  active  in  medical  organization  and 
was  a past  president  of  the  Tuscarawas  County 
Medical  Society.  Surviving  him  are  his  widow, 
three  sons,  two  daughters. 

Sarah  E.  Fletcher,  M.D.,  Columbus;  Hahne- 
mann Medical  College  and  Hospital,  Chicago, 
1896;  aged  83;  died  February  7 at  the  Nurses’ 


Home  in  Grove  City,  following  a long  illness.  Dr. 
Fletcher  located  in  Columbus  following  her  grad- 
uation. Surviving  her  are  a son,  two  sisters  and 
a brother. 

Albert  Matthias  Freund,  M.D.,  Cincinnati; 
State  University  of  Iowa,  College  of  Medicine, 
Iowa  City,  1888;  aged  72;  died  January  18.  Dr. 
Freund  practiced  in  Appleton,  Wisconsin,  before 
moving  to  Cincinnati  ten  years  ago.  Besides  his 
widow,  he  leaves  four  sons  and  four  daughters. 

LeRoy  L.  Imes,  M.D.,  Denver,  Colorado;  Physio- 
Medic  College  of  Indiana,  Indianapolis,  1894;  aged 
57;  died  January  19  of  tuberculosis.  Dr.  Imes 
practiced  at  Logan  and  New  Marshfield  for  sev- 
eral years  before  he  moved  to  Colorado.  He  is 
survived  by  his  widow,  two  sons  and  a daughter; 
and  two  brothers. 

James  Irving,  M.D.,  Cincinnati;  Chicago  Col- 
lege of  Medicine  and  Surgery,  1913;  aged  56;  died 
December  19  of  heart  disease.  Dr.  Irving  for- 
merly w'as  a physician  at  Longview  Hospital. 

Merle  W.  King,  M.D.,  Johns  Hopkins  University 
School  of  Medicine,  Baltimore,  1917;  aged  48; 
member  of  the  Ohio  State  Medical  Association; 
Fellow  of  the  American  Medical  Association  and 
the  American  College  of  Surgeons;  and  member 
of  the  American  Urological  Association;  was 
killed  in  an  automobile  accident,  January  9,  at 
Willoughby,  Ohio.  Dr.  King  worked  his  way 
through  Allegheny  College,  graduating  in  1908. 
He  taught  school  for  five  years  before  entering 
Johns  Hopkins  University  from  which  school  he 
received  his  medical  degree.  Folowing  graduation 
he  became  interne  and  assistant  resident  at 
Woman’s  Hospital  in  Baltimore,  and  later  was 
resident  in  Surgery  at  Mt.  Sinai  Hospital,  Cleve- 
land. For  the  last  12  years  he  held  staff  appoint- 
ments in  Surgery  and  Urology  at  St.  Luke’s  Hos- 
pital and  Charity  Hospital,  Cleveland.  His  widow 
and  two  daughters  survive  him. 

Fredei-iek  Karl  Kislig,  M.D.,  Dayton;  Ohio  State 
University  College  of  Medicine,  Columbus,  1911; 
aged  46 ; member  of  the  Ohio  State  Medical  Asso- 
ciation; Fellow  of  the  American  Medical  Associa- 
tion, and  Fellow  of  the  American  College  of  Sur- 
geons; died  February  7 of  heart  collapse  follow- 
ing an  attack  of  influenza.  Dr.  Kislig  attended 
clinics  at  New  York  and  Boston,  and  took  post 
graduate  work  at  Johns  Hopkins  University 
School  of  Medicine,  Baltimore.  He  served  with 


194 


March,  1933 


State  News 


195 


Pershing  on  the  Mexican  border  and  in  France 
during  the  World  War,  and  won  a citation  for 
caring  for  the  wounded  through  an  enemy  bar- 
rage. After  the  war,  he  returned  to  Dayton.  At 
the  time  of  his  death,  he  was  chief  surgeon  at 
Miami  Valley  hospital.  Dr.  Kislig  was  president 
of  the  Montgomery  County  Medical  Society  in 
1932,  and  was  a member  of  the  Committee  on 
Military  and  Veterans’  Affairs  of  the  State  Asso- 
ciation. Besides  his  widow,  he  is  survived  by  his 
mother,  two  brothers  and  a sister. 

Michael  McN alley,  M.D.,  Canton;  Detroit  Medi- 
cal College,  1872 ; aged  91 ; died  December  19  at 
the  home  of  his  son,  Dr.  Joseph  E.  McNalley,  of 
Canton.  Dr.  McNalley  had  lived  in  Canton  for 
five  years.  He  was  a Civil  War  veteran,  and  a 
member  of  the  G.A.R.  of  Quenemo,  Kansas.  Sur- 
viving are  his  widow,  three  sons,  Dr.  Joseph  Mc- 
Nalley of  Canton,  Dr.  James  McNalley  of  Cleve- 
land, and  Leo  McNalley  of  Minneapolis;  and  one 
daughter,  Dr.  Anna  Hendrickson,  of  Canton. 

John  L.  McHenry,  M.D.,  Hamilton;  Eclectic 
Medical  College,  Cincinnati,  1892;  aged  64;  died 
January  27,  from  shock  and  pneumonia  following 
severe  burns  accidently  received  when  his  bath 
robe  caught  fire.  Dr.  McHenry  practiced  in 
Somerville  from  1893  to  1905,  when  he  located 
in  Hamilton.  He  is  survived  by  one  son  and  one 
sister. 

Victor  Wade  Metzler,  M.D.,  Coshocton;  Jeffer- 
son Medical  College,  Philadelphia,  1898;  aged  62; 
died  January  18  of  heart  disease  complicated  by 
influenza.  He  was  a son  of  the  late  Dr.  Abraham 
Metzler  and  Mrs.  Eleanor  Metzler.  Following  his 
internship  at  Jefferson  Medical  hospital,  Phila- 
delphia, he  practiced  in  Atlantic  City  for  23  years. 
For  the  past  several  years  he  has  made  his  home 
with  his  sister,  Mrs.  M.  D.  Custer,  of  Coshocton, 
who  with  his  mother  and  three  other  sisters,  sur- 
vive him. 

Walter  Peters,  M.D.,  Cleveland;  University  and 
Bellevue  Hospital  Medical  College,  New  York 
City,  1905;  aged  59;  former  member  of  the  Ohio 
State  Medical  Association;  died  December  12. 
Dr.  Peters  served  an  internship  at  Bellevue  Hos- 
pital, and  pi’acticed  in  Passaic,  New  Jersey,  be- 
fore locating  in  Cleveland  21  years  ago.  He  was 
a staff  member  of  Glenville  Hospital.  Dr.  Peters 
was  born  in  Poland,  and  was  an  organizer  and 
treasurer  of  the  Polish  Medical  and  Dental  Arts 
Association,  founded  in  Cleveland  for  Polish- 
speaking physicians  and  dentists.  He  is  survived 
by  his  widow  and  four  sons,  among  them  Dr. 
Eugene  Peters,  an  intern  at  Glenville  Hospital. 

Joseph  P.  Riddile,  M.D.,  Rushville;  Medical  Col- 
lege of  Ohio,  Cincinnati,  1885;  aged  74;  died  Jan- 
uary 26,  following  a long  illness  Dr.  Riddile  prac- 
ticed many  years  ago  at  Pleasantville  before  re- 
moving to  Hastings,  Nebraska.  Returning  to 


Ohio,  he  practiced  for  five  years  at  New  Comers- 
town  before  locating  in  Rushville  two  years  ago. 
Surviving  him  are  his  widow,  three  daughters, 
one  son,  and  three  sisters. 

Henry  Ambrose  Schollenberger,  M.D.,  Smith- 
ville;  National  Normal  University,  College  of 
Medicine,  Lebanon,  Ohio,  1892;  aged  71;  died 
January  15.  He  had  practiced  in  Wayne  and 
adjoining  counties  for  40  years,  and  was  active 
until  a few  weeks  prior  to  his  death.  He  is  sur- 
vived by  his  widow,  one  son,  two  daughters,  one 
sister  and  one  brother. 

William  H.  Weaver,  M.D.,  Canton;  Ohio  Medical 
University,  Columbus,  1902;  aged  59;  member  of 
the  Ohio  State  Medical  Association  and  Fellow  of 
the  American  Medical  Association;  died  January 
28  in  Mercy  Hospital,  Canton.  Dr.  Weaver  had 
practiced  for  many  years  in  Canton,  and  was  a 
member  of  the  staff  of  Mercy  Hospital.  Fun- 
eral services  were  in  charge  of  the  Knights 
Templar.  Pallbearers  included  the  following  Can- 
ton physicians:  Drs.  H.  M.  Schuffell,  D.  F. 

Banker,  George  F.  Zinninger,  E.  0.  Morrow,  R. 
D.  Schirack,  George  H.  Hansel,  C.  A.  Portz  and 
L.  D.  Stoner. 


A High-Sounding  Title  for  a Cult  School 

The  Council  on  Medical  Education  and  Hos- 
pitals of  the  American  Medical  Association  has 
issued  a letter  to  superintendents  of  hospitals 
registered  by  the  A.M.A.  and  to  the  executive 
officers  of  colleges  of  arts  and  sciences  and  junior 
colleges  approved  by  the  A.M.A.,  informing  them 
of  a recent  announcement  circulated  by  an  organi- 
zation calling  itself  the  Illinois  College  of  Phy- 
sicians and  Surgeons,  of  20  North  Ashland  Boule- 
vard, Chicago,  an  institution  conducted  by  a group 
of  chiropractors. 

In  the  announcement  issued  by  the  Chicago  in- 
stitution, this  statement  appeared: 

“Courses  offered  and  requirements  for  gradu- 
ation are  class  ‘A’  requirements.” 

The  A.M.A.  Council  in  its  statement  declares 
that  the  announcement  implies  that  the  above 
named  school  conforms  to  the  standards  pre- 
scribed by  the  Council  on  Medical  Education  and 
Hospitals  of  the  American  Medical  Association, 
which  implication  is  wholly  unwarranted.  It  is 
pointed  out  that  the  chiropractic  school  does  not 
even  remotely  approach  the  standards  of  a class 
A medical  school. 

The  Council  advises  hospitals  not  to  be  misled 
by  the  school’s  announcement  and  unwittingly 
employ  as  interns  any  of  the  graduates  of  that 
institution.  Moreover,  it  suggests  that  executives 
of  pre-medical  institutions  by  the  A.M.A.  advise 
students  who  may  wish  to  choose  a medical  career 
not  to  be  misled  by  the  chiropractic  school’s  pro- 
paganda. 


L/NEW5  NOTESs^OHIO] 


Chillicothe — “The  Practice  of  Medicine”  was 
the  subject  of  an  address  made  by  Dr.  R.  W. 
Holmes  at  a meeting-  of  the  Young  Men’s  Club  of 
the  local  Y.M.C.A. 

Sandusky — Dr.  George  F.  Thompson,  assistant 
surgeon  at  the  Ohio  Soldiers’  and  Sailors’  Home 
for  the  past  18  years,  has  been  appointed  chief 
surgeon,  succeeding  the  late  Dr.  John  T.  Haynes. 

Wellsville — Dr.  C.  J.  Maxwell,  formerly  of 
Orrville,  has  become  an  associate  of  Dr.  J.  M. 
King,  Jr.,  of  this  city. 

Lima — Eleven  Lima  physicians  made  the  ninth 
annual  clinical  tour  held  by  the  Lima  Physicians’ 
Travel  Club  in  February.  Clinics  in  Chicago  and 
St.  Louis  were  visited. 

Cincinnati — Dr.  William  H.  Haines  was  honored 
with  a testimonial  dinner  February  15  by  a num- 
ber of  his  local  associates. 

Lisbon — Dr.  E.  G.  Egli,  formerly  on  the  staff 
of  Lakeside  Hospital,  Cleveland,  has  opened 
offices  here. 

Findlay — Dr.  Porter  C.  Pennington  has  been 
appointed  to  the  city  board  of  health. 

Columbus — Dr.  H.  L.  Mitchell  has  been  ap- 
pointed health  commissioner  of  Franklin  County 
on  a part-time  basis,  succeeding  Dr.  B.  E.  Neis- 
wander,  full-time  commissioner  for  the  past  year. 

Willard — Dr.  L.  W.  Scott  is  taking  post-grad- 
uate work  at  Washington  University,  St.  Louis. 

Cleveland — Dr.  Frederick  C.  Waite  of  the 
School  of  Medicine,  Western  Reserve  University, 
addressed  the  meeting  of  the  Northwestern  Ohio 
Dental  Society  on  “The  Historical  Relation  of 
Medicine  and  Dentistry,”  at  Lima,  February  15. 

Napoleon — Dr.  J.  J.  Harrison  spoke  on  “The 
Practice  of  Medicine”  before  the  local  Hi-Y  Club. 
It  was  the  first  of  a series  of  vocational  guidance 
talks  to  be  given  before  the  club. 

Portsmouth — -Announcement  has  been  made  of 
the  marriage  of  Miss  Katherine  Bannon  to  Dr. 
Franklin  C.  Beeks,  both  of  Portsmouth. 

Youngstown — A testimonial  dinner  was  given 
recently  by  the  Youngstown  Medical  Arts  Club  in 
honor  of  Dr,  R.  D.  Gibson. 

Cleveland  — The  following  members  of  the 
faculty  of  the  School  of  Medicine,  Western  Re- 
serve University,  have  been  elected  to  Sigma  Xi, 
honorary  scientific  society:  Dr.  Carl  H.  Lenhart, 
professor  of  surgery;  Dr.  Claude  S.  Beck,  as- 
sistant professor  of  surgery;  Dr.  Norman  C. 
Wetzel,  assistant  professor  of  pediatrics;  Dr. 
Rafael  Dominguez,  associate  in  pathology,  and 
Dr.  Carroll  G.  Barber,  fellow  in  anatomy. 


Columbus — Miss  Helen  Haupert,  formerly  of 
this  city  and  last  year  a student  at  Women’s 
Medical  College,  Philadelphia,  and  Dr.  Ervin  B. 
Wallace,  Baltimore,  Maryland,  a graduate  of  the 
College  of  Medicine,  Ohio  State  University,  were 
united  in  marriage  here  recently.  They  will  re- 
side in  Baltimore. 

Cincinnati — Dr.  Mark  E.  Bowles  addressed  the 
Masonic  Forum  on  “Cancer  Control”. 

Pioneer — Dr.  E.  R.  Jacka,  formerly  of  Toledo, 
has  opened  offices  here. 

Empire — Dr.  J.  W.  Young  has  been  appointed 
a captain  in  the  medical  corps,  U.  S.  A.,  and 
ordered  to  active  service  at  Walter  Reed  Hos- 
pital, Washington,  D.  C. 

Akron — Dr.  R.  F.  Etienne  has  been  elected 
president  of  the  North  Akron  Board  of  Trade. 

Mansfield — Dr.  C.  Z.  Gaber,  a native  of  Mans- 
field and  who  has  been  residing  here  since  his  re- 
turn from  Munich  where  he  took  post-graduate 
work,  has  been  appointed  chief  pathologist  at  the 
Fifth  Avenue  Hospital,  New  York  City. 

Portsmouth — Dr.  George  G.  Hunter,  Ironton, 
addressed  a recent  meeting  of  the  19th  District 
Undertakers’  Association  here. 

Cuyahoga  Falls — The  local  Lions  Club  was  ad- 
dressed recently  by  Dr.  J.  R.  Shoemaker. 

Mansfield — The  Brotherhood  of  St.  Mark’s 
Lutheran  Church  was  adressed  by  Dr.  George 
Mynchenberg,  Elyria. 

Sandusky — Dr.  F.  M.  Houghtaling  read  a paper 
on  “Some  High  Points  in  the  History  of  Medi- 
cine” at  a meeting  of  the  Men’s  Literary  Club. 

Cincinnati — Eight  members  of  the  Cincinnati 
Obstetrical  Society  who  have  been  active  in  the 
society  for  the  past  30  years  were  honored  at  a 
testimonial  dinner  given  by  the  society  at  the 
Sinton-St.  Nicholas  Hotel.  They  were:  Drs.  W. 
H.  Wenning,  E.  W.  Mitchell,  Rufus  B.  Hall,  W. 
D.  Porter,  L.  S.  Colter,  Ambrose  Johnston,  Mag- 
nus A.  Tate  and  James  W.  Rowe. 

Defiance — Dr.  Robert  B.  Cameron,  a prac- 
titioner of  medicine  for  nearly  60  years,  health 
commissioner  of  Defiance  County,  and  formerly 
member  of  the  Ohio  Legislature,  recently  cele- 
brated his  87th  birthday  anniversary. 

Archbold — Dr.  and  Mrs.  W.  E.  McKee  an- 
nounce the  birth  of  a daughter,  Carol  Anne,  on 
December  12.  Dr.  McKee,  a graduate  of  the  Col- 
lege of  Medicine,  Ohio  State  University,  in  1930, 
located  here  in  1931  after  completing  his  intern- 
ship at  Grant  Hospital,  Columbus. 


196 


HOSPITAL  NOTES 


— Dr.  D.  A.  Prendergast  has  been  elected  chief 
of  staff  of  St.  John’s  Hospital,  Cleveland.  Other 
officers  are:  Vice  Chief,  Dr.  Carl  McDonald;  di- 
rector of  surgery,  Dr.  George  P.  O’Malley;  direc- 
tor of  medicine,  Dr.  R.  K.  Updegraff;  director  of 
obstetrics.  Dr.  C.  A.  O’Connell. 

— The  staff  of  Lakewood  Hospital  has  elected 
Dr.  Louis  M.  Starin  president  for  the  ensuing 
year,  succeeding  Dr.  C.  L.  Graber  who  declined 
to  head  the  staff  after  serving  in  that  capacity  for 
the  past  25  years.  Dr.  E.  R.  Bailey  was  elected 
secretary  of  the  staff. 

— Dr.  Eslie  Asbury  has  been  elected  president 
of  the  staff  of  Good  Samaritan  Hospital,  Cincin- 
nati. Other  officers  are:  Vice  president,  Dr.  D. 
J.  Bradley;  secretary,  Dr.  Charles  J.  McDevitt; 
members  of  executive  board,  Dr.  E.  A.  Wagner, 
Dr.  Edward  King  and  Dr.  Oscar  Berghausen. 

— At  the  annual  meeting  of  the  directors  of 
Peoples’  Hospital,  Akron,  Edward  S.  Babcock, 
president  of  the  board,  announced  that  the  hos- 
pital showed  a net  income  of  approximately 
$15,000  in  comparison  to  a deficit  of  $34,000  in 
1931.  It  was  pointed  out  that  this  was  accom- 
plished by  an  adjustment  of  salaries  and  careful 
buying  of  hospital  supplies.  Plans  were  an- 
nounced for  placing  into  effect  a budget  plan 
of  payment  for  patients  under  which  bills  may  be 
paid  in  installments  through  the  Morris  Plan 
Bank.  The  report  of  the  nurse  training  school 
shows  that  during  the  past  five  years  no  graduate 
of  the  school  had  failed  to  pass  the  state  board 
examinations  for  registration.  The  directors 
voted  to  cooperate  with  the  Summit  County  Medi- 
cal Society  in  arranging  for  the  annual  meeting 
of  the  Ohio  State  Medical  Association  in  Akron, 
May  2 and  3. 

— Two  new  department  heads  were  appointed  at 
the  recent  annual  meeting  of  the  board  of  direc- 
tors of  White  Cross  Hospital,  Columbus.  Dr.  W. 
D.  Inglis  was  named  head  of  the  department  of 
obstetrics,  and  Dr.  Frank  W.  Harrah  head  of  the 
department  of  gynecology.  Other  department 
heads  were  reappointed.  Dr.  R.  W.  Kissane  was 
elected  chief  of  the  staff. 

— Dr.  Hugh  A.  Baldwin  was  elected  chairman 
of  the  staff  of  Grant  Hospital  at  the  recent  an- 
nual meeting  of  the  staff.  Dr.  Drew  L.  Davies 
was  re-elected  secretary.  Plans  were  made  for 
electing  an  advisory  board  of  11  physicians  to  co- 
operate with  the  board  of  directors  of  the  hos- 
pital. 

— Gates  Hospital  for  Crippled  Children,  Elyria, 
was  willed  the  greater  portion  of  the  $160,000 
estate  left  by  Miss  Sarah  Fickinger. 


- — Dr.  Carl  R.  Steinke  has  been  elected  chief  of 
staff  of  St.  Thomas  Hospital,  Akron,  Vice  chief 
of  the  staff  is  Dr.  James  G.  Kramer.  Members  of 
the  executive  committee  are  Drs.  Roy  G.  Werner, 
John  E.  Monnig  and  Daniel  C.  Brennan. 

—Dr.  J.  M.  Firmin  was  reappointed  chief  of 
staff  of  the  Findlay  Home  and  Hospital  at  the 
recent  business  meeting  of  the  directors  of  the 
institution.  Dr.  J.  C.  Tritch  was  named  assistant 
chief. 

— Miss  Freda  Swinehart  has  been  appointed 
superintendent  of  the  Lancaster  Municipal  Hos- 
pital. 

— At  the  regular  meeting  of  the  staff  of  Piqua 
Memorial  Hospital  on  February  20,  Dr.  George 

M.  Curtis,  director  of  the  department  of  surgical 
research,  Ohio  State  University,  was  the  prin- 
cipal speaker. 

— Miami  Valley  Hospital,  Dayton,  has  an- 
nounced selection  of  the  following  interns  for  the 
year  beginning  July  1,  1933:  David  Taylor,  Chi- 
cago, Rush  Medical  College;  Harold  Bockoven, 
Plymouth,  Ind.,  Rush;  Cecil  K.  Bender,  Goshen, 
Ind.,  Northwestern;  C.  Allen  Payne,  Mount  Car- 
mel, Pa.,  Hahnemann  Medical  College;  Charles  A. 
Smith,  Massillon,  University  of  Michigan;  Roger 
E.  Heering,  Grand  Rapids,  University  of  Michi- 
gan; Charles  E.  Mumma,  Lewisburg,  University 
of  Cincinnati;  Frank  Prather,  Dayton;  Burton  G. 
Must,  Dayton;  Paul  Lenhart,  Englewood;  William 
L.  Wead,  Xenia,  and  George  W.  Slagle,  Center- 
ville. 

— Intern  appointments,  effective  July  1,  at  St. 
Mary’s  Hospital,  Cincinnati,  are:  Francis  C. 

Haberman,  Joseph  H.  Jansen,  Jr.,  Frederick  P. 
Swing,  Kirmet  I.  Johnson  and  Aloysius  Huesman, 
all  of  the  University  of  Cincinnati. 

Interns  who  will  serve  at  the  Cincinnati  Gen- 
eral Hospital  after  July  1 are: 

Charles  Allison,  A.  Altemeir,  Jr.,  Lester  Bossert,  Jess  V. 
Cohn,  Andre  Cueto,  C.  Douglas  Deeds,  Clyde  Dummer,  Joseph 

N.  Freiden,  J.  Emmert  Groff,  Henry  B.  Koehler,  Louis 
Arthur  Safer,  Janies  A.  Schaal,  Louis  W.  Seyler,  Benyce 
Tavel  and  Richard  C.  Wenrick,  all  of  Cincinnati. 

J.  Herbert  Bain,  Jr.,  Ohio  State ; Robert  Bowman,  Vander- 
bilt; Henry  W.  Brosin,  Wisconsin;  Wm.  E.  Callison,  Yale; 
Theodore  J.  Catlin,  Minnesota ; Howell  J.  Davis.  Pennsyl- 
vania; Walter  L.  Kilby,  Virginia;  Carl  A.  Hartung,  Tulane ; 
Edgar  P.  McKinney,  Virginia ; James  R.  Mack,  Harvard ; 
Arthur  J.  Merrell,  Emory ; McKinnie  L.  Phelps,  Rush  ; Hugh 
Smith,  Jr.,  Tennessee. 

Alternates  recommended  were;  Bessie  Mae  Beach,  Ed- 
ward J.  Bender,  C.  W.  Hunsche  and  Aaron  Kanter,  all  of 
Cincinnati,  and  E.  R.  Blondie,  Western  Reserve : S.  J. 
Bochner,  Toronto ; Jerome  Gaskel,  Duke ; William  N.  Offut, 
Pennsylvania;  Caroline  Scott,  Pennsylvania;  Justin  Stein, 
Jr.,  Baylor. 

— Six  interns  have  been  appointed  at  Bethesda 
Hospital,  Cincinnati.  They  are:  J.  Stewart 

Hagen,  Jr.,  University  of  Cincinnati;  Christine 
Carter,  University  of  Louisville  Medical  Depart- 


197 


198 


The  Ohio  State  Medical  Journal 


March,  1983 


ment;  Dorothy  Lee  Ferris,  University  of  Cincin- 
nati Medical  College;  Robert  E.  Slemmer,  Hahn- 
emann Medical  College,  Philadelphia;  Bert  N. 
Ryan,  Baylor  University,  Dallas,  Texas,  and  John 
B.  Nuckolls,  University  of  Tennessee,  Memphis. 

— The  following  have  been  appointed  interns  at 
Christ  Hospital,  Cincinnati,  for  the  year  begin- 
ning July  1:  Huston  H.  Rinehart,  Louis  E. 

Snyder,  Clyde  I.  Stafford,  Charles  L.  Pfeiffer,  Jr., 
Herbert  C.  Boehner  and  C.  W.  Hunsche,  Uni- 
versity of  Cincinnati;  George  R.  Coe,  University 
of  Louisville,  and  James  A.  Black,  Ohio  State 
University. 

— The  following  program  was  presented  Feb- 
ruary 2 at  the  regular  meeting  of  the  staff  of  the 
Detwiler  Memorial  Hospital,  Wauseon:  “In- 

fluenza”, Dr.  J.  McKee,  Archbold,  the  history; 
Dr.  P.  S.  Bishop,  Delta,  the  clinical  picture  1918 
vs.  1932-33;  Dr.  Denver  Burns,  Bryan,  complica- 
tions; Dr.  R.  W.  Reynolds,  Fayette,  Dr.  E.  C. 
Raabe,  Morenci,  Michigan,  and  Dr.  W.  L.  Peters, 
Morenci,  Michigan,  the  medical  aspects;  Dr.  John 
Foster,  Defiance,  the  surgical  aspects,  and  Dr. 
Bernard  Steinberg,  Toledo,  etiology  and  path- 
ology. At  the  January  19  meeting  of  the  staff,  the 
principal  address  was  made  by  Dr.  Grover  C. 
Pemberthy,  professor  of  clinical  surgery,  Detroit 
Medical  College,  on  “Traumatic  Surgery”. 

— The  following  interns  have  been  appointed 
to  begin  active  duty  July  1 at  Good  Samaritan 
Hospital,  Cincinnati:  Edward  J.  Bender,  Roy  C. 

A.  Bock,  L.  Courtney  Jack,  W.  C.  Schmidter,  Jr., 
Louis  P.  Stickley,  Lee  C.  Wertheimer  and  Albert 
Wyss,  all  of  Cincinnati  and  seniors  in  the  Uni- 
versity of  Cincinnati  Medical  College,  and  John 
H.  King,  Cleveland,  Western  Reserve  Medical 
School;  Robert  Weinrich,  Massillon,  Ohio  State 
University. 

— The  1933  staff  of  Mt.  Sinai  Hospital,  Cleve- 
land, has  been  announced  as  follows  by  Dr.  H.  L. 
Rockwood,  director  of  the  hospital: 

DEPARTMENT  OF  SURGERY:  Dr.  M.  E.  Blahd,  sur- 

geon in  charge ; Drs.  A.  Strauss,  L.  W.  Strauss,  J.  G.  Jones, 
G.  M.  Hawk,  H.  M.  Gans,  M.  Briokman  and  W.  W.  Sirak. 

DEPARTMENT  OF  MEDICINE:  Dr.  S.  S.  Berger,  chief 
physician ; Drs.  H.  Feil,  S.  Baumoel,  G.  H.  Reeve,  O.  B. 
Markey,  S.  Littman,  J.  J.  Selman,  H.  S.  Applebaum,  A. 
Loveman,  M.  Siegel,  M.  D.  Friedman,  J.  R.  Breitbart,  B. 
Levine,  L.  Steuer,  M.  Grossberg,  S.  F.  Weinman,  M.  H. 
Fineberg,  M.  A.  Weitz,  S.  Permut,  H.  C.  Schock,  H. 
Schweid,  E.  H.  Adler,  M.  A.  Shapiro,  H.  J.  Kumin,  S.  Hant- 
man,  D.  Lubin,  B.  Nozik,  L.  J.  Marcus  and  S.  Hurwitz. 

DEPARTMENT  OF  UROLOGY:  Dr.  P.  A.  Jacobs, 

urologist,  and  Dr.  W.  Rosenberg. 

DEPARTMENT  OF  GYNECOLOGY:  Dr.  J.  L.  Bubis, 

gynecologist,  and  Drs.  J.  S.  Wolfstein,  L.  Biskind,  L.  Chal- 
fin,  D.  Benjamin  and  L.  H.  Brooks. 

DEPARTMENT  OF  PEDIATRICS:  Dr.  J.  W.  Epstein, 
pediatrician,  and  Drs.  A.  B.  Grossman,  I.  B.  Silber,  L.  E. 
Blachman,  S.  E.  Rosen,  A.  Papish,  H.  S.  Lieberman,  B.  P. 
Persky,  A.  J.  Riemer,  J.  Robboy  and  B.  Chavison. 

DEPARTMENT  OF  OBSTETRICS:  Dr.  M.  Garbei,  ob- 

stetrician, and  Drs.  S.  B.  Abrams,  H.  Gusman,  D.  Wiener, 
V.  Woldman  and  E.  Eichner. 

DEPARTMENT  OF  ORTHOPEDICS:  Dr.  Walter  G. 

Stern,  orthopedist,  and  Drs.  C.  Heyman,  R.  Reich  and  L. 
E.  Papurt. 

DEPARTMENT  OF  OTO-LARYNGOLOGY : Dr.  S.  S. 

Quittner,  chief  of  oto-laryngology,  and  Drs.  A.  A.  Stone,  S. 

B.  Cowen,  M.  Metzenbaum,  A.  L.  Stotter,  L.  Lieberman,  D. 
Marcus,  M.  I.  Marks  and  S.  Lemel. 

DEPARTMENT  OF  OPHTHALMOLOGY:  Dr.  Leo  Wol- 
fenstein,  ophthalmologist,  and  Drs.  M.  E.  Gans  and  L. 
Lieberman. 


DEPARTMENT  OF  MINOR  ORAL  SURGERY:  Dr.  M. 
B.  Galvin,  chief  of  department,  and  Drs.  J.  M.  Courtney,  H. 
Steuer,  C.  Adelstein,  A.  V.  Bartow,  S.  Cohen,  S.  Weisman, 
J.  S.  Persky,  D.  A.  Rosenberg,  O.  Rosen  and  H.  Caplan. 

CONSULTING  STAFF:  Drs.  A.  S.  Maschke,  consultant 
in  medicine ; Adolph  Steiner,  consultant  in  oto-laryngology ; 
J.  L.  Bubis,  consultant  in  obstetrics ; Daniel  Heimlich, 
clinician-emeritus,  department  of  medicine. 

DEPARTMENT  OF  ROENTGENOLOGY:  Dr.  E.  F. 

Freedman  and  Dr.  H.  A.  Mahrer. 

DEPATMENT  OF  LABORATORIES:  Dr.  B.  S.  Kline 

and  Dr.  A.  M.  Young. 

RESIDENT  APPOINTMENTS:  Drs.  Elmer  Gooel,  resident 
in  surgery ; Joseph  Gross,  resident  in  orthopedics ; Joseph 
Goodman,  resident  in  medicine ; M.  W.  Selznick,  resident  in 
obstetrics,  and  Reuben  Strauss,  resident  in  pathology. 

INTERNE  APPOINTMENTS:  Drs.  Robert  R.  Blondis, 

William  W.  Herman,  Alfred  S.  Gldsmith,  Alvyn  W.  Traumer, 
Herschel  H.  Pevaroff,  Samuel  B.  Frank,  William  E.  Chaikin, 
Ben  C.  Eisenberg,  Manning  Cohn  and  Alex  A.  Rogow. 

— Staff  appointments  have  been  announced  as 
follows  at  the  Springfield  City  Hospital; 

Anesthesia — Dr.  E.  R.  Brubaker,  chief.  Dr.  J.  H.  Riley. 

Dental — Dr.  G.  P.  Fitzgerald,  chief.  Dr.  E.  G.  Benham 
and  Dr.  N.  C.  Farrel. 

Dermatology — Dr.  A.  A.  Gavey. 

Electrocardiology — Dr.  C.  L.  Jones. 

Gynecology — Dr.  E.  P.  Greenawalt,  chief.  Dr.  Joseph 
Webb,  Dr.  J.  H.  Poulton  and  Dr.  H.  B.  Elliott. 

Medicine — Dr.  F.  P.  Anzinger,  chief,  Dr.  R.  R.  Richison, 
Dr.  C.  L.  Jones  and  Dr.  L.  H.  Mendelson. 

Neurology — Dr.  A.  Richard  Kent. 

Obstetrics — Dr.  C.  S.  Ramsey,  chief,  Dr.  A.  K.  Howell, 
Dr.  J.  Roger  Marquart  and  Dr.  W.  D.  Beasley. 

Ophthalmology — Dr.  C.  L.  Minor. 

Orthopedics — Dr.  J.  A.  Link,  chief.  Dr.  C.  E.  M.  Finney. 

Otolaryngology — Dr.  D.  W.  Hogue,  chief.  Dr.  F.  A. 
Hartley,  Dr.  J.  C.  Easton  and  Dr.  J.  E.  Burgman. 

Out-patient  Department — Dr.  R.  R.  Richison,  chief,  Drs. 
F.  A.  Holloran,  C.  M.  Hullinger,  J.  H.  Hebble,  R.  D.  Arn, 
S.  E.  Flook  and  W.  D.  Beasley. 

Pathology — Dr.  Charles  B.  Kingry. 

Pediatrics — Dr.  H.  B.  Martin,  chief.  Dr.  H.  H.  Hildred. 

Surgery — Dr.  H.  A.  McKnight,  chief,  Dr.  A.  H.  Potter, 
Dr.  J.  H.  Rinehart  and  Dr.  G.  C.  Ullery. 

Urology — Dr.  N.  L.  Burrell,  chief.  Dr.  S.  W.  Mulholland. 

X-Ray — Dr.  William  Ultes. 

— Officers  were  reelected  as  follows  by  the 
staff  of  the  Springfield  City  Hospital:  President, 
Dr.  C.  S.  Ramsey;  vice  president,  Dr.  C.  L.  Minor; 
secretary -treasurer,  Dr.  E.  Paul  Greenawalt. 

- — The  building  fund  of  the  Mansfield  General 
Hospital  will  receive  $10,000  under  the  will  of  the 
late  L.  R.  Dronberger. 

- — Dr.  O.  S.  Steiner  has  been  elected  chief  of  the 
staff  of  St.  Rita’s  Hospital,  Lima.  Other  officers 
are  Dr.  T.  R.  Thomas,  assistant  chief;  Dr.  V.  H. 
Hay,  secretary. 

— Dr.  Charles  A.  Bowers  has  been  named  acting 
director  of  surgery  at  St.  Luke’s  Hospital,  suc- 
ceeding Dr.  Carl  H.  Lenhart,  new  director  of 
surgery  at  the  University  Hospitals. 

— A new  “fever  machine”  is  now  being  con- 
structed for  the  Miami  Valley  Hospital,  Dayton, 
to  replace  the  one  recently  destroyed  by  fire 
originating  from  a short  circuit. 

— The  staff  of  the  East  Liverpool  City  Hospital 
has  elected  Dr.  Samuel  Rich  president;  Dr.  V.  E. 
McEldowney,  vice  president;  Dr.  J.  A.  Fraser, 
secretary-treasurer,  and  Dr.  M.  D.  McCutcheon 
and  Dr.  E.  W.  Miskall,  trustees. 

— Lakewood  must  float  a new  bond  issue  to 
raise  funds  for  a city  hospital,  the  Ohio  Supreme 
Court  has  ruled  in  deciding  that  the  $1,000,000 
bond  issue  approved  by  the  voters  three  years  ago 
is  illegal  because  of  faulty  wording  on  the  ballots 
marked  by  the  voters. 


March,  1933 


State  News 


199 


Medical  Golfers  Already  Feel  the  Golf 
Itch  for  Coining  Annual  Tournament 

Preliminary  arrangements  have  been  completed 
for  the  Thirteenth  Annual  Tournament  of  the 
Ohio  State  Medical  Golfers’  Association  to  be  held 
at  the  Portage  Country  Club,  Akron,  on  May  1, 
the  day  preceding  the  opening  of  the  Eighty- 
Seventh  Annual  Meeting  of  the  Ohio  State  Medi- 
cal Association. 

Several  meetings  have  been  held  by  the  Akron 
golf  committee,  headed  by  Dr.  J.  L.  McEvitt,  and 
Dr.  J.  B.  Morgan,  Cleveland,  secretary  of  the 
golfers’  association,  at  which  arrangements  for 
the  tournament  were  discussed. 

A record-breaking  entry  for  the  tournament  is 
anticipated.  It  is  planned  to  make  the  playing 
fees  less  than  for  recent  tournaments.  It  is  be- 
lieved that  many  golfing  physicians  will  want  to 
take  advantage  of  the  opportunity  of  playing  the 
Portage  course,  one  of  the  finest  in  the  state  and 
the  scene  of  many  state  professional  and  amateur 
tournaments  during  the  past  few  years. 

An  attractive  prize  list  is  being  arranged,  with 
prizes  for  the  officers  as  well  as  the  sharks. 
Every  player  will  be  carefully  handicapped  so 
that  all  participating  will  have  a chance  to  cop 
one  or  more  of  the  prizes. 

Every  male  member  of  the  Ohio  State  Medical 
Association  is  eligible  to  membership  in  the 
golfers’  association  on  payment  of  an  enrollment 
fee  of  $2.00  which  makes  him  a member  for  life. 
Those  wishing  to  join  the  association  so  that  they 
can  take  part  in  the  Akron  tournament  may  mail 
a check  for  this  amount  to  Dr.  Morgan,  Medical 
Arts  Building,  Cleveland,  or  pay  it  when  teeing 
off  the  morning  of  May  1. 

Further  details  for  the  tournament  and  enter- 
tainment in  the  evening  are  being  handled  by  the 
Akron  committee  and  will  be  announced  in  sub- 
sequent issues  of  The  Journal.  The  Akron  com- 
mittee is  anxious  to  make  the  1933  tournament 
the  best  in  the  history  of  the  association  and  is 
leaving  nothing  undone  to  bring  this  about. 

Dr.  L.  M.  Otis,  Celina,  is  the  present  champion 
of  the  association,  having  won  the  honor  last  year 
at  Dayton.  It  is  anticipated  he  will  be  on  deck  to 
defend  his  crown. 

Officers  of  the  association  in  addition  to  Dr. 
Morgan,  who  has  been  secretary  almost  since  the 
founding  of  the  golfers’  association,  are:  Presi- 
dent, Dr.  J.  P.  DeWitt,  Canton;  first  vice  presi- 
dent, Dr.  F.  T.  Gallagher,  Cleveland;  second  vice 
president,  Dr.  McEvitt,  Akron;  third  vice  presi- 
dent, Dr.  F.  C.  Haney,  Columbus;  fourth  vice 
president,  Dr.  J.  F.  Wright,  Toledo,  and  fifth  vice 
president,  Dr.  E.  C.  Yingling,  Lima. 


Toledo — Dr.  A.  H.  Rudolph  has  resumed  his 
practice  here  after  post-graduate  work  abroad. 

Columbus — Dr.  and  Mrs.  Earl  M.  Gilliam  are 
now  on  their  third  trip  around  the  world. 


Medical  Board  Ruling  on  Nurse  Ap- 
plicants Approved  by  Attorney 
General 

The  regulation  of  the  State  Medical  Board  de- 
fining a nurses’  training  school  in  good  standing 
as  a school  connected  with  a hospital  which  re- 
quires nursing  to  be  practiced  therein  by  Ohio 
registered  nurses,  as  adopted  January  5,  1932, 
effective  July  1,  1932,  is  a valid  rule  and  not 
violative  of  any  constitutional  rights  of  those  who 
may  have  theretofore  matriculated  in  schools  of 
nursing  which  are  not  in  good  standing  as  defined 
by  such  rule,  according  to  an  opinion  given  re- 
cently by  the  Attorney  General  of  Ohio  (Opinion 
4835). 

Aside  from  holding  that  it  is  the  statutory  duty 
of  the  State  Medical  Board  to  determine  the 
standing  of  schools  of  nursing  and  that  the  rule 
in  question  is  reasonable  and  valid,  the  Attorney 
General  discussed  that  angle  of  the  question  rela- 
tive to  the  retroactive  provisions  of  the  rule  and 
whether  or  not  it  is  in  violation  of  the  Federal 
Constitution. 

“In  so  far  as  non-registered  nurses  which  may 
have  been  heretofore  employed  in  such  hospitals 
as  are  here  under  consideration  are  concerned,” 
the  Attorney  General  stated,  “your  inquiry  pre- 
sents no  question  of  impairment  of  the  obligation 
of  contracts  in  violation  of  Section  10,  Article  1 of 
the  Federal  Constitution — this  for  the  reason  that 
the  Medical  Board  is  not  seeking  to  dictate  the 
type  of  nurses  which  any  hospital  may  employ 
but  is  only  concerning  itself  with  its  statutory 
power  in  determining  what  applicants  for  regis- 
tration may  be  considered  as  graduates  of  nurses’ 
training  schools  in  good  standing.  Obviously  any 
hospital  may  continue  to  employ  non-registered 
nurses  as  long  as  it  may  see  fit  to  do  so. 

“Coming  to  the  question  of  whether  or  not  the 
rule  may  be  said  to  be  retroactive  as  to  applicants 
for  registration  who  have  heretofore  enrolled  in 
schools  of  nursing  connected  with  hospitals  em- 
ploying non-registered  nurses,  the  statute  con- 
tains no  provision  whereby  the  Medical  Board 
shall  determine  in  advance  of  an  application  being 
filed  whether  the  diploma  accompanying  such 
application  is  from  a school  in  good  standing  as 
defined  by  the  Board.” 

The  opinion,  in  effect,  upholds  the  authority  of 
the  State  Medical  Board  to  refuse  to  issue  a 
registration  certificate  to  an  applicant  who  is  a 
graduate  of  a nurses’  training  school  not  in  good 
standing  as  defined  by  the  board  under  reasonable 
rules  and  regulations  and  holds  that  the  Federal 
Constitution  would  not  be  violated  by  any  nurses’ 
training  school  in  any  procedure  it  might  take  to 
comply  with  these  rules  and  regulations. 


Wellsville — Dr.  J.  S.  McCulloch  has  been 
elected  president  of  the  local  board  of  education. 


Ownership  ©£  X^Kay  Plates,  Liahility  ©£  Physician  to 
Family  of  Patient,  Municipal  Hospital  Responsibilities 
and  Other  MedicahLegal  Questions  in  Recent 
Court  Decisions 


The  controversial  question  of  the  ownership  of 
X-ray  plates  was  raised  recently  in  a case  filed 
in  the  Dayton  municipal  court  by  a dentist  who 
sued  to  recover  on  an  account  owed  by  a patient 
who  had  refused  to  pay  his  bill  for  X-ray  work 
because  the  dentist  had  refused  to  turn  the  X-ray 
plates  over  to  him 

Acting  Municipal  Judge  I.  H.  Rohlfs  decided 
the  case  in  favor  of  the  dentist,  holding  that  the 
X-ray  plates  are  the  property  of  the  person  taking 
them,  regardless  of  whether  the  patient  had  paid 
for  the  work  or  not. 

Explaining  his  decision,  the  court  declared  that 
he  was  “of  the  opinion  that  the  protection  of  the 
person  taking  said  film  depends  largely  on  the 
proper  preservation  of  the  same  and  such  films 
should  remain  with  said  dental  surgeon  or  phy- 
sician”. He  added  that  in  his  opinion  “the  in- 
terpretation is  the  all-important  thing  in  con- 
nection with  an  X-ray  examination,  the  film  itself 
simply  being  the  basis  of  the  interpretation”. 

The  Dayton  judge  followed  closely  in  his  de- 
cision the  points  made  in  two  Michigan  cases  in 
which  the  circuit  coui'ts  held  that  the  X-ray  plates 
should  be  regarded  as  the  property  of  the  phy- 
sician or  hospital  making  the  examination. 
Analysis  of  the  Michigan  cases  will  be  found  in 
the  July,  1932,  and  the  August,  1932,  issues  of 
The  Journal. 

* * * 

The  Ohio  Supreme  Court  recently  rendered  a 
decision  in  a suit  for  alleged  malpractice  against 
a physician  in  which  the  question  of  liability  to  a 
husband  for  loss  of  services  of  his  wife  who  had 
died  following  an  operation  was  raised.  (Opinion 
23378). 

The  plaintiff"  husband  asked  for  damages  for 
the  loss  of  his  wife’s  services  who  died  on  the 
same  day  the  operation  was  performed.  At  the 
conclusion  of  the  plaintiff’s  testimony,  the  de- 
fendant physician  moved  the  court  to  arrest  the 
testimony  and  to  instruct  the  jury  to  return  a 
verdict  for  the  defendant,  which  motion  the  com- 
mon pleas  court  granted.  On  appeal,  the  Court  of 
Appeals  reversed  the  trial  court  on  the  ground 
that  the  court  erred  in  sustaining  the  motion  for 
a directed  verdict  in  favor  of  the  defendant. 

In  deciding  the  case  and  affirming  the  judg- 
ment of  the  trial  court  in  favor  of  the  physician, 
the  Supreme  Court  held  that  in  an  action  based 
upon  alleged  malpractice  by  a physician,  result- 
ing in  the  death  of  the  patient,  a husband  may  re- 
cover for  the  loss  of  his  wife’s  services  only  be- 


tween the  time  she  sustained  the  injury  and  her 
resulting  death,  and  that  in  a case,  such  as  this, 
where  no  averment  was  made  showing  that  any 
time  had  intervened  between  the  time  of  injury 
and  death,  a motion  to  direct  a verdict  for  the 
defendant  is  proper. 

* * * 

A city  is  not  liable  to  a patient  for  alleged 
negligent  treatment  received  in  a municipal  hos- 
pital operated  with  municipal  funds  for  public 
charitable  treatment  of  the  sick  and  injured,  not- 
withstanding some  patients  pay  for  services 
therein,  the  Court  of  Appeals  of  Lucas  decided 
in  the  case  of  Lloyd  v.  City  of  Toledo. 

The  plaintiff  had  sued  the  City  of  Toledo  for 
damages,  alleging  personal  injuries  sustained  by 
her  through  the  alleged  negligence  of  servants 
and  employes  in  the  Toledo  Municipal  Hospital. 
The  court  of  common  pleas  sustained  a motion  of 
the  city  for  a judgment  in  its  favor  upon  the 
pleadings.  The  case  was  appealed,  the  Court  of 
Appeals  holding  that  the  hospital  is  a municipal 
institution  maintained  and  operated  by  the  city  in 
the  interest  of  and  for  the  preservation  of  the 
public  health  and  that  the  municipality  in  con- 
ducting the  institution  is  performing  a govern- 
mental function,  and,  therefore,  that  the  rule  that 
a municipal  corporation  is  not  liable  for  the  torts 
of  its  officers  and  employes  should  apply. 

* * * 

The  amendment  to  the  Workmen’s  Compensa- 
tion Law,  enacted  in  1931,  prescribing  a limita- 
tion of  10  years  for  the  reopening  of  workmen’s 
compensation  claims  and  making  this  limitation 
specifically  applicable  to  claims  filed  prior  as  well 
as  subsequent  to  the  amendment  was  held  valid 
and  enforceable  by  the  Ohio  Supreme  Court  in  a 
decision  in  the  case  of  State  ex  rel.  Boswell  v. 
the  Industrial  Commission  of  Ohio  and  four  other 
related  cases.  The  court  held  that  the  legislature 
had  the  right  to  impose  the  10-year  limitation  on 
all  claims  whether  filed  before  or  after  the  statute 
was  amended  because  workmen’s  compensation  is 
not  a common  law  right  but  one  solely  of  statu- 
tory creation. 


Columbus — Dr.  Augustus  A.  Hall  has  been 
elected  chairman  of  the  General  Practitioners’ 
Section  of  the  Columbus  Academy  of  Medicine. 
Other  officers  are:  Secretary -treasurer,  Dr.  Rich- 
ard Wallace;  members  of  executive  committee: 
Drs.  C.  C.  Ross,  C.  M.  Valentine  and  John  Rausch- 
kolb. 


200 


March,  1933 


State  News 


201 


PUBUC  HEALTH  NOTES 


— Dr.  R.  G.  Hunter,  Wapakoneta,  was  re-elected 
president  of  the  Northwest  District,  Ohio  Federa- 
tion of  Public  Health  Officials,  at  a recent  meet- 
ing of  the  district  in  the  Norval  Hotel,  Lima.  He 
is  health  commissioner  of  Auglaize  County.  Other 
officers  elected  were:  Vice  president,  Gertrude 
Matson,  Bucyrus;  secretary-treasurer,  Dr.  Alfred 
Lippert,  health  commissioner  of  Sidney;  member 
of  executive  committee,  Dr.  H.  J.  Powell,  health 
commissioner  of  Bowling  Green.  Among  those 
who  addressed  the  meeting  were  Dr.  R.  W.  De- 
Crow,  Dr.  E.  R.  Shaffer,  and  Dr.  Finley  Van  Ors- 
dall,  of  the  staff  of  the  State  Department  of 
Health. 

— Meeting  of  the  Central  District,  Ohio  Federa- 
tion of  Public  Health  Officials,  was  held  December 
28  at  the  Hotel  Chittenden,  Columbus.  Among 
those  who  spoke  were  Mrs.  Elizabeth  P.  August, 
R.N.,  general  secretary,  Ohio  State  Nurses’  As- 
sociation; Senator  (Dr.)  E.  LeFever,  Glouster, 
and  Dr.  Guy  T.  Wasson,  Bucyrus,  president  of 
the  state  federation.  The  meeting  was  arranged 
by  Dr.  R.  E.  Bower,  Chillicothe,  president  of  the 
district,  and  Dr.  James  F.  Wilson,  Washington 
C.  H.,  secretary. 

— Dr.  Floyd  R.  Stamp  has  been  appointed 
health  commissioner  and  city  physician  for  the 
city  of  Alliance. 

— The  district  board  of  health  of  Jackson 
County  has  appointed  Dr.  B.  J.  Allison,  Oak  Hill, 
as  county  health  commissioner. 

— Dr.  W.  B.  Lacock  has  been  appointed  health 
commissioner  of  Hocking  County  for  a two-year 
term. 

- — The  Butler  County  Board  of  Health  has  re- 
appointed Dr.  C.  J.  Baldridge  as  county  health 
commissioner. 

— Dr.  A.  H.  Smith,  former  assistant  superin- 
tendent of  the  Atlanta,  Ga.,  Tuberculosis  Sana- 
torium, has  been  appointed  superintendent  of  the 
Pleasant  View  Sanatorium,  Lorain  County,  suc- 
ceeding the  late  Dr.  H.  F.  Gammons. 

— Dr.  W.  K.  Ruble  has  been  appointed  for  two 
years  as  health  commissioner  of  Clinton  County. 

— The  Lawrence  County  Board  of  Health  has 
re-employed  Dr.  Forest  R.  Stewart  as  health  com- 
missioner of  the  county. 

— Dr.  J.  J.  Sutter  will  serve  for  another  year 
as  health  commissioner  of  Allen  County. 

— Dr.  J.  H.  Hayes,  former  assistant  health  com- 
missioner of  Mansfield,  has  joined  the  staff  of  the 
Division  of  Communicable  Diseases,  State  De- 
partment of  Health. 

— Dr.  E.  L.  Pettibone  has  been  appointed  to  the 
Cuyahoga  County  Board  of  Health. 


Steps  Taken  to  Meet  Over-Production  and 
Unemployment  Among  Graduate 
Nurses 

Due  to  poor  economic  conditions  and  the  in- 
auguration of  a number  of  far-reaching  move- 
ments, national  in  scope,  to  solve  the  problems  of 
overproduction  of  and  unemployment  among 
graduate  nurses,  Ohio  may  expect  within  a few 
years  a considerable  decrease  in  the  number  of 
graduates  of  accredited  nurse  training  schools. 

This  is  reflected  in  a report  by  Mrs.  Elizabeth 
P.  August,  general  secretary,  Ohio  State  Nurses’ 
Association,  issued  in  connection  with  a report  of 
the  American  Nurses’  Association  reviewing  the 
1932  activities  in  the  nursing  field  nationally. 

Six  Ohio  hospitals  had  up  to  January  1,  1933, 
closed  their  schools  of  nursing.  They  are:  Home 
and  Hospital,  Findlay;  Memorial  Hospital,  Piqua; 
Lake  County  Memorial  Hospital,  Painesville; 
Jane  Case  Hospital,  Delaware;  Memorial  Hos- 
pital, Marietta,  and  Radium  Hospital,  Columbus. 

Memorial  Hospital,  Fremont;  Alliance  City 
Hospital,  and  Providence  Hospital,  Sandusky,  ac- 
coi’ding  to  Mrs.  August,  are  contemplating  closing 
their  nursing  schools  in  the  near  future. 

The  following  hospitals,  it  was  pointed  out,  did 
not  accept  a full  class  of  student  nui*ses  dui-ing 
1932:  East  Liverpool  Hospital;  Memorial  Hos- 
pital, Elyria;  Glenville  Hospital,  Cleveland; 
Mercy  Hospital,  Columbus;  Newai'k  City  Hos- 
pital, Schirrman  Hospital,  Poi’tsmouth.  The  fol- 
lowing institutions  have  not  accepted  a 1933 
spring  class:  Aultman,  Canton;  Bethesda,  Zanes- 
ville; Charity,  Cleveland ; Coshocton  City;  Flower, 
Toledo;  Good  Samaritan,  Cincinnati;  Good  Sa- 
maritan,  Zanesville;  Good  Samaritan,  Sandusky; 
Grant,  Columbus;  Huron  Road,  Cleveland;  Lake- 
wood  City;  Lucas  County,  Toledo;  Massillon  City; 
Mercy,  Toledo;  Ohio  Valley,  Steubenville;  Ports- 
mouth General;  Springfield  City;  St.  John”s 
Cleveland;  St.  Mary’s,  Cincinnati;  St.  Rita’s, 
Lima;  St.  Thomas,  Akron;  Toledo  Women”s  and 
Children. 

The  l’eport  issued  by  the  Ameidcan  Nurses’ 
Association  states  that  135  schools  of  nursing 
thi’oughout  the  country  have  been  closed  during 
the  past  yeai\  It  is  pointed  out  that  economic 
conditions  hastened  the  closing  of  some  of  these 
schools  but  that  most  of  them  were  in  hospitals 
where  the  training  given  was  of  limited  scope  or 
where  facilities  were  not  adequate  for  well-bal- 
anced nurse  training. 

“Another  l'eform  which  is  aimed  directly  at  the 
relief  of  nurse  unemployment  but  which  works  to 
the  advantage  of  the  sick  in  hospitals  is  the  cut- 
ting down  on  the  number  of  students  enrolled  in 
schools  of  nursing,”  the  report  declares.  “By 
omitting  whole  autumn  or  spring  classes  or  by 
limiting  the  number  of  students  admitted,  it  is 
necessary  for  hospitals  to  employ  more  graduate 


202 


The  Ohio  State  Medical  Journal 


March,  1933 


nurses  to  give  care  to  patients.  Thus  the  hos- 
pitalized sick  get  the  benefit  of  the  expert  care 
that  comes  from  nurses  of  true  professional  grade. 
Much  of  the  graduate  service  is  costing  the  hos- 
pital no  more  than  student  service  costs.” 

Various  local  measures  to  cope  with  the  “dis- 
astrous unemployment”  of  nurses  are  reported, 
such  as  eight-hour  day  for  special  duty  nurses, 
spreading  of  work,  and  free  nursing  service  to 
the  poor  out  of  special  nurse  relief  funds. 

Other  reforms  that  have  gained  momentum  in- 
clude the  abolishment  of  student  allowances  in 
many  schools  of  nursing,  and  the  use  of  this 
money  to  develop  the  school,  and  an  increase  in 
the  number  of  clinical  postgraduate  courses 
offered  nurses  for  training  in  special  fields  in 
which  there  is  a shortage  of  properly  trained 
women. 


New  Physicians  Licensed  In  Ohio 

The  following  physicians  have  been  granted 
licenses  through  reciprocity  by  the  State  Medical 
Board:  Drs.  John  A.  Altdoerffer,  Poland,  North- 
western Medical  School;  William  V.  Barton,  Ham- 
ilton, Emory  University;  Malcolm  E.  Boylan, 
Fremont,  University  of  Michigan;  Emanuel  B. 
Brandes,  Cincinnati,  University  of  Michigan; 
William  A.  Evans,  Lakewood,  Jefferson  Medical 
College;  John  V.  Goode,  Cincinnati,  Johns  Hop- 
kins University;  Charles  S.  Higley,  Cleveland, 
University  of  Michigan;  Edward  B.  Holmes,  Cool- 
ville.  University  of  Virginia;  Bertha  B.  M.  Joseph, 
Martins  Ferry,  Woman’s  Medical  College;  Nich- 
olas E.  Keseric,  Sandusky,  Indiana  University; 
Harry  K.  Lynne,  Warren,  University  of  Pennsyl- 
vania; Wilmer  H.  Rogers,  Amsterdam,  Tulane 
University;  Arno  E.  Town,  Toledo,  Jefferson 
Medical  College;  Raymond  E.  Tyvand,  Dayton, 
Rush  Medical  College;  Jack  K.  Williams,  Lorain, 
University  of  Toronto;  Isadore  H.  Kass,  Toledo, 
University  of  Michigan;  Samuel  L.  Meltzer, 
Portsmouth,  Boston  University;  Joseph  B.  Jack- 
son,  Zanesville,  Howard  Medical  School;  Melville 
D.  Smith,  Columbus,  University  of  Virginia;  John 
W.  Fairing,  Aurora,  Baltimore  Medical  College. 


Important  Notice  to  Delinquent 
Members 

In  compliance  with  federal  postal  regula- 
tions, the  names  of  all  unpaid  members  of 
the  State  Association  must  be  removed  from 
The  Journal  mailing  list  after  this  issue. 

If  you  are  among  those  on  the  “delin- 
quent” membership  list  of  the  State  Asso- 
ciation, your  membership  dues  for  1933 
should  be  transmitted  to  the  Secretary- 
Treasurer  of  your  medical  society  or  acad- 
emy of  medicine  immediately . 

Prompt  payment  of  dues  will  insure  the 
continuance  of  The  Journal,  as  well  as  other 
organization  benefits.  All  physicians  should 
be  anxious  to  receive  the  April  issue  which 
will  contain  the  complete  program  and  an- 
nouncements of  the  Eighty-Seventh  Annual 
Meeting  of  the  State  Association  to  be  held 
at  Akron,  May  2 and  3. 

Membership  dues  for  1933  were  due  on  or 
before  January  1.  As  a courtesy  to  those 
who  through  neglect  or  oversight  have  thus 
far  failed  to  pay  their  1933  dues,  The 
Journal  has  been  mailed  to  them  for  the 
first  three  months  of  this  calendar  year. 


Dr.  E.  R.  Shaffer,  since  1919  associated  with 
the  State  Department  of  Health  in  various  ad- 
ministrative capacities,  has  resigned  to  become 
field  manager  for  Ohio  of  the  Hixson  Labora- 
tories, Inc.,  Johnstown,  Ohio,  with  offices  in  Co- 
lumbus. Dr.  Shaffer  joined  the  State  Department 
of  Health  as  a district  supervisor.  Later  he  was 
appointed  chief  of  the  Bureau  of  Local  Health 
Organization.  During  the  past  year  he  was  ap- 
pointed chief  of  the  Bureau  of  Child  Hygiene. 
Dr.  Shaffer  is  secretary-treasurer  of  the  Ohio 
Federation  of  Public  Health  Officials. 


LANGDON  - MEYER  LABORATORIES 

ESTABLISHED  1919 

Complete  Clinical  and  Chemical  Laboratory  Service  for  Physicians 


FOURTEEN  YEARS  OF  LABORATORY  EXPERIENCE  ARE  AT 

YOUR  SERVICE 


Friedman  Pregnancy  Tests 
Toxicological  Analyses 
Expert  Legal  Testimony 
Blood  Chemistry 
Vaccines 
Etc. 


A post  card  will  bring  you 
containers  without  charge 


Wasserman  and  Kahn  Tests 
Bacteriological  Analyses 
Pneumococcus  Typing 
Urinalyses 
Tissues 
Etc. 


519  MAIN  STREET 


CINCINNATI,  OHIO 


March,  1933 


State  News 


203 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

THE  PIONEER  POST-GRADUATE  MEDICAL 
INSTITUTION  IN  AMERICA 


W e Announce 

FOR  THE  GENERAL  SURGEON 

A Combined  Surgical  Course  Comprising 

GENERAL  SURGERY  PROCTOLOGY 

TRAUMATIC  SURGERY  THORACIC  SURGERY 

ABDOMINAL  SURGERY  GASTRO-ENTEROLOGY 

ORTHOPEDIC  SURGERY  ORTHOPEDIC  SURGERY 

GYNECOLOGICAL  SURGERY  LABORATORY 

UROLOGICAL  SURGERY  X-RAY  DIAGNOSIS 

CADAVER  COURSES  in  all  branches  of  Surgery 
SPECIAL  COURSES  in  all  Medical  and  Surgical  specialties 


For  Information  Address 

MEDICAL  EXECUTIVE  OFFICER 


345  West  50th  Street 


NEW  YORK  CITY 


THE  UNIVERSITY  OF  MICHIGAN  MEDICAL  SCHOOL 

and  THE  MICHIGAN  STATE  MEDICAL  SOCIETY 

Intensive  Courses  for  1933 


Pulmonary  Tuberculosis  

Diseases  of  Metabolism 

Diseases  of  the  Heart  

Ophthalmology  and  Otolaryngology 
Serology  and  Clinical  Microscopy 
Registration  limited. 


March  20-24 

.March  27-31 

-April  3 - 7 


April  24-29 


Throughout  the  year 

Normal  fees. 

Director,  Department  of  Post-Graduate  Medicine 


Proctology  

Practitioners'  Course  

Gynecology  and  Obstetrics 

Roentgenology  

Physical  Therapy  


May  15-27 

June  19-July  1 

June  19-July  1 

June  26-August  4 

.Throughout  the  year 


For  further  information  . address: 

University  Hospital,  Ann  Arbor,  Michigan. 


POSTGRADUATE  COURSE 


LABORATORY  COURSE 


For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

A house  doctor  is  appointed  July  1st  and 
January  1st 


For  Nurses  and  Graduates  of  High  School 
CLASSES  LIMITED  TO  SIX 
X-ray,  Basal  Metabolism,  Electro-cardiography  and 
Physical  Therapy 


150  clinical  patients  daily  provide  material  for  classes. 

Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 


For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


COOK  COUNTY  GRADUATE  SCHOOL  OF  MEDICINE 

(Iii  affiliation  with  Cook  County  Hospital) 

ANNOUNCES  CONTINUOUS  COURSES 

MEDICINE — General  and  Intensive  Courses,  all  branches 

PEDIATRICS — (Special)  Intensive  Course,  Four  Weeks  starting  May  1st 
OBSTETRICS — Extensive  Courses — Two  Weeks  Intensive  Course 

GYNECOLOGY — Three  Months  Course — Two  Weeks  Course 

ORTHOPEDICS — Three  Months  Course — Two  Weeks  Course 

UROLOGY — Two  Months  Course — Two  Weeks  Course 
CYSTOSCOPY — Intensive  Two  Weeks  Course 

SURGERY — Three  Months  General  Course — Two  Weeks  Intensive  Review  Course  Surgical  Technique  (Laboratory) 
General,  Intensive  or  Special  Courses,  Tuberculosis,  Fractures  and  Traumatic  Surgery,  Roentgenology  Dermatology 
and  Syphilis,  Ophthalmology,  Ear,  Nose  and  Throat,  Anatomy,  Pathology,  Nervous  and  Mental  Diseases. 

Teaching  Faculty — Attending  Staff  of  Cook  County  Hospital 

Address:  Registrar,  427  South  Honore  Street,  CHICAGO,  ILLINOIS 


204 


The  Ohio  State  Medical  Journal 


March,  1933 


Dental  Education  Started  in  Ohio  as  an 
Early  Specialty  in  Medicine 

Dentistry,  so  far  as  professional  educational 
training  is  concerned,  had  its  birth  in  the  little 
village  of  Bainbridge,  Ross  County,  Ohio,  in  the 
year  1827,  according  to  an  article  written  by  Dr. 
Edward  C.  Mills,  D.D.  S.,  Columbus,  and  featured 
in  The  Journal  of  the  American  Dental  Associa- 
tion. 

Dr.  Mills’  story  on  “the  cradle  of  dental  edu- 
cation” is  based  on  data  obtained  through  an  in- 
tensive and  exhaustive  search  of  historical 
records  and  is  a valuable  collection  of  facts  con- 
cerning not  only  the  early  history  of  dentistry 
but  also  the  history  of  medicine  as  practiced  in 
Ohio  during  the  early  years  of  the  Nineteenth 
Century. 

To  a physician,  John  Harris,  is  given  the  credit 
for  having  established  the  first  school  where 
students  might  obtain  instruction  in  dentistry 
under  proper  supervision  and  obtain  some  knowl- 
edge of  the  medical  sciences  so  important  in  the 
practice  of  dentistry. 

According  to  Dr.  Mills’  survey,  John  Harris 
moved  to  Bainbridge  in  1825.  He  has  been  a 
practicing  physician  at  Madison,  Ohio,  a post 
town  in  Hamilton  County  10  miles  from  Cincin- 
nati, and  had  practiced  dentistry  in  conjunction 
with  medicine,  realizing  as  did  few  physicians  of 
that  period  the  importance  of  dentistry  as  a 
health  measure. 

“Dentistry  was  being  practiced  without  any 
legal  restraint  and  was  destined  to  continue  so 
for  some  time,  as  it  was  many  years  before  it  re- 
ceived the  consideration  as  a health  measure 
which  it  merited,”  Dr.  Mills  writes  concerning 
that  period. 

“The  success  of  some  who  had  been  in  practice 
induced  many  incompetent  and  unqualified  per- 
sons to  enter  its  ranks,  and  the  newspapers  dur- 
ing these  years  contained  many  announcements 
of  itinerant  dentists,  making  extravagant  claims 
as  to  their  ability.” 

At  the  time  Harris  moved  to  Bainbridge,  all 
candidates  for  examination  by  the  board  of  cen- 
sors of  the  district  medical  societies,  created  by 
the  Act  of  1824,  were  required  to  have  had  in- 
struction under  a preceptor.  This  provided  an 
opportunity  for  Harris  to  establish  a school  for 
medical  instruction  where  he  could  prepare  stu- 
dents for  entrance  into  medicine  and  impart  to 
them  information  concerning  dentistry,  obtained 
by  him  from  study  and  a decade  of  active  prac- 
tice both  as  a physician  and  dentist. 

“Owing  to  the  absence  of  data,  it  is  impossible 
to  estimate  the  number  of  students  enrolled  at 
Dr.  Harris’  school,  or  what  percentage  of  them, 
intent  on  the  practice  of  medicine,  became  more 
interested  in  dental  surgery,”  Dr.  Mills  writes. 
“In  fact,  the  latter  class  is  the  only  one  of  which 
we  have  information,  which  indicates  that  pre- 


paring students  for  the  practice  of  dentistry  was 
Dr.  Harris’  chief  motive.” 

Two  men  who  came  under  the  influence  of 
Harris  in  his  enthusiasm  for  raising  the  stand- 
ards of  dentistry  were  destined  to  carry-on  on  a 
more  pretentious  scale  the  precepts  which  John 
Harris  instilled  into  their  minds  and  those  of 
others  who  attended  his  school  of  instruction. 

They  were:  Chapin  A.  Harris,  a brother  of 
John  Harris  and  a practicing  physician  who  had 
been  a student  in  his  brother’s  office  at  Madison 
and  was  located  about  1827  at  Greenfield,  15 
miles  to  the  north  of  Bainbridge;  and  James  Tay- 
lor, a native  of  Ross  County,  who  entered  Dr. 
John  Harris’  office  as  a medical  student  and  later 
became  a physician,  but  due  to  the  influence  of 
his  preceptor  became  more  interested  in  the  den- 
tal phase  of  medicine  and  devoted  his  later  life  to 
dentistry. 

Chapin  A.  Harris  in  1840  founded  the  Balti- 
more College  of  Dental  Surgery,  the  first  dental 
college  in  the  world  and  established  the  American 
Journal  of  Dental  Science,  the  first  dental  journal 
ever  published. 

Taylor,  in  1845,  founded  the  Ohio  College  of 
Dental  Surgery  in  Cincinnati  and  in  1847  estab- 
lished the  Dental  Register  of  the  West,  the  second 
dental  journal  ever  published. 

The  histories  of  a dozen  or  more  other  students 
who  studied  and  received  their  first  training 
under  John  Harris  are  traced  in  Dr.  Mills’  article, 
showing  the  influence  which  the  Bainbridge  phy- 
sician had  on  those  who  attended  his  “school  of 
instruction”  and  the  contributions  which  he  made 
to  dental  science  and  dental  education. 

In  commemoration  of  John  Harris,  Chapin  A. 
Harris  and  James  Taylor,  the  pioneers  of  modern 
dentistry,  Dr.  Mills  and  his  brother,  Charles  W. 
Mills,  D.D.S.,  have  had  erected  in  the  town  hall 
at  Bainbridge  a tablet  which  pays  appropriate 
tribute  to  those  pioneers  who  made  the  Ross 
County  village  the  “cradle  of  dental  education” 
and  “who  conceived  the  possibilities  of  dentistry 
in  the  alleviation  of  human  suffering  and  whose 
ideas  gave  dentistry  a new  birth  into  a scientific 
and  professional  calling  from  which  position  it 
has  emerged  into  one  of  the  most  important  and 
beneficial  division  of  health  service”. 


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Assistance  of  Medical  Writers — Abstracts,  Translations, 
Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  PL,  Chicago,  111. 


For  Sale  or  Rent — Doctor’s  location.  Address  Mrs.  C.  E. 
Kerney,  2510  East  Fifth  Street,  Dayton,  Ohio. 


March,  1933 


State  News 


207 


HYCLORITE 


Accepted  by  the  Council  on  Pharmacy  and 
Chemistry  of  the  American  Medical 
Association  (N.N.R.) 

ANTISEPTIC 

To  Prevent  Infection  of  Ringworm 

For  irrigating,  swabbing  and  dressing 
infected  cases  wherever  an  anti- 
septic is  needed. 

For  Hand  and  Skin  Sterilization. 

To  Make  a Dakin’s  Solution  of  Correct 
Hypochlorite  Strength  and  Alkalinity. 

NON-POISONOUS 

NON-IRRITATING 

Write  for  Literature 

BETHLEHEM  LABORATORIES 

INCORPORATED 
300  Century  Building, 
PITTSBURGH,  PENN  A. 


LABORATORY  APPARATUS 

Coors  Porcelain  Pyrex  Glassware 

R.  & B.  Calibrated  Ware 
Chemical  Thermometers 
Hydrometers  Sphygmomanometers 


J.  T.  Baker  & Co.’s  C.  P.  Chemicals 

Stains  and  Reagents 
Standard  Solutions 


BIOLOG1CALS 

Serums  Bacterins  Media 

Antitoxins  Vaccines  Pollens 


We  are  completely  equipped,  and  solicit 
your  inquiry  for  these  lines  as  well  as  for 
Pharmaceuticals,  Chemicals  and  Supplies, 
Surgical  Instruments  and  Dressings. 


The  Rupp  & Bowman  Co. 

319  Superior  St.  Toledo,  Ohio 


AS  PURE, 

SAFE  anti  WHOLESOME 
AS  MILK  CAN  BE 

Evaporated  milk  is  considered  by  many 
pediatricians  to  be  tlie  best  form  of  cow's 
milk  for  the  baby’s  formula.  And  many 
baby  specialists  recommend  that  the  pa- 
tient get  Wilson’s  when  they  prescribe  evap- 
orated milk.  This  is  because  Wilson’s  is  a 
standard  brand  of  evaporated  milk  that 
conforms  to  the  highest  known  standards. 
You  can  depend  on  Wilson’s  to  be  always 
the  same — as  pure  and  safe  and  wholesome 
as  cow’s  milk  can  be — with  all  the  other 
known  qualities  that  make  evaporated  milk 
so  desirable  for  the  feeding  formulas  of 
many  infants.  It  is  convenient  and  econom- 
ical for  the  mother  to  use  — and  always 
available  from  a nearby  grocer.  Clinical 
samples,  also  information  and  literature 
sent  to  physicians  upon  request. 


A Product  of 

The  Indiana  Condensed  Milk 

Indianapolis  Company  Indiana 


IfLSOhfc 


208 


The  Ohio  State  Medical  Journal 


March,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

John  B.  Alcorn,  Chairman,  (1933) 


Columbus 

J.  H.  J.  Upham  (1934) Columbus 

C.  W.  Stone  (1935) Cleveland 

H.  M.  Platter,  (ex-officio) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

D.  C.  Houser,  (special) Urbana 

C.  W.  Waggoner,  (special) Toledo 

A.  H.  Freiberg,  (special) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

A.  B.  Denison,  (1933) . Cleveland 


Gilbert  Micklethwaite,  (1935)... .Portsmouth 
MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

W.  H.  Snyder,  (1933) Toledo 

F.  P.  Anzinger,  (1935) Springfield 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) Toledo 

R.  H.  Birge,  (1935) Cleveland 

MEDICAL  ECONOMICS 
J.  Craig  Bowman,  Chairman,  (1933) 

Upper  Sandusky 

A.  B.  Brower,  (1934) Dayton 

E.  0.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 


V.  C.  Rowland,  Chairman .Cleveland 

Jonathan  Forman Columbus 

Beatrice  T.  Hagen Zanesville 

R.  R.  Hendershott Tiffin 

C.  I.  Stephen Ansonia 

MILITARY  AND  VETERANS'  AFFAIRS 

C.  W.  Stone,  Chairman Cleveland 

Fred  K.  Kislig Dayton 

A.  E.  Brant Youngstown 


COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

S.  J.  Goodman,  Chairman Columbus 

John  A.  Caldwell Cincinnati 

I.  P.  Seiler Piketon 


ARRANGEMENTS  1933  ANNUAL  MEETING 


H. 

S,  Davidson,  Chairman 

Akron 

E. 

M.  Huston 

Dayton 

E.  B.  Shanley New  Philadelphia 

PROGRAM  1933  ANNUAL  MEETING 

C.  L.  Cummer,  Chairman Cleveland 

B.  J.  Hein Toledo 

E.  R.  Brush . Zanesville 


SECTION  OFFICERS  FOR  1932-1933 


MEDICINE 

Carll  S.  Mundy Chairman 

12B  16th  St.,  Toledo 

Cecil  Striker Secretary 

700  Provident  Bank  Bldg.,  Cincinnati 

SURGERY 

Carl  R.  Steinke Chairman 

1027  Second  Natl.  Bldg.,  Akron 

Norris  Gillette Secretary 

320  Michigan  St.,  Toledo 
OBSTETRICS  AND  PEDIATRICS 

B.  H.  Carroll Chairman 

240  Michigan  St.,  Toledo 

Edward  A.  Wagner Secretary 

2560  Grandin  Rd.,  Cincinnati 


EYE,  EAR.  NOSE  AND  THROAT 


W.  V.  Mullin Chairman 

Euclid  at  93rd  St.,  Cleveland 

Ivor  G.  Clark Secretary 

188  E.  State  St.,  Columbus 

NERVOUS  AND  MENTAL  DISEASES 

J.  Fremont  Bateman Chairman 

Box  36,  Elmwood  Place 

Henry  C.  Schumacher Secretary 

2525  Euclid  Ave.,  Cleveland 

PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 
R.  H.  Markwith Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 

J.  P.  DeWitt,  (1933) Canton 

C.  E.  Kiely,  (1933) . Cincinnati 

C.  W.  Waggoner,  (1933) Toledo 

Wells  Teachnor,  Sr.,  (1934)  Columbus 

Ben  R.  McClellan,  (1934) Xenia 

E.  R.  Brush,  (1934) Zanesville 

C.  W.  Stone,  (1934) Cleveland 


ALTERNATES 


G.  F.  Zinninger,  (1933) Canton 

L.  H.  Schriver,  (1933) Cincinnati 

John  Sprague,  (1933) Athens 

D.  H.  Morgan,  (1934) Akron 

A.  C.  Messenger,  (1934) . Xenia 

A.  Howard  Smith,  (1934) . Marietta 

C.  L.  Cummer,  (1934) Cleveland 


Eighty-Seventh  Annual  Meeting,  Akron,  May  2-3,  1933 


April,  1933 


Advertisements 


209 


THE  SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 


Treats  Nervous  and  Mental  Diseases 


Send  For  House 


PHYSIOTHERAPY,  including 
hydrotherapy,  electrotherapy, 
and  massage;  medical  measures, 
thorough  diagnosis,  occupation 
therapy,  are  provided  for  pa- 
tients suffering  from  Nervous 
Diseases  at  the  Sawyer  Sana- 
torium. 

Book.  Address 


SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 


The  Ohio  State  Medical  Association 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879:  Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year;  single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 

Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1933) Cleveland 

Gilbert  Micklethwaite,  M.D.  (1935) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager  | 


b Officers  1932-1933 


PRESIDENT 

H.  M.  Platter,  M.D Columbus 

PRESIDENT-ELECT 

C.  L.  Cummer,  M.D. Cleveland 

TREASURER 

James  A.  Beer,  M.D Columbus 

EXECUTIVE  SECRETARY 
Don  K.  Martin Columbus 


State  Council 


First  District 


E. 

Second 

District 

O. 

Third 

P.  Klotz,  M.D. 

District 

B. 

Fourth 

District 

H. 

Fifth  : 

District 

H. 

Sixth 

District 

E. 

Seventh 

District 

Philadelphia 

E. 

Eighth 

District 

I. 

Ninth 

District 

S. 

Tenth 

District 

D. 

Ex-Officio,  The  Ex-President 
C.  Houser,  M.D.  . .. 

Urbana 

210 


The  Ohio  State  Medical  Journal 


April,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies  President  Secretary 

First  District 

Adams R.  L.  Lawwell,  Seaman O.  T.  Sproull,  West  Union 3d  Wednesday  in  April,  June.  Aus.. 

Oct. 

Brown R.  B.  Hannah,  Georgetown Geo.  P.  Tyler.  Jr.,  Ripley 4th  Wednesday  in  Feb.,  May  and 

Nov. 

Butler H.  O.  Lund,  Middletown Walter  Roehl,  Middletown 2d  Wednesday,  monthly. 

Clermont -T.  K.  Ashburn,  Batavia Allan  B.  Rapp.  Owen3ville Sd  Wednesday,  monthly. 

Clinton F.  A.  Peele,  Wilmington - Wm.  L.  Regan,  Wilmington 1st  Tuesday,  monthly. 

Fayette S.  E.  Boggs,  Washington  C.  H J.  F.  Wilson,  Washington  C.  H...  1st  Thursday,  monthly. 

Hamilton Parke  G.  Smith,  Cincinnati Geo.  B.  Topmoeller,  Cincinnati — Monday  evening  of  each  week. 

Highland J.  C.  Bohl,  Hillsboro W.  B.  Roads,  Hillsboro 1st  Wednesday,  monthly. 

Warren J.  E.  Witham,  Waynesvill6 James  Arnold.  Lebanon 1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 


Second  District Cyril  Hussey,  Sidney H.  R.  Huston,  Dayton 


Champaign N.  M.  Rhodes,  Urbana  _ L.  A.  Woodburn,  Urbana 

Clark C.  W.  Evans,  Springfield Roger  Marquart,  Springfield 

Darke W.  T.  Fitzgerald,  Greenville. W.  D.  Bishop,  Greenville 

Greene L.  L.  Taylor,  Yellow  Springs H.  C.  Schick,  Xenia.__.__ 

Miami F.  D.  Kiser,  Tippecanoe  City G.  A.  Woodhouse,  Pleasant  Hill — 

Montgomery A.  F.  Kuhl,  Dayton  Miss  M.  E.  Jeffrey,  Dayton 

Preble C.  M.  Treffinger,  Eaton C.  J.  Brian,  Eaton 

Shelby R.  E.  Paul,  Botkins A.  B.  Lippert,  Sidney 

Third  District V.  H.  Hay,  Lima _C.  E.  Hufford,  Toledo 

Allen E.  C.  Yingling,  Lima H.  L.  Stelzer,  Lima 

Auglaize E.  F.  Heffner,  Wapakoneta __C.  C.  Berlin,  Wapakoneta 

Hancock A.  E.  King,  Mt.  Cory H.  O.  Crosby,  Findlay . 

Hardin F.  M.  Elliott,  Ada W.  N.  Mundy,  Forest 

Logan O.  C.  Amstutz,  Bellefontaine W.  H.  Carey,  Bellefontaine 

Marion E.  L.  Brady,  Marion J.  W.  Jolley,  Marion 

Mercer M.  B.  Fishbaugh,  CeIina.-_ F.  E.  Ayers,  Celina 

Seneca Paul  Leahy,  Tiffin R.  E.  Hershberger,  Tiffin 

Van  Wert A.  T.  Rank,  Van  Wert R.  H.  Good.  Van  Wert 

Wyandot B.  A.  Moloney,  Upper  Sandusky__J.  Craig  Bowman,  Up.  Sandusky 


Fourth  District — (With  Third  District  in  Northwestern  Ohio  District) 

Defiance S.  E.  DeMuth,  Hicksville._ D.  J.  Slosser,  Defiance 

Fulton P.  S.  Bishop,  Delta Geo.  McGuffin,  Pettisville 

Henry T.  P.  Delventhal,  Napoleon F.  M.  Harrison,  Napoleon 

Lucas L.  R.  Effler,  Toledo  A.  P.  Hancuff,  Toledo 

Ottawa R.  A.  Willett,  Elmore Cyrus  R.  Wood,  Port  Clinton — . 

Paulding C.  E.  Houston,  Paulding Gaile  L.  Doster,  Paulding 

Putnam E.  Blackburn,  Kalida W.  B.  Light,  Ottawa 

Sandusky D.  W.  Philo,  Fremont J.  C.  Boyce,  Fremont 

Williams B.  C.  Bly,  Bryan H.  R.  Mayberry,  Bryan 

Wood F.  l.  Sterling,  Bowling  Green R.  N.  Whitehead,  Bowling  Green- 


2d  Thursday,  monthly. 

2d  and  4th  Wednesday  noon. 

2nd  Friday,  monthly. 

1st  Thursday,  monthly. 

1st  Friday,  monthly,  except  July 
and  August. 

1st  and  8d  Friday  each  month. 

3d  Thursday,  monthly. 

1st  Friday,  monthly. 

Lima,  1982. 

8d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 

1st  Thursday,  monthly. 

17th  of  each  month. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Thursday,  monthly. 

3rd  Thursday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


3d  Thursday,  monthly,  except 
July,  August,  December. 

2nd  Thursday  monthly. 

1st  Wednesday,  monthly. 

Friday,  each  week. 

2d  Thursday,  monthly. 

Sd  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Thursday,  monthly. 

3d  Thursday,  monthly. 


Fifth  District — — H.  V.  Paryzek,  Councilor Chrm.  Com.  on  Arrangements 

Ashtabula J.  F.  Docherty,  Conneaut A.  M.  Mills,  Ashtabula 

Cuyahoga H.  V.  Paryzek,  Cleveland Clarence  H.  Heyman,  Cleveland — 

Erie J.  C.  Kramer,  Sandusky G.  A.  Stimson,  Sandusky 


Geauga H.  E.  Shafer,  Middlefield ... 

Huron W.  W.  Lawrence,  Norwalk 

Lake G.  O.  Hedlund,  Painesville 

Lorain H.  C.  Stevens,  Elyria 

Madina Harry  Streett,  Litchfield 

Trumbull E.  P.  Adams,  Warren 


Isa  Teed-Cramton,  Burton 

Geo.  F.  Linn,  Norwalk.__ 

B.  T.  Church,  Painesville 

W.  E.  Hart,  Elyria 

J.  K.  Durling,  Wadsworth 

R.  H.  McCaughtry,  Warren 


Cleveland. 

2nd  Tuesday,  monthly. 

3d  Fri.  Feb.,  March,  May,  Sept., 
Nov.,  Dec. 

Last  Wednesday,  monthly,  except 
July,  Aug.,  Sept. 

Last  Wednesday,  Apr.  to  Oct. 

3d  Tuesday,  Feb.,  May, 

August,  Nov. 

4th  Tuesday,  monthly. 

2d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  monthly,  except 
June,  July,  August. 


April,  1933 


The  Ohio  State  Medical  Journal 


211 


Societies  President  Secretary 

Sixth  Districts. A.  E.  Brant,  Youngstown . J.  H.  Seiler.  Akron 2d  Wed.,  Jan.,  April  ft  Oct. 

Ashland W.  F.  Emery,  Ashland Paul  E.  Kellogg.  Ashland 2nd  Friday,  Sept,  to  May. 

Holmes L.  E.  Anderson,  Mt.  Hope C.  T.  Bahler,  Walnut  Creek 1st  Tuesday,  quarterly,  Jan.,  April. 

July,  October. 

Mahoning J.  P.  Harvey,  Youngstown W.  M.  Skipp,  Youngstown 3d  Tuesday,  monthly. 

Portage S.  U.  Sivon,  Ravenna E.  J.  Widdecombe,  Kent 1st  Thursday,  monthly. 

Richland C.  H.  Bell,  Mansfield Mabel  Emery,  Mansfield Last  Thursday,  monthly. 

8tark H.  Welland,  Canton F.  S.  VanDyke,  Canton 2d  Tuesday,  monthly. 

Summit J.  H.  Selby,  Akron A.  S.  McCormick,  Akron 1st  Tuesday,  monthly. 

Wayne E.  H.  McKinney.  Doylestown R.  C.  Paul,  Wooster 2d  Tuesday,  monthly. 


Seventh  District 

Belmont G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire 

Carroll (With  Stark  Co.  Society) 

Columbiana J.  W.  Robinson,  Lisbon T.  T.  Church,  Salem — 

Coshocton Floyd  Craig,  Coshocton J.  D.  Lower,  Coshocton 

Harrison A.  C.  Grove,  Jewett W.  C.  Wallace,  Hopedale 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville — 

Monroe G.  W.  Steward.  Woodsfield A.  R.  Burkhart,  Woodsfield — 

Tnecarawas F.  B.  Larimore,  New  Phila. G.  L.  Sackett,  New  Phila 


1st  Thurs.,  monthly,  4 p.  m.„ 

except  July  and  August. 

2d  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Wednesday,  monthly. 

Last  Thursday,  monthly. 

2d  Wednesday,  monthly. 

2d  Thursday,  monthly. 


■Ighth  District 


Athens C.  E.  Welch,  Nelsonville .T.  A.  Copeland,  Athens 1st  Monday,  monthly. 

Fairfield E.  B.  Roller,  Lithopolis C.  W.  Brown,  Lancaster 2d  Tuesday,  monthly. 

Guernsey C.  C.  Headley,  Cambridge E.  F.  Hunter,  Cambridge 1st  and  3rd  Thursday  each  month. 

Licking Geo.  W.  Sapp,  Newark G.  A.  Gressle,  Newark Last  Friday,  monthly. 

Morgan D.  G.  Ralston,  McConnelsville C.  E.  Northrup,  McConnelsville Sd  Wednesday,  monthly. 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 1st  Wednesday,  monthly. 

Noble 

Perry James  Miller,  Corning F.  J.  Crosbie,  New  Lexington Sd  Monday,  monthly. 

Washington  s W.  W.  Sauer,  Marietta G.  M.  James,  Marietta 2d  Wednesday,  monthly 


Ninth  District 


Gallia _0.  A.  Vornholt,  Gallipolia Milo  Wilson,  Gallipolis 1st  Wed.,  Feb.,  May.  Sept,  and  Dec. 

Hocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan  ..  ..  Quarterly. 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 2nd  Tuesday,  monthly. 

Lawrence Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 1st  Thursday,  monthly. 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 3d  Thursday,  bi-monthly. 

Pike L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly___ 1st  Monday,  monthly. 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  ScaggB,  Portsmouth 2d  Monday,  monthly. 

Vinton O.  S.  Cox.  McArthur H.  S.  James.  McArthur 3d  Wednesday,  monthly 


Tenth  District — 

E.  C.  Brandt,  Crestline ... 

. Geo.  D.  Lowry,  Delaware..... , 

Jonathan  Forman,  Columhna 

Hnrrnw 

Glen  Nisley,  Chillicothe 

Union 

. E.  J.  Marsh.  Broadway 

R.  L.  Solt,  Bucyrus 1st  Monday,  monthly. 

J.  G.  Parker,  Delaware 1st  Tuesday,  monthly. 

John  H.  Mitchell,  Columbus Every  Monday,  8:30  p.  m. 

R.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly. 

G.  C.  Scheett,  West  Jefferson — 4th  Wednesday,  monthly. 

T.  Caris,  Mt.  Gilead igt  Wednesday,  monthly. 


C.  C.  Beale,  Circleville 

W.  C.  Breth,  Chillicothe 

Angus  Maclvor,  Marysville- 


— 1st  Friday,  monthly. 

— 1st  Thursday,  monthly. 

— 2d  Tuesday,  monthly. 


212 


ADVERTISEMENTS 


April,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 


This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL,  M.D. 

Medical  Directors. 

Dayton,  Ohio 

MRS.  GEORGE  V.  SHERIDAN, 

President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

WILLIAM  LYNDON  CROOKS 
Resident  General  Manager 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


WHITING  MINERAL  SPRINGS 

SANITARIUM  AND  BATHS 

L.  A.  WHITING,  Owner 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and  allied  diseases, 
together  with  cases  for  elimination  and  rest  cure. 

Medical  department  thorpughly  proficient  and  STRICTLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

WHITING  SANITARIUM  » » M A R Tl  N S VI L L E , I N D . 

VAN  W.  WHITING,  Manager  DR.  R.  H.  RICHARDS,  Medical  Director 


THE  MERCER  SANITARIUM  • MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristown,  Pa.) 


AN  approved  and  fully  equipped  Sanitarium 
for  convalescence,  diagnosis,  physical 
therapy,  and  medical  attention  under  recog- 
nized physicians. 

Created  like  a country  estate,  28  miles  south 
of  Pittsburgh.  No  mental  or  drug  cases. 
Admission  by  letter  from  physician  is  desired. 
Reports  will  be  made  to  him  on  request. 
Specially  interested  in  diabetes,  arthritis,  neu- 
ritis, anemias,  cardiovascular  diseases,  gen- 
eral orthopedic  conditions.  Isolation  for  nerv- 
ous cases.  Physical  therapy  in  all  phases. 
Address  professional  mail  to  G.  H.  McKinstry, 
M.D.,  Box  483  i;  Ilillsview  Farms,  Washing- 
ton, Pa.  Phone:  Washington  2650. 


THE  OXFORD  RETRAT 

Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 
FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


The  Council  of  the  Ohio  State  Medical  Association,  acting  through  an 
Executive  Committee  selected  for  the  purpose  of  determining  the  question,  has 
officially  postponed  the  87th  Annual  Meeting  of  the  Ohio  State  Medical  As- 
sociation scheduled  to  be  held  in  Akron  on  Tuesday  and  Wednesday,  May  2 and 
3,  1933,  to  sometime  in  the  Fall,  probably  September  or  October,  on  dates  to 
be  definitely  decided  later. 

This  action  (with  the  approval  and  sanction  of  the  local  committees  on 
arrangements  of  the  Summit  County  Medical  Society)  was  taken  after 
thorough  consideration  of  the  many  factors  in  the  present  situation,  compli- 
cated by  the  banking  “holiday”  and  the  possibility  of  other  contingencies  which 
might  affect  adversely  the  attendance  at  the  meeting. 

In  view  of  the  innumerable  and  complicated  problems  confronting  the 
medical  profession  at  this  time,  the  Council  and  the  committees  of  the  Ohio 
State  Medical  Association  have  redoubled  their  efforts  to  represent  the  pro- 
fession effectively  in  connection  with  the  unprecedented  movements  and  de- 
velopments which  might  adversely  affect  public  health  or  the  medical  pro- 
fession itself.  Never  before  has  there  been  a time  when  united  and  effective 
activity  is  so  vital  to  the  promotion  or  the  preservation  of  sound  principles  in 
government  and  in  public  health. 

For  some  time  there  has  been  a sentiment  among  members  of  the  State 
Association  for  holding  the  meeting  in  the  Fall  rather  than  in  the  Spring. 
Recent  developments  not  only  make  this  experiment  possible  but  desirable, 
at  least  for  this  year.  A splendid  program  for  the  Annual  Meeting,  already 
nearing  completion,  will  be  further  developed  to  be  of  maximum  interest  and 
value  when  the  meeting  is  held.  Moreover,  the  economic,  social  and  govern- 
mental situation  is  expected  to  be  better  clarified  by  that  time,  when  positive 
and  official  action,  based  on  activity,  findings,  recommendations  and  reports  of 
the  officers  and  committees,  may  be  taken  by  the  House  of  Delegates. 

As  soon  as  possible  the  dates  for  the  annual  meeting  will  be  announced. 


History  In 
The  Making 


Momentous  developments  of  the  past  month, 
which  have  literally  shaken  the  structure  of  so- 
ciety, have  tended  to  emphasize  the  possibility 
that  our  government  may  be 
at  the  crossroads,  with  change 
impending  in  character  and 
in  the  direction  of  its  activi- 
ties. 

What  effect  probable  social,  economic  and  gov- 
ernmental changes  would  have  on  the  practice  of 
medicine  are,  of  course,  problematical.  But,  we 
must  be  prepared  to  do  our  part  in  dissipating 
mass  hysteria  and  in  rallying  to  the  support  of 
sound  fundamentals  of  government,  and  of  proven 
principles  underlying  our  social  and  economic  life. 

National  events  of  late  have  colored  the  devel- 
opment of  legislation  and  governmental  activities 
in  Ohio  and  other  states;  while  reformers  and  the 
promoters  of  panaceas  have  been  quick  to  use  the 
present  troubled  times  and  period  of  unrest  for 


propagandizing  and  promoting  their  proposals 
wherever  possible. 

It  had  been  predicted  by  some  that  the  fact  that 
government  is  already  topheavy  and  overburdened 
with  expense  would  prevent  innovations  of  a 
paternalistic  or  communistic  nature.  However, 
the  demand  for  “relief”  has  evidently  lent  impetus 
to  many  changes  which  would  not  have  been  an- 
ticipated in  normal  times.  Recent  events  which 
have  come  with  dramatic  suddenness  have  re- 
sulted in  more  persistence  on  the  part  of  theorists 
and  those  who  believe  a complete  overthrow  of 
existing  policies  and  principles  is  necessary  to 
restoration. 

The  “social  program”  adopted  at  a recent  meet- 
ing of  the  Ohio  Pastors’  Convention  is  a striking 
example  of  the  movements  now  underway  to  de- 
part from  existing  governmental,  social  and  eco- 
nomic institutions. 

That  program  recommended  abandonment  of 


225 


226 


The  Ohio  State  Medical  Journal 


April,  1933 


the  “capitalistic  system”,  abolishment  of  “private 
profits  for  industry”,  and  advocated  radical 
changes  from  what  was  characterized  as  “our 
present  unjust  and  unwise  social  order”.  The 
specific  program  of  political  action  included  in 
that  program  are  the  following  eight  points:  1. 

unemployment  insurance,  2.  old-age  pensions, 
3.  sickness  insurance,  4.  increased  socialization 
of  mines,  5.  increased  socialization  of  forests,  6. 
increased  socialization  of  water  power,  7.  in- 
creased socialization  of  public  utilities,  and  8.  in- 
creased socialization  of  the  “basic  key  industries”. 

The  “spirit  of  the  times”  has  been  reflected  in 
the  work  of  the  Ohio  Legislature.  Appeals  for 
“relief”  have  caused  the  Legislature  to  be  more 
sympathetic  than  in  previous  years  to  the  pleas 
of  those  backing  governmental  socialized  insur- 
ance programs,  which  would  place  an  additional 
burden  on  government  in  order  to  meet  situations 
which  otherwise  or  in  normal  times  would  be 
alleviated  by  individual  and  community  responsi- 
bility. 

In  addition,  “unrest”  is  shown  in  the  sympathy 
exhibited  by  some  members  of  the  Legislature  in 
listening  to  the  demands  of  special  interests, 
those  with  cure-alls  for  complex  problems. 

The  cross-currents  produced  by  faddists,  spe- 
cial-interest groups,  and  cultists  have  added  to 
the  confusion  in  the  Legislature  and  made  it  dif- 
ficult for  it  to  settle  down  to  thorough  considera- 
tion and  solution  of  the  serious  problems  of 
finance,  taxation,  public  welfare,  unemployment, 
poor  relief,  etc. 

As  this  was  written  there  was,  however,  en- 
couraging evidence  that  the  Legislature  would 
soon  get  its  feet  on  the  ground,  map  out  a definite 
program  to  meet  these  problems  in  an  adequate 
way,  and  cast  into  the  discard  pending  dangerous, 
foolish  and  faddish  proposals. 

Although  the  winds  of  adversity  have  deferred, 
diverted  or  modified  many  of  the  social  and  gov- 
ernmental programs  which  would  necessarily 
have  an  important  bearing  on  medical  practice 
and  public  health,  there  are  clear  indications  of 
further  high-pressure  group  activities  as  soon  as 
the  present  crisis  has  subsided. 

Vigilance  and  concerted  activity  on  the  part  of 
the  medical  profession  are  more  essential  now 
than  ever  before.  The  necessity  for  strong  and 
active  medical  organization  is  apparent.  We  must 
marshal  our  forces  and  join  with  others  in  a 
mighty  effort  to  meet  the  emergency  which  gov- 
ernment is  facing.  It  is  impossible  to  forecast 
the  form  or  direction  governmental  functions  may 
take  or  the  new  social  and  economic  programs 
which  may  be  evolved.  But,  we  should  be  pre- 
pared to  meet  the  issues  confronting  us  and 
formulate  our  program  for  future  situations.  Im- 
portant history  is  in  the  making.  Medical  organ- 
ization should  have  a hand  in  shaping  the  course 
it  will  take. 


With  the  prompt  action  by  the  President  and 
with  the  assistance  of  the  new  Congress  in  special 
session  to  meet  grave  national  emergencies,  there 
was  indication,  at  least 

Constitutional  temporarily,  that  the 

hey-day  is  waning  ot 
Meconstruction  those  special  interests, 

which  have  been  making 
a pi'actice  of  telling  everybody  else  how  to  run 
everybody’s  else  business  and  caring  little  for  the 
effect  which  their  expensive  programs  may  have 
on  the  nation  as  a whole.  While  “the  proof  of 
the  pudding  is  in  the  eating”,  we  can  assist  with 
hope  and  patriotic  service  for  a return  to  more 
normal  times. 

It  would  seem  as  if  the  plea  made  by  Merle 
Thorp,  editor  of  Nation’s  Business,  at  the  begin- 
ning of  the  current  year,  may  become  a prophecy 
and  a reality.  In  the  light  of  recent  events,  espe- 
cially on  a national  scale,  we  believe  the  following 
comments  of  Mr.  Thorpe  are  even  more  signifi- 
cant than  they  were  when  originally  published: 

“We  have  been  hearing  a good  deal  recently 
about  ‘the  forgotten  man’,  the  lone  individual,  the 
little  fellow  who  has  no  great  tribunal  to  fend  for 
him.  There  has  been  a more  grievous  oversight. 
What  has  been  forgotten  is  the  Nation. 

“The  national  interest,  our  common  heritage, 
is  challenged  by  organized  minorities,  by  self- 
seeking  cliques  and  blocs,  by  special  pleaders. 
Lip-service  on  the  platform  is  to  ‘E  Pluribus 
Unurn’,  but  votes  upon  roll-call  are  for  the  ag- 
grandizement of  one  of  the  many. 

“What  price  this  aggressive  selfishness!  The 
mounting  cost  of  the  national  Government,  in 
treasury  deficits,  in  the  heavy  burden  of  federal 
taxes,  in  the  spread  of  bureaucracy,  in  the  in- 
creasing barter  of  freedom  for  the  dubious  pot- 
tage of  paternalism. 

“An  interdependent  society  like  ours  must 
maintain  a sensitive  equilibrium.  The  advantage 
of  the  few  at  the  expense  of  the  many  destroys 
that  delicate  balance.  Let  discrimination  become 
the  rule,  all  eventually  will  feel  the  burden  of  dis- 
crimination. 

“Interpret  the  national  interest  by  microscope 
rather  than  telescope,  and  specialized  acquisitive- 
ness becomes  predatory  and  parasitical.  In  its 
rawest  form  it  is  known  as  pork.  ‘Relief’  is  a 
softer  word.  Under  these  familiar  labels  localism, 
sectionalism,  and  group  consciousness  have  devel- 
oped an  insatiable  megalomania  for  federal  favor. 
Even  the  hard-run  taxpayer  is  not  proof  against 
the  allure  of  ‘gifts’  from  an  impersonal  munifi- 
cence. The  national  interest  has  been  lost  in  a 
national  chorus  petitioning  government  for  more, 
bigger  and  better  roads,  parks,  fish  hatcheries, 
post  offices,  buildings,  inland  waterways,  army 
posts,  navy  yards,  inter-oceanic  canals,  irrigation 
projects,  power  dams,  and  more  and  better  paid 
officeholders. 

“National  feeling  and  national  responsibility 
are  sadly  wanting.  The  deficiency  is  acute.  Oc- 
casionally, when  national-mindedness  speaks  out, 
as  a keen  political  observer  puts  it — • 

‘against  every  specific  proposal  to  economize  or  to 
tax  there  are  arrayed  a collection  of  powerful  in- 
terests. Thus,  if  Congress  touches  the  debt  serv- 
ice, it  collides  with  the  investing  classes,  and  im- 
pairs the  credit  it  is  seeking  to  preserve.  If  it 
touches  the  veterans’  payments,  it  collides  with 


April,  1933 


Editorial 


227 


the  soldiers’  vote  If  it  touches  government  sal- 
aries, it  collides  with  the  officeholders  who  are  the 
backbone  of  the  party  machine.  If  it  touches  sub- 
sidies, it  collides  with  sectional  and  class  inter- 
ests.’ 

“How  raise  the  common  interest  over  the  spe- 
cial interest?  When  citizens  demand  that  their 
representatives  courageously  withstand  local  im- 
portunities, rise  above  clamor  and  pressure,  see 
the  nation  whole  and  not  in  broken  arcs  of  a 
circle,  and  consider  the  general  welfare  clause  of 
the  Constitution  with  emphasis  upon  the  ‘general’ 
rather  than  upon  the  ‘welfare’. 

“If  the  individual  be  not  resolved  to  escape 
from  the  serious  delegation  of  his  freedom,  in- 
itiative, and  private  decision,  ‘he  concedes  what 
injures  both  him  to  lose  and  the  dispensing  power 
to  gain’.” 

Leadership  and  faithful  public  service  may  and 
should  solve  the  serious  imbalances — governmen- 
tal, economic  and  social.  It  is  our  duty  as  citi- 
zens, to  assist,  to  the  extent  of  our  power,  in  a 
concerted  effort  to  insure  and  preserve  our  na- 
tional strength  and  constitutional  purpose. 


“The  Council  urges  hospitals  to  proceed  with 
caution  in  the  development  of  periodic  payment 
plans,”  warns  the  executive  board  of  the  Ameri- 
can Hospital  Association  in' 
a communication  to  the 
members  of  the  national 
hospital  organization,  ae- 
Servace  ccmpanying  a bulletin  con- 

taining recommendations  for 
the  guidance  of  hospitals  considering  such  plans. 


In  addition,  the  hospital  council’s  statement 
said : 

“Local  committees  which  take  this  matter  un- 
der advisement  are  urged  to  familiarize  them- 
selves with  the  principles  set  forth  in  the  i*eport, 
and  interested  hospitals  are  advised  to  make  no 
commitments  until  they  have  considered  the  prob- 
lem from  the  respective  standpoints  of  public 
service,  administrative  practice,  medical  stand- 
ards, and  actuarial  requirements. 

“The  Council  wishes  especially  to  caution  hos- 
pitals not  to  accept  hastily  the  plans  of  promoters 
who  approach  this  matter  with  profits  chiefly  in 
view  and  to  enter  into  no  contract  which  would 
deprive  them  of  full  control  of  promotional 
methods  and  other  pi-ocedures  and  relationships 
which  the  plan  involves.  * * * In  the  formulation 
of  a plan,  those  interested  will  naturally  turn  to 
similar  agreements  already  in  force  in  various 
communities.  It  would  be  wise  to  check  such 
agreements  against  the  Council’s  recommenda- 
tions and,  where  any  doubt  arises  about  the  rela- 
tive merits  of  divergent  procedures,  to  communi- 
cate with  the  Council  * * 

The  fact  that  the  hospital  council,  after  study 
of  periodic  payment  plans  for  the  purchase  of 
hospital  care,  has  seen  fit  to  address  such  a com- 
munication to  members  of  the  hospital  associa- 
tion should  be  sufficient  warning  to  move  slowly 
in  adopting  programs  of  that  sort  and  would 


seem  to  indicate  that  hidden  dangers  exist  in 
many  of  them. 

A number  of  hospitals  in  various  cities  of  Ohio 
have  group  hospitalization  plans  under  considera- 
tion at  present.  The  timely  warning  of  the  na- 
tional hospital  organization,  despite  the  fact  that 
its  statement  endorses  the  general  principle  of 
periodic  payment  for  hospitalization,  should  stim- 
ulate additional  thorough  consideration  on  the 
part  of  Ohio  hospitals,  now  interested  in  such  a 
program. 

Members  of  the  medical  profession  in  cities 
where  such  plans  are  being  discussed  should  make 
it  their  business  to  see  that  they  are  fully  in- 
formed regarding  the  matters  under  considera- 
tion, providing  they  have  not  already  been  con- 
sulted. The  fact  that  questions  of  public  service, 
administrative  practice  and  medical  standards  are 
involved  makes  it  essential  that  the  medical  staffs 
of  hospitals  keep  themselves  informed  of  develop- 
ments and  be  given  an  opportunity  to  sit  in  on 
conferences  where  such  plans  are  being  discussed. 
Academies  of  medicine  and  county  medical  so- 
cieties where  such  plans  are  under  consideration 
should  be  alert  and  informed  on  the  sitdation. 

The  relationship  between  hospitals  and  physi- 
cians who  practice  within  their  doors  is  such  that 
any  steps  taken  by  either  which  would  be  detri- 
mental to  the  interests  of  the  other,  would,  event- 
ually, prove  detrimental  to  the  public  good. 

The  hospital  council  in  its  statement  summar- 
izes what,  in  its  opinion,  are  definite  benefits 
which  would  result  from  group  hospitalization. 
Some  of  these  are,  perhaps,  well  grounded.  On 
the  other  hand,  many  fundamental  and  important 
principles  are  involved  in  any  and  all  plans  of 
this  nature.  These  must  be  taken  into  considera- 
tion. Because  the  medical  profession  is  directly 
involved  in  and  affected  by  any  changes  made  in 
hospital  administration  and  procedure,  it  is  up  to 
physicians  to  insist  that  their  own  interests  and 
the  interests  of  those  who  look  to  the  medical  pro- 
fession for  advice  and  guidance  on  medical  and 
hospital  matters  are  favorably  considered. 


“There  are  many  temptations  in  the  field  of 
medicine  the  suri-endering  to  which  might  destroy 
the  future  of  many  excellent  men,”  warns  Dr.  C. 

W.  Waggoner,  writing  in 
The  Toledo  Academy  of 


Privileges  and 
Principles  of 
the  Profession 


Medicine  Bulletin. 

“Not  many  doctors,” 
Dr.  Waggoner  continues, 
“are  influenced  by  these 
temptations,  but  some  few  are,  and  thei’efore  it 
becomes  necessary  for  the  protection  of  the  vastly 
larger  number  that  a code  of  ethics  which  has 
been  established,  be  followed  and  made  an  almost 
organic  law,  the  transgression  of  which  calls  for 
disciplinary  measures. 

“In  any  community  there  is  always  danger  of 
some  few  doctors  doing  some  act  that  not  only 


228 


The  Ohio  State  Medical  Journal 


April,  1933 


embarrasses  their  local  organization  but  may  lead 
to  state  involvement,  and  many  times  this  is  be- 
cause of  bad  advice  or  defiance,  on  the  doctor’s 
part,  of  the  controlling  powers.  Doctors  must 
understand  that  unless  they  respect  organized 
medicine,  they  cannot  hope  to  have  the  layman”s 
respect,  scientifically  or  economically.” 

Dr.  Waggoner’s  sound  advice  is  particularly 
pertinent  at  this  time  when,  confronted  by  com- 
plex economic  problems,  a few  members  of  the 
medical  profession  may  thoughtlessly  fail  to 
realize  the  importance  of  the  fundamental  rules 
and  principles  which  have  made  medicine  a dis- 
tinguished and  esteemed  calling. 

In  medicine,  as  in  every  other  profession  or 
group  of  workers,  there  are  a few  who  have  little 
or  no  consideration  for  ethics  and  law.  Some  may 
feel  that  scientific  medicine  is  unharmed  by  the 
transgressions  of  a comparatively  small  group. 
However,  the  profession  is  blamed  for  not  taking 
necessary  disciplinary  action  against  these  offend- 
ers when  such  action  is  indicated  and  proper. 
Medicine  has  the  inherent  right  to  control  its  own 
affairs  but  its  duty  is  to  control  them  in  such  a 
way  that  the  confidence  of  the  public  in  the  pro- 
fession as  a whole  may  be  retained. 

In  this  connection,  every  physician  should  give 
thoughtful  consideration  to  the  principles,  re- 
sponsibilities and  rights  of  medicine  as  they  exist 
now  and  have  existed  through  the  centuries.  These 
have  been  summarized  repeatedly  in  the  past  in 
various  ways.  For  the  sake  of  emphasis,  we  list 
them  as  summarized  by  Dr.  William  A.  Pusey, 
Chicago,  former  president  of  the  American  Medi- 
cal Association,  at  the  last  annual  conference  of 
state  secretaries  and  editors  at  Chicago : 

Principles — 1.  Medicine  is  the  trustee  of  society 
in  the  care  of  the  sick  and  injured;  its  policies 
must  always  be  governed  by  this  fundamental 
fact. 

2.  The  good  of  society  must  be  the  sole  aim  of 
its  public  policies  and  the  good  of  the  patient  the 
first  consideration  in  the  relations  between  phy- 
sicians and  patients. 

3.  Medicine’s  first  responsibility  must  be  to  see 
that  its  services  are  available  to  all  men. 

4.  The  public  interest  demands  the  most  com- 
petent medical  profession  possible.  Medicine  must 
be  an  attractive  profession  to  compete  success- 
fully with  other  professions  for  the  ablest  young 
men. 

5.  In  the  sense  that  every  calling  from  which  a 
living  must  be  gained  is  a business,  medicine  is  a 
business;  it  must  accept  the  competitive  con- 
ditions of  practical  life  but,  as  a profession  of 
high  ideals,  it  must  seek  to  prevent  selfish  com- 
mercialism. 

6.  Experience  has  shown  that  the  vast  ma- 
jority of  disease  conditions  afflicting  man  can  be 
most  satisfactorily  and  economically  diagnosed 
and  treated  by  a competent  individual  general 
practitioner. 

Responsibilities — 1.  The  services  of  medicine 
include  (a)  the  practice  of  medicine;  (b)  the  pro- 
motion of  preventive  medicine  and  the  public 


health;  (c)  the  fostering  of  research  and  the  in- 
crease of  knowledge. 

2.  Medicine’s  chief  concern  must  be  for  the 
individual  physician;  the  service  rendered  by  in- 
dividual physicians  in  the  aggregate  constitutes 
the  great  bulk  of  medical  service.  The  quality  of 
service  which  is  given  depends  on  the  com- 
petency of  the  individual  physicians  who  give  it. 

Rights — 1.  The  medical  profession  asks  for  its 
practitioners:  Freedom  of  opportunity  to  develop 
to  the  limit  of  their  individual  capacities. 

2.  It  asks  a career  of  independence  under  con- 
ditions of  free  and  dignified  competition. 

3.  It  asks  remuneration  sufficient  for  reason- 
able comfort  for  the  individual  and  his  family. 

4.  In  its  ideals  of  independence,  medicine  has  a 
right  to  control  its  own  affairs.  Its  history  of 
capacity  and  altruism  justifies  this  claim. 


At  a recent  meeting  of  the  Council  of  the 
Columbus  Academy  of  Medicine  the  following 
resolution  relative  to  advertising  by  physicians 
was  adopted: 

A Resolution  “Resolved,  That  the  Coun- 
cil of  the  Columbus  Acad- 
1031  emy  of  Medicine  reaffirms 

Advertising  its  previous  stand  and  that 

of  the  Ohio  State  Medical 
Association  and  looks  with  disfavor  on  any  kind 
of  advertising  by  physicians  in  magazines,  pub- 
lications other  than  medical,  under  the  guise  of 
directory  or  the  like,  or  special  editions  of  news- 
papers; furthermore,  the  Council  cautions  and 
advises  the  members  against  participating  in 
such  procedures,  unless  they  receive  the  endorse- 
ment of  the  Council. 

“Resolved  further,  That  pictures  and  biographi- 
cal sketches  of  physicians  who  have  been  on  their 
staff  for  some  time  used  either  as  introduction  to 
popular  articles  on  medical  topics  or  alone  in  the 
pages  of  the  “House  Organs”  of  the  various  hos- 
pitals are  not  in  good  taste  and  the  Council 
cautions  and  advises  the  members  against  such 
practice;  a copy  of  these  resolutions  should  be 
sent  to  the  superintendent  of  each  hospital  which 
sends  out  such  a publication  to  lay  persons  in- 
terested in  the  hospital.” 

Action  of  the  governing  board  of  the  Columbus 
Academy  is  a local  application  of  a resolution 
adopted  some  time  ago  by  the  Council  of  the  State 
Association  following  a study  of  the  question  of 
professional  advertising. 

Obviously,  the  action  of  the  Council  of  the 
State  Association  will  have  little  or  no  effect  un- 
less it  receives  support  from  the  component 
county  medical  societies  and  academies  of  medi- 
cine. Ethical  questions  of  this  kind  are  in  the 
first  instance  problems  which  must  be  dealt  with 
by  the  local  societies. 

Of  course,  the  mere  passing  of  a resolution 
will  not  solve  this  or  any  problem,  ethical  or 
otherwise.  However,  it  is  a step  toward  clear 
definition  and  establishes  the  basis  for  further 
action  in  case  of  violations  of  ethical  principles 
set  forth  in  the  resolution. 


A Plea  For  Early  Diagnosis  and  Surgical  Treatment  of 
Acute  Gall  Bladder  Disease 

M.  M.  Zinninger,  A.B.,  M.D.,  Cincinnati,  Ohio 


WHILE  the  dangers  of  allowing  an  acute 
attack  of  appendicitis  to  go  without 
operation  are  well  recognized,  it  seems 
that  the  dangers  of  a similar  condition  in  the  gall- 
bladder have  been  insufficiently  emphasized.  As  a 
result,  patients  with  acute  infectious  lesions  of 
the  gall  bladder  are  often  treated  by  watchful 
waiting  in  the  hope  that  the  attack  will  subside. 
It  is  well  known  that  such  a happy  termination 
frequently  occurs,  but  is  it  as  well  known  that 
prolongation  of  the  condition  may  ensue,  to  be 
followed  by  subsequent  serious  complications? 
We  believe  that  it  has  not  been  sufficiently  em- 
phasized that  this  may  happen,  and  we  know  that 
there  are  many  surgeons  who  do  not  believe  that 
operation  in  the  early  stage  of  an  acute  cholecys- 
titis has  advantage  over  delayed  operation. 

It  is  our  belief  that  early  operation  is  in- 
dicated in  many  cases  of  acute  cholecystic  disease. 
Let  us  first  make  clear  the  condition  to  which  we 
ai-e  referring.  The  attack  begins  usually  with 
pain  in  the  abdomen,  nausea  and  vomiting.  The 
fever  may  be  slight  and  the  pulse  but  little  ac- 
celerated. In  the  beginning  the  pain  is  generally 
localized  in  the  right  upper  quadi-ant  of  the  ab- 
domen, though  later  it  may  become  more  gen- 
eralized. There  is  usually  muscle  spasm  and 
rigidity  in  the  region  of  the  gall-bladder.  If  they 
are  not  too  intense,  an  enlarged  gall-bladder  may 
be  seen  or  felt  as  a rounded,  tender  mass  below 
the  right  costal  mar-gin.  Leucocytosis  is  present, 
as  a rule,  and  is  often  marked.  The  condition  may 
be  confused  with  acute  pancreatitis,  acute  gastro- 
enteritis, or  acute  appendicitis,  but  if  a careful 
history  and  physical  examination  are  made  the 
correct  diagnosis  can  generally  be  established. 

Pathologically,  in  the  early  stage,  the  gall-blad- 
der is  distended,  its  wall  is  reddened  and  oedema- 
tous,  and  there  may  be  some  fibrinous  adhesions 
around  it.  The  cystic  duct  is  usually  occluded 
either  by  adhesions,  by  inflammatory  oedema,  or, 
more  often,  by  an  impacted  stone.  It  is  generally 
believed  that  if  the  obstruction  is  relieved,  drain- 
age will  occur,  and  the  attack  subside.  It  is  in  this 
early  stage  that  one  may  have  to  decide  whether 
early  operation  or  conservative  treatment  is  in- 
dicated. If  the  disease  progresses,  the  viscus  be- 
comes filled  with  hemorrhagic  or  purulent  exudate, 
and  gangrene  and  rupture  of  the  wall  may  occur. 
When  such  complications  develop  the  clinical  pic- 
ture is  that  of  an  extremely  ill  patient  with  signs 
of  an  acute  intra-abdominal  infection,  in  whom 

Read  before  the  Third  General  Session,  Ohio  State  Medi- 
cal Association,  at  the  86th  Annual  Meeting,  Dayton.  May 
3-4,  1932. 

From  the  College  of  Medicine,  University  of  Cincinnati. 


operation  is  urgently  indicated  if  the  patient  is 
to  survive. 

Unfortunately  when  the  stage  of  gangrene  or 
perforation  is  reached,  and  the  need  for  operation 
is  obvious,  we  are  not  in  a position  to  offer  the 
patient  as  favorable  an  outlook  as  we  would  have 
been  by  earlier  operation.  The  occurrence  of  such 
complicatitons  is  not  so  infrequent  as  you  may 
suppose.  For  example,  Alexander1  reported  20 
cases  of  perforation  from  among  1000  consecutive 
patients  with  disease  of  the  gall-bladder  and 
biliary  tract  admitted  to  the  Episcopal  Hospital, 
Philadelphia,  an  incidence  of  2 per  cent.  In  a re- 
cent study  of  200  consecutive  cases  of  gall-bladder 
disease  operated  upon  at  the  Cincinnati  General 
Hospital  it  was  found  that  there  were  six  in- 
stances of  perforation  and  eight  of  gangrene 
without  perforation,  an  incidence  of  3 and  of  4 
percent  respectively,  and  a total  of  7 percent  for 
both  complications.  You  must  remember  that 
these  figures  are  for  the  incidence  in  all  soi’ts  of 
surgical  gall  bladder  disease,  chronic  as  well  as 
acute.  If  one  calculates  it  only  for  the  acute 
cases,  the  figure  in  our  series  rises  to  15.7  per 
cent. 

Now,  if  we  are  dealing  with  a patient  in  the 
early  stage  of  this  disease  what  attitude  should 
we  adopt?  Should  our  attitude  be  “How  long 
shall  I postpone  operation?”  or,  as  Miller3  sug- 
gests, should  it  be  “Why  should  I not  operate 
now?”  In  order  to  answer  this  question  we  should 
like  to  know  what  are  the  chances  that  the  attack 
will  subside;  how  long  it  is  safe  to  wait  in  the 
hope  that  it  will  subside,  and  what  are  the  rela- 
tive advantages  and  disadvantages  of  early  as  op- 
posed to  late  operation.  It  is  my  opinion  that 
those  who  have  seriously  considered  these  ques- 
tions have  reached  the  conclusion  that  our  ability 
to  predict  the  outcome  in  an  individual  case  is  not 
dependable  and  there  are  no  safe  criteria  on  which 
to  base  a prognosis.  A great  difficulty  also  has 
been  that  there  have  been  few  statistical  reports 
available  which  have  considered  this  subject,  and 
the  individual  physician  has  been  forced  to  rely 
on  his  own  opinion  and  experience. 

Recently  with  the  object  of  obtaining  some 
statistical  data  on  this  matter  we  reviewed  89 
cases  of  acute  inflammatory  disease  of  the  gall- 
bladder admitted  to  the  Cincinnati  General  Hos- 
pital during  a six  year  period.4  In  all  of  these, 
operation  was  performed  and  the  diagnosis  of 
cholecystitis  confirmed.  In  35  instances,  the  pa- 
tients were  in  relatively  advanced  stages  of  the 
disease  at  the  time  of  admission,  and  there  seemed 
no  reasonable  justification  for  further  observa- 


229 


230 


The  Ohio  State  Medical  Journal 


April,  1933 


tion,  and  operation  was,  therefore,  performed  im- 
mediately. In  the  majority  of  these  cases,  ad- 
vanced pathologic  lesions  were  present,  the  de- 
gree corresponding  in  general  with  the  duration 
of  the  attack.  The  mortality  was  three  cases  or 
8.5  per  cent,  and  it  is  interesting  to  note  that  no 
death  occurred  in  the  group  operated  upon  within 
48  hours  of  the  onset  of  the  attack. 

In  the  remaining  54  cases,  operation  was  de- 
layed and  the  patients  held  under  observation  for 
a period  of  one  to  twelve  days  after  admission  and 
before  operation.  A number  of  factors  were  in- 
strumental in  bringing  about  delay.  In  some  in- 
stances operation  was  advised,  but  permission  was 
temporarily  refused  by  the  patient;  in  others,  the 
diagnosis  was  not  clearly  evident  at  admission 
and  further  study  was  indicated,  while  in  still 
others,  operation  was  postponed  in  the  hope  that 
the  attack  would  subside.  In  this  group  of  54 
patients,  the  following  events  took  place.  Twenty 
or  37.7  per  cent  improved,  the  attack  subsided  and 
operation  was  subsequently  performed  in  an  in- 
terval. Nineteen  or  35.1  per  cent  failed  to  change 
significantly,  and  at  the  time  of  operation  were  in 
essentially  the  same  status  as  at  the  time  of  ad- 
mission. Fifteen  or  27.7  per  cent  became  definitely 
worse.  In  this  last  group  of  15  patients,  there 
were  found  at  operation  four  instances  of  per- 
foration, and  in  three  of  these  it  seems  relatively 
certain  that  the  perforation  occurred  while  the 
patients  were  on  the  wards. 

In  summary  then,  in  34  or  62.9  per  cent  of  54 
patients  with  acute  inflammatory  cholecystitis  the 
attack  either  failed  to  subside  or  became  worse 
while  the  patients  were  under  observation.  It  is 
also  to  be  emphasized  that  most  of  these  were 
cases  that  we  thought  might  subside,  or  at  least 
were  running  no  risk  in  waiting.  While  the  type 
of  patients  admitted  to  a City  Hospital  may  not 
represent  a good  cross  section  of  the  kind  seen  by 
the  average  physician  in  private  practice,  these 
figures  show,  clearly  that  one  cannot  delay  opera- 
tion indiscriminately  in  instances  of  acute 
cholecystitis  and  expect  uniformly  good  results, 
and  they  serve  also  to  emphasize  the  statement 
made  earlier  that  our  ability  to  predict  the  out- 
come in  individual  cases  is  not  dependable. 

In  an  effort  to  discover  the  cause  of  failure  of 
an  attack  to  subside  we  made  a careful  study  of 
the  pathologic  condition  found  at  operation  in  all 
of  our  cases.  This  showed  the  expected  finding, 
namely,  that  in  the  ones  that  subsided  spontan- 
eously there  was  a relatively  benign  pathologic 
condition,  while  in  those  that  failed  to  subside  it 
was  much  more  serious.  The  high  incidence  of 
empyema  of  the  gall  bladder  in  one  group  and  its 
absence  in  the  other  led  us  to  believe  that  if 
empyema  once  developed  it  was  extremely  un- 
likely that  the  attack  would  subside  spontaneously. 

Another  significant  finding  was  the  close  corre- 
lation between  empyema  and  leucocytosis.  In  our 
total  group  the  average  leucocyte  count  was 


15,766;  the  highest  31,000;  the  lowest  6,500.  In 
all  cases  of  empyema,  the  count  was  above  15,000 
though  in  many  of  these  the  pulse  rate  and  tem- 
perature were  but  slightly  elevated.  If  these  two 
findings  can  be  confirmed  by  others,  they  should 
be  significant  factors  in  prognosis,  and  criteria 
that  should  be  valuable  in  indicating  that  an  at- 
tack might  be  expected  not  to  subside.  Certainly 
with  a diagnosis  of  acute  cholecystitis  in  which 
the  leucocyte  count  is  found  to  be  15,000  or  more, 
delay  in  operation  might  well  be  dangerous. 

The  prolongation  of  an  attack  of  acute  cholecy- 
stitis without  remission  seems  to  increase  the 
pathologic  lesion  and  the  mortality.  For  example, 
in  our  series  there  were  45  cases  whose  attack 
lasted  more  than  one  week,  and  44  whose  attack 
lasted  less  than  one  week — approximately  equal 
numbers  as  you  see.  In  the  first  group  there  were 
16  instances  of  abscess,  gangrene  or  perforation 
of  the  gall  bladder  and  only  two  in  the  second 
group.  The  mortality  in  the  two  groups  was  9 
per  cent  and  6.66  per  cent  respectively. 

Miller  3 in  a study  of  200  cases  of  acute  cholecy- 
stitis from  the  Massachusetts  General  Hospital 
found  that  in  the  fatal  cases  the  average  duration 
of  the  attack  before  operation  was  15.0  days, 
while  in  the  cases  that  recovered,  the  average 
duration  was  8.3  days.  Alexander1  reported  20 
cases  of  perforation  with  a mortality  of  50  per 
cent  in  the  cases  with  acute  perforation,  and  25 
per  cent  in  the  cases  of  subacute  perforation.  In 
our  entire  series  of  acute  cases,  the  general  mor- 
tality was  7.8  per  cent,  while  in  the  cases  with 
gangrene  or  perforation,  it  was  18.7  per  cent.  All 
of  this  data  shows  that  with  the  prolongation  of 
an  attack  of  acute  cholecystic  disease,  the  danger 
of  serious  complications  increases,  and  that  these 
conditions  are  associated  with  a high  mortality. 

Having  shown  some  of  the  dangers  of  delaying 
operation  in  certain  cases  of  acute  cholecystitis 
are  we  able  to  show  that  there  are  any  additional 
advantages  of  early  operation?  The  recent  report 
of  Graham2  of  198  cases  from  the  Methodist  Hos- 
pital in  Brooklyn,  New  York,  answers  this  ques- 
tion very  clearly.  He  divided  the  cases  into  two 
groups,  those  in  which  less  than  48  hours  and 
those  in  which  more  than  48  hours  had  elapsed 
between  the  onset  of  the  attack  and  operation.  He 
found  that  in  the  group  operated  early,  i.e.,  with- 
in 48  hours  of  onset,  the  mortality  was  1 per  cent 
less,  the  average  number  of  days  in  the  hospital 
was  seven  less,  the  average  number  of  dressings 
was  approximately  one-half,  and  the  incidence  of 
postoperative  complication  was  only  one-third  of 
that  in  the  cases  operated  upon  late.  While  our  own 
cases  were  not  studied  so  carefully  in  all  these  re- 
spects, the  findings  conform  in  general  with  those 
of  Graham — namely,  lower  mortality,  shorter  hos- 
pital stay  and  fewer  complications  in  patients 
operated  upon  early. 

Another  consideration  of  importance,  and  one 
about  which  no  statistical  data  is  available,  is  the 


April,  1933 


Acute  Gall  Bladder  Disease — Zinninger 


231 


fact  that  operation  during  the  acute  stages  may 
not  be  difficult,  contrary  to  the  opinion  of  many 
surgeons.  Certainly  this  is  true  early  in  the  at- 
tack. My  experience  and  that  of  many  others  who 
have  made  a practice  of  operating  early  in  such 
cases,  is  that  on  the  whole  the  operation  is  easier 
than  in  the  average  chronically  infected  case  of 
long-standing.  Although  the  gall  bladder  is  tense 
and  distended  the  adhesions  are  often  soft  and 
tend  to  be  fibrinous  lather  than  fibrous.  The 
peritoneal  reflection  is  often  thick  and  oedematous, 
but  both  it  and  the  surrounding  adhesions  separ- 
ate easily  and  readily,  while  if  one  waits  till  an 
interval  the  soft  adhesions  may  have  become  re- 
latively tough,  fibrous  and  adherent.  Great  caution 
must  be  observed,  however,  not  to  rupture  the 
gall  bladder  or  tear  the  cystic  duct  or  artery,  for 
these  also  may  be  more  friable  than  usual  during 
the  acute  infection.  I do  not  mean  to  imply  that 
operation  is  always  easy  for  in  the  very  late 
stages  with  an  extremely  sick  patient,  adherent 
omentum  and  perhaps  a subacute  perforation  with 
abscess,  it  may  be  very  difficult,  and  in  them 
drainage  of  the  abscess  and  the  gall  bladder  may 
be  all  that  can  be  done.  In  general,  however,  we 
believe  that  it  is  feasible  to  remove  the  gall 
bladder  in  most  acute  cases.  In  our  own  series  the 
gall  bladder  was  removed  77  times,  drained  only 
12  times.  The  mortality  rate  with  cholecystectomy 
was  6.5  per  cent;  with  cholecystostomy  16.6  per 
cent.  This  does  not  mean  that  drainage  is  a more 
serious  procedure  than  removal,  but  is  undoubted- 
ly due  to  the  fact  that  the  patients  in  whom  ’ 
drainage  alone  was  done,  were  very  ill  and  suc- 
cumbed even  though  the  simplest  possible  opera- 
tion was  carried  out. 

In  this  short  presentation  we  have  ti-ied  to  show 
that  acute  cholecystitis  may  often  be  a serious 
disease,  and  require  energetic  treatment.  When 
groups  of  cases  rather  than  individuals  are 
studied  it  can  be  shown  that  contrary  to  the  be- 
lief of  many  doctors,  the  attack  often  fails  to 
subside  by  conservative  measures.  It  can  also  be 
shown  that  the  incidence  of  serious  complications 
is  not  small — 15.7  per  cent  in  our  series  of  acute 
cases.  The  longer  an  attack  persists  the  more 
likelihood  there  is  of  a dangerous  situation  de- 
veloping with  increased  mortality  rate  and  pro- 
longed hospitalization  and  convalescence. 

In  rapidly  progressing  infections  or  when  high 
leucocytosis  is  present,  even  in  the  absence  of 
high  fever  and  rapid  pulse,  a serious  pathologic 
lesion  may  be  developing  and  operation  should 
not  be  too  long  delayed.  In  addition,  operation 
during  the  early  acute  stage  is  usually  not  diffi- 
cult, in  fact  may  be  easier  than  during  an  inter- 
val, and  does  not  predispose  to  higher  mortality 
or  prolonged  convalescence  but  rather  the  reverse. 

In  conclusion  I want  to  make  it  clear  that  we 
are  not  advocating  immediate  operation  as  a 
routine  in  every  case  of  acute  inflammatory  gall 


bladder  disease  as  soon  as  the  diagnosis  is  made. 
We  are  of  the  opinion,  however,  that  routine  pro- 
longed observation  is  even  a worse  policy.  Each 
case  must  be  judged  on  its  own  merits,  but  enough 
evidence  has  been  presented  to  indicate  that  if  a 
case  is  fulminant  from  the  beginning  or  if  it  fails 
to  subside  promptly,  or  increases  in  intensity 
while  under  observation,  early  operation  is  in- 
dicated and  offers  definite  advantages  over  late 
operation. 

BIBLIOGRAPHY 

1.  Alexander,  E.  G. : Acute  Perforation  or  Rupture  of 

the  Gall-Bladder.  Ann.  Surg.,  Vol.  86,  765,  1927. 

2 Graham,  H.  F. : The  Value  of  Early  Operation  for 
Acute  Cholecystitis.  Ann.  Surg.,  Vol.  93,  1152,  1931. 

3.  Miller,  R.  H. : Acute  Cholecystitis.  Ann.  Surg.,  Vol. 

92,  644,  1930. 

4.  Zinninger,  M.  M.  : The  Surgical-  Treatment  of  Acute 

Cholecystitis.  Ann.  Surg.,  Vol.  96,  406,  1932. 


New  Books  Received 

The  Action  of  the  Living  Cell,  by  the  late  Fen- 
ton B.  Turck,  M.D.;  an  experimental  research  in 
biology.  The  Macmillan  Co.,  60  Fifth  Avenue, 
New  York  City;  price,  $3.50. 

The  Incomes  of  Physicians,  by  Maurice  Leven, 
Ph.D.;  a publication  of  the  Committee  on  the 
Costs  of  Medical  Care;  University  of  Chicago 
Press,  Chicago;  price,  $2.00. 

Criteria  for  the  Classification  and  Diagnosis  of 
Heart  Disease,  third  edition,  published  by  the 
Criteria  Committee  of  the  New  York  Tuberculosis 
and  Health  Association,  Inc. 

The  History  of  Dermatology,  by  William  Allen 
Pusey,  M.D.,  professor  of  dermatology  emeritus, 
University  of  Illinois,  and  former  president  of  the 
American  Dermatology  Association  and  the 
American  Medical  Association;  Charles  C. 
Thomas,  Springfield,  Illinois,  publisher;  price 
$3.00. 


Columbus — Dr.  H.  P.  Worstell,  formerly  con- 
nected with  the  University  of  Iowa,  is  associated 
with  Dr.  A.  M.  Steinfeld  in  the  practice  of  ortho- 
pedic surgery. 


At  the  recent  annual  meeting  of  the  Cleveland 
Medical  Library  Association,  Dr.  Russell  H. 
Birge  was  elected  president,  succeeding  Dr.  Geo. 
Edw.  Follansbee.  The  following  officers  were  re- 
elected: Chairman  of  the  board,  Dr.  C.  L.  Cum- 
mer; director  of  finance,  Dr.  C.  W.  Stone;  director 
of  the  library.  Dr.  C.  H.  Lenhart;  director  of 
maintenance,  Dr.  A.  A.  Jenkins;  director  of  pro- 
gram and  extension,  Dr.  Howard  Dittrick;  direc- 
tor of  membership,  Dr.  Theodore  Miller;  secre- 
tary, Dr.  T.  P.  Shupe;  and  treasurer,  Dr.  F.  S. 
Gibson.  The  annual  report  showed  that  the  regis- 
tration of  readers  during  the  year  1932  was 
12,840  and  that  the  library  collection  now  consists 
of  46,121  books  and  bound  journals.  The  associa- 
tion has  a total  of  692  members  with  invested 
funds  amounting  to  $323,303.43. 


Clinical  Consideration  of  Secondary  Anemias 

G.  I.  Nelson,  M.D.,  Columbus,  Ohio 


THE  great  amount  of  work  that  has  been 
done  in  the  field  of  hematology  during  the 
past  ten  or  twelve  years  has  been  of  value 
to  the  medical  profession  in  a number  of  ways. 
First  it  has  confirmed  the  clinician’s  faith  in  the 
value  of  iron  as  a hematopoetic  agent.  On  the 
other  hand  it  has  almost  ruined  the  status  of 
arsenic  as  a stimulus  to  red  blood  cell  formation. 
Secondly,  we  have  been  given  new  therapeutic 
agents  in  the  treatment  of  blood  dyscrasias,  not- 
ably liver,  liver  extract  and  ventriculin  in  the 
treatment  of  pernicious  anemia,  iron  and  possibly 
copper  in  the  treatment  of  secondary  anemias. 
But  more  than  this  it  has  given  us  a better  con- 
cept of  the  fundamental  mechanisms  underlying 
the  development  of  the  anemias  and  the  various 
blood  dyscrasias. 

In  the  light  of  our  present  knowledge  the 
classification  of  the  anemias  into  disease  entities 
is  a difficult  and  in  the  end  a somewhat  unsatis- 
factory procedure.  Their  clinical  identification  in 
the  patient  is  often  even  more  difficult.  Many 
times  it  is  impossible  to  make  the  blood  picture 
as  we  see  it  in  the  peripheral  blood  exactly  corre- 
spond with  that  of  any  known  blood  dyscrasia. 
This  is  not  surprising  when  we  consider  the  multi- 
plicity of  factors  involved  in  the  normal  blood 
formation.  The  mechanism  whereby  a proper 
number  of  red  blood  cells,  white  blood  cells  of  the 
granulocytic  series  and  blood  platelets  are  de- 
livered into  the  blood  stream  is  complex,  sensitive 
and  a£  yet  little  understood.  As  pointed  out  by 
Sabin5  and  Doan8  in  regard  to  the  erythrocytes 
alone,  it  is  necessary  to  consider  (1)  cell  division, 
(2)  cell  maturation,  (3)  the  assimilation  and 
elaboration  of  hemaglobin,  and  (4)  the  rate  of 
delivery  of  the  mature  cells  into  the  blood  stream. 

Similar  factors  must  also  be  considered  in  re- 
gard to  the  white  blood  cells  and  platelets.  There 
must  therefor  be  a rather  complex  arrangement 
of  normal  stimuli  and  normal  inhibitors  which 
are  normally  effective  on  the  bone  marrow  in 
order  to  maintain  a normal  picture  in  the  peri- 
pheral blood.  We  know  that  there  are  many 
noxious  or  toxic  agents  that  can  alter  the  function 
of  the  bone  marrow  in  blood  formation.  We  also- 
know  that  an  insufficient  amount  of  material 
necessary  for  the  production  of  the  red  blood  cell 
and  hemoglobin  may  depress  their  rate  of  forma- 
tion. This  lack  of  material  may  be  brought  about 
by  lack  of  sufficient  intake,  by  failure  of  absorp- 
tion from  the  alimentary  tract  or  possibly  by  a 
failure  of  assimilation  after  absorption.  Many  of 
these  factors  seem  to  be  independently  specific  in 
that  they  may  depress  one  series  to  a much 
greater  degree  than  another. 

Read  before  the  Third  General  Session,  Ohio  State  Medi- 
cal Association,  at  the  86th  Annual  Meeting,  Dayton,  May 
3-4,  1932. 


Because  of  the  number  of  factors  involved  in 
blood  formation  and  because  these  factors  may  be 
effective  in  varying  degrees,  it  is  not  difficult  to 
see  that  the  blood  picture  and  the  clinical  symp- 
toms of  one  disease  entity  may  merge  into  those 
of  another.  We  know  very  little  as  to  the  nature 
of  the  substances  that  in  the  normal  individual 
maintain  a constant  balance  between  the  processes 
of  blood  production  and  blood  loss,  and  we  are 
equally  ignorant  of  many  of  the  noxious  or  toxic 
agents  which  in  pathological  conditions  bring 
about  a negative  balance  between  these  two  pro- 
cesses. 

Broadly  speaking,  anemia  occurs  as  a result  of 
one  of  the  following  conditions,  (1)  a defective  or 
insufficient  production  of  blood,  (2)  increased  in- 
travascular destruction  or  (3)  direct  loss  as  in 
hemorrhage,  or  (4)  a combination  of  the  above 
factors. 

I wish  to  call  attention  especially  to  those 
anemias  that  are  due  to  insufficient  blood  forma- 
tion. This  failure  on  the  part  of  the  bone  mar- 
row may  involve  any  one  or  all  of  its  functions 
and  to  a varying  degree.  We  believe  that  through 
the  proper  interpretation  of  the  peripheral  blood 
picture  in  the  majority  of  instances  we  can  obtain 
an  accurate  concept  of  the  functional  disturbance 
in  the  bone  marrow.  From  a knowledge  of  this 
functional  disturbance  we  can  predict  to  a certain 
extent,  the  response  to  therapeutic  agents,  even  if 
we  do  not  know  the  exact  mechanism  of  their 
action. 

If  the  failure  of  the  bone  marrow  involves  all  of 
its  functions  we  have  what  is  usually  called  an 
aplastic  anemia.  This  is  not  an  accurate  term  be- 
cause the  bone  marrow  is  probably  never  entirely 
aplastic.  It  would  be  more  accurate  to  call  these 
anemias  hypoplastic  rather  than  aplastic.  This 
hypoplasia  may  be  of  varying  degrees  and  of 
varying  etiology.  The  best  known  type  is  that  due 
to  benzol  which  we  know  is  a specific  bone  mar- 
row depressant.  An  exactly  similar  blood  picture 
and  clinical  syndrome  is  sometimes  found  when 
no  known  etiological  factor  is  present.  The  blood 
picture  in  this  condition  is  quite  characteristic. 
The  red  blood  cell  count  is  low,  the  hemoglobin  is 
low,  the  color  index  is  less  than  one,  there  is  a 
leukopenia  which  is  essentially  a neutropenia,  and 
the  blood  platelets  are  diminished  in  number.  On 
the  stained  smear  there  is  no  marked  change  in 
size  or  shape  of  the  red  blood  cells,  there  is  some 
achromia.  That  the  depression  is  diffuse  and  not 
focal  is  shown  by  the  relative  and  absolute  de- 
crease in  the  number  of  reticulocytes  and  the  ab- 
sence of  any  shift  to  the  left  of  the  granulocytes. 
The  absence  of  an  increased  serum  bilirubin 
shows  that  there  is  no  increased  intravascular 
destruction.  In  summary,  there  is  a lack  of 


232 


April,  1933  Clinical  Consideration  of  Secondary  Anemia — Nelson 


233 


all  the  elements  produced  by  the , bone  marrow 
without  any  evidence  of  increased  destruction  or 
of  an  increased  rate  of  formation.  The  severity  of 
the  clinical  symptoms  will  depend  on  the  degree 
of  depression  of  the  bone  marrow.  The  therapy 
and  prognosis  will  depend  entirely  upon  our 
ability  to  remove  the  depressant. 

CASE  REPORT 

Case  I represents  the  condition  of  hypoplastic 
anemia  with  a known  etiology.  A white  male,  22 
years  of  age  presented  himself  at  the  University 
clinic  complaining  of  shortness  of  breath.  For  the 
past  two  weeks  he  had  noticed  some  bleeding  from 
the  gums,  and  two  days  previous  to  admission  he 
had  noted  blurring  of  the  vision  in  the  right  eye. 
His  past  history  was  irrelevant  except  that  he 
had  been  working  in  an  automobile  tire  plant  for 
ten  months.  In  his  work  he  had  been  exposed  to 
benzol  fumes.  On  physical  examination  he  was 
dyspnoeic  without  orthopnoea.  There  was  an  ex- 
treme pallor  without  icterus.  There  were  numer- 
ous petechiae,  most  marked  over  extremities. 
Mucous  membranes  of  mouth  and  nose  were 
hemorrhagic.  The  eyes  showed  a few  episcleral 
and  many  retinal  hemorrhages.  Lymphatic  glands 
and  spleen  were  not  palpable. 

Laboratory:  Urine  normal,  Wassermann  nega- 
tive. Blood  culture  neg.  Blood  findings  as  follows : 
red  blood  cells  900,000;  hemoglobin  10  per  cent, 
white  blood  cells  860,  24  per  cent  neutrophiles,  76 
per  cent  lymphocytes.  Platelets  10,000,  reticulocy- 
tes and  nucleated  red  blood  cells  could  not  be 
found.  In  the  stained  specimen  the  red  cells 
showed  a slight  degree  of  achromia,  otherwise 
they  were  normal.  Coagulation  time  4 minutes; 
bleeding  time  25  minutes  and  clot  was  non-re- 
tractile.  There  was  a slightly  increased  resistance 
to  laking  in  a hypotonic  salt  solution.  Following 
a transfusion  of  whole  blood  his  bleeding  stopped 
for  three  days  and  he  felt  greatly  improved.  The 
hemorrhagic  tendency  again  reappeared  and 
could  only  be  controlled  by  further  transfusion. 
Six  transfusions  were  given  over  a period  of  three 
months  when  he  began  to  regenerate  blood 
rapidly  enough  to  increase  his  count.  Six  months 
after  admission  his  blood  count  was  4,296,000  red 
blood  cells,  80  per  cent  hemoglobin,  5,200  white 
blood  cells;  74  per  cent  polys  and  26  per  cent 
lymphos,  and  no  tendency  to  bleed.  Three  years 
after  his  discharge  he  was  alive,  working  and  in 
good  health. 

This  case  illustrates  the  ability  of  the  bone 
marrow  to  regenerate  or  recover  its  function  if 
only  the  depressant  is  removed. 

Case  II  is  similar  in  type  as  far  as  the  bone 
marrow  function  is  concerned  but  the  etiological 
agent  is  unknown.  H.  W.,  white  male  21 
years  of  age,  college  student,  was  admitted  to 
the  University  Hospital  complaining  of  general 
weakness.  He  apparently  had  been  well  until 
seven  weeks  prior  to  admission  when  his  friends 
told  him  he  was  becoming  pale.  At  the  same  time 
he  began  to  note  a general  weakness.  This  grad- 
ually increased  until  he  sought  the  aid  of  a 
physician,  who  referred  him  to  the  hospital.  His 
physical  examination  was  as  nearly  identical  with 
the  previous  case  as  it  would  be  possible  to  find  in 
two  individuals.  There  was  a similar  pallor  with- 
out icterus,  similar  petechiae  on  the  extremities, 
blood  oozing  from  the  mucous  membranes  of  the 
nose  and  mouth,  episcleral  and  retinal  hemor- 
rhages. Urine  normal;  Wassermann  negative; 
blood  culture  negative;  A-ray  of  the  long  bones 
normal.  Blood  examination  as  follows:  Red  blood 


cells  750,000;  Hb  10;  white  blood  cells  1,600;  poly- 
nuclears  34  per  cent;  lymphocytes  66  per  cent. 
Coagulation  time  4 min.;  bleeding  time  16%  min.: 
non-retractile  clot;  platelet  count  15,000;  resist- 
ance of  the  red  blood  cells  to  laking  in  hypotonic 
salt  solution  was  slightly  increased.  There  was  no 
increase  in  the  bilirubin  of  the  blood  serum. 

In  this  case  it  was  impossible  to  detect  and  re- 
move the  etiological  agent.  Transfusions  were  be- 
gun as  an  emergency  measure.  It  is  needless  to 
describe  the  results  after  each  transfusion  except 
to  say  that  it  always  raised  his  blood  count,  stop- 
ped his  purpuric  manifestations  for  a period 
varying  from  three  days  to  three  weeks,  and 
brought  about  very  marked  subjective  improve- 
ment. At  the  end  of  this  time  he  would  again  be- 
gin bleeding,  his  blood  count  would  drop  and  an- 
other transfusion  would  become  imperative.  Dur- 
ing the  first  15  months  in  the  hospital  he  was 
given  38  transfusions  by  the  direct  method,  vary- 
ing in  amounts  from  400  to  1,100  c.c.  During  this 
time  he  was  continuously  on  a diet  containing 
from  200  to  300  grams  of  cooked  liver  daily.  In 
addition  he  was  given  diets  high  in  iron  and 
green  vegetables  and  protein  and  low  in  fat.  He 
was  also  given  iron,  copper  and  arsenic  in  vary- 
ing amounts  and  combinations  in  an  effort  to 
stimulate  his  blood  forming  tissues.  They  were 
all  without  visible  results.  Berglund1  at  this  time 
reported  the  apparent  ability  of  fetal  calves  liver 
to  stimulate  red  blood  cell  formation.  Following 
this  suggestion  we  began  giving  him  raw  fetal 
liver  in  amounts  varying  from  400  to  1,000  grams 
daily.  Shortly  after  the  institution  of  the  raw 
fetal  liver  feeding  his  purpuric  manifestations 
ceased  and  there  was  a slow  but  gradual  rise  in 
his  reticulocytes  up  to  7%  per  cent  with  a grad- 
ual recession  back  to  normal.  Though  he  no  lon- 
ger lost  blood  by  hemorrhage  and  there  was  some 
evidence  of  increased  bone  marrow  activity,  he 
was  not  quite  able  to  maintain  his  blood  count 
even  at  a low  level.  After  approximately  18 
months  on  this  diet  he  again  began  to  show  pur- 
puric manifestations.  These  gradually  increased 
in  severity  and  whereas  formerly  a transfusion 
had  always  stopped  the  purpura  for  at  least  a 
few  days,  it  now  seemed  to  have  no  effect.  His 
condition  gradually  grew  worse  and  numerous 
transfusions  were  given  without  beneficial  effect. 
He  died  three  and  one  half  years  after  admission 
to  the  hospital.  Autopsy  showed  a broncho-pneu- 
monia. The  bone  marrow  of  the  long  bones,  ribs 
and  vertebrae  was  yellow,  oily  and  almost  liquid 
in  consistency.  Microscopic  examination  showed 
only  a few  scattered  and  very  small  areas  where 
blood  regeneration  was  taking  place. 

In  this  instance  all  known  methods  of  stimulat- 
ing the  bone  marrow  to  activity  were  without 
avail,  probably  because  the  depressing  agent  was 
still  active. 

Case  III  a white  woman  59  years  of  age  was 
admitted  to  the  University  Hospital  complaining 
of  shortness  of  breath.  She  gave  a history  that 
for  the  past  year  she  had  been  troubled  with  dys- 


234 


The  Ohio  State  Medical  Journal 


pnoea  and  weakness.  This  had  gradually  in- 
creased in  severity  until  she  was  unable  to  do  her 
housework  with  any  degree  of  comfort.  Her  past 
history  was  negative  for  any  bleeding.  Meno- 
pause two  years  previous  to  admission.  She  had 
had  10  children  and  two  miscarriages.  Her  diet 
seemed  to  have  been  normal.  Physical  examina- 
tion showed  a cataract  in  the  right  eye.  The 
lymphatic  glands  were  normal.  The  spleen  was 
palpable  3 cm.  below  the  costal  margin.  Otherwise 
the  examination  was  normal.  Urine  showed  a 
faint  trace  of  albumen  and  a few  white  blood 
cells  in  the  voided  specimen.  Wassermann  nega- 
tive. Gastric  analysis  showed  the  presence  of 
free  HCL.  X-ray  of  stomach  and  colon  were  nor- 
mal. Blood  examination  as  follows:  red  blood 
cells  2,330,000;  Hb  2 per  cent;  white  blood  cells 
7,000;  polys  68  per  cent;  lympocytes  32  per  cent; 
platelets  824,000;  reticulocytes  2.6  per  cent; 
icteric  index  4.5;  color  index  .6. 

This  blood  picture  seems  to  show  that  the  de- 
ficiency is  chiefly  in  the  red  blood  cells  and 
hemoglobin  forming  function  of  the  bone  marrow. 
The  extremely  low  color  index  together  with  the 
moderate  number  of  reticulocytes  indicates  that 
the  defect  is  chiefly  in  the  hemoglobin  synthesiz- 
ing function.  The  myeloid  and  platelet  functions 
are  apparently  undisturbed  as  indicated  by  the 
normal  number  of  white  blood  cells,  normal  dif- 
ferential and  platelet  count.  The  absence  of  any 
history  or  indication  of  blood  loss  and  the 
normal  icteric  index  seems  to  show  that  the  low 
red  blood  cell  count  and  hemoglobin  are  due  to  in- 
sufficient formation  rather  than  increased  loss. 
This  is  the  type  of  blood  picture  that  has 
been  associated  with  chlorosis  in  the  past  and 
which  is  now  more  frequently  called  idiopathic 
hypochromatic  anemia.  The  etiology  and  patho- 
genesis are  unknown.  In  recent  years  the  writing 
of  Hare,2  Witts,3  Minot4  and  many  others  have 
brought  this  type  of  anemia  to  the  attention  of 
the  medical  profession.  Although  very  little  has 
been  learned  as  to  the  etiology,  its  response  to  iron 
therapy  has  been  very  consistent  and  gratifying. 

This  patient  was  put  on  iron  ammonium  citrate 
30  gr.  t.i.d.  There  was  an  almost  immediate  re- 
ticulocyte response  reaching  a maximum  of  9.4 
per  cent  on  the  sixth  day.  It  then  gradually 
dropped  back  to  approximately  1 per  cent  at  the 
end  of  three  weeks.  Coincident  with  this  there 
was  a slower  but  consistent  rise  in  her  red  blood 
cells  and  hemoglobin  values.  Twenty-six  days 
after  the  institution  of  the  iron  therapy  her 
hemoglobin  had  increased  from  32  to  65  per  cent 
and  her  red  blood  cells  from  2,330,000  to  3,980,000. 

Whether  this  clinical  entity  is  the  same  as  the 
chlorosis  described  in  the  older  medical  writings 
is  not  certain.  It  resembles  chlorosis  in  sex  in- 
cidence, blood  picture  and  response  to  iron.  It 
differs  from  the  older  disease  in  age  incidence, 
occurring  most  frequently  between  the  ages  of  40 
and  50,  nearly  all  cases  being  included  in  the  ages 
of  20  to  60.  Chlorosis  on  the  other  hand  occurred 
almost  entirely  before  the  age  of  20.  Since  the 
etiology  of  chlorosis  and  ‘hypochromatic  anemia” 
are  equally  vague,  discussion  in  regard  to  their 


April,  1933 

identity  is  quite  futile.  However  the  similarity 
of  the  blood  picture  and  the  similar  response  to 
iron  therapy  seems  to  indicate  that  the  underly- 
ing mechanism  producing  the  anemia  is  similar  in 
the  two  diseases.  It  seems  to  be  chiefly  an  in- 
ability to  produce  hemoglobin,  and  the  substance 
lacking  for  its  elaborations  is  apparently  iron. 

The  most  important  factor  in  the  treatment  of 
anemia  secondary  to  hemorrhage  is  the  control  of 
bleeding.  Usually  this  is  followed  by  a prompt 
return  to  a normal  blood  picture.  Sometimes  how- 
ever, even  though  there  is  no  further  loss  of  blood, 
the  red  blood  cells  and  Hb  do  not  rise  to  their 
normal  levels.  Again  we  do  not  know  all  the  fac- 
tors responsible  for  the  continued  anemia,  but  oc- 
casionally at  least  it  is  due  to  a lack  of  iron. 

Case  IV* — C.  W.,  aged  49,  first  entered  Uni- 
versity Hospital  March  22,  1927,  complaining  of 
epigastric  distress.  He  had  noted  no  blood  loss  in 
stools  or  vomitus.  Blood  count  was  4,800,000  red 
blood  cells,  Hb  70  per  cent;  11,500  white  blood 
cells,  88  per  cent  polys  and  12  per  cent  lymph- 
ocytes. He  was  diagnosed  as  a perforating 
duodenal  ulcer,  and  resection  of  the  pyloric  portion 
of  the  stomach  was  done  by  Dr.  V.  A.  Dodd. 
After  a somewhat  stormy  convalescence  he 
was  discharged  on  June  21,  1927.  He  was  not 
seen  again  until  October  6,  1930,  when  he  was 
readmitted  to  University  Hospital  and  gave  a 
history  of  having  been  in  quite  good  health  until 
a few  weeks  previous  to  admission.  At  that  time 
he  began  to  notice  some  epigastric  distress.  On 
October  1,  1930  he  suddenly  became  dizzy  and 
fainted.  That  same  day  he  noted  tarry  stools.  On 
October  2,  1930,  he  vomited  a large  quantity  of 
blood. 

On  admission  he  had  the  general  appearance  of 
dehydration  and  pallor.  Blood  count  1,610,000,  Hb 
19  per  cent;  white  blood  cells  7,250,  polys,  85, 
lymphocytes  14,  monocytes  1,  slight  anisocytosis 
and  poikylocytosis  and  archromia.  Even  though  his 
bleeding  stopped  immediately  on  medical  man- 
agement, his  red  blood  cells  and  Hb  did  not  rise. 
On  October  31,  his  red  blood  cells  were  only 
1,870,000,  Hb  20  per  cent,  78  polys,  2 eosino- 
philes  18  lymphocytes  2 transitionals,  smear  still 
showed  anisocytosis.  poikylocytosis  and  achromia. 
He  was  then  placed  on  liver  extract,  amp  1 t.i.d. 
and  this  was  continued  for  13  days.  During  this 
time  there  was  no  reticulocyte  response  and  no  in- 
crease in  Hb  or  red  blood  cells.  On  November  13, 
1932,  the  liver  extract  was  discontinued  and  he 
was  placed  on  iron  ammonium  citrate,  30  grains 
t.i.d.  On  the  16th,  (3  days  later)  his  reticulocytes 
had  risen  to  14  per  cent,  which  they  maintained 
for  24  hours  and  then  gradually  dropped  to  nor- 
mal over  a period  of  two  weeks.  Coincident  with 
this  there  was  a gradual  rise  in  red  blood  cells 
and  Hb  to  normal.  This  patient  is  also  interest- 
ing in  that  after  his  red  blood  cells  and  Hb  had 
reached  normal  limits  his  iron  dosage  was  dis- 
continued with  an  almost  immediate  drop  in 
erythrocytes  and  hemoglobin.  Resuming  iron 

*1  am  indebted  to  Dr.  V.  A.  Dodd  and  Dr.  C.  A.  Doan 
for  permission  to  report  this  case. 


April,  1933 


Subdural  Abscess — Gardner 


235 


therapy  again  brought  them  to  normal.  This  has 
been  repeated  a number  of  times  with  similar 
results. 

Though  iron  in  sufficient  dosage  has  been 
proven  to  be  of  value  in  the  treatment  of  some 
secondary  anemias,  it  is  by  no  means  of  value  in 
all.  In  our  experience  it  has  been  efficacious  only 
in  a certain  percentage  of  those  anemias  (as  illus- 
trated by  cases  III  and  IV)  in  which  only  the 
erythropetic  portion  of  the  bone  marrow  is  in- 
volved. 

If  we  consider  the  mechanisms  which  hinder  the 
formation  of  red  blood  cells  we  may  classify  them 
somewhat  as  follows: 

1 —  The  mechanical  displacement  of  red  blood 
cells,  e.g.,  the  infiltration  of  the  bone  marrow  by 
leukemic  cells,  tumors,  etc. 

2 —  Depression  of  erythropoesis  by  toxins,  e.g. 
a.  infection;  b.  chemical  poisons  as  benzol  and  c. 
endogenous  toxins  as  in  uremia. 

3 —  Lack  of  material  necessary  for 

a — cell  division, 
b — cell  maturation, 
c — elaboration  of  Hb. 

d — delivery  of  red  blood  cells  into  blood 
stream. 

So  far  as  our  knowledge  goes  at  present,  iron  is 


of  value  only  in  those  anemias  in  which  there  is 
apparent  only  a lack  of  material  necessary  for  the 
elaboration  of  Hb.  Obviously  it  is  not  the  only 
substance  which  may  be  lacking  for  this  par- 
ticular function.  Certain  amino  acids,  vitamines, 
and  unknown  substances  contained  in  liver  are 
also  of  value  in  specific  instances.  As  yet  we  have 
no  exact  criteria  for  determining  with  certainty 
the  factor  which  is  lacking.  Clinically  we  know 
that  a large  percentage  of  those  anemias  which 
show  only  depression  of  the  red  blood  cells  and 
Hb  forming  power  of  the  bone  marrow  respond 
satisfactorily  to  rather  massive  doses  of  iron. 


BIBLIOGRAPHY 

1.  Berglund,  H.,  Watkins,  C.  H.,  Johnson,  R. : Rapid 
stimulation  of  hemoglobin  synthesis  in  secondary  anemias 
after  feeding  fetal  calves  liver.  Proc.  Soc.  Exper.  Biology 
and  Medicine.  25  : 814-817,  June,  1928. 

2.  Hare,  D.  C.  : Simple  achlorhydric  anemia  treated 
with  iron.  British  Medical  Journal  2:  888-891.  Nov.  14,  1931. 

3.  Witts,  L.  J. : Chronic  microcytic  anemia.  British 

Medical  Journal  2:883-888.  Nov.  14,  1931.  Varieties  of 

secondary  anemia  and  their  treatment.  Lancet  2 : 531-532. 
Sept.  5,  1931. 

4.  Minot,  G.  R.,  Heath,  C.  W. : Response  of  reticul- 

ocytes to  iron  and  some  aspects  of  iron  thera,py.  Trans. 
Ass.  Am.  Physicians  46 : 290-295.  1931. 

5.  Sabin,  Florence  R.  : The  Bone  Marrow.  Physiological 

Reviews.  Vol.  VIII,  p.  191.  1928. 

6.  Doan,  C.  A. : Clinical  implications  of  experimental 

hematology.  Medicine.  Vol.  X 323-371.  Sept.,  1931. 


Subdural  Abscess?  Its  Relation  to  Sterile  Purulent 

Leptomeningitis 

W.  James  Gardner,  M.D.,  Cleveland,  Ohio 


THE  incidence  of  meningitis  in  acute  mas- 
toditis  is  rather  low  especially  when  the 
proximity  of  the  brain  and  its  membranes 
to  the  infective  focus  is  considered.  The  com- 
paratively low  incidence  of  this  complication  is  a 
a measure  of  the  effectiveness  of  the  natural  bar- 
riers in  limiting  the  spread  of  infection.  These 
natural  barriers,  from  without  inward,  are  the 
bone,  the  dura  mater,  the  arachnoid  membrane 
and  the  pia.  (Fig.  1).  The  dura  matter  is  in 
direct  apposition  to  the  inner  surface  of  the  bony 
mastoid  and  consists  of  several  layers  of  dense 
fibrous  tissue.  It  is  nourished  by  branches  of  the 
meningeal  vessels.  The  arachnoid  is  a trans- 
parent, mesothelial  membrane  which  is  separated 
from  the  dura  by  a potential  space  known  as  the 
subdural  space.  There  is  no  adhesion  between  the 
dura  and  arachnoid  except  at  points  where  blood 
vessels  cross  the  subdural  space.  The  arachnoid 
membrane  contains  no  nuti'ient  blood  vessels.  Be- 
neath the  arachnoid  is  the  subarachnoid  space 
containing  the  cerebrospinal  fluid.  The  space  is 
crossed  by  innumerable  filamentous  adhesions 
which  connect  the  arachnoid  to  the  pia.  This  lat- 
ter membrane  is  a single  layer  of  mesothelial  cells 
which  closely  invests  the  brain.  There  are  no  com- 


Read  before  the  Section  on  Eye,  Ear,  Nose  and  Throat, 
Ohio  State  Medical  Association,  at  the  86th  Annual  Meet- 
ing, Dayton,  May  3-4,  1932. 


municating  lymph  channels  between  the  brain  and 
the  scalp. 

From  this  brief  anatomic  review  it  may  be  seen 
that  the  arachnoid  membrane  constitutes  to  in- 
vading organisms  the  last  barrier  which  must  be 
crossed  before  these  organisms  can  infect  the 
cerebrospinal  fluid.  Furthermore,  it  would  appear 
that  organisms  having  gained  access  to  the  sub- 
dural space,  should  pierce  the  thin,  filmy  arch- 
noid  with  ease.  However,  such  is  certainly  not 
always  the  case.  The  occurrence  of  subdural  ab- 
scess with  the  absence  of  an  infective  leptomenin- 
gitis is  proof  of  remarkable  powers  of  resisting 
infection  in  the  arachnoid  membrane. 

In  two  cases  of  subdural  abscess  about  to  be 
described,  the  spinal  fluid  though  purulent  in  the 
early  stages,  at  no  time  contained  organisms.  The 
sequence  of  events  in  these  two  patients  was  very 
similar.  Beginning  with  an  acute  otitis  media  a 
sterile  purulent  meningitis  rapidly  supervened. 
Following  the  subsidence  of  this  acute  stage, 
symptoms  of  intracranial  abscess  appeared. 
Operation  in  each  case  disclosed  a subdural  ab- 
scess containing  streptococcus  hemolyticus.  Re- 
covery occurred  in  the  first  case  in  which  two 
subdural  abscesses  we  re  drained  thirty-three  days 
and  sixty-two  days  respectively  after  the  onset  of 
cerebral  symptoms.  There  was  a fatal  outcome  in 
the  second  case  in  which  a single  subdural  abscess 


236 


The  Ohio  State  Medical  Journal 


April,  1933 


was  drained  nine  days  after  the  onset  of  cerebral 
symptoms. 

CASE  REPORT 

A boy,  aged  9 years,  was  admitted  to  the  de- 
partment of  neurosurgery  on  March  30,  1931.  Six 
weeks  previously  the  boy  had  been  ill  with  in- 
fluenza. One  week  later  there  had  occurred  a 
spontaneous  discharge  of  pus  from  the  left  ear, 
the  temperature  rose  to  150°  and  the  patient  be- 
came stuporous.  A spinal  puncture  at  that  time 
had  disclosed  cloudy  fluid  under  increased  pres- 
sure. The  fluid  had  contained  4,800  white  cells, 
almost  all  of  which  were  polymorphonuclear,  but 
no  organisms  had  been  found  on  smear  or  culture. 
At  that  time  Kemig’s  sign  was  present  on  both 
sides  and  there  had  been  retraction  of  the  head. 
Following  the  spinal  puncture  the  patient  had 
improved  symtomatically  and  the  temperature  re- 
turned to  normal  within  a few  days.  Headaches 
accompanied  by  vomiting  and  diplopia  soon  ap- 
peared, however,  and  increased  in  severity.  For 
three  days  before  the  patient  came  under  my  care 
he  was  in  a semistuporous  condition. 

On  examination,  thirty-two  days  after  the  in- 
itial onset  of  cerebral  symptoms,  the  patient  was 
found  to  be  very  greatly  emaciated  and  in  a semi- 


Boum 


stuporous  condition.  The  head  was  markedly  re- 
tracted and  could  not  be  brought  forward.  The 
rectal  temperature  was  99°,  the  pulse  rate  68,  the 
respirations  numbered  18  per  minute  and  were 
irregular.  There  was  an  edema  of  the  optic  discs. 
There  was  almost  complete  left  lower  facial  palsy. 
The  patient  moved  all  four  extremities  but  it  was 
impossible  to  test  their  strength.  There  was  a 
bilateral  Babinski  response,  more  pronounced  on 
the  left  side.  The  spinal  fluid  pressui'e  was  300 
millimeters  of  water.  The  fluid  was  clear  and 
colorless.  It  contained  two  white  cells  per  cubic 
millimeter  and  the  quantitative  protein  was 
within  normal  limits. 

The  sequence  of  events  in  this  case  indicated 
that  an  intracranial  abscess  was  present.  The 
left-sided  facial  palsy  of  central  type  and  the 
more  pronounced  Babinski  response  in  the  left 
foot  suggested  a right  cerebral  lesion,  although 
the  otitis  media  had  been  on  the  left  side. 

It  was  decided  to  make  an  exploratory  brain 
puncture  on  the  right  side.  Therefore,  under 
avertin  anesthesia  a small  trephine  opening  was 
made  in  the  right  temporal  region  and  a brain 
cannula  was  introduced.  No  pus  was  encountered 
but  at  a depth  of  four  centimeters  the  cannula 
entered  the  ventricle  and  forty-five  cubic  cen- 
timeters of  clear  fluid  escaped.  A ventriculogram 
was  then  performed  by  introducing  a small 


amount  of  air.  The  resulting  films  disclosed  a 
dilated  right  ventricle  which  was  considerably 
displaced  to  the  right,  especially  in  its  anterior 
portion.  None  of  the  injected  air  had  gained 
access  to  the  other  ventricles.  The  diagnosis  from 
the  ventriculogram  was  left  frontal  lobe  abscess 
displacing  the  brain  to  the  right  and  causing  an 
obstruction  of  the  foramina  of  Monro.  It  was  ap- 
parent from  this  examination  that  the  misleading 
neurologic  signs,  namely  the  left  central  facial 
weakness  and  the  left  sided  Babinski  were  the  re- 
sult of  the  displacement  of  the  brain  to  the  right 
which  produced  pressure  on  the  right  cerebral 
peduncle  where  it  passed  through  the  incisure  of 
the  tentorium.  (Fig.  2). 

The  following  day  the  abscess  was  drained. 
Under  nitrous  oxide  anesthesia  a linear  incision 
was  made  in  the  left  fronto-temporal  region  and 
a bony  opening  three  centimeters  in  diameter  was 
made.  The  exposed  dura  was  found  to  be  un- 
usually vascular  and  upon  incision  a layer  of 
granulation  tissue  about  three  millimeters  in 
thickness  was  found  adherent  to  its  inner  surface. 
The  presence  of  a subdural  abscess  was  verified 
by  needle  puncture  after  which  the  dura  and  ab- 
scess wall  were  incised  in  a crucial  manner.  Ap- 
proximately three  ounces  of  pus  escaped  under 
pressure.  The  remaining  pus  was  then  removed 
with  an  aspirator  and  the  cavity  gently  irrigated 
with  a mild  antiseptic  solution.  The  cavity  was 
found  to  extend  forward  almost  to  the  frontal 
pole  and  backward  to  a point  behind  the  level  of 
the  ear.  Its  greatest  depth  was  in  the  temporal 
region.  In  its  evacuated  state  the  cavity  accom- 
modated three  and  one-half  ounces  of  fluid  and  it 
was  estimated  that  the  original  content  was 
probably  about  six  ounces.  The  scalp  incision  was 
left  widely  open,  hemostasis  being  secured  by  a 
running  catgut  stitch  in  the  subcutaneous  layer. 
Marsupialization  of  the  abscess  cavity  was  then 
done  by  everting  the  triangular  flaps  of  dura 
and  abscess  wall  and  suturing  them  to  the  scalp. 
The  cavity  was  packed  lightly  with  several  soft 
rubber  tissue  drains.  A culture  from  the  pus  re- 
vealed a pure  strain  of  streptococcus  hemolyticus. 

For  ten  days  the  patient’s  convalescence  was 
very  satisfactory.  A postoperative  aphasia,  which 
at  first  had  been  complete,  improved  rapidly. 


April,  1933 


Subdural  Abscess — Gardner 


237 


After  ten  days,  however,  the  boy  began  to  ex- 
hibit occasional  periods  of  listlessness  with  mild 
headache.  The  spinal  pressure  which  had  been 
normal,  gradually  mounted  to  290  millimeters  of 
water.  It  was  thought  that  pei'haps  the  posterior 
portion  of  the  abscess  was  not  draining  satis- 
factorily. Therefore  on  April  17  another  trephine 
opening  was  made  a few  centimeters  posterior  to 
the  drainage  tract.  A needle  was  introduced 
through  the  dura  but  no  pus  was  encountered. 
The  dura  was  incised  and  the  wall  of  the  original 
abscess  was  encountered.  It  was  found  to  be  col- 
lapsed. It  was  felt  that  drainage  of  the  abscess 
had  been  satisfactory  and  the  wound  was  closed. 

Dui-ing  the  next  ten  days  the  patient’s  con- 
dition grew  steadily  worse.  The  choking  of  the 
optic  discs  which  had  been  subsiding,  began  to 
increase.  The  spinal  fluid  pressure  rose  to  480 
millimeters  of  water.  Since  the  aphasia  was  still 
improving  in  spite  of  the  increasing  pressure  it 
was  felt  that  another  abscess  must  be  present 
elsewhere.  Neurological  examination  yielded  no 
information  of  localizing  value  and  perimetric 
studies  were  unreliable  due  to  poor  cooperation. 
In  order  to  localize  the  lesion,  an  encephalogram 
was  performed  on  April  27. 

Under  avertin  anesthesia  a spinal  needle  was 
introduced  with  the  patient  sitting  in  an  en- 
cephalogram chair.  The  initial  pressure  was  over 
700  millimeters  of  water.  Ten  cubic  centimeters 
of  air  were  injected  following  which  the  fluid 
was  removed  in  amounts  of  five  cubic  centimeters 
and  substituted  with  air  in  similar  amounts  until 
a total  of  68  cubic  centimeters  of  fluid  were  re- 
moved and  78  cubic  centimeters  of  air  were  intro- 
duced. The  resulting  films  showed  both  lateral 
ventricles  well  outlined  with  a displacement  of  the 
midline  of  the  brain  one  centimeter  to  the  right. 
There  was  also  a displacement  of  the  left  ven- 
tricle downward,  most  marked  in  its  posterior 
portion.  The  diagnosis  from  the  encephalogram 
was  left  cerebral  abscess,  probably  posterior. 

The  patient  was  then  returned  to  the  operating 
room  where  after  four  or  five  attempts  with  the 
exploring  cannula,  pus  was  finally  encountered  in 
the  occipital  region.  The  trephine  opening  through 
which  the  pus  was  removed  was  eight  centimeters 
from  the  wall  of  the  abscess.  Therefore,  after 
two  and  one-half  ounces  of  pus  had  escaped  the 
cannula  was  removed  without  any  attempt  at  in- 
stituting permanent  drainage.  A culture  of  the 
pus  revealed  a pure  strain  of  streptococcus  hem- 
olyticus. 

The  patient’s  condition  remained  improved  for 
forty-eight  hours  following  the  evacuation,  at 
which  time  it  was  considered  advisable  to  drain 
the  second  abscess.  Accordingly  on  April  19  a 
subdural  abscess  in  the  left  occipital  region  was 
opened  and  drained.  The  operative  findings  were 
exactly  the  same  as  at  the  operation  on  March  31 
except  that  this  cavity  was  considerably  smaller. 


The  patient’s  convalescence  thereafter  was  very 
satisfactory  and  he  was  discharged  from  the  hos- 
pital on  May  8 to  return  daily  for  dressings. 
Eight  days  later  the  patient  was  readmitted  with 
continuous  Jacksonian  convulsions  of  the  right 
arm  and  leg.  Under  avertin  anesthesia  another 
encephalogram  was  performed  in  order  to  exclude 
the  presence  of  another  abscess  and  in  the  hopes 
of  controlling  the  convulsions.  With  the  patient 
in  the  sitting  position  the  spinal  fluid  was  with- 
drawn, five  cubic  centimeters  at  a time,  and  sub- 
stituted with  air  in  similar  amounts  until  136 
cubic  centimeters  of  fluid  has  been  removed  and 
146  cubic  centimeters  of  air  had  been  introduced. 
The  resulting  films  disclosed  a slight  dilatation  of 
the  ventricular  system  without  displacement.  The 
subarachnoid  air  markings  were  normal  over  the 
right  cerebral  hemisphere  but  entirely  absent 
over  the  left.  The  encephalographic  diagnosis  was 
pia-arachnoid  adhesions  over  the  left  cerebrum. 

The  patient  left  the  hospital  four  days  after 
this  procedure  and  has  remained  perfectly  well  to 
date. 

A lad,  17  years  of  age,  was  admitted  to  the 
neurosurgical  service  on  April  6,  1931.  The  story 
was  that  seventeen  days  previously  the  patient 
had  developed  a left  otitis  media  requiring  para- 
centesis. Four  days  later  a left  mastoidectomy 
had  been  performed  for  an  acute  purulent  mas- 
toiditis. Six  days  before  admission  the  patient 
had  begun  to  compain  of  headache  which  steadily 
had  increased  in  severity.  The  temperature  then 
had  begun  to  rise  and  on  the  day  of  admission 
the  patient  was  actually  ill,  and  mildly  irrational. 

On  examination  the  patient  was  found  to  be 
in  moderate  opisthotonos  and  he  was  also  dis- 
oriented. The  temperature  was  104.2°,  the  pulse 
rate  120,  the  respiration  rate  18  and  the  blood 
pressure  110  systolic,  45  diastolic.  The  Kemig 
test  was  positive  and  the  neck  was  rigid.  There 
was  no  choking  of  the  optic  discs.  The  spinal  fluid 
pressure  was  410  millimeters  of  water,  the  fluid 
had  a “ground  glass’”  appearance  and  contained 
per  cubic  millimeter,  1250  cells  which  were  prac- 
tically all  polymorphonuclears.  A smear  of  the 
fluid  was  reported  to  contain  organisms.  On  the 
basis  of  the  history  and  these  findings  the  clinical 
diagnosis  was  septic  meningitis. 

On  the  day  of  admission  a spinal  fistula  was 
established  by  removing  the  first  lumbar  lamina 
and  suturing  a drain  to  the  opened  dura  after 
the  method  of  Spurling.* 

Following  the  operation  the  patient  was  placed 
in  the  Fowler  position  and  fluids  were  forced  to 
the  extent  of  6,000  cubic  centimeters  in  twenty- 
four  hours.  The  dressings  rapidly  became  sat- 
urated and  were  changed  every  six  hours  with 
aseptic  precautions.  The  temperature  and  the 

* In  1928,  Spurlingi  reported  his  results  in  the  treat- 
ment of  staphylococcis  meningitis  by  means  of  continuous 
drainage.  His  method  consisted  in  the  removal  of  the 
lamina  of  the  second  lumbar  vertebra  and  the  insertion  of  a 
gutta-percha  drain  into  the  incised  dural  sac.  The  fluid 
intake  was  then  kept  at  a high  lervel,  above  5,000  c.c.  in 
twenty-four  hours,  in  order  to  encourage  the  elimination  of 
cerebrospinal  fluid.  By  this  means,  an  autolavage  of  the 
cerebrospinal  system  was  accomplished  which  resulted  in 
four  cures  in  seven  cases  of  staphylococcic  meningitis. 
About  the  same  time,  Kubie2  demonstrated  the  feasibility  of 
this  method  from  the  experimental  standpoint. 


238 


The  Ohio  State  Medical  Journal 


April,  1933 


meningeal  symptoms  began  to  subside  immedi- 
ately. The  culture  of  the  spinal  fluid  removed 
prior  to  operation  was  found  to  be  sterile.  Sub- 
sequent specimens  obtained  from  the  operative 
site  revealed  no  organisms  in  smear  or  culture. 
It  appeared  that  instead  of  an  infective  menin- 
gitis, the  condition  was  a sterile  meningitis.  A 
blood  culture  taken  on  admission  remained  sterile. 

The  day  after  admission  the  mastoidectomy 
wound  was  reopened  and  explored  under  avertin 
anesthesia.  The  lateral  sinus  was  found  to  be  in 
a healthy  condition  and  the  drainage  of  the  mas- 
toid had  been  adequate. 

On  April  9,  three  days  after  admission  and  nine 
days  after  the  onset  of  headache,  the  patient  de- 
veloped a complete  motor  aphasia.  A diagnosis 
of  left  temporal  lobe  abscess  was  made  and  opera- 
tion decided  upon.  Accordingly,  a cranial  per- 
foration was  made  in  the  left  temporal  region  and 
the  dura  was  opened.  A quantity  of  pus  at  once 
escaped  from  the  subdural  space  which  on  sub- 
sequent cultures  revealed  streptococcus  hemolyti- 
cus.  The  process  was  acute  and  the  abscess  wall 
quite  thin.  From  the  findings,  it  was  my  impres- 
sion that  the  prognosis  would  have  been  more 
favorable  had  the  operation  been  delayed  until 
more  definite  encapsulation  had  occurred. 

Following  this  operation,  however,  the  con- 
valescence for  a time  was  very  gratifying.  The 
temperature  gradually  subsided  and  the  aphasia 
improved.  Sterile  fluid  continued  to  drain  from 
the  laminectomy  site.  The  drainage  from  the  sub- 
dural abscess  rapidly  became  less.  On  April  24, 
1931,  fifteen  days  after  operation,  the  respira- 
tions suddenly  ceased  without  warning  and  in 
spite  of  all  efforts  at  resuscitation  the  patient  died 
five  hours  later.  Necropsy  disclosed  very  marked 
edema  of  the  left  cerebral  hemisphere  and  a ser- 
pentine subdural  abscess  in  the  left  temporal  and 
parietal  areas  which  had  been  incompletely 
drained. 

These  two  cases  are  strikingly  similar  in  that 
they  began  with  an  infection  of  the  left  middle 
ear  which  spread  to  the  subdural  space  and  by 
contact  with  the  arachnoid  membrane,  caused  a 
sterile  irritative  leptomeningitis.  The  organisms 
failed  to  traverse  the  arachnoid  membrane  and 
the  meningitic  symptoms  rapidly  disappeared  to 
be  replaced  later  by  symptoms  of  brain  abscess. 
The  infecting  organism  in  each  case  was  strep- 
tococcus hemolyticus.  The  first  case  shows  that 
a favorable  result  may  be  obtained  even  when 
there  are  multiple  subdural  abscesses.  The  termi- 
nal outcome  in  the  second  case  emphasizes  the  in- 
advisibility  of  early  operative  interference. 

Cleveland  Clinic. 

1.  Spurling,  R.  G.,  Surgical  treatment  of  meningitis 
with  report  of  cases,  Kentucky  Medical  Journal,  26  -242-250 
May,  1928. 

2.  Kubie,  L.  S.,  Forced  drainage  of  cerebrospinal  fluid 
in  relation  to  treatment  of  infections  of  central  nervous 
system.  Arch,  of  Neurol,  and  Psych.,  19 :997-1005,  June, 


Interesting  Program  Arranged  for  North- 
ern Tri-State  Meeting 

Sixtieth  Annual  Meeting  of  the  Northern  Tri- 
State  Medical  Association  is  scheduled  for  Tues- 
day, April  11,  at  LaPorte,  Indiana. 

The  program  is  to  be  presented  at  the  Civic 
Auditorium,  where  luncheon  also  will  be  served, 
and  the  banquet  to  be  held  at  the  Hotel  Rumely. 

The  following  program  will  be  presented: 


MORNING  SESSION 

8 :30  a.  m.  “Fracture  Symposium”,  Dr.  Paul  B.  Magnuson, 

professor  of  surgery.  Northwestern  University ; 
Dr.  Harry  E.  Mock,  associate  professor  of  sur- 
gery, Northwestern  University,  and  Dr.  R.  W. 
McNealy,  associate  professor  of  surgery,  North- 
western University. 

9 : 30  a.  m.  “Diseases  of  l^aracnyroid  with  Special  Reference 

to  Parathyroid  Overfunction”,  Dr.  Russell  M. 
Wilder,  Mayo  Clinic,  Rochester,  Minnesota. 
10:15  a.m.  “Some  Diagnostic  Points  Differentiating  Ab- 
dominal and  Gen ito-Uri nary  Diseases”,  Dr.  E. 
Benjamin  Gillette,  Toledo. 

11:00  a.m.  “The  Control  of  Chronic  Intractable  Asthma 
with  Pollen”,  Dr.  George  L.  Waldbott,  Detroit. 

11  :45  a.  m.  “Early  Clinical  Diagnosis  of  Diseases  of  the 

Mammary  Gland”,  Dr.  Arthur  E.  Hertzler,  pro- 
fessor of  surgery,  University  of  Kansas. 

12  :30  to  1 :15  p.  m.  Luncheon. 


AFTERNOON  SESSION 


1 :15  p.  m. 
2 :00  p.  m. 

2 :45  p.  m. 

3 :30  p.  m. 

4 :15  p.  m. 

5 :00  p.  m. 


“Other  Uses  of  Digitalis  Than  in  the  Treatment 
of  Cardiac  Decompensation”,  Dr.  Henry  A. 
Christian,  professor  of  medicine,  Harvard 
Medical  School. 

“Acute  Appendicitis  with  Special  Reference  to 
the  Delayed  Treatment  of  Advanced  Cases”,  Dr. 
Frederick  A.  Coller,  professor  of  surgery,  Uni- 
versity of  Michigan. 

“The  Management  of  Hepatic  Disease”,  Dr. 
Charles  A.  Elliott,  professor  of  medicine.  North- 
western University. 

“Special  Sense  Organs  as  a Factor  in  Head- 
aches”, Dr.  Charles  Lukens,  Toledo. 

“Newer  Methods  for  the  Relief  of  Prostatic 
Obstruction”,  Dr.  Reed  M.  Nesbit.  assistant 
professor  of  surgery.  University  of  Michigan. 
“Acute  Vascular  Accidents”,  Dr.  Plinn  F. 
Morse,  Harper  Hospital,  Detroit. 


EVENING  SESSION 
6 :30  p.  m.  Banquet. 

8 :00  p.  m.  “Neuropsychoses  from  the  Internist’s  Point  of 
View”,  Dr.  Charles  P.  Emerson,  professor  of 
medicine,  University  of  Indiana. 

Officers  of  the  association  who  cooperated  in  arranging 
the  program  are : President,  Dr.  Edward  B.  Pedlow,  Lima  ; 
vice  president,  Dr.  G.  O.  Larson,  LaPorte,  Indiana;  secre- 
tary, Dr.  Edward  P.  Gillette,  Toledo ; treasurer.  Dr.  H.  E. 
Randall,  Flint,  Michigan  ; councilors.  Dr.  Charles  Lukens, 
Toledo,  Dr.  P.  N.  Sutherland,  Angola,  Indiana,  and  Dr. 
Joseph  H.  Andries,  Detroit. 


Zanesville — Dr.  Daniel  G.  Caudy  has  been  ap- 
pointed physician  for  the  poor  of  the  city,  suc- 
ceeding the  late  Dr.  J.  B.  McBride. 

Bucyrus — Dr.  W.  E.  Baker  and  Dr.  D.  G. 
Arnold  have  been  appointed  physicians  for  the 
county  jail  and  county  home,  respectively. 

Youngstown — Dr.  A.  V.  Hindman  has  been  re- 
tained as  physician  for  the  Mahoning  County 
Home. 

The  Executive  Committee  of  the  Board  of 
Trustees,  Western  Reserve  University,  has  ac- 
cepted an  anonymous  gift  of  $300,000  to  found  the 
Oliver  H.  Payne  chair  of  surgery  in  the  School  of 
Medicine.  Colonel  Payne  was  one  of  the  early 
philanthropists  of  Cleveland  and  one  of  its  out- 
standing citizens  for  many  years  until  his  death 
in  1917. 


Howard  D.  McIntyre,  M.D.,  Cincinnati,  Ohio 


THE  subject  of  encephalitis  has  undergone 
much  revision  since  1917.  The  epidemic  of 
so-called  lethargic  encephalitis  modified  our 
pre-existing  concepts  while  the  recent  investiga- 
tion into  the  encephalitides  following  the  exanthe- 
mata have  still  further  altered  our  ideas,  not  only 
on  encephalitis  in  general  but  also  our  opinions 
on  multiple  sclerosis. 

If  one  pei’uses  the  world’s  neurological  litera- 
ture he  is  struck  by  two  important  facts.  Prior 
to  1914,  there  are  relatively  few  papers  dealing 
with  encephalitis.  From  then  on  to  1922,  a 
veritable  avalanche  of  papers  appear  dealing  with 
epidemic  encephalitis  in  all  its  phases,  acute  and 
chronic. 

From  1922  to  the  present,  a new  group  of  en- 
cephalitis cases  appears,  that  is  the  encephalitis 
following  contagious  diseases,  various  procedures 
of  vaccination  and  a new  and  strange  disease 
described  under  various  headings  such  as  acute 
multiple  sclerosis,  neuro-myelitis  optica,  and  dis- 
seminated encephalitis. 

From  the  clinico-pathological  angle,  we  are 
struck  with  two  important  facts. 

(1)  The  virus  of  epidemic  encephalitis  has  a 
remarkable  selective  affinity  for  the  basal  ganglia 
producing  extra-pyramidal  syndromes,  while 

(2)  the  virus  of  the  large  group  of  encephali- 
tides arising  after  the  contagious  diseases,  vac- 
cinia, etc.,  has  a special  predilection  for  the  white 
matter  and  all  foi-ms  have  the  common  pathologi- 
cal picture  of  areas  of  demyelinization  with  some 
perivascular  infiltration  and  glial  proliferation. 

Any  encephalitis  may  be  acute,  even  apoplectic, 
subacute  or  chronic. 

In  order  to  better  orient  ourselves  it  were  best 
to  attempt  a classification  in  the  light  of  our 
newer  knowledge. 

CLASSIFICATION  OF  THE  ENCEPHALITIDES 
(1)  Encephalitis  occurring  in  the  course  of  any 
disease  of  the  brain. 

(a)  Lues;  (b)  Tuberculosis;  (c)  Purulent 
meningitis.  In  the  last  two  conditions  the  neur- 
ological symptoms  outweigh  those  of  encephalitis. 

(2)  Encephalitis  as  a variant  of  anterior  pol- 
iomyelitis. 

(3)  Encephalitis  occurring  in  the  course  of  or 
following  the  contagious  diseases  of  childhood. 

(a)  Mumps;  (b)  Measles;  (c)  Whooping 
cough;  (d)  Chicken  pox;  (e)  Small  pox;  (f) 
Scarlet  fever. 

(4)  Encephalitis  following  vaccination  pro- 

Read  before  the  Section  on  Nervous  and  Mental  Diseases, 
Ohio  State  Medical  Association,  at  the  86th  Annual  Meeting, 
Dayton,  May  3-4,  1932. 


cedures  for  (a)  Small  pox;  (b)  Rabies;  (c) 
Tetanus;  (d)  Diphtheria. 

(5)  Encephalitis  occurring  in  other  infectious 
diseases  (a)  Influenza;  (b)  Pneumonia. 

(6)  Encephalitis  due  to  known  poisons — (a) 
Arsphenamine;  (b)  Lead;  (c)  Alcohol — Acute 
hemorrhagic  encephalitis  of  Strumpell;  (d)  Polio- 
encephalitis superior  of  Wernicka  also  due  to 
alcohol. 

(7)  Acute  serous  encephalitis  occurring  in  in- 
fections and  toxemias;  (8)  Encephalosis  of  chil- 
dren (Winkleman)  ; (9)  Acute  disseminated  en- 
cephalitis or  acute  multiple  sclerosis  as  it  is  also 
called,  perhaps  wrongly;  (10)  Epidemic  or  so- 
called  lethargic  encephalitis;  (11)  Acute  hemor- 
rhagic encephalitis  of  children;  (12)  Sydenham’s 
Chorea;  (13)  Encephalitis  complicating  spinal 
anesthesia. 

In  this  paper  I shall  discuss  only  the  -following 
types: 

(1)  Influenzal  encephalitis;  (2)  Encephalitis  as 
a variant  of  anterior  poliomyelitis;  (3)  Encephal- 
itis following  the  contagious  diseases;  (4)  Acute 
disseminated  encephalitis;  (5)  Acute  hemorrhagic 
encephalitis;  (6)  Sydenham’s  chorea;  (7)  En- 
cephalitis complicating  spinal  anesthesia. 

INFLUENZAL  ENCEPHALITIS 

Case  Report: — Patient,  age  11.  Onset  with 
fever,  diagnosed  as  influenza  at  eight  months. 
Convulsions  at  this  time.  Patient  now  shows 
weakness  of  the  left  arm  and  leg  with  positive 
Chadduck  on  the  left.  Has  had  grand  and  petit 
mal  attacks  since  age  of  one  year.  No  family  his- 
tory of  epilepsy.  Slight  mental  deterioration, 
irritable,  inclined  to  be  quarrelsome  at  times. 

ENCEPHALITIS  AS  A VARIANT  OF  ANTERIOR 
POLIO-MYELITIS 

Case  Report:- — This  case  is  very  difficult  to 
classify.  Patient  was  a young  woman,  age  25, 
whose  first  baby  was  born  August  22,  1930.  Seven 
days  after  the  baby  was  born  patient  had  pyelitis. 
Eleven  days  afterward  she  complained  of  pain  in 
the  right  leg.  On  September  20th  the  fever  rose 
to  102  and  two  days  following,  both  legs  were 
paralyzed  and  patient  complained  bitterly  of  pain 
in  the  legs.  I saw  this  patient  October  16,  1930. 
At  that  time  she  was  disoriented,  complained  bit- 
terly of  pain. 

Neurological  examination  showed  a bilateral 
choked  disc,  unequal  pupils,  left  being  larger  than 
right.  Deep  reflexes  were  present  and  equal  in 
the  arms,  abdominal  reflexes  absent.  Knee  and 
Achilles  reflexes  absent.  No  plantar  reversal 
signs.  Patient  had  flaccid  paralysis  of  both  legs, 
this  more  marked  on  the  right.  Sensation  dimin- 
ished to  light  touch  in  the  legs  but  there  was 
marked  hypersensitivity  to  pain  especially  over 
the  muscles  and  nerve  trunks.  Spinal  fluid  pres- 
sure registered  50  centimeters  of  water.  Spinal 
fluid  Wassermann  was  negative,  fluid  contained  5 


239 


240 


The  Ohio  State  Medical  Journal 


April,  1933 


cells,  a very  great  amount  of  globulin  and  al- 
bumen. 

The  psychotic  symptoms  subsided  in  about  six 
weeks.  I saw  patient  again  October  2,  1931. 
Mentality  was  absolutely  normal.  Cranial  nerves 
normal.  Deep  reflexes  in  the  legs  were  gone,  pa- 
tient had  bilateral  foot  drop  with  absence  of  ab- 
dominal reflexes. 

We  see  in  this  woman  a patient  with  increased 
intracranial  pressure,  bilateral  choked  disc,  in- 
equality of  the  pupils  and  lower  motor  neuron 
findings  together  with  posterior  root  symptoms. 
The  case  does  not  fit  either  anterior  polio-myelitis 
or  encephalitis.  It  is  probably  a case  of  encephalo- 
myelitis secondary  to  the  toxemia  of  pregnancy. 

ENCEPHALITIS  ASSOCIATED  WITH  CONTAGIOUS 
DISEASE 

(a)  Mump  encephalitis.  Here  the  onset  is  usually 
within  a week  after  the  parotitis.  The  symptoms 
are  headache,  vomiting,  somnolence;  temperature, 
103-4  F.  The  veins  of  the  retina  are  injected, 
there  is  neck  rigidity,  perhaps  positive  Kernig 
and  Brudzinski,  tache  cerebrale  is  usually  present, 
the  deep  reflexes  are  diminished.  The  spinal  fluid 
usually  shows  a lymphocytosis,  even  as  many  as 
500  cells  per  cubic  millimeter.  It  is  interesting  to 
note  that  many  patients  with  mumps  show  a 
lymphocytosis  in  the  spinal  fluid  even  without 
signs  of  meningo-encephalitis.  The  temperature 
usually  subsides  within  a week.  Sequelae  are  rare 
but  do  occur  as  hemiplegia,  aphasia,  tremors, 
nystagmus,  cranial  nerve  palsies.  The  treatment 
resolves  itself  into  repeated  lumbar  punctures. 

(b)  Encephalitis  of  Measles. 

Symptoms: — Stupor,  coma,  unequal  pupils  slug- 
gish to  light,  neck  rigidity,  Brudzinski  and  Ker- 
nig. The  deep  and  superficial  reflexes  ai*e  dimin- 
ished, Babinski  sign  or  its  confirmatories  may  be 
present.  Bulbar  symptoms  may  supervene  with 
respiratory  death.  The  spinal  fluid  is  under  pres- 
sure, clear,  shows  increased  mononuclears  and 
globulin. 

The  pathological  process  is  that  of  peri-vas- 
cular glial  proliferation  in  the  white  matter  with 
perivascular  infiltration  and  areas  of  demyelini- 
zation.  This  is  more  pronounced  in  the  white  mat- 
ter but  the  gray  may  also  be  involved.  For  ex- 
ample, the  basal  ganglia  as  well  as  the  myelin 
sheaths  and  axons  may  all  be  involved  in  contrast 
to  the  pathological  picture  of  multiple  sclerosis, 
in  which  the  axons  are  spared.  The  demyeliniza- 
tion  may  affect  any  part  of  the  white  matter  e.g., 
posterior  columns,  lateral  columns,  or  cerebellar 
pathways. 

The  constant  finding  is  peri-vascular  infiltra- 
tion and  proliferation  of  glial  cells  with  areas  of 
peri-vascular  demyelinization. 

(c)  Encephalitis  of  Whooping  Cough. 

These  patients  show  signs  of  meningo-en- 
cephalitis ; convulsions  are  common.  Toxic  de- 
generative changes  are  found  in  the  brain.  Hem- 


orrhage due  to  a paroxysm  of  coughing  is  really 
very  rare.  (Eckstein,  Encephalitis  in  children, 
Berlin,  1929). 

CASE  REPORTS 

Patient,  age  24.  Had  whooping  cough  with 
fever,  delirium,  neck  rigidity,  headache  at  age  of 
6 years.  Following  this  hiccoughed  a great  deal. 
Developed  weakness  of  left  arm  and  leg,  diffi- 
culty in  swallowing,  developed  contracture  of  left 
hand. 

Neurological  examination: — spontaneous  nys- 
tagmus aggravated  by  looking  to  left.  Ptosis  of 
left  eyelid.  Crossed  hemiplegia,  weakness  right 
lower  motor  neuron  type,  weakness  left  palate, 
left  arm  and  leg.  Ankle  clonus  and  Babinski  left 
side. 

Case  2. — Patient,  age  15,  Convulsions  since  the 
age  of  6 months.  No  family  history  of  epilepsy. 
Has  both  grand  and  petit  mal  attacks.  Whooping 
cough,  with  high  fever,  convulsions,  neck  rigidity 
and  coma  for  one  week  during  course  of  whooping 
cough.  Has  had  grand  and  petit  mal  attacks  at 
intervals  since  that  time.  Objective  neurological 
examination  negative. 

(d)  Encephalitis  of  Chicken-Pox. 

Onset  of  symptoms  five  to  twenty  days  after 
rash  has  appeared  usually  seven  to  ten  days.  The 
symptoms  are  fever,  headache,  vomiting,  dizzi- 
ness, irritability,  delirium,  perhaps  convulsions. 
The  symptoms  may  fall  into  one  of  three  groups : 

(1)  Neuro-myelitis,  with  spastic  or  flaccid 
paralysis 

(2)  Diffuse  encephalo-myelitis 

(3)  Mild  meningitis. 

The  cell  count  may  be  twenty  or  more  mononu- 
clears per  cubic  millimeter. 

The  pathological  picture  is  that  of  perivascular 
destruction  of  myelin  sheaths  with  fatty  de- 
generation and  phagocytosis  of  fat. 

(e)  Encephalitis  of  Small-Pox. 

Troup  and  Hurst,  Lancet,  March,  1930,  report 
the  case  of  a man  who  seven  days  after  the  rash 
appeared,  developed  paraplegia  and  incontinence. 
Death  occurred  four  weeks  after  the  onset. 

The  pathological  picture  was  identical  with  that 
produced  by  vaccinial  and  measles  encephalitis, 
namely,  extensive  areas  of  demyelinization. 

(f)  Post-vaccinal  Encephalitis. 

Ninety  cases  were  observed  in  two  years  in 
England  and  Wales.  There  was  a mortality  rate 
of  50  per  cent.  The  pathological  changes  were 
identical  with  those  observed  in  measles  and 
small-pox  encephalitis,  namely,  extensive  areas  of 
demyelinization. 

Onset  nine  to  twelve  days  after  vaccination. 

Symptoms — paraplegia,  blindness,  fixed  pupils, 
swelling  of  the  discs,  perhaps  paralysis  of  respira- 
tion and  swallowing. 

Cell  count  twenty  or  above.  Sometimes  lower 
motor  neuron  atrophy  in  the  hands  develops. 
There  may  be  neck  rigidity  and  Kernig  sign. 
Recovery  may  be  complete  in  some  cases. 


April,  1933 


The  Encephalitides — McIntyre 


241 


Sequelae  of  Post-vaccinal  Encephalitis. 

(1)  Extensive  lower  motor  neuron  changes  as 
in  anterior  polio-myelitis;  (2)  Hemiplegia;  (3) 
Mental  deficiency;  (4)  Choreic  and  athetoid  move- 
ments; (5)  Pictures  resembling  Huntington’s 
chorea  with  mild  mental  defect. 

(g)  Encephalitis  after  Anti-rabic  Inoculation. 

Symptoms  begin  about  a week  after  inoculation 
with  headache,  fever,  insomnia,  nystagmus,  ptosis, 
ocular  palsies.  Recovery  usually  takes  place. 

(h)  Encephalitis  after  Diphtheria  Anti-toxin. 

Case  Report: — Patient  aged  5.  Seven  weeks  be- 
fore patient  received  diphtheria  shots,  after  the 
inoculation  hemorrhagic  purpura  on  the  skin. 
On  admission  fever  101.  Twelve  cells  in  the 
spinal  fluid.  Fluid  under  increased  pressure. 
Bilateral  choked  disc  three  diopters.  Weakness 
right  face.  Ataxia  left  leg.  Broad  base  gait, 
choked  disc  persisted.  Operated  for  cerebellar 
tumor.  Patient  died  of  shock.  Examination  of 
brain  showed  thrombophlebitis  of  the  lepto- 
meninges  with  areas  of  softening  in  the  right 
hemisphere. 

ACUTE  DISSEMINATED  ENCEPHALITIS 

In  the  last  three  years  considerable  has  been 
written  on  the  subject  of  acute  disseminated  en- 
cephalo-myelitis.  Speculation  has  been  rife  as  to 
whether  this  disease  and  acute  multiple  sclerosis 
and  perhaps  neuro-myelitis  were  one  and  the 
same  disease. 

McAlpine — (Lancet,  April,  1931),  states  that  in 
encephalitis  disseminata,  that  fever  is  usually 
present,  diplopia  is  not  common,  euphoria  not 
present,  while  the  Lange  gold  curve  is  negative. 
I might  add  that  the  rapid  progression  of  the  dis- 
ease, the  frequently  early  fatal  termination  in 
disseminated  encephalitis  serves  to  differentiate  it 
from  multiple  sclerosis. 

Pette  believes  that  multiple  sclerosis  and  dis- 
seminated encephalitis  are  one  and  the  same. 

Spielmeyer  (Zeitschr.  fur  die  ges.  Neurol,  und 
Psych.  Vol.  123-1930)  considers  the  two  diseases 
as  separate  entities.  He  points  out  that  in  mul- 
tiple sclerosis  the  axon  is  spared  for  many  years, 
while  in  encephalitis  disseminata  we  encounter 
areas  of  softening  in  which  both  myelin  and  axis 
cylinder  are  destroyed. 

From  the  clinical  standpoint  it  may  be  said 
that  the  striking  remissions  observed  in  multiple 
sclerosis  are  lacking  in  disseminated  encephalo- 
myelitis. 

Histologically,  we  see  in  disseminated  en- 
cephalitis, areas  of  softening  with  demyelinization 
associated  with  destruction  of  the  axis  cylinder, 
lymphocytic  infiltration  with  glial  proliferation. 

CASE  REPORTS 

Case  1. — Patient,  white  woman,  age  32.  Was 
seen  April  10,  1930.  In  February,  1929,  the  onset 
occurred  with  double  vision  which  followed  an 
attack  of  infection  diagnosed  as  grippe.  Since 
that  time  has  been  unable  to  walk.  Has  shown 


mental  symptoms  with  rapid  change  from  laugh- 
ing to  crying. 

Neurological  examination  at  the  time  showed 
bitemporal  pallor  of  the  disc.  Nystagmus  on  look- 
ing laterally.  Weakness  right  face.  Bilateral 
ankle  clonus  more  marked  on  the  left  side.  Vi- 
bratory and  muscle  sense  both  legs  diminished. 
Ataxia  of  the  legs  and  paralysis  of  the  four  ex- 
tremities more  marked  on  the  right  side.  Speech 
scanning  type. 

Spinal  fluid  pressure  measured  5 cm.  There 
were  no  cells  in  the  fluid,  trace  of  globulin  and 
negative  gold  curve. 

Patient  was  seen  six  weeks  after  the  birth  of 
the  baby.  She  stated  that  the  feet  were  numb  as 
though  balls  of  cotton  were  on  the  feet.  Two 
days  later  noticed  dizziness,  then  double  vision  ap- 
peared. 

Patient  was  reexamined  May  16,  1930.  At  this 
time  patient  showed  paralysis  of  lateral  gaze  to 
the  right,  slow  nystagmus  on  looking  to  the  right, 
quick  nystagmus  on  looking  to  the  left,  corneal 
analgesia  left  side.  Weakness  left  lower  face, 
difficulty  in  swallowing.  Deep  reflexes  in  the  arms 
hyperactive  and  equal.  Abdominal  reflexes  not 
obtained.  Bilateral  Babinski  with  inexhaustible 
ankle  clonus  on  the  left.  Diminished  vibratory^ 
sense  both  legs  especially  the  right.  There  is 
hyperesthesia  to  cold  right  leg.  There  is  atrophy 
of  the  small  muscles  of  the  hand  especially  the 
right.  Marked  emotional  instability,  patient 
laughs  and  cries  inordinately.  No  disturbance  of 
the  bladder  and  rectum.  Patient  so  dizzy  unable 
to  sit  up,  the  head  falls  forward  and  patient  has 
difficulty  keeping  the  head  erect.  Marked  ataxia 
of  the  left  hand;  so  ataxic  it  is  impossible  for  her 
to  walk  at  all.  Patient  died  in  September,  1930. 
The  onset  of  the  condition  after  an  attack  of  in- 
fluenza, the  absence  of  cells  and  gold  reaction  in 
the  spinal  fluid,  the  rapid  progress  of  the  con- 
dition, the  upper  and  lower  motor  neuron  symp- 
toms with  fatal  termination  in  a short  time  point 
to  a diagnosis  of  acute  disseminated  encephalitis 
rather  than  multiple  sclerosis. 

Case  2. — Patient,  white  man,  aged  32.  First 
symptoms;  weakness  right  arm  in  March,  1931. 

A month  later  the  right  leg  became  weak,  also 
noticed  difficulty  in  writing.  Six  weeks  ago  had 
paralysis  of  swallowing,  regurgitated  fluids 
through  the  nose.  Double  vision  one  month  after- 
ward. In  June,  speech  became  alfected,  woke  up 
one  morning,  could  not  talk  at  all. 

Neurological  examination  August  3,  1931: 

papillae  showed  temporal  pallor  of  the  left  disc, 
low  grade  optic  neuritis  right  eye.  Marked 
nystagmus  on  looking  to  the  right,  weakness  right 
lower  face,  difficulty  in  swallowing.  Patient  is 
very  dizzy,  when  he  sits  up  the  room  revolves 
around  him  to  the  right.  Deep  reflexes  hyper- 
active, more  so  on  the  right  side,  right  arm 
paralyzed,  upper  motor  neuron  paralysis.  Ab- 
dominals absent  on  the  right,  slow  on  the  left. 
Bilateral  Chaddock  and  Babinski  are  more  pro- 
nounced on  the  right.  Marked  emotional  insta- 
bility with  rapid  change  from  laughing  to  crying. 
Spinal  fluid  pressure  measures  18  centimeters. 
Fluid  showed  negative  Wassermann,  contained 
two  and  a half  lymphocytes  per  cubic  millimeter. 
Globulin  normal  amount,  gold  curve  negative. 
Patient  seen  again  August  22,  1931.  Complained 
of  headache,  could  not  control  the  bladder,  paraly- 
•^s  of  lateral  gaze  to  the  left,  difficulty  swallow- 
ing, weakness  right  lower  face,  paralysis  right 
side,  bilateral  Babinski  more  so  on  the  right,  ab- 
sent abdominal  both  sides.  Patient  died  Novem- 
ber, 1931.  Rapid  progress  in  this  case  without  his- 


242 


The  Ohio  State  Medical  Journal 


April,  1933 


tory  of  previous  attacks  and  remissions  together 
with  negative  gold  curve,  fatal  termination,  point 
to  a diagnosis  of  acute  disseminated  encephalitis 
rather  than  brain  tumor. 

Case  3. — Patient,  G.  S.,  aged  32,  seen  March  7, 
1932.  In  1925,  patient  had  an  attack  which  was 
diagnosed  as  infantile  paralysis.  The  patient  had 
headache,  double  vision  and  stiff  neck  at  that  time. 
She  became  comatose,  was  paralyzed  in  all  four- 
extremities  at  that  time.  She  gradually  improved 
and  now  has  only  slight  weakness  of  right  arm 
and  right  leg. 

Neurological  examination: — March  7,  1932. 

Papillae  normal,  pupils  normal,  upper  motor 
neuron  weakness  right  lower  face,  deep  reflexes 
hyperactive  right  arm.  Abdominals  absent  both 
sides,  positive  Chaddock  right  side,  segmental 
atrophy  muscles  of  right  hand  and  arm  and  right 
leg.  Here  we  see  an  infection  of  the  nervous 
system  which  began  with  a meningo-encephalitis 
together  with  upper  and  lower  motor  neuron 
symptoms  showing  residuals  of  the  same  seven 
years  after. 

Case  4 — G.  B.,  aged  54,  seen  May  1,  1928.  On- 
set ten  days  before  with  fever  and  headache.  Had 
been  diagnosed  typhoid  fever.  Nine  days  after 
onset  diplopia  developed.  When  seen  on  May  1st 
patient  showed  the  following  findings : 

Headache,  diplopia,  bilateral  choked  disc,  stiff 
neck,  segmental  atrophy  in  muscles  of  arms  and 
legs,  deep  reflexes  hyperactive  in  the  sound  mus- 
cles, paralysis  of  bladder,  pyramidal  type,  a band 
of  hyperesthesia  such  as  is  seen  in  transverse 
myelitis  at  the  level  corresponding  to  fifth  and 
ninth  dorsal  segments;  bilateral  loss  of  abdominal 
reflexes,  bilateral  Babinski  and  bilateral  ankle 
clonus.  There  were  also  neuritie  signs  with 
marked  tenderness  over  both  sciatic  nerves.  There 
was  hypesthesia  in  the  area  below  the  band  of 
hyperesthesia.  Ten  days  later  bulbar  signs  super- 
vened with  paralysis  of  swallowing  and  respira- 
tion and  death.  Unfortunately,  an  autopsy  was 
refused.  However,  we  saw  in  this  case  meningo- 
encephalitic  signs  associated  with  transverse 
myelitis,  anterior  polio-myelitis  as  well  as  marked 
radicular  signs.  This  was  an  undoubted  case  of 
acute  disseminated  encephalo-myelitis. 

ACUTE  HEMORRHAGIC  ENCEPHALITIS 

This  disease  is  characterized  by  hemorrhagic 
foci  throughout  the  brain.  There  is  usually 
thrombo-phlebitis  of  the  cortical  and  pial  vessels, 
the  so-called  brain  purpura. 

Symptoms:  Headache,  meningeal  signs,  coma, 
convulsions,  choked  disc,  cranial  nerve  palsies, 
hemi  and  mono  plegias.  Death  may  occur  within 
a week  or  partial  recovery  may  supervene. 

I have  known  two  cases  of  this  disease  to  be 
operated  for  brain  tumor.  Both  died  following 
operation. 

SYDENHAM’S  CHOREA 

Formerly  this  disease  was  classed  as  a neurosis. 
However,  there  is  now  little  doubt  but  that  acute 
chorea  is  a form  of  encephalitis.  Bassoe  in  the 
preface  to  the  year  book  of  1928  speaks  of  Syden- 
ham’s chorea  as  a form  of  encephalitis. 

Numerous  contributions  to  the  pathology  of 
Sydenham’s  Chorea  definitely  establish  the  above 
view. 

Creutzfeldt  Arch,  fur  Psychiat.,  Vol.  71,  1924, 


describes  focal  inflammatory  lesions  especially  of 
the  white  matter  as  well  as  degenerative  processes 
in  the  gray  matter  especially  the  small  cells  of  the 
corpus  striatum.  No  bacteria  were  found. 

VanGehuchten  Revue  Neurol.,  1931,  reports 
hyperemia  of  pia  of  brain  with  peri-vascular  in- 
filtration of  lymphocytes  in  the  caudate  nuclei, 
bulb,  pons  and  crura  cerebri  as  well  as  ganglion 
cell  changes  in  the  thalamus,  putamen  and  caudate 
nucleus.  He  describes  both  inflammatory  and  de- 
generative changes. 

Case  1 — H.  S.  Seen  April  8,  1931.  Complain- 
ing of  loss  of  taste  on  left  side  of  tongue.  The  left 
side  of  body  including  face  feels  numb.  Complains 
of  headache  and  involuntary  crying.  Patient  had 
St.  Vitus  dance  ten  years  ago,  left  side  of  body 
was  weak  at  that  time.  The  following  day  com- 
plained of  tingling  in  left  hand,  the  left  arm  and 
leg  feeling  heavy  and  tired. 

Neurogolical  findings: — Papillae  normal.  Pu- 
pils normal.  No  nystagmus,  external  eye  muscles 
normal.  Weakness  left  lower  face.  Abdominals 
diminished  left  side.  There  is  a positive  Babinski 
on  the  left  side.  All  symptoms  subsided  following 
spinal  puncture. 

Case  b — L.  W.  Patient,  white  girl,  aged  16. 
Seen  February  4,  1929.  Chief  complaint  twitching 
of  right  hand,  also  twitching  of  right  leg.  Irregu- 
lar choreic  movements  of  tongue  at  times.  Pa- 
tient has  athetoid  movements  of  the  right  hand 
and  arm.  Sensation  diminished  on  right  side  of 
body  in  all  modes.  Diagnosis  of  Sydenham’s 
Chorea  made  at  this  time. 

Patient  seen  again  January,  1931.  Choreiform 
and  athetotic  movements  had  been  present  at  in- 
tervals since  1929.  An  enlarged  thyroid  had  been 
removed  in  hope  of  cure. 

Neurological  examination  in  1930: — Upper 
motor  neuron  paresis  of  left  arm  and  leg  with 
athetotic  jerking  of  left  leg.  Abdominals  absent 
left,  Chaddock  and  Babinski  on  the  left.  Spinal 
fluid  under  normal  pressure.  Spinal  fluid  Wasser- 
mann  negative.  Fluid  contained  no  cells,  a great 
excess  of  globulin,  Lange’s  gold  curve  was  normal. 
A-rays  of  skull  were  negative.  Patient  was 
operated  for  brain  tumor.  No  tumor  was  found. 
Inspection  of  the  brain  at  operation  revealed 
chronic  leptomeningitis.  Autopsy  was  refused. 

SUMMARY 

In  this  paper  we  have  reviewed  the  literature 
dealing  with  encephalitis.  We  have  seen  that 
many  neurological  disorders  of  childhood  such  as 
epilepsy  have  their  origin  in  a previous  enceph- 
alitis. 

When  confronted  with  neurological  symptoms 
in  a child  which  suggest  a diagnosis  of  brain 
tumor  or  epilepsy,  we  should  carefully  inquire 
concerning  meningo-encephalitic  symptoms  oc- 
curring in  the  course  of  the  ordinary  infections  of 
childhood  as  well  as  any  such  symptoms  asso- 
ciated with  vaccination  or  immunization  pro- 
cedures. By  so  doing  we  will  be  better  able  to 
understand  the  symptoms  with  which  we  are 
dealing.  Furthermore,  unnecessary  operations  for 
brain  tumor  with  their  attendant  disastrous  re- 
sults will  be  avoided. 

903  Carew  Tower. 


Pnewmococcic  Memiingitis  Comfomed  "Witli  Streptococcus 
and  EDlplococcus^  Catarrhalis 

S.  H.  Ashmun,  M.D.,  Dayton,  Ohio 


A TYPE  of  case  that  is  similar  to  forty 
others  that  have  been  reported,  ceases  to 
be  new  or  unusual  and  yet,  it  is  a com- 
paratively short  time  since  the  recovery  from 
meningitis  caused  by  pneumococcus  was  thought 
well  nigh  impossible.  Whiting,  in  1913,  said  that 
all  cases  of  general  suppurative  meningitis  die. 

It  is  interesting  to  analyze  the  methods  of 
treatment  used  and  one  is  quickly  impressed  with 
the  tremendous  increase  in  the  chance  for  re- 
covery if  the  diagnosis  is  early  and  if  the  solu- 
tion of  numoquin  hydrochloride  is  used  in  the 
pneumococcic  variety.  The  dosage  of  numoquin 
hydrochloride,  (now  sold  under  the  trade  name  of 
optochin  hydrochloride)  is  more  or  less  generally 
accepted  to  be  1 c.c.  of  1:1000  solution  in  sterile 
normal  salt  solution  to  each  2 kilos  of  body  weight 
divided  into  4 to  6 injections,  one  or  more  intra- 
spinal  injections  daily  until  the  spinal  fluid  is 
sterile. 

Kolmer'  deserves  credit  for  his  early  mention 
in  reporting  the  successful  treatment  of  strepto- 
coccus meningitis.  He  advocates  the  use  of  ethyl 
hydrocuprein  hydrochloride  by  intravenous,  in- 
tramuscular and  intrathecal  routes  and  the  use 
of  gentian  violet  and  neutral  acriflavin  and 
Pregl’s  solution  by  intravenous  injections.  He 
does  not  seem  to  be  much  concerned  with  staph- 
lococcus  as  a complicating  organism,  but  I am 
sure  that  it  may  be  the  deciding  factor  if  not 
treated  promptly  by  injection  10  to  30  c.c.  of  .5 
aqueous  gentian  violet  solution.  Kolmer  adds  the 
solution  to  anti-streptococcus  serum. 

Rosenberg  and  Nottley2  of  Brooklyn,  N.  Y., 
used  repeated  injections  of  anti-streptococcus 
serum  and  irrigated  the  spinal  canal  with  acri- 
flavin solutions.  They  reported  40  cases  in  the 
literature.  This  is  now  increased  to  50.  Most  of 
these  cases  followed  acute  tonsillitis.  Seven  cases 
responded  to  lumbar  drainage  alone,  no  other 
therapy  being  used. 

Rohrbach'  reports  a case  of  pneumococcus 
meningitis  with  uveitis  and  loss  of  sight  in 
one  eye  without  the  other  eye  being  affected 
and  with  deafness  of  both  ears.  He  did  not  use 
the  ethyl  hydrocuprein  hydrochloride  in  his  case, 
or  many  clinicians  would  have  attributed  the  loss 
of  sight  and  involvement  of  hearing  to  the  drug. 
I mention  this  because  I have  not  observed  the 
amblyopia  that  has  been  attributed  to  the  drug; 
however,  one  of  my  cases  did  have  severe  involve- 


Read  before  the  Section  on  Obstetrics  and  Pediatrics, 
Ohio  State  Medical  Association,  86th  Annual  Meeting,  Day- 
ton,  May  3 and  4,  1932. 

Pediatrist,  St.  Elizabeth  Hospital,  Dayton,  Ohio. 


ment  of  one  eye  before  treatment  was  begun. 
Synge4  had  recovery  of  one  case  of  type-4-pneu- 
mococcus  meningitis  with  drainage  alone.  Huene- 
kens  and  Stroesser5  used  drainage  and  irrigation 
in  case  of  hemolytic  streptococcus.  Their  case 
recovered.  Christianson,  quoted  by  Bauer  and  St. 
Clair,  had  16  fatal  cases,  four  of  them  after 
otitis  media,  all  type-3-pneumococcus.  In  their 
own  18  cases,  those  that  followed  ear  disease  were 
type-3.  Those  without  otitis  were  type-4. 

Globus  and  Kasonin14  say  type—3-pneumococcus 
is  common  or  may  predominate  if  otitis  media 
precedes  the  attack.  Lynch7  used  Felton’s  serum 
and  drainage  and  reported  recovery  without  use 
of  ethyl  hydrocuprein  hydrochloride.  No  type  was 
recorded.  Korkavy8  also  used  Felton’s  serum  on 
type-1 -pneumococcus  with  recovery  that,  he  at- 
tributed to  early  diagnosis.  Moersch  and  Thomp- 
son’ had  two  cases  of  micrococcus  catarrhalis 
meningitis  that  recovered  with  drainage  and  sup- 
portive treatment.  Vining  and  Thompson'"  re- 
corded the  most  rapid  recovery  of  their  cases  of 
hemolytic  streptococcus  meningitis,  of  tonsillar 
origin  with  use  of  anti-meningococcus  serum,  in- 
traspinally.  Recovery  in  24  hours.  Eagleton'1 
says  rhinorrheal  cases  nearly  always  develop 
miningitis  due  to  a lack  of  closure  of  subdural 
spaces,  and  the  frontal  mucosa  invades  these 
openings  by  cyst-like  growth  into  the  sub-arach- 
noid space,  thus  explaining  hereditary  predisposi- 
tion to  meningitis.  My  first  case  shows  a marked 
hereditary  tendency. 

Ratnoff  and  Litvak'2  advocate  the  use  of  the 
ethyl  hydrocuprein  hydrochloride  solution  along 
with  serum  either  the  pneumococcic,  anti-menin- 
gococcic  or  anti-streptococcic  serum,  lest  a cura- 
tive dose  of  the  ethyl  hydrocuprein  hydrochloride 
alone  might  cause  amblyopia  or  blurring  of  vision. 
Kolmer1  says  the  toxic  dose  is  60  times  the  ad- 
vocated dose.  My  cases  all  received  relatively 
high  doses,  yet  none  suffered  any  more  than  slight 
papilledema  and  no  blurring  of  vision  unless  in 
the  cases  of  the  very  young  babies  where  these 
symptoms  would  be  difficult  to  elicit.  Hugo  Wells13 
reported  paling  of  the  discs  but  no  further  signs. 
Others  that  have  made  valuable  reports  on  septic 
meningitis  are  Goldstein13,  Apfel16,  Homer  Cassel17, 
J.  A.  Evans18,  and  a most  excellent  report  by 
Emanuel  Appiebaum18.  A still  more  recent  report 
has  been  made  by  Crawford20  of  Detroit. 

I shall  now  review  three  recovered  cases  and 
two  fatal  cases,  and  shall  mention  the  postmortem 
findings  in  a more  recent  case  that  emphasizes 
the  advantages  of  cistern  and  ventricular  punc- 
ture. 


243 


244 


The  Ohio  State  Medical  Journal 


April,  1933 


CASE  REPORTS 

Ned.  D. — Six  years  of  age,  well  nourished  boy, 
whose  birth  history  was  very  normal  in  every 
way,  but  at  three  weeks  he  developed  pyloric 
stenosis  and  had  a Fredet-Rammstedts  operation. 
He  has  had  a right  inguinal  hernia.  Has  noc- 
turnal enuresis.  Had  whooping  cough,  acute 
bronchitis,  and  measles,  followed  by  acute  otitis 
media  at  5 years  of  age.  The  otitis  recovered  in 
average  time. 

Family  History:  Is  one  of  importance,  inas- 
much as  two  maternal  uncles  died  of  meningitis, 
one  at  the  age  of  14  years,  the  other  died  at  the 
age  of  18  years,  both  streptococcic  infection. 
Another  uncle  now  living  is  a victim  of  chronic 
sinus  infection. 

Present  History:  This  attack  followed  a long 
ride  from  Hartford,  Connecticut,  where  he  had 
been  definitely  exposed  to  epidemic  poliomyelitis. 
I saw  him  within  a few  hours  after  he  began  to 
complain  of  sore  throat  and  headache  and  extreme 
restlessness.  He  was  very  excited,  talkative,  in- 
coherent and,  in  all,  was  behaving  very  un- 
usually. 

Physical  Examination:  Temperature,  101  de- 

grees, pulse,  96.  His  face  Was  flushed;  you  could 
see  that  the  boy  was  very  sick. 

Eyes:  Pupils  equal — moderately  dilated  and  re- 
acted normally  to  light  and  distance.  Eye  grounds 
normal. 

Ears:  Canals  clean,  left  drum  has  a scar  well 
healed,  site  of  perforation  during  measles. 

Teeth:  Has  not  lost  any  of  deciduous  teeth. 

Throat:  Very  important  on  account  of  redness 
and  slight  amount  of  exudate  on  both  tonsils.  I 
made  a throat  smear  and  culture.  There  were  no 
ulcers  in  throat  and  tongue  showed  absence  of  any 
sign  of  long  illness. 

The  Thorax:  Was  essentially  negative. 

Heart:  Was  not  enlarged,  no  murmur. 

Lungs:  Breathing  rate  increased  but  no  rales, 
sturtor  or  abnormal  areas  of  dullness. 

The  Abdomen:  Was  slightly  distended,  no  ten- 

derness, but  extremely  sensitive  all  over.  There 
was  a scar  at  site  of  Rammstedts  operation.  The 
hernia  was  visible  and  easily  reducible.  The  skin 
was  clear,  no  eruption. 

The  Neck:  Was  stiff,  there  was  a definite  neck 
sign.  There  was  positive  Kemig  and  Babinski 
but  no  clonus  present.  He  was  unable  to  permit 
flexion  of  the  head  on  the  chest  or  the  chest  on 
the  thighs,  a most  valuable  test  for  poliomyelitis. 
He  had  unusual  sub-occipital  and  spinal  tender- 
ness. He  had  entered  school  the  same  day,  and  in 
view  of  unusual  excitement  and  its  attending  ef- 
fects, I placed  an  ice  cap  to  his  head,  emptied 
bowels,  and  waited  till  morning  when  the  signs 
left  no  doubt  that  we  had  a meningo-encephalitis 
because  he  was  mentally  dopey,  more  stiff  and  the 
throat  appeared  worse.  Spinal  puncture  was  done, 
30  c.c.’s  of  turbid  fluid  was  sent  to  laboratory. 
The  blood  count  was  made.  Hemoglobin,  .90. 
Red  cells,  4,352,000.  Leucocytes,  6,400.  Polys,  60. 
Segmented  48.  Unsegmented  12.  Small  32.  Large, 
7.  Eosinophiles,  1.  The  throat  smears  were  re- 
ported as  pneumococcus,  diplococcus,  catarrhalis 
and  streptococcus  hemolyticus.  The  culture  re- 
port was  the  same  as  the  smear.  The  smear  of 
the  spinal  fluid  as  well  as  the  culture  was  identical 
with  that  from  the  throat.  The  cell  count  was 
only  40. — 80  lymphocytes.  Sugar  normal,  globulin 
increased,  certainly  this  was  a very  early  involve- 
ment of  the  meninges.  I gave  him  numoquin 
hydrochloride  by  spine  within  two  hours  of  the 
examination  of  the  smear  from  the  spinal  fluid. 


At  the  same  time  I gave  30  c.c.  of  neutral  acri- 
flavin  solution  intravenously.  Fluid  drawn  from 
spine  on  second  day  gave  identical  report  from 
smear  and  culture.  The  pneumococcus  was  re- 
ported as  a luxuriant  growth.  Two  injections  of 
the  ethyl  hydrocuprein  hydrochloride  were  given 
on  the  second  day  and  fluid  drawn  on  the  third 
day  of  disease  showed  480  cells,  polys,  85,  lymph- 
ocytes, 15.  Globulin  very  much  increased.  Smear 
showed  no  bacteria.  Culture  sterile  after  48 
hours.  He  had  a great  deal  of  abdominal  pain  and 
considerable  nausea  that  responded  to  glucose  by 
vein. 

Recovery  was  complete  in  one  week.  He  was 
kept  in  bed  for  another  week.  We  had  tonsils  re- 
moved one  month  later.  A biopsy  of  tonsils 
showed  marked  inflammatory  changes  and  culture 
showed  same  combination  of  organism  in  luxur- 
iant growth,  pneumococcus,  and  streptococcus 
hemolyticus.  I realize  full  well  that  virulence  may 
vary  considerably  in  different  cases,  but  this  case 
enables  us  to  draw  some  valuable  inference.  First, 
there  was  an  apparent  family  predisposition  to 
meningeal  disease.  Second,  the  response  to  numo- 
quin hydrochloride,  neutral  acriflavin  and  drain- 
age was  very  prompt  and  seemingly  specific. 
Third,  the  origin  was  obviously  from  tonsils. 
Fourth,  there  was  striking  resemblance  of  the 
onset  to  that  of  poliomyelitis  and  the  rapid  re- 
covery was  no  doubt  due  to  the  early  diagnosis 
and  treatment. 

Dale  D. — Seven  years  of  age,  born  when  mother 
was  42  years  of  age  and  during  her  climacteric. 
He  had  several  brothers,  the  next  older  being  17 
years  of  age  when  the  patient  was  born.  His 
nursing  period  and  early  development  were  very 
bad  and  he  had  a vesicular  skin  eruption  at  one 
year  that  involved  palms,  soles  and  entire  body 
and  left  brownish  discoloration  when  they  healed. 
He  had  chicken  pox,  whooping  cough,  and  epi- 
demic mumps  three  and  four  years  of  age.  The 
illness  that  I am  reporting  Was  the  outcome  of  an 
illness  that  had  really  been  continuous  from 
September,  1930  to  June,  1931.  The  illness  began 
with  a streptococcus  sore  throat  requiring  trach- 
eotomy with  a sequence  of  pneumonia,  empyema, 
long  drainage,  etc.  He  had  vomited  and  was 
irrational  for  five  or  six  months,  carried  a low 
temperature,  was  very  emaciated,  and  his  lower 
limbs,  especially  the  left,  were  markedly  con- 
tracted. However,  when  I was  called,  he  had  be- 
come acutely  ill,  temperature,  104  degrees.  The 
eye  grounds  were  very  pale,  with  choking  of  discs. 
The  throat  and  ears  were  normal,  heart  sounds 
weak,  pulse  rapid  and  soft,  lungs  were  now  clear. 
The  skin  was  dry.  Palms  of  the  hands  and  soles 
of  the  feet,  both  showed  vasomotor  map  of  men- 
ingitis. Spinal  puncture  showed  marked  increase 
of  pressure,  turbid  fluid  with  many  flakes  but  no 
web  formation.  Cells,  21,000.  Polys,  95.  Globulin, 
(four  plus.)  Sugar,  normal  amount.  Smear, 
many  extra  cellular  gram  negative  and  positive- 
cocci.  No  intracellular  cocci  and  no  T.  B.  pneu- 
mococci in  streptococcic  formation.  The  culture 
showed  pneumococci  and  diplococci  catarrhalis. 
Wasserman,  (Four  plus.)  Neutral  acriflavin  was 
given  at  once  by  vein,  and  optochin  hydro- 
chloride by  spinal  route,  but  severe  nervous  re- 
action followed,  so  that  on  following  days  I re- 
duced amount  in  spine  to  % and  gave  % by 
vein.  Two  days  later,  smear  and  culture  were 
sterile,  and  cells  25  polys  from  web.  Six  days 
later,  smear  from  web  formed  in  spinal  fluid  was 
free  from  bacteria,  but  culture  still  showed 
diplococci  catarrhalis.  Another  dose  of  neutral 
acriflavin  was  given,  and  all  subsequent  punctures 
gave  a sterile  fluid.  He  required  frequent  ejec- 
tions of  glucose  and  was  given  courses  of  bismuth 


April,  1933 


Pneumococcic  Meningitis — Ashmun 


245 


and  cacodylate  of  soda  with  negative  blood  Was- 
sermann,  five  months  later.  He  did  not  cerebrate 
at  all  for  months  but  finally  recovered  from  his 
mental  aberration  and  learned  to  talk  much  as  a 
baby  begins.  He  learned  to  crawl  and  walk,  and 
has  made  a very  complete  recovery.  My  impres- 
sions are  that  this  case  may  well  have  been  a 
pneumococcic  abscess  that  ruptured  and  caused 
the  general  pneumococcic  meningo-encephalitis. 
While  there  were  no  localizing  signs  on  examina- 
tion, the  mother  noticed  that  the  left  leg  had  been 
drawn  up  long  before  the  other,  and  the  left  arm 
was  practically  useless. 

Robert  G. — Age  six  years.  Parents  were  Irish- 
American.  Admitted,  12-25-26.  Discharged,  well, 
3-31-27.  C.  C. : — Frontal  headache  and  nausea. 
Previous  history:  was  essentially  negative  except 
for  mental  backwardness. 

Family  history:  Both  parents  were  living  but 
of  inferior  intelligence.  One  brother  died  at  six 
months  of  intestinal  obstruction,  due  to  many  con- 
genital bands.  He  was  born  with  imperforate 
anus.  One  sister  died  of  pneumococcic  meningitis 
that  ran  a very  rapid  course.  Physical  examina- 
tion showed  child  to  present  the  usual  picture  of 
acute  purulent  meningitis.  Eyes:  pupils  sluggish, 
choking  of  discs.  Ears:  no  redness,  no  bulging 
of  drums,  no  evidence  of  previous  involvement. 
Tonsils,  uninvolved.  Teeth,  good.  Heart:  no  en- 
largement, no  abnormal  sounds,  rate,  120.  Pulse, 
good  volume  and  regular.  Lungs:  no  areas  of 
impaired  resonance,  no  friction,  no  rales.  Ab- 
domen, extremely  tender,  as  was  also  entire  body. 
G.  U.:  had  hypospadias.  Nervous  system,  marked 
oposthotomus.  Brudzinski,  or  neck  sign,  positive, 
and  Kemig  and  Babinski  were  positive.  Kernig’s, 
very  positive.  Knee  jerks  were  very  exaggerated. 
Tache  Cerebrale  present. 

Daily  lumbar  punctures  were  made  for  several 
days.  Fluid  turbid,  marked  increase  of  globulin. 
Cell  count  showed  20,000  cells.  Polys,  90  on  first 
count,  dropping  to  4, 000. -3, 000. -500. -400. -300. -cells 
succeeding  days.  Gram  positive  intracellular 
diplococcus  was  found  constantly  in  smear 
until  the  eighth  day  when  a pneumococcus 
in  streptococcus  arrangement  was  reported  by 
laboratory  technician.  The  blood  count  was  one 
that  would  have  done  credit  to  any  pneumococcic 
septicemia— 28,000  whites,  90  polys,  hemoglobin, 
82.  Large,  8.  Small,  2.  Temperature  104  degrees. 
Of  course  antimeningitic  serum,  intravenously 
and  intraspinally,  was  used  till  pneumococci  were 
reported,  then  we  changed  to  pneumococcic  im- 
munogin  combined.  Patient  had  a recrudescence 
about  50  days  after  admittance,  requiring  cistern 
drainage.  Patient  had  a very  slow  convalescence 
requiring  much  fluid  by  every  route  known,  forced 
feeding,  etc.  He  became  speechless  and  even  his 
eyesight  was  in  question,  as  well  as  his  hearing. 
All  these  faculties  were  completely  recovered. 
He  suffered  an  attack  of  lobar  pneumonia  two 
years  later  and  made  another  complete  recovery, 
but  I would  say  he  still  has  a rather  low  intel- 
ligence quotient.  This  case  was  remarkable  be- 
cause of  his  sister’s  having  same  infection,  be- 
cause of  change  in  laboratory  report  from  epi- 
demic type  of  organism  to  that  of  pneumococcic 
meningitis,  and  because  we  did  not  use  any  mer- 
curochrome  or  other  dye  injections.  I might  also 
add  that  the  recrudescence  of  the  attack  appeared 
due  to  spinal  block  and  responded  to  Cisterna 
Magna  puncture  and  drains,  with  1500  cells  but 
negative  culture  after  36  hours. 

L.  B. — Baby  boy,  age  13  months  of  age,  who 
had  been  ill  for  about  eight  days,  was  seen  by 
consultant  from  another  city  four  days  before. 


He  diagnosed  meningeal  condition  but  warned 
family  not  to  allow  spinal  puncture  because  “baby 
would  surely  die  if  punctured”.  At  time  of  my 
visit,  baby  was  moribund,  extremely  rigid,  one  eye 
showed  extreme  strabismus,  and  the  fontanelle, 
though  nearly  closed,  was  tightly  bulging.  The 
baby  Was  not  vomiting,  urine  contained  many  pus 
cells,  and  intestinal  elimination  was  about  normal. 
Ventricular  puncture  was  done  to  relieve  pressure 
when  it  was  found  that  block  existed  due  to  thick 
fluid.  Cell  count,  ^,000.  Globulin,  Four  Plus. 
Culture,  short  chained  streptococci  and  pneu- 
mococcus. Neutral  acriflavin  was  given  intra- 
venously 20  c.c.  containing  O.I.  gm.  of  the  drug 
in  normal  salt  solution.  Improvement  was  marked 
and  optochin  hydrochloride  was  given  next  A.  M. 
after  relieving  pressure  by  cistern  puncture.  The 
baby  died  at  9:00  A.  M.  the  following  day — a 
penalty  for  delayed  diagnosis  and  delayed  treat- 
ment. 

Janet  McK. — Two  and  one-half  years  of  age. 
Sick  two  and  one-half  months  with  typical  his- 
tory of  acrodynia.  Both  ears  bad,  had  been 
opened  one  or  more  times  by  various  consultants 
in  effort  to  determine  cause  of  restlessness.  Ex- 
amination quickly  confirmed  the  diagnosis  of 
acrodynia.  Hands  and  feet  swollen,  red  and 
desquamating.  Child  was  constantly  pulling  the 
hair  and  had  very  little  left  to  pull  out.  It  suffi- 
ces to  say  that  two  weeks  later  the  baby  became 
very  dopey,  and  I was  called  back  to  find  a baby 
that  now  had  a discharging  ear,  marked  opisth- 
otonus and  unconsciousness.  The  eye  grounds 
showed  choking  of  the  discs.  Spinal  puncture  was 
made.  Fluid  report  showed  1,420  cells,  75  polys, 
globulin  very  unusually  increased.  Smear  showed 
diplococci,  pneumococci,  and  streptococci.  Culture 
showed  short  chained  streptococci  and  pneumo- 
cocci, not  typed.  Three  doses  of  optochin  hydro- 
chloride were  given  by  spinal  route  and  one  dose 
of  acriflavin  by  vein.  On  the  fourth  day,  fluid 
was  free  from  pneumococcus  and  streptococcus. 
Cell  count,  410  cells.  Child  became  worse  and 
died  with  extremely  high  temperature.  Post- 
mortem showed  ventricules  filled  with  turbid  fluid 
that  showed  streptococci  but  no  pneumococci. 

SUMMARY 

The  following  conclusions  seem  very  evident: 
First,  the  early  differential  bacteriological  diag- 
nosis of  the  various  types  of  meningitis  is  very 
essential.  Second,  the  prompt  use  of  ethyl  hydro- 
cuprein  hydrochloride  intraspinally,  when  indi- 
cated, combined  with  the  intravenous  use  of 
neutral  acriflavin.  Third,  drainage  of  both  spine 
and  cistern  are  necessary,  if  spinal  is  not  wholly 
adequate.  Fourth,  the  importance  of  changing 
the  prognosis  from  one  entirely  hopeless  to  one 
in  which  there  is  a fair  chance  of  recovery. 

1084  Reibold  Building. 

discussion 

J.  P.  Farson,  M.D.,  Columbus. — I wish  to  con- 
gratulate Dr.  Ashmun  upon  his  excellent  paper, 
and  upon  his  successful  treatment  of  this  dreaded 
disease.  My  experience  with  septic  meningitis  has 
been  limited  and  my  mortality  rate  still  remains 
the  same — 100  per  cent. 

In  the  past  we  have  been  considering  these 
cases  as  practically  hopeless,  with  a tendency  to 
treat  them  as  such.  But  now  it  seems  that  we  are 
justified  in  changing  our  attitude  to  a more  hope- 
ful one. 


246 


The  Ohio  State  Medical  Journal 


April,  1933 


As  I see  it,  the  first  consideration  in  the  treat- 
ment of  this  condition  is  to  establish  good  drain- 
age— perhaps  continuous  drainage.  This  is  ac- 
complished by  a combination  of  lumbar  punctures, 
cisterna  punctures,  and  ventricular  taps,  which 
may  also  be  aided  by  the  injection  of  air.  Intra- 
carotid injections  seem  to  show  promise.  Just 
what  additional  therapy  should  be  used,  such  as 
serum,  dye,  or  a combination  of  the  two,  seems  to 
be  more  deeply  imbedded  in  the  experimental 
stage.  A specific  serum  should  be  used  when  pos- 
sible. 

Such  contributions  as  Dr.  Ashmun  has  just 
given  us,  along  with  two  articles  published  only 
last  month  in  The  Journal,  A.M.A.,  one  by  Ap- 
plebaum,  April  9,  the  other  by  Crawford,  April 
30,  and  the  recent  work  of  Gardner,  Kolmer,  and 
others,  in  the  treatment  of  septic  meningitis,  is 
certainly  encouraging,  and  the  time  is  not  far  dis- 
tant, I hope,  when  we  can  meet  these  cases  with 
a certain  degree  of  confidence. 

BIBLIOGRAPHY 

1.  Kolmer,  J.  A. — Journal  A.M.A.,  March  16,  1929.  Vol. 
92,  Page  874.  April  25,  1932.  Vol.  96.  Page  1358. 

2.  Rosenberg,  Lester,  and  Nottley,  H.  W.,  of  Brooklyn. 
Recovery  from  Streptococcic  Meningitis.  Arm.  Int.  Med., 
March,  1931,  Vol.  4,  Page  1154. 

3.  Rohrback,  Harvey  O.,  Bethlehem,  Pa. — Penn.  Med. 
Jour.,  Vol.  32.  Pages  646-647.  June,  1929. 

4.  Synge,  V.  M. — Pneumococcic  Meningitis  with  Recovery. 
Lancet.  April  10-26. 

5.  Huenekens,  E.  J.,  and  Stoesser,  A.  V.,  Memphis — 
Meningitis,  Streptococcus  Hemolyticic  and  Pneumococcus. 
Am.  Jour.  Dis.  Children.  May,  1927.  Vol.  33,  pp.  729-783, 

6.  Bauer  and  St.  Clair — Jour  A.M.A.,  Vol.  90,  pp.  1429- 
1430. 

7.  Lynch — Report  of  Recovery  of  one  case  of  Pneu- 
mococcic Meningitis.  New  England  Med.  Jour.  Aug.  7, 
1930. 

8.  Korkavy,  Joseph,  New  York — Pneumococcic  Menin- 
gitic. Recovery  with  Felton  Serum.  Jour.  A.M.A.,  Feb.  25, 

1928.  Vol.  90,  pp.  597-599. 

9.  Moersch  and  Thompson,  Rochester— -Mayo  Clinic.  Two 
cases  Micrococcus  Catarrhalis  Meningitis,  with  recovery. 
Lancet.  1928. 

10.  Vining,  C.  W.  and  Thompson,  H.  P.^— Recovery — 
Hemolytic,  Streptococcic,  Meningitis,  Tonsilar  origin.  British 
Med.  Jour.,  Oct.  11,  24. 

11.  Eagleton,  W.  P.,  Newark,  N.  J. — Anatomical  Predis- 
position to  Meningitis.  “Laryngoscope.'’  St.  Louis,  October, 

1929. 

12.  Ratnoff,  H.  L.  and  Litzak,  A.  M. — Pneumococcus 
Meningitis,  treated  with  Morgenroths  Optochin  Hydroch- 
loride with  recovery.  Archives  Ped.  Vol.  43,  p.  466,  July, 
1926. 

13.  Wella,  Hugo — Pneumococcic  Meningitic  with  recovery. 
U.  S.  Vet  Bureau  Med.  Bui.  Vol.  7,  pp.  77-78. 

14.  Globus  and  Kasonin — Pneumococcic  Meningitic.  Jour. 
A.M.A.  Feb.  25,  1928.  Vol.  90. 

15.  Goldstein,  Hyman,  I — Numoquin  Ethyl  Hydrocuprein 
Sol.  Med.  Jour,  and  Record.  Aug.  3,  1927. 

16.  Apfel  Harry — Pneumococcic  Meningitic,  treated  with 
Pregl’s  Solution.  Recovery  Arch.  Ped.  Aug.,  1929. 

17.  Cassel,  Homer — Streptococcic  Meningitis,  treated  with 
one  injection  serum.  O.  S.  Med.  Jour.,  May,  1930.  Vol.  26, 
pp.  401-402. 

18.  Evans,  J.  A. — Welsh,  S.  N.  “Treatment  of  Septic 
Meningitis  by  Carotid  Method.”  Ann.  Int.  Med.  April,  1913. 

19.  Applebaum,  Emanuel — “Streptococcic  Meningitis.” — 
Jour.  A.M.A.  Vol.  98,  1253..  April  9,  1932, 

20.  Crawford,  Albert,  Detroit — The  treatment  of  Strepoc- 
occic  Meningitis  by  Intra  Corotid  Route  with  Pregl’s  solu- 
tion. Jour.  A.M.A.,  April  30-32,  p.  1531. 


— Dr.  Mont  R.  Reid,  professor  of  surgery,  Uni- 
versity of  Cincinnati,  College  of  Medicine  has  been 
appointed  head  of  the  department  of  surgery,  Cin- 
cinnati General  Hospital,  succeeding  Dr.  George 
J.  Heuer,  now  at  Cornell  University.  The  direc- 
tors of  the  18  other  departments  of  the  hospital 
were  re-appointed  for  1933  by  the  Board  of 
Directors  of  the  University. 


Program  for  Post  Graduate  Day  of 
Mahoning  County  Society 

Sixth  Annual  Post  Graduate  Day  of  the  Ma- 
honing County  Medical  Society  is  planned  for 
Thursday,  April  20.  The  morning  and  afternoon 
sessions  to  be  held  at  the  Hotel  Ohio  and  the  din- 
ner and  evening  sessions  at  the  Youngstown  Club. 
Registration  fee,  including  dinner,  $5. 

The  following  program  has  been  arranged  by 
the  Post  Graduate  Committee,  consisting  of  Dr. 
G.  G.  Nelson,  chairman,  Dr.  J.  H.  Getty,  Dr.  P.  J. 
Fuzy,  Dr.  J.  D.  Brown,  Dr.  Saul  Tamarkin,  and 
Dr.  P.  H.  Kennedy: 

MORNING  SESSION 

9:00  a.m.  “Refinements  in  Tumor  Diagnosis”,  Dr.  James 
Ewing,  director  Memorial  Hospital,  New  York, 
and  professor  of  oncology,  Cornell  University 
Medical  School. 

10 :00  a.  m.  “Diagnosis  and  Treatment  of  Hodgkins’  Dis- 
ease, Leukemia  and  Lymphosarcoma”,  Dr.  Lloyd 
F.  Craver,  attending  physician.  Memorial  Hos- 
pital, New  York  City. 

11  :00  a.  m.  “The  Past  and  the  Present  in  the  Treatment 
of  Genito-Urinary  Carcinoma”,  Dr.  Benjamin 
S.  Barringer,  attending  urologist,  Memorial  Hos- 
pital, New  York  City. 

AFTERNOON  SESSION 

1:00  p.m.  “Melanoma”,  Dr.  Ewing. 

2 :00  p.  m.  “Medical  Problems  in  the  Treatment  and  Diag- 
nosis of  Cancer”,  Dr.  Craver. 

3:00  p.m.  “Radium  Treatment  of  Cancer  of  the  Bladder”, 
Dr.  Barringer. 

4 :00  p.  m.  “Cancer  of  the  Breast”,  Dr.  Burton  J.  Lee, 
clinical  director.  Memorial  Hospital,  New  York, 
and  clinical  professor  of  surgery,  Cornell  Uni- 
versity Medical  School. 

6 :00  p.  m.  Dinner,  Youngstown  Club. 

EVENING  SESSION 

8 :00  p.  m.  “Specializing  in  Cancer”,  Dr.  Ewing. 

9 :00  ]?.  m.  “The  Role  of  Surgery  and  the  Role  of  Irra- 
diation in  the  Treatment  of  Cancer”,  Dr.  Lee. 


Dinner  Honoring  Dr.  Haines 

Dr.  W.  D.  Haines,  staff  surgeon  at  the  General 
Hospital,  University  of  Cincinnati,  and  former 
member  of  the  Council  of  the  Ohio  State  Medical 
Association,  was  greeted  by  a large  group  of 
friends  in  and  outside  of  the  profession  at  a testi- 
monial dinner  at  the  Netherland  Plaza  on  Febru- 
ary 15. 

Dr.  George  W.  Crile,  Cleveland,  was  the  prin- 
cipal speaker,  with  Dr.  Robert  Carothers,  former 
president  of  the  Ohio  State  Medical  Association, 
as  toastmaster. 

Dr.  Edwin  Khuon,  a life-long  intimate,  told  of 
the  old  days  of  the  horse  and  buggy  in  service 
with  the  general  practitioner  of  medicine  and 
when  Dr.  Haines  took  over  the  reins  as  chief 
organizer  of  the  West  End  Medical  Society. 

Dr.  Martin  H.  Fischer,  Mayor  Wilson,  and  Dr. 
E.  W.  Mitchell  were  other  speakers. — The  (Cin- 
cinnati) Journal  of  Medicine. 


— The  staff  at  Mansfield  General  Hospital  has 
elected  Di\  Leopold  Adams  president;  Dr.  P.  A. 
Stoodt,  vice  president;  Dr.  Hugh  C.  Winbigler, 
secretary-treasurer,  and  Dr.  John  S.  Hattery  and 
Dr.  C.  R.  Dameron,  members  of  the  advisory 
board. 


The  Presidents  P&qe 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


To  meet  the  desires  of  a number  of  the  members  of  our  State  Association,  and 
especially  in  view  of  the  uncertainty  of  conditions  for  the  next  few  weeks,  the  annual 
meeting’  has  been  postponed  from  May  2 and  3 to  sometime  in  the  Fall,  possibly  early 
in  October.  Official  announcement  of  this  postponement  is  carried  elsewhei’e  in  this 
Journal. 

The  publication  of  The  Journal  will  be  carried  on  regularly,  and  additional  an- 
nouncements on  the  exact  date  of  the  annual  meeting,  program,  and  other  details  will 
be  announced  from  time  to  time.  Our  machinery  of  organization  will  be  maintained 
and  continued  at  maximum  efficiency  to  meet  developments  incident  to  the  unusual 
problems  of  government  and  society,  which  affect  directly  the  practice  of  physicians. 

In  this  time  of  uncertainty  and  unrest,  your  membership  in  medical  organization 
is  more  important  and  relatively  more  valuable  to  you  now  than  ever  before. 

* if-  * 

“Where  there  is  no  vision  the  people  perish.”  (Proverbs  29:18). 

Our  people  have  not  lacked  vision.  They  have  been  visionary.  One  group  saw  the 
abolition  of  poverty,  sickness,  disease  and  death.  Another  saw  each  citizen  a million- 
aire. Nearly  all  were  firmly  convinced  that  we  should  not  return  to  the  state  of  being 
which  we  enjoyed  prior  to  the  World  War.  The  experts  who  assembled  the  data  upon 
which  the  conclusions  were  drawn  in  the  report  of  the  Committee  on  Costs  of  Medical 
Care  also  indulged  in  visions. 

How  silly  all  of  them  appear  in  the  light  of  present  day  developments!  We  might 
admit  that  if  all  the  accumulated  medical  knowledge  could  over  night  be  transmitted 
to  the  individual  physicians  of  America,  and  if  all  men  engaged  in  medical  practice 
were  actuated  by  ethical  motives  that  a Substantial  reduction  might  be  made  in  mor- 
bidity and  mortality.  But  such  a plan  will  be  immediately  assailed  as  impossible  for 
mortal  men  to  accomplish,  and  the  dream  fades. 

Similarly,  there  is  perhaps  sufficient  money  and  credit_in  our  country,  if  properly 
distributed,  to  relieve  poverty;  but  the  problem  of  distribution  has  ever  been  a puzzle 
which  remains  unsolved. 

What  can  we  do  about  it?  Nothing  spectacular.  Rather  we  can  discharge  each 
day’s  duties  to  the  best  of  our  ability  and  as  good  citizens  make  our  contribution  to 
human  welfare.  Gradually  our  critics  will  disappear  and  the  people  will  be  brought 
to  realize  the  great  contribution  the  medical  profession  has  been  making  and  that  the 
family  doctor  is  indispensable. 

The  time  has  arrived  when  each  county  society  must  study  its  problems  and  de- 
vise ways  and  means  to  serve  each  community.  This  can  not  be  done  effectively  in  a 
national  manner  for  the  problems  which  must  be  met  are  always  local,  many  of  them 
emergencies.  We  need  no  new  dispensation — the  Code  of  Ethics  is  all  sufficient.  Let 
us  proceed  with  clear  vision  and  the  courage  to  adhere  to  our  tested  policies. 


247 


248 


The  Ohio  State  Medical  Journal 


April,  1933 


Preparation  for  Emergency  To  Meet  Problems  Confronting 
the  Profession  and  Medical  Organisation  Provided 
By  Council  At  March  Meeting 


MINUTES 

The  Council  of  the  Ohio  State  Medical  Associa- 
tion met  in  the  headquarters  office,  Columbus,  at 
1:00  P.  M.  on  Sunday,  March  5,  1933. 

The  Officers  and  Councilors  present  were : 
President,  Dr.  Platter;  President-Elect,  Dr.  Cum- 
mer; Ex-President,  Dr.  Houser;  Treasurer,  Dr. 
Beer;  Councilors,  Drs.  Brush,  Caldwell,  Huston, 
Klotz,  Hein,  Paryzek,  Davidson,  Shanley,  Seiler, 
Goodman;  Dr.  Alcorn,  chairman,  and  Dr.  Upham, 
member  of  the  Policy  Committee;  Dr.  Southard, 
State  Director  of  Health;  Executive  Secretary 
Martin  and  Assistant  Executive  Secretary  Nel- 
son. 

The  minutes  of  the  Council  meeting  held  on 
December  11,  1932,  (published  on  pages  44  to  47, 
inclusive,  of  the  January,  1933,  issue  of  The 
Journal) , were  read,  and  on  motion  by  Dr.  Cald- 
well, seconded  by  Dr.  Paryzek,  and  carried,  were 
approved. 

EMERGENCY  PROBLEMS 

Dr.  Platter,  the  President,  and  Dr.  Cummer, 
President-Elect,  discussed  at  some  length  the  gov- 
ernmental situation  complicated  by  limitation  on 
withdrawal  from  banks  as  they  affect  the  medical 
profession  and  the  people  to  whom  the  profession 
renders  professional  service.  Need  for  emergency 
preparation,  to  meet  sudden  changes  in  the  eco- 
nomic situation  or  general  governmental  actions 
affecting  public  health,  medical  practice  or  social- 
ized medicine,  were  also  emphasized. 

They  also  discussed  recent  developments  and 
the  financial  situation  as  bearing  on  the  possi- 
bility of  deferring  the  annual  meeting,  on  adver- 
tising, exhibits,  publication  problems,  salaries, 
wages  and  other  State  Association  expenditures. 
It  was  pointed  out  that  in  anticipation  of  the 
present  situation  a large  part  of  the  current  funds 
of  the  Association  had  been  converted  into  fed- 
eral bonds,  which  could  be  utilized  from  time  to 
time  in  maintaining  the  machinery  of  organiza- 
tion to  meet  the  serious  problems  confronting  the 
profession  and  to  be  prepared  to  represent  the 
profession  in  connection  with  governmental  acts 
affecting  public  health,  medical  practice  and  ser- 
vice to  the  people. 

On  motion  by  Dr.  Huston,  seconded  by  Dr. 
Klotz  and  carried,  the  Council  authorized  the 
President,  the  President-Elect  and  the  Chairman 
of  the  Auditing  and  Appropriations  Committee  to 
serve  as  an  Executive  Committee  on  behalf  of  the 
Council  during  the  emergency  and  to  meet  prob- 
lems promptly;  such  authorization  to  continue  un- 
til the  next  meeting  of  Council. 


THE  1933  ANNUAL  MEETING 

As  bearing  on  the  question  of  the  possible  post- 
ponement of  the  annual  meeting  until  the  eco- 
nomic situation  is  clarified,  the  Council  specifically 
authorized  the  Emergency  Executive  Committee 
in  cooperation  with  the  Council  Committee  on  Ar- 
rangements, of  which  Dr.  Davidson  is  chairman, 
and  the  local  committee  on  arrangements,  to  de- 
termine, according  to  developments,  whether  or 
not  the  annual  meeting  should  be  postponed  and 
if  so,  to  what  dates. 

Dr.  Cummer,  chairman  of  the  Council  Program 
Committee,  submitted  for  consideration  of  the 
Council  the  detailed  program  for  the  annual  meet- 
ing as  previously  sent  to  the  Councilors  in  proof 
form  for  their  decision  at  this  meeting.  Upon 
motion  by  Dr.  Cummer,  seconded  by  Dr.  Seiler 
and  carried,  the  Council  approved  as  the  official 
program  the  detailed  set-up,  schedule  and  an- 
nouncements as  considered  in  proof  form.  The 
committee  also  approved  the  recommendation  sub- 
mitted by  Dr.  Cummer  on  the  unfeasibility  of 
scheduling  the  annual  addresses  of  the  outgoing 
and  incoming  presidents  at  the  Organization 
Luncheon. 

Dr.  Davidson  submitted  in  detail  a report  on 
the  plans  and  activities  of  the  several  local  com- 
mittees now  making  preparation  for  the  annual 
meeting.  These  committees  already  at  work  with 
definite  plans  include  committees  on  entertainment, 
halls  and  meeting  places,  exhibits  and  scientific 
exhibits,  projection  apparatus  and  illustrations, 
reception,  and  publicity.  This  report  included 
places  and  plans  for  the  scientific  exhibits,  plans 
for  publicity,  entertainment  and  badges.  The 
Council  considered  the  use  of  inexpensive  sou- 
venir badges  of  a novelty  nature  characteristic  of 
Akron.  Dr.  Davidson  as  chairman  of  the  Coun- 
cil Committee  on  Arrangements,  together  with 
the  Emergency  Executive  Committee  and  the 
Program  Committee  of  Council,  were  authorized 
to  make  final  decision  on  this  detail. 

A communication  was  read  relative  to  a more 
general  discussion  to  be  participated  in  by  officers 
of  county  medical  societies  at  the  Organization 
Luncheon  during  the  annual  meeting.  This  com- 
munication was  referred  to  the  Council  Program 
Committee  for  its  consideration. 

PROBLEMS  OF  MEDICAL  ECONOMICS  AND 
WORKMEN’S  COMPENSATION 

Each  of  the  Councilors  reported  in  some  detail 
on  developments  locally  and  in  the  county  medical 
socities  in  their  respective  districts,  on  the  “re- 
actions” to  the  propaganda  growing  out  of  the 
final  report  of  the  national  Committee  on  the 


April,  1933 


State  News 


249 


Costs  of  Medical  Care.  It  was  the  consensus  of 
opinion  of  the  Councilors  that  public  meetings 
should  not  be  sponsored  by  the  medical  societies, 
but  that  the  societies  themselves  should  discuss 
the  report  of  the  Committee  on  the  Costs  of  Med- 
ical Care  and  urge  their  members  to  study  the 
complete  report  including  the  numerous  socialized 
recommendations  which  would  affect  medical  prac- 
tice. It  was  further  recommended  that  each 
medical  society  be  prepared,  when  and  if  local, 
social  or  civic  groups  urged  adoption  of  any  of 
the  various  proposals  on  socialized  medicine,  to 
guide  these  developments  along  the  lines  of  sound 
economic,  social  and  scientific  principles.  Atten- 
tion was  also'  called  to  the  official  statement 
adopted  by  the  Council  at  its  last  meeting  on  this 
general  question  and  published  on  pages  48  and 
49  of  the  January,  1933,  issue  of  The  Journal. 

Members  of  Council  also  discussed  various  local 
developments  in  the  field  of  contract  practice,  and 
it  was  urged  that  each  academy  of  medicine  or 
county  medical  society  be  prepared,  through  com- 
mittees on  medical  economics,  civics,  or  public 
relations,  to  meet  these  problems  peculiar  to  in- 
dividual communities,  on  the  basis  of  sound  and 
established  policies. 

Attention  was  called  to  developments  in  the  ad- 
ministration of  the  Workmen’s  Compensation 
Law,  including  problems  of  finance,  policy  and  ad- 
ministration. Reference  was  also  made  to  a pro- 
posed audit  of  the  Workmen’s  Compensation  Fund 
and  its  administration,  which  would  include  a de- 
tailed inquiry  into  medical,  surgical  and  hospital 
costs,  with  a comparison  of  time  periods  for  the 
treatment  of  various  types  of  injuries  and  dis- 
abilities. 

There  was  also  a discussion  on  the  conformity 
by  the  Commission  to  the  request  of  the  State 
Medical  Association  in  regard  to  routine  in  the 
Claims  Department,  with  the  abolishment  of  the 
former  procedure  of  quoting  to  claimaints  whose 
claims  were  disallowed,  the  adverse  reports  by 
physicians  on  which  such  action  by  the  Commis- 
sion was  based;  as  well  as  a discontinuance  of  the 
procedure  whereby  the  Claims  Department  had  in 
some  instances  quoted  the  Medical  Department 
on  the  reduction  of  fee  bills  in  cases  not  reviewed 
by  the  Medical  Department. 

CONSTITUTIONAL  AND  ETHICAL  QUESTIONS 

Dr.  Cummer  submitted  on  behalf  of  the  Council 
Committee  on  Constitutions,  an  amendment  sub- 
mitted by  the  Academy  of  Medicine  of  Cincinnati 
to  Article  II,  Section  2 of  the  By-Laws  of  that 
academy,  relative  to  the  dues  of  members.  Dr. 
Cummer  pointed  out  that  the  proposed  amend- 
ment as  submitted  would  automatically  exclude 
from  membership  in  the  State  Association  and  in 
the  American  Medical  Association  all  classes  of 
local  members  except  active  members  and  includ- 
ing retired  and  honorary  members  who  might  de- 
sire to  continue  their  affiliation  in  medical  organi- 
zation. 


On  motion  by  Dr.  Cummer,  seconded  by  Dr. 
Paryzek  and  carried,  the  Council  approved  the 
amendment  submitted  by  the  Academy  of  Medi- 
cine of  Cincinnati,  subject  to  the  omission  of  the 
sentence  reading  as  follows:  “Only  active  mem- 

bers are  eligible  to  membership  in  the  Ohio  State 
Medical  Association.” 

There  was  also  submitted  for  the  consideration 
of  the  Council,  an  amendment  to  Chapter  V,  Sec- 
tion 2 of  the  By-Laws  of  the  Montgomery  County 
Medical  Society,  relative  to  membership  dues.  On 
motion  by  Dr.  Cummer,  seconded  by  Dr.  Huston 
and  carried,  the  Council  officially  approved  this 
amendment. 

There  was  submitted  to  the  Council  a communi- 
cation from  the  Columbus  Academy  of  Medicine, 
containing  a resolution  of  disfavor  toward  “ad- 
vertising by  physicians  in  magazines,  publications 
other  than  medical,  under  the  guise  of  directory 
or  the  like,  or  special  editions  of  newspapers,  in- 
cluding pictures  and  biographical  sketches.”  Mem- 
bers of  Council  expressed  approval  of  the  action 
of  the  Columbus  Academy  of  Medicine  on  this 
resolution. 

There  was  submitted  a detailed  communication 
to  the  Council,  received  since  the  last  Council 
meeting,  from  a physician  appealing  to  the  Coun- 
cil from  the  action  of  the  Clinton  County  Medical 
Society  in  suspending  him  from  membership.  This 
communication  was  considered  at  length,  and  it 
was  pointed  out  that  by  failing  or  refusing  to 
avail  himself  of  the  constitional  procedure  when 
disciplinary  inquiry  was  being  made  by  the  Board 
of  Censors  of  his  society,  this  physician  could  not 
properly  appeal  from  the  action  which  had  been 
taken  in  regular  procedure  by  the  Board  of  Cen- 
sors and  his  society,  and  that  he  is,  therefore, 
estopped  from  raising  the  issue  of  prejudice, 
which  is  the  basis  of  his  appeal,  having  refused 
to  avail  himself  of  the  provisions  of  his  own  Con- 
stitution. On  motion  by  Dr.  Cummer,  seconded 
by  Dr.  Caldwell  and  carried,  the  Council,  for  the 
reasons  stated  herein,  denied  the  appeal. 

OTHER  ORGANIZATION  QUESTIONS 

There  was  submitted  to  the  Council  a communi- 
cation to  the  President  from  the  Secretary  of  the 
Ohio  State  Nurses’  Association,  requesting  him  to 
represent  this  Association  as  a member  of  a Com- 
mittee of  that  Association  on  Educational  and 
Professional  Relations.  In  view  of  the  fact  that 
under  policies  adopted  by  resolution  by  the  House 
of  Delegates,  individuals  or  officers  of  this  Asso- 
ciation are  prevented  from  officially  representing 
this  Association,  unless  doing  so  under  specific 
policies  adopted  in  advance;  and  on  motion  by 
Dr.  Goodman,  seconded  by  Dr.  Seiler,  the  Council 
expressed  interest  in  and  a desire  to  cooperate 
with  the  State  Committee  on  Education  and  Pro- 
fessional Relations,  and  recommended  that  such 
contact  and  cooperation  be  established  through 
the  Committee  on  Medical  Education  and  Hospi- 
tals of  this  Association,  which  committee  is  re- 


250 


The  Ohio  State  Medical  Journal 


April,  1933 


quested  to  report  back  to  the  Council  for  authori- 
zation before  expressing  or  proceeding  with  spe- 
cific policies. 

There  was  submitted  to  the  Council  a request 
from  the  Chairman  of  the  Publication  Committee 
for  interpretation,  a communication  from  a mem- 
ber who  had  submitted  a scientific  paper  to  the 
Publication  Committee  as  a “substitute”  for  a 
paper  which  he  had  presented  before  the  last  an- 
nual meeting  and  which  had  been  published  in  the 
Journal  of  the  American  Medical  Association.  The 
Council  felt  that  a decision  on  this  matter  was 
entirely  within  the  province  of  the  Publication 
Committee  iteslf,  and  that  the  committee  should 
consider  each  individual  paper  on  its  merit,  but 
not  as  a substitute  for  any  other  paper. 

A brief  report  was  submitted  on  the  prospective 
early  conference  of  the  Medical  Defense  Com- 
mittee with  the  special  sub-committee  of  the  Com- 
mittee on  the  Unauthorized  Practice  of  Law  of 
the  State  Bar  Association,  in  relation  to  the 
legal  service  feature  of  the  Medical  Defense  Plan. 
Reference  was  made  to  previous  developments  and 
reports  on  this  question. 

POLICY  AND  LEGISLATION 

Dr.  Alcorn,  chairman  of  the  Policy  Committee, 
summarized  briefly  problems  and  developments  in 
the  present  session  of  the  Ohio  Legislature  with 
reference  to  the  economic  situation,  taxation,  un- 
employment, relief,  schools,  etc.,  as  referred  to  in 
recent  legislative  bulletins,  and  with  the  possible 
effect  on  public  health  administration  and  medical 
practice,  of  a new  taxation  program  involved  with 
various  phases  of  welfare,  social  insurance,  auto- 
mobile legislation,  term  extender  measures,  gar- 
nishee procedure,  etc. 

Specific  but  brief  report  was  made  on  approxi- 
mately 40  bills  in  the  field  of  welfare,  many  of 
which  impinge  directly  on  questions  of  medical 
service  and  health  protection. 

In  addition,  a half-dozen  other  bills  were  ana- 
lyzed and  discussed  pertaining  directly  to  health 
administration  and  numerous  other  bills  in  the 
direct  field  of  medicine  and  allied  professions. 
Several  cult  and  fad  bills  were  also  analyzed  from 
their  effect  on  medical  practice,  and  reference  was 
made  to  the  official  position  and  attitude  of  allied 
professions  and  conflicting  viewpoints  toward 
these  measures. 

Dr.  Southard  supplemented  this  report  from  the 
standpoint  of  the  State  Department  of  Health. 
He  expressed  appreciation  for  cooperation  and 
analyzed  more  in  detail  several  of  the  bills  di- 
rectly affecting  health  administration  and  finance. 

MEMBERSHIP  MATTERS 

A report  was  submitted  to  the  Council  showing 
a membership  in  the  State  Association  to  date 
for  1933  of  4,118,  as  compared  with  4,276  on  the 
same  date  last  year,  and  as  compared  with  a total 
at  the  end  of  1932  of  5,352.  The  Council  con- 
sidered the  problem  in  connection  with  those  mem- 


bers who  had  paid  their  dues  to  their  local  soci- 
eties prior  to  the  development  of  the  banking  situa- 
tion whereby  withdrawals  were  curtailed  or  dis- 
continued but  whose  dues  in  the  State  Association 
had  not  been  transmitted  from  the  county  society 
treasurer  in  time  to  be  negotiable  or  credited  to 
the  State  Association.  On  motion  by  Dr.  Cum- 
mer, seconded  by  Dr.  Klotz  and  carried,  the  Coun- 
cil authorized  the  State  Association  headquarters 
office  to  enter  on  our  records  as  members,  those 
whose  dues  had  been  paid  locally  to  their  local 
societies  immediately  prior  to  the  restriction  on 
bank  withdrawals,  whose  dues  were  deposited  and 
credited  to  the  funds  of  their  county  society  but 
where  certification  had  not  been  made  in  time  to 
transfer  and  credit  such  dues  to  the  bank  account 
of  the  State  Association;  this  provision,  however, 
to  be  subject  to  reimbursement  in  cash,  money- 
order  or  in  other  acceptable  and  negotiable  form. 

The  Council  adjourned  to  meet  at  the  call  of  the 
President. 

S.  J.  Goodman,  M.D., 
Secretary  of  Council. 


Factors  Affecting-  a Change  in  Diet  of  the 
American  People 

A variety  of  causes  have  combined  to  effect  dis- 
tinct changes  in  the  diet  of  the  American  people 
in  the  last  20  years,  according  to  0.  E.  Baker, 
Division  of  Land  Economics,  U.  S.  Department  of 
Agriculture. 

While  the  diet  of  the  people  has  changed,  there 
probably  has  been  only  a slight  decrease  in  the 
amount  of  calories  of  food  taken  per  capita  and 
this  change  has  been  in  the  types  of  food  rather 
than  in  total  amount  of  food  value,  he  pointed  out. 

The  sedentary  habits  of  the  population,  apart- 
ment house  life,  the  use  of  machinery  instead  of 
human  labor,  education  of  the  people  as  to  a 
more  healthful  diet  and  the  development  of  new 
varieties  of  vegetables  and  new  methods  of  trans- 
porting them  are  among  the  factors  that  have 
affected  diet,  Mr.  Baker  said. 

The  modern  diet  contains  more  protein  and 
less  carbohydrates  than  was  formerly  the  case, 
according  to  Mr.  Baker.  The  carbohydrates  and 
fats  are  principally  energy  producers,  and  with 
the  rapid  expansion  of  the  use  of  machinery  and 
the  decline  in  farm  population,  less  energy  is 
needed  by  the  Nation  for  the  performance  of 
physical  work.  The  city  worker,  engaged  mostly 
in  office  activities  which  require  little  physical 
effort,  requires  less  of  the  energy-producing 
foods,  Mr.  Baker  said,  and  this  may  have  had  an 
effect  on  diets. 

Probably  the  outstanding  change  in  diet  is  a 
decline  of  about  100  pounds  per  capita  in  con- 
sumption of  cereals,  shown  in  a comparison  of 
consumption  for  the  last  five  years  with  the 
average  for  the  five  years  1909  to  1913,  according 
to  Mr.  Baker. 


April,  1933 


State  News 


251 


Caustic  Critic  and  Wise^Cracker  Extraordinary  Dissects 


of 


Medical 


Social  Phases 


IN  the  March,  1933,  issue  of  The  American 
Mercury,  the  editor  of  that  publication  and 
critic  extraordinary,  Henry  L.  Mencken,  de- 
votes nine  pages  of  pertinent  and  caustic  com- 
ment to  the  recent  report  of  the  Committee  on 
the  Costs  of  Medical  Care. 

Even  H.  L.  M.,  whose  keen  and  vitriolic  pen 
has  on  more  than  one  occasion  taken  the  medical 
profession  for  a “ride”,  finds  himself  unable  to 
agree  with  the  costs  of  medical  care  report  which, 
in  his  opinion,  offers  no  better  suggestion  for 
solving  the  problems  of  medical  care  than  that  the 
costs  should  be  met  “by  throwing  the  burden  on 
the  taxpayer”  and  “in  converting  the  doctors,  or 
at  all  events  most  of  them,  into  public  function- 
aries”. 

This  latter  eventuality  is  what  physicians  “fear 
and  object  to,”  Mr.  Mencken  declares,  adding: 
“They  want  to  remain  free  agents,  as  they  are 
now  (or  believe  they  are),  and  they  give  public 
notice  that  they  will  resist  to  the  last  ditch  any 
effort  to  turn  them  into  anything  else.” 

Mencken  calls  particular  attention  to  the  recom- 
mendation of  the  committee  for  “the  extension  of 
all  basic  public  health  services — whether  by  gov- 
ernmental or  non-governmental  agencies — so  that 
they  will  be  available  to  the  entire  population  ac- 
cording to  its  needs”,  pointing  out  that  in  his 
opinion  that  recommendation  is  the  one  that  should 
be  most  alarming  to  physicians  since  it  “really 
offers  the  most  serious  menace  to  their  profes- 
sional security  and  dignity,  for  it  offers  encour- 
agement without  limit  to  a competition  that  has 
already  done  them  great  damage,  and  might  very 
easily  ruin  them  altogether”. 

He  refers  to  the  tremendous  expansion  of  pub- 
lic health  activities  in  recent  years,  pointing  out 
that  some  public  health  departments  “of  late  have 
gone  in  for  doctoring  and  nursing  on  a truly 
colossal  scale,  and  when  the  supply  of  customers 
runs  out  they  actually  send  out  catchpolls  to  track 
them  down”.  Calling  attention  to  the  fact  that  a 
generation  ago  the  activity  of  public  health  ser- 
vices was  pretty  largely  confined  to  compiling 
vital  statistics,  to  safeguarding  water  and  food 
supplies,  and  maintaining  quarantines  against  con- 
tagious diseases,  Mencken  Observes  that  many 
health  departments  by  increasing  their  scope  and 
activities  “have  gobbled  at  least  a half  of  the 
work  that  private  doctors  were  doing  thirty  or 
forty  years  ago”. 

Mencken  cites  the  case  of  a hard-working  and 
competent  physician  of  the  “old  school”  and  an 
old  friend. 

“When  the  health  department  of  his  town  be- 
gan to  go  into  the  medicine  business,”  Mencken  re- 


ports, “his  practice  was  as  good  as  ruined.  Half 
a dozen  free  dispensaries  of  one  sort  or  another 
were  opened  in  his  bailiwick,  and  nurses  on  the 
city  payroll  began  to  rove  the  streets  in  municipal 
Fords,  seeking  prospects.  One  of  his  chief  sources 
of  income,  in  his  palmy  days,  had  been  his  ob- 
stetrical practise.  He  delivered  babies  at  $20  a 
head,  and  took  in  enough  at  the  business  to  pay 
his  rent.  But  now  the  city  nurses  began  pounc- 
ing on  his  patients  at  the  first  sign  of  devine 
retribution,  and  by  the  time  those  patients  came 
to  term  they  were  installed  luxuriously  in  some 
tax-supported  maternity  hospital,  and  having  the 
time  of  their  lives.  My  friend,  of  course,  could 
not  remonstrate  with  them,  but  it  was  at  least 
ethical  for  him  to  make  some  discreet  inquiries. 
‘The  nurse  told  me,’  he  was  commonly  informed, 
‘that  I could  get  a professor  to  help  me— and  it 
wouldn’t  cost  a cent.’  In  a few  years  the  prac- 
tise of  this  laborious  worthy  man  was  ruined.” 

The  recommendations  of  the  costs  of  medical 
care  committee  for  the  organization  of  physicians 
into  groups  and  the  financing  of  medical  costs  on 
a group  payment  basis  “deserve  all  the  damnation 
that  the  embattled  doctors  have  been  heaping 
upon  them”,  Mencken  believes,  in  so  far  as  these 
recommendations  contemplate  eventually  saddling 
the  costs  upon  the  public.  However,  Mencken 
hastens  to  observe  that  the  reservation  that  the 
whole  scheme  be  tried  on  a voluntary  basis  first 
may  prove  to  be  the  salvation  of  the  physician,  as 
well  as  the  taxpayer. 

“There  is  no  sign  of  tenderness  toward  the  tax- 
payer; he  is  allowed  to  escape,  it  appears,  only 
until  the  details  of  the  group  scheme  has  been 
worked  out  to  a sufficiency  of  decimals  and  it  is 
in  smooth  running-order,”  he  points  out. 

“But  all  the  same,  he  is  indubitably  given  that 
humane  time  to  grace,  and  while  it  lasts  he  will 
have  some  chance  to  put  up  a defense  and  maybe 
to  fight  his  way  to  security.  A few  years  ago  his 
prospects  under  the  circumstances  would  have 
been  dismal  indeed,  for  the  tide  was  roaring 
against  him  and  the  public-school  pedagogues  were 
showing  all  other  varieties  of  uplifters  how  easy 
it  was  to  take  him.  But  since  he  has  begun  to 
protest  and  revolt — to  such  an  extent,  indeed,  that 
even  the  pedagogues  are  being  chased  away 
from  the  trough.  Thus  the  advocates  of  free 
medicine  for  all  have  brought  their  goods  to  what 
seems  to  be  a falling  market,  and  by  the  time 
they  close  with  their  victim  and  try  to  get  his 
signature  on  the  dotted  line,  he  may  be  ready 
to  soak  him  in  the  kishkes  and  make  off  un- 
scathed.” 

The  editor  of  The  Mercury  sympathizes  with 


252 


The  Ohio  State  Medical  Journal 


April,  1933 


the  medical  profession  “in  their  combat  with  the 
visionaries  of  the  committee”  but  he  administers 
a verbal  spanking  to  physicians  for  errors  of 
omission  which  have  placed  them  in  a poor  posi- 
tion to  defend  themselves. 

‘On  the  one  hand,”  he  declares,  “they  have  not 
offered  sufficient  resistance  to  the  evil  tendency, 
so  apparent  since  the  turn  of  the  century,  to  make 
medical  care  moi’e  and  more  expensive,  especially 
hospital  care.  On  the  other  hand,  they  have  given 
far  too  much  encouragement  to  the  baleful  pro- 
liferation of  free  service.  If  now,  with  a depres- 
sion in  full  swing,  these  costs  begin  to  be  pro- 
hibitive to  larger  and  larger  numbers  of  patients, 
and  they  go  flocking  to  the  dispensaries  for  the 
treatment  that  they  can’t  afford  to  pay  for,  it  is 
certainly  not  surprising  to  find  the  professional 
do-gooders,  who  are  always  eager  for  more  power, 
reaching  out  eagerly  for  the  whole  business,  and 
proposing  to  reduce  the  doctors  to  the  estate  and 
dignity  of  hirelings  working  for  them  at  their 
direction.” 

Admitting  the  belief  that  the  medical  profession 
generally  has  not  profited  to  any  considerable  ex- 
tent by  the  increase  in  the  costs  of  medical  care 
and  that  a substantial  part,  of  the  increase  has 
been  due  to  improvements  in  the  art  of  medicine, 
calling  for  the  use  of  expensive  apparatus  and 
kinds  of  skill  that  cannot  be  had  for  nothing, 
Mencken  expresses  the  opinion  that  a large  part  of 
the  excess  has  been  wasted  in  the  construction  of 
“luxurious  hotels  for  the  entertainment  and  flat- 
tery of  the  sick”,  an  extravagance  stimulated  by 
a “keeping-up-with-the-Jonses”  attitude  on  the 
paid;  of  a large  portion  of  the  public. 

“People  will  not  go  to  a hospital  that  has  the 
name  of  being  run  parsimoniously;  they  prefer 
the  gilded  hell  which  offers  all  the  latest  luxuries, 
from  sunbaths  on  the  roof  to  bedside  radios,”  he 
states. 

“They  think  that  they  have  the  whole  works; 
it  somehow  caresses  their  armour  propre,  and 
gives  them  a standing  with  the  neighbors.  Years 
ago,  patients  emerging  from  surgery  used  to  de- 
vote their  talk  mainly  to  their  sensations  on  go- 
ing under  the  ether;  now  what  they  talk  about  is 
the  cost  of  the  adventure.  And  even  those  who 
pay  nothing,  I am  informed,  got  pleasure  out  of 
the  thought  that  the  bigwigs  who  looked  after 
them,  if  paid  at  all,  would  have  been  paid  a lot. 

“The  middle-class  hospitals  have  been  anything 
but  roaring  successes,  save  maybe  in  a few 
places,”  he  comments.  “The  very  fact  that  they 
are  relatively  cheap  seems  to  be  the  chief  objec- 
tion to  them;  the  normal  American,  when  he  is 
sick,  is  eager  for  the  best  attention  that  he  can 
get,  and  the  general  habit  of  mind  of  the  country, 
apparently  surviving  the  Depression,  makes  him 
believe  that  the  best  is  necessarily  the  most  ex- 
pensive. So  he  goes  in  for  a swell  room  and 
special  nurses,  and  the  quarters  that  were  es- 
tablished to  save  him  from  banla-uptcy  ax*e  occu- 
pied by  patients  who  ought  to  be  in  the  wards. 


His  doctor,  I dax’e  say,  txnes  often  enough  to  dis- 
suade him,  for  the  money  that  he  wastes  will 
usually  have  to  come  out  of  the  doctor’s  pocket, 
but  pex’suading  him  is  not  easy.  Indeed,  it  will 
probably  take  a few  more:  years  of  the  Depres- 
sion to  convince  him  that  he  is  living,  in  sickness 
even  more  than  in  health,  a good  deal  beyond  his 
means,  and  that  he  will  continue  in  difficulties 
until  he  goes  back  to  the  simpler  life  of  his 
fathers.” 

Mencken  observes  that  the  costs  of  medical  care 
repoxi;  makes  much  of  the  lack  of  hospital  facili- 
ties and  physicians  in  the  more  remote  paxffs  of 
the  country  where  persons  are  easy  prey  for 
quacks  and  nine-tenths  of  the  patent  medicines 
consumed  find  a max-ket.  However,  he  is  at  a 
loss  to  know  what  can  be  done  about  it,  voicing  the 
opinion  that  “it  can’t  be  easy  to  tempt  a medical 
man  of  any  dignity  to  live  in  an  American  country 
town,  with  its  complete  lack  of  civilized  contacts, 
even  if  the  bait  be  economic  security”. 

Mencken  lambasts  the  “professional  uplifters” 
whom  he  suspects  have  been  largely  responsible 
for  the  present  state  of  mind  of  the  public  and 
who  “spend  a gi’eat  deal  more  time  discussing 
what  ought  to  be  done  than  what  can  be  done”. 

“Their  chief  postulate,”  he  wi'ites,  “seems  to  be 
that  it  is  the  bounden  duty  of  the  state  to  take 
cai'e  of  every  citizen  who  can’t  or  woix’t  take 
care  of  himself,  and  they  are  always  eager  to 
pour  out  the  taxpayers’  money  to  that  end.  But 
there  is  really  no  such  duty.  The  really  helpless 
and  fxdendless  sick,  of  course,  must  be  cared 
for  * * * but  the  public  i-esponsibility  does  not 
go  half  so  far  beyond  that  simple  business  as  up- 
lifters appear  to  think. 

“Nor  as  a good  many  otherwise  sensible  doctors 
have  apparently  come  to  think.  They  have,  in 
their  chax-ity,  allowed  themselves  to  be  imposed 
upon  in  a gross  and  shameless  manner.  They  be- 
gin by  giving  free  treatment  to  persons  whose  in- 
ability to  pay  for  it  is  only  too  obvious,  but  bit  by 
bit  they  find  themselves  facing  larger  and  larger 
hordes  of  dead-heads,  until  in  the  end,  at  least 
in  cex-tain  fields,  there  are  precious  few  pay  cus- 
tomers left.  The  public  schools,  now  in  the  pro- 
cess of  radical  liquidation  at  last,  have  led  in  this 
movement,  but  the  public  health  uplifters  have 
followed  hard  upon  theix*  heels.  The  dubious  doc- 
tx-ine  that  what  ought  to  be  done  must  be  done 
has  been  converted  into  the  even  more  dubious  doc- 
tx-ine  that  what  ought  to  be  done  must  be  done 
free,  and  as  a result  great  multitudes  of  Amer- 
icans, hithei’to  willing  enough  to  pay  their  way, 
have  been  converted  into  mendicants,  and  a large 
part  of  the  burden  of  their  medicancy  has  been 
thrown  upon  the  medical  profession. 

“There  is,  as  a matter  of  fact,  no  plausible  rea- 
son for  arguing,  as  uplifters  always  do,  that  the 
px-ivilege  of  first-rate  medical  care  is  a right  that 
every  free-born  American  acquires  at  birth,  re- 
gardless of  his  merits  or  his  means.  It  is  noth- 
ing of  the  sort.  Charity  is  not  a franchise;  it  is 


April,  1933 


State  News 


253 


only  a favor,  and  it  is  a favor  properly  offered  to 
the  really  helpless,  and  to  no  one  else.  It  may 
impose  upon  the  benefactor  something  that  he 
chooses  to  regard  as  a duty,  but  it  certainly  gives 
no  vested  right  to  the  beneficiary.  In  this  region, 
as  in  others,  sentimentality  is  a potent  weapon  in 
the  hands  of  uplifters.  They  are  adepts  at  con- 
vincing their  betters  that  what  they  think  ought 
to  be  done  is  ordained  by  God,  and  cannot  be 
evaded  without  a grave  breach  of  decency. 

“Thus  the  doctors  are  beset  by  uplifters  on  the 
one  side,  as  they  are  beset  by  quacks  on  the  other, 
and  it  is  no  wonder  that  they  begin  to  be  con- 
cerned about  the  future  of  their  trade.  The  re- 
port of  the  Committee  on  the  Costs  of  Medical 
Care  has  shaken  them  mainly  because  it  seems 
to  show  that  the  uplift  is  beginning  to  invade 
their  own  house.  But  the  truth  is  that  it  has  been 
there  for  a long  while,  and  with  their  own  in- 
nocent connivance.  If  they  were  converted  into 
public  job-holders  tomorrow,  as  the  committee 
proposes,  they  would  scarcely  be  much  worse  off 
than  they  are  in  many  an  American  community 
today,  with  free  dispensaries  taking  half  of  their 
patrons  away  from  them  and  luxurious  hospital- 
hotels  bankrupting  the  rest,  and  so  leaving  noth- 
ing for  their  own  fees.” 

How  physicians  are  going  to  get  out  of  their 
difficulties,  Mencken  admits  is  a tough  problem 
for  “one  whose  gift  for  constructive  criticism  is 
indeed  somewhat  meagre”.  He  tersely  suggests, 
however,  that  perhaps  the  medical  profession 
might  alleviate  the  situation  somewhat  by  restor- 
ing to  the  family  doctor  his  old  functions  and  not 
try  “to  save  him  by  attaching  him  to  a hospital 
and  making  a sort  of  minor  bureaucrat  out  of 
him”;  by  staging  a revival  of  the  home  care  of 
the  sick,  and  by  undertaking  a “more  bilious  scru- 
tiny of  applicants  for  free  service  and  of  agencies 
which  seek  to  provide  it”. 

Referring  again  to  how  physicians  have  been 
imposed  upon  by  health  uplifters,  Mencken  said : 

“In  particular,  the  magic  words,  preventive 
medicine,  have  upset  them,  and  led  them  into 
transparent  follies.  The  first  duty  of  a doctor, 
in  prevention  as  in  cure,  is  to  his  own  patients, 
and  not  to  a vague  and  miscellaneous  mass  of 
people  who  ought  to  be  other  doctors’  patients. 
The  limits  of  prevention  are  fixed  by  Nature, 
and  within  the  limits  of  private  practise  they  are 
plain  enough,  but  when  a medical  man  succumbs 
to  uplifters  and  begins  to  rove  the  wide  pastures 
of  Utopia  he  sometimes  loses  all  contact  with 
fact,  and  begins  to  talk  as  foolishly  as  the  up- 
lifters themselves. 

“If  all  the  health  departments  ran  as  wild  as 
the  public  schools  were  lately  running,  and  every 
crazy  scheme  to  abolish  death  were  in  full  opera- 
tion, people  would  still  continue  to  die.  The  post- 
ponement of  that  event  can  never  be  achieved  so 
effectively  by  public  functionaries  as  by  private 
practitioners.  The  man  who  can  really  manage  it, 
in  so  far  as  it  is  possible  at  all,  is  the  family  doc- 


tor, and  he  will  succeed  in  proportion  as  he  de- 
votes himself  to  his  actual  patients,  and  lets  the 
rest  of  humanity  take  care  of  itself.” 

In  conclusion,  Mencken  apologizes  for  “ventur- 
ing to  tell  the  medical  granddams  how  to  suck 
eggs”  and  points  out  that  his  excuse  is  that  “the 
report  which  now  disturbs  them  is  addressed,  not 
to  the  profession  only,  but  to  the  general  public 
and  that  its  recommendations,  if  carried  out,  would 
make  every  American  his  brother’s  keeper  with 
a vengeance”. 

“But  though  the  doctors  thus  seem  to  run  no 
hazard  of  being  converted  into  robots  operated  by 
politicians,  as  they  might  be  if  the  committee’s 
recommendations  were  put  into  thorough  going 
execution,”  he  declares,  “they  still  face  a very  un- 
pleasant professional  situation,  and  it  is  no  wonder 
that  they  discuss  it  in  some  alarm. 

“Their  remedy,  as  I have  ventured  to  hint,  is 
probably  in  their  own  hands.  If,  on  the  one  side, 
they  unite  in  a genuine  effort  to  throw  off  the  up- 
lifters who  now  victimize  them,  and  on  the  other 
side  try  to  rid  their  customers  of  the  grotesque 
idea  that  being  ill  is  a romantic  business,,  and  an 
excuse  for  the  indulgence  of  levantine  luxury 
and  the  waste  of  a great  deal  of  money,  most  of 
it  not  in  hand — if  they  will  proceed  realistically 
in  both  of  these  directions  they  may  conceivably 
throw  off  some  of  the  difficulties  which  now  be- 
set them. 

“I  confess  that  it  always  irritates  me  to  hear 
medical  men  denounced  as  prehensile,  as  is  often 
done,  not  only  by  quacks,  but  also  by  persons  who 
should  know  better.  They  are  actually,  with  very 
few  exceptions,  fellows  of  a vast  and  innocent 
sentimentality.  The  great  majority,  indeed, 
might  be  described  as  easy  marks.  The  men  of  no 
other  profession  are  so  facilely  operated  on  by 
specialists  in  other  peoples’  duties.  They  walk 
into  the  arms  of  every  new  uplifter  who  happens 
down  the  road.  My  hope  is  that  the  report  of 
the  Committee  on  the  Costs  of  Medical  Care,  with 
its  bald  proposals  to  reduce  them  to  a kind  of 
peonage,  will  at  last  awaken  them  to  the  fact  that 
they  also  owe  some  duties  to  themselves,  and  that, 
with  everything  else  equal,  the  more  they  regard 
those  duties  the  better  they  will  be  able  to  serve 
their  actual  patients.” 


— At  a recent  meeting  of  the  staff  of  Piqua 
Memorial  Hospital  case  reports  were  presented 
and  two  papers  were  read,  one  by  Dr.  W.  W. 
Trostel  on  “Observations  on  the  Treatment  of 
Tuleraemia”  and  one  by  Dr.  R.  D.  Spencer  on 
“Roentgenologic  Aspects  of  Osteitis  Deformans, 
Paget’s  Disease”. 

— Annual  spring  meeting  of  the  staff  of  Mt. 
Carmel  Hospital,  Columbus,  attended  by  many 
medical  guests  from  other  counties,  was  addressed 
by  Dr.  R.  W.  Scott,  Cleveland.  He  spoke  on  “The 
Management  of  Patients  with  Cardio  Vascular 
Disease”. 


254 


The  Ohio  State  Medical  Journal 


April,  1933 


Federal  ^Economy  Measure"  May  Result  in  Equitable 
Adjustment  of  Benefits  to  Military  Veterans 


AUTHORITY  to  make  sweeping  changes  in 
the  federal  veterans’  relief  program  is 
granted  to  President  Roosevelt  under  the 
provisions  of  the  “economy  bill”,  passed  by  Con- 
gress, Which  is  designed  to  reduce  by  a half  a bil- 
lion dollars  the  annual  expenditures  of  the  Fed- 
eral Government. 

The  motives  underlying  the  measure  granting 
broad  powers  to  the  Chief  Executive  to  revise 
the  present  system  of  distributing  veterans’  bene- 
fits conform  in  principle  to  the  established  policy 
of  the  Ohio  State  Medical  Association  which  was 
reiterated  and  re-emphasized  in  a resolution 
adopted  at  the  1932  meeting  of  the  State  Asso- 
ciation by  the  House  of  Delegates.  (Pages  453 
and  454,  June,  1932,  issue  of  Thz  Journal).  This 
policy,  is  in  effect,  that  in  justice  to  deserving  ex- 
service  men  and  the  public  as  a whole,  veterans’ 
benefits  of  all  kinds,  including  medical  care  and 
hospitalization,  should  be  based  on  whether  the 
disability  for  which  any  veteran  is  receiving  com- 
pensation or  medical  and  hospital  care,  was  the 
result  of  service-connected  disease  or  injury. 

It  has  been  estimated  that  approximately 
$400,000,000  will  be  saved  annually  through  read- 
justments in  veterans’  benefits  and  another 
$100,000,000  as  a result  of  a 15  per  cent  reduction 
in  the  pay  of  those  on  the  federal  payroll,  also  a 
provision  of  the  economy  measure. 

A provision  of  the  measure  of  special  interest 
to  the  medical  profession  is  that  relative  to  medi- 
cal and  hospital  benefits  to  ex-service  men. 

As  presented  to  Congress,  the  measure  pro- 
vided : 

“In  addition  to  the  pensions  provided  in  this 
title,  the  administrator  of  veterans’  affairs  is 
hereby  authorized  under  such  limitations  as  may 
be  prescribed  by  the  President  and  within  the 
limits  of  existing  veterans’  administration  facili- 
ties, to  furnish  to  veterans  of  any  war,  including 
the  Boxer  Rebellion  and  the  Philippine  Insurrec- 
tion, domiciliary  care  where  they  are  suffering 
with  permanent  disabilities  and  medical  and  hos- 
pital treatment  for  diseases  and  injuries  incurred 
or  aggravated  in  line  of  duty  in  the  active  military 
and  naval  service.” 

Amendments  submitted  on  the  floor  of  the  Sen- 
ate and  adopted,  changed  this  section  slightly  to 
permit  domiciliary  care  of  all  veterans  suffering 
from  tubercular  or  neuro-psychiatric  ailments  not 
traceable  to  war  service,  and  to  authorize  the 
President,  if  he  deems  it  necessary,  to  provide  hos- 
pital ti’eatment,  as  well  as  domiciliary  care,  to 
veterans  suffering  from  non-service-connected  dis- 
abilities. 

The  question  of  whether  veterans  suffering  from 
non-service-connected  disabilities  should  receive 
medical  and  hospital  care  at  government  expense 
is  left  to  the  discretion  of  the  President  with 
authority  to  formulate  regulations  governing  such 
cases  if  he  so  desires. 


In  addition  the  President  is  granted  the  author- 
ity to  revamp  the  entire  pension  and  compen- 
sation system.  He  is  permitted  under  the  economy 
measure  to  formulate  regulations  governing  the 
payment  of  pensions  to  the  following  classes  of 
persons : 

(1)  Any  person  who  served  in  the  active  mili- 
tary or  naval  service  and  who  is  disabled  as  a re- 
sult of  disease  or  injury  or  aggravation  of  a pre- 
existing disease  or  injury  incurred  in  the  line  of 
duty  in  such  service. 

(2)  Any  person  who  served  in  the  active  mili- 
tary or  naval  service  during  any  war  subsequent 
to  the  Civil  War,  including  the  Boxer  Rebellion 
and  the  Philippine  Insumection,  and  who  is  per- 
manently disabled  as  a result  of  wound  or  disease. 

(3)  The  widow,  child,  or  children,  dependent 
mother  or  father,  of  any  person  who  dies  as  a re- 
sult of  disease  or  injury  incurred  or  aggravated 
in  line  of  duty  in  the  active  military  or  naval 
service. 

(4)  The  widow  and,  or,  child  of  any  deceased 
person  who  served  during  any  war  subsequent  to 
the  Civil  War,  including  the  Boxer  Rebellion  and 
the  Philippine  Insurrection  and  prior  to  the  World 
War. 

The  minimum  and  maximum  monthly  rate  of 
pension  which  may  be  paid  for  disability  or  death : 
For  disability,  from  $6  to  $275;  for  death,  from 
$12  to  $75. 

The  Chief  Executive  is  authorized  to  prescribe 
by  regulation  the  minimum  degrees  of  disability 
and  such  higher  degrees,  if  any,  as  in  his  judg- 
ment should  be  recognized;  prescribe  the  rate  of 
pension  payable  for  each  degree  of  disability,  and 
to  prescribe  by  regulation  such  differentiation  as 
he  may  deem  just  and  equitable  in  the  rates  to  be 
paid  veterans  of  different  wars  and  for  disabilities 
incurred  in  war-time  service,  peace-time  service, 
or  not  incurred  in  military  service. 

Pensions  for  Civil  War  veterans  are  reduced 
10  per  cent  for  the  year  ending  June  30,  1934. 

The  measure  provides  that  no  World  War  and 
Spanish  American  War  veteran  suffering  from 
disabilities  directly  traceable  to  war  service  shall 
be  removed  from  the  compensation  and  pension 
rolls,  but  it  permits  the  President  to  change  the 
rates  in  these  groups. 

Interference  with  judgments  which  may  here- 
after be  rendered  on  insurance  claims  pending  in 
suits  yet  to  be  decided  is  prevented.  The  names 
of  Spanish  American  War  veterans  over  62  years 
of  age  must  be  retained  on  the  pension  rolls  but 
the  rates  of  their  pensions  are  subject  to  change 
by  the  President. 

The  possibilities  for  huge  savings  to  the  gov- 
ernment and  for  placing  veterans’  relief  on  an 
equitable  and  economical  basis  under  the  pro- 


April,  1933 


State  News 


255 


past  23  years.  During  1918  the  death  rate  from 
tuberculosis  began  to  show  a decrease;  occasion- 
ally the  rate  would  increase  during  some  one  year, 
but  this  would  be  followed  by  a decrease  the  next 
year  sufficient  to  overcome  the  increase.  The  de- 
cline in  rate  from  1918  to  1921  was  much  greater 
than  during  the  succeeding  10  years. 

Among  the  accidental  group  railroad  accidents 
was  the  only  one  to  record  an  increase,  the  death 
rate  being  3.52  in  1931  and  4.03  per  100,000  popu- 
lation in  1932.  Suicides  showed  a small  increase, 
but  the  homicides  death  rate  decreased  from  8.90 
in,  1931  to  7.57  in  1932. 

Tabulated  below  is  a comparison  of  a few  of 
the  causes  of  death  with  rates  per  100,000  popu- 
lation for  1931,  and  the  provisional  figures  for 
1932: 


Number  Number  Rate 

Rate 

Disease 

1931 

1932  1931 

1932 

Typhoid  fever  

172 

134 

2.53 

1.95 

Smallpox  

3 

1 

.04 

.01 

Measles  

150 

163 

2.22 

2.38 

Scarlet  fever  

226 

223 

3.34 

3.25 

Whooping  cough  

158 

336 

2.33 

4.91 

Diphtheria  

189 

224 

2.79 

3.27 

Influenza  

1,979 

2,309 

29.28 

33.73 

Acute  anterior  poliomyelitis 

50 

25 

.74 

.36 

Lethargic  encephalitis.-. 

Epidemic  cerebrospinal  men- 

68 

56 

1.00 

.82 

ingitis  

99 

58 

1.46 

.85 

Rabies  

3 

4 

.04 

.05 

Tuberculosis  (all  forms) .... 

4,204 

3,770 

62.21 

55.08 

Cancer  (all  forms) 

7,467 

7,549 

110.51 

110.29 

Diabetes  . 

Diseases  of  the  nervous  sys- 

1,467 

1,654 

21.71 

24.16 

tern  

8,983 

8,942 

132.94 

130.64 

Cerebral  hemorrhage  

Diseases  of  the  circulatory 

7,008 

7,520 

103.73 

109.86 

system  ...  

17,289 

18,290 

255.87 

267.22 

Diseases  of  the  heart  

Diseases  of  the  respiratory 

15,063 

16,197 

222.93 

236.64 

system  

5,987 

5,799 

88.60 

84.72 

Pneumonia  (all  forms) 

Diseases  of  the  digestive 

5,273 

5,223 

78.04 

76.30 

system  

Diarrhea  and  enteritis  under 

5,050 

4,400 

74.74 

64.28 

2 years  

Diseases  of  the  genitouri- 

307 

626 

4.54 

9.14 

nary  system  

6,030 

6,164 

89.24 

90.05 

Nephritis  

5,067 

5,345 

74.98 

78.09 

The  puerperal  state 

Malformations  and  diseases 
peculiar  to  early  in- 

665 

563 

9.84 

8.22 

fancy  

3,750 

3,362 

55.42 

49.71 

1,261 

1,289 

18.66 

18.33 

Homicide  

602 

518 

8.90 

7.57 

Conflagration  .... 

Accidental  bums  (confla- 

50 

61 

.74 

.89 

Kration  excepted ) 

329 

261 

4.86 

3.81 

Accidental  falls  

1,389 

1,237 

20.69 

18.07 

Railroad  accidents  

238 

276 

3.52 

4.03 

Streetcar  accidents  

54 

49 

.79 

.72 

Automobile  accidents 

2,010 

1,771 

24.74 

25.87 

Other  accidents  

2,124 

1,660 

31.43 

24.25 

Total  accidents  

6,194 

5,315 

91.67 

77.65 

All  other  causes 

3,455 

4,727 

51.05 

69.06 

Totals  

75,500 

75,875 

1117.40  1108.53 

- — Staff  of  the  Ohio  Valley  Hospital,  Steuben- 
ville, has  elected  officers  as  follows : President, 

Dr.  F.  B.  Harrington;  vice  president,  Dr.  C.  W. 
Sunseri;  secretary-treasurer,  Dr.  N.  H.  Rosen- 
blum;  members  of  executive  board,  Drs.  John  Y. 
Bevan,  J.  E.  Miller,  Reed  Cranmer,  Carl  Goeh- 
ring  and  A.  E.  Weinstein. 

— Physicians  on  the  staff  of  the  Bucyrus  City 
Hospital  have  organized  by  electing  the  following 
officers:  President,  Dr.  W.  L.  Yeomans;  vice 

president,  Dr.  C.  A.  Lingenfelter ; secretary-treas- 
urer, Dr.  R.  L.  Solt.  The  officers  and  Dr.  W.  G. 
Carlisle  comprise  the  executive  committee. 


HOSPITAL  NOTES 


— The  newly-completed  annex  to  the  Chillicothe 
Hospital  has  been  opened  to  the  public. 

— Dr.  Thomas  Higgins  has  been  appointed  su- 
perintendent of  the  Lucas  County  Hospital. 

— Miss  Vida  R.  Nevison  has  resigned  as  super- 
intendent of  the  Massillon  City  Hospital.  Her 
successor  is  J.  B.  Burton,  former  auditor  of  the 
Eaton  Manufacturing  Company. 

— The  medical  staff  of  Jewish  Hospital,  Cincin- 
nati, has  elected  the  following  officers:  President, 
Dr.  Albert  H.  Freiberg;  vice  president,  Dr.  J. 
Victor  Greenebaum;  secretary,  Dr.  Louis  G. 
Heyn;  chairman  of  the  board,  Dr.  Max  Dreyfoos; 
associate  members  of  the  board,  Dr.  E.  O.  Swartz 
and  Dr.  Julien  E.  Benjamin. 

— Two  new  departments  have  been  created  at 
Mt.  Carmel  Hospital,  Columbus;  the  department 
of  urology,  headed  by  Dr.  Harley  O.  Bratton,  and 
the  department  of  orthopedic  surgery,  by  Dr.  E 
Harlan  Wilson. 

— J.  Craig  Smith,  former  Y.M.C.A.  secretary, 
has  been  named  manager  of  the  Robinson  Mem- 
orial Hospital,  Ravenna. 

— Dr.  William  A.  Teveluwe  was  elected  presi- 
dent of  the  staff  of  St.  Mary’s  Hospital,  Cincin- 
nati. Dr.  F.  X.  Siegel  is  vice  president,  and  Dr. 
Robert  Kotte,  secretary. 

— The  staff  at  Bethesda  Hospital,  Cincinnati, 
has  reelected  Dr.  Frank  D.  Phinney  to  his  sixth 
term  as  president.  Dr.  C.  S.  Amidon  is  vice  presi- 
dent and  Dr.  Charles  E.  Eha  secretary-treasurer 
of  the  staff. 

— Lima’s  new  $500,000  city  hospital  will  be 
ready  for  occupancy  about  April  1,  it  has  been 
announced  by  the  contractors  in  charge. 

— Dr.  H.  M.  Page,  president  of  the  Warren  City 
Hospital  staff,  has  presented  the  hospital  with 
portraits  of  a number  of  men  who  have  made 
valuable  contributions  to  scientific  medicine,  in- 
cluding Hippocrates,  Harvey,  Pasteur,  Lister, 
Rontgen,  Reed,  etc. 

— Dr.  F.  P.  Bennett  has  been  elected  president 
of  the  staff  of  the  Alliance  City  Hospital.  Dr.  H. 
L.  Weaver  is  vice  president,  Dr.  R.  R.  Mosely, 
treasurer,  and  Dr.  G.  L.  King,  Jr.,  secretary. 

— Dr.  A.  S.  McKitrick  was  elected  president  of 
the  attending  staff  of  Elyria  Memorial  Hospital. 
Other  officers  elected  are:  Vice  president,  Dr.  H. 
C.  Stevens;  secretary-treasurer,  Dr.  George 
Mynchenberg,  Jr. 

— A community  hospital  has  been  opened  in 
Bowling  Green  by  Miss  Betty  Riggs,  R.N.,  and 
Miss  Bertha  Strobel,  R.N.  The  hospital  accommo- 
dates 15  patients. 


256 


The  Ohio  State  Medical  Journal 


April,  1933 


visions  of  the  measure  and  the  powers  granted  to 
the  President  are  far-reaching. 

It  is  anticipated  that  large  savings  will  be  made 
immediately  by  excluding  from  veterans’  hospitals 
many  ex-service  men  whose  disabilities  were  in- 
curred in  civilian  life  and  are  in  no  way  trace- 
able to  military  service,  many  of  whom  are  finan- 
cially able  to  provide  medical  and  hospital  care 
for  themselves  from  private  physicians  and 
civilian  hospitals. 

Additional  savings  are  expected  by  calling  a 
halt  on  the  construction  of  additional  veterans’ 
hospitals  or  the  expansion  of  the  costly,  central- 
ized medical  and  hospital  service  now  operated  at 
government  expense  for  the  care  of  veterans  of 
both  service-connected  and  non-service-connected 
groups. 

By  minimizing,  or  eliminating  entirely,  free 
medical  and  hospital  care  for  veterans  suffering 
from  non-service-connected  disabilities,  the  gov- 
ernment will  have  removed  the  necessity  for  more 
veterans’  hospitals,  it  being  estimated  that  facili- 
ties in  existing  veterans’  hospitals  are  more  than 
adequate  to  care  for  the  service-connected  load 
and  to  provide  domiciliary  care  for  permanently 
disabled  veterans  and  those  with  tubercular  or 
neuro-psychiatric  ailments. 

The  authority  given  to  the  President  to  limit 
medical  and  hospital  facilities  of  the  veterans’ 
administration  for  the  most  part  to  veterans  with 
service-connected  disabilities  is  expected  to  result 
in  new  regulations  which  will  reduce  to  a mini- 
mum government  competition  with  private  phy- 
sicians and  privately-operated  hospitals. 

Adjustment  of  pension  and  compensation  rates 
by  the  President  under  authority  of  the  economy 
measure  should  result  in  additional  large  savings 
to  the  government  and  in  the  elimination  of  many 
injustices  and  inequalities  in  the  distribution  of 
veterans’  benefits.  It  paves  the  way  for  the  foun- 
dation of  an  entirely  new  schedule  of  compensa- 
tion and  disability  rates. 

Analysis  of  the  measure  discloses  that  there  is 
a disposition  on  the  part  of  the  federal  govern- 
ment to  provide  adequately  for  deserving  ex- 
service  men  or  the  dependents  of  those  who  died 
in  line  of  duty.  The  rights  of  such  veterans  and 
their  dependents  are  securely  safeguarded,  both  as 
to  compensation  and  to  medical  and  hospital  care. 
On  the  other  hand,  there  is  a determination, 
backed  by  the  strong  pressure  of  public  opinion, 
to  put  an  end  to  government  benefits  for  those  who 
have  no  just  and  equitable  claim  to  participate  in 
veterans’  relief  or  to  establish  a policy  governing 
veterans’  benefits  which  will  make  the  nation’s 
care  of  its  ex-service  men  a matter  of  merit. 


■ — Two  Dayton  hospitals  have  elected  staff 
officers  as  follows:  St.  Elizabeth  Hospital:  Dr. 

Curtiss  M.  Ginn,  chief,  and  Dr.  W.  R.  Hochwalt, 
secretary;  Miami  Valley  Hospital:  Dr.  Clarke 

Sullivan,  chief;  Dr.  R.  K.  Finley,  vice  chief,  and 
Dr.  W.  M.  Simpson,  secretary. 


Year  1932  Healthful  One  for  Ohioans, 
State  Report  Shows 

Citizens  of  Ohio  continued  to  enjoy  an  unusu- 
ally healthful  year  during  1 932,  when  they  were 
passing  through  an  era  which  made  conditions 
such  as  to  lower  the  resistance  and  vitality  of  the 
people  to  battle  against  diseases  causing  death. 

Records  of  death  filed  in  the  State  Department 
of  Health,  Division  of  Vital  Statistics,  for  last 
year  made  a general  death  rate  of  11.0  per  1000 
population,  which  is  the  lowest  ever  recorded  for 
any  one  year  since  the  establishment  of  the  Di- 
vision in  1908. 

During  1932,  75,875  deaths  were  recorded,  with 
a rate  of  11.0  as  compared  with  75,500  deaths  for 

1931  and  a rate  of  11.1  per  1000  population.  The 
number  of  deaths  increased  375  during  the  year, 
but  the  estimated  population  of  the  state  figured 
by  the  arithmetical  method  increased  the  popu- 
lation 86,566  for  this  period. 

If  the  1931  death  rate  had  continued  in  1932 
the  increase  in  the  number  of  deaths  would  have 
been  969.  This  saving  in  the  total  number  of 
lives  is  very  small,  but  when  the  report  is  ana- 
lyzed there  is  found  an  increase  of  283  deaths  in 

1932  among  the  group  of  causes  in  which  proper 
nutrition  and  medical  care  are  very  vital,  namely, 
diarrhea  and  enteritis  under  two  years  of  age, 
diabetes,  nephritis  and  cerebral  hemorrhage,  along 
with  diseases  of  the  heart  and  cancer. 

Diarrhea  and  enteritis  under  two  years  of  age 
made  the  greatest  gain,  307  deaths  in  1931  and 
626  in  1932,  with  a death  rate  of  9.14  per  100,000 
population,  the  highest  rate  since  the  year  1921. 

During  the  year  1932  there  were  no  major 
epidemics  in  the  state  spreading  with  sufficient 
magnitude  to  increase  the  number  of  deaths.  In 
the  group  of  deaths  from  communicable  diseases, 
328  fewer  were  reported  during  1932,  which  shows 
the  results  of  a well  organized  health  unit  in 
each  county  and  city  in  the  state  laboring  to  pre- 
vent the  spread  of  communicable  disease. 

The  value  of  prenatal  care  is  shown  in  the 
group  of  deaths  listed  under  the  puerperal  state 
and  congenital  malformations  and  diseases  pecu- 
liar to  early  infancy,  wherein  490  fewer  deaths 
were  reported  in  1932. 

There  were  879  fewer  deaths  in  1932  reported 
from  accidental  causes.  It  is  known  that  many 
automobiles  were  kept  off  the  highways  during  the 
year,  and  fewer  men  were  employed  in  industry, 
but  a saving  of  lives  in  this  group  also  was  found 
among  deaths  due  to  accidental  falls  and  burns, 
along  with  many  other  similar  causes,  which  is 
evidence  of  the  value  of  the  educational  work 
carried  on  by  the  safety  organizations  within 
the  state. 

Deaths  from  tuberculosis,  all  forms,  continues 
to  decline.  They  numbered  3,770  in  1932,  with  a 
rate  of  55.08  per  100,000  population,  or  3,409 
fewer  deaths  than  were  reported  in  1910,  with  a 
decrease  in  the  death  rate  of  95.68  during  the 


April,  1933 


State  News 


257 


Legislation  and  Machinery  in  Ohio  for  ''Relief"  Dnrin: 
Remainder  of  1932^33  Bienninm 


Initial  steps  in  establishing  the  machinery  for 
financing  and  administering  relief,  including  med- 
ical and  hospital  care,  to  the  indigent  and  unem- 
ployed of  Ohio  during  the  remainder  of  1933  and 
in  1934  have  been  completed  by  the  Ohio  General 
Assembly. 

Legislation  providing  ways  and  means  for 
townships,  counties  and  cities  to  meet  immediate 
poor  relief  needs  and  to  tide  them  along  until 
state  relief  funds,  supplemented  by  money  from 
the  Reconstruction  Finance  Corporation,  are 
available,  has  been  enacted  by  the  State  Legisla- 
ture. 

Among  the  measures  which  have  to  date  been 
enacted,  continuing  the  provisions  of  the  emer- 
gency relief  laws  enacted  at  the  special  session  of 
the  89th  General  Assembly  in  the  Spring  of  1932, 
are: 

SENATE  BILL  No.  60,  providing  for  the 
continuance  and  operation  of  the  State  Re- 
lief Commission,  established  in  1932  to  set 
up  a centralized  control  in  the  state-wide  ad- 
ministration of  poor  and  unemployment  re- 
lief. 

SENATE  BILL  No.  61,  authorizing  town- 
ships, counties  and  cities  to  use  a portion  of 
their  share  of  the  state  gasoline  tax  for  poor 
relief. 

SENATE  BILL  No.  63,  permitting  counties 
and  cities  to  issue  bonds  and  to  levy  an  ex- 
cise tax  on  public  utilities  for  the  relief  of 
the  poor  and  unemployed. 

SENATE  BILL  No.  64,  permitting  boards 
of  education  to  furnish  relief  to  needy  school 
children. 

The  relief  needs  of  the  entire  state  during  the 
current  year  have  been  estimated  at  between  40 
and  50  millons  of  dollars.  Under  the  present 
plan  devised  to  meet  this  need,  it  is  hoped  that 
one-third  of  the  money  can  be  raised  by  local  sub- 
divisions from  general  revenue  funds  and  by 
taking  advantage  of  the  emergency  legislation 
summarized  above.  The  state  government  ex- 
pects to  raise  between  $12,000,000  and  $14,000,000 
through  the  levy  of  new  taxes  or  by  diverting  a 
part  of  the  highway  construction  funds  for  poor 
and  unemployment  relief  in  all  parts  of  the  state. 
The  remainder  of  the  sum  needed  for  relief  pur- 
pose will  be  sought  from  the  Reconstruction 
Finance  Corporation. 

Legislation  to  provide  the  state’s  share  of  ad- 
ministering the  state-wide  relief  program  was 
under  consideration  by  the  Legislature  and  ar- 
rangements made  for  securing  federal  funds. 

Recently,  misunderstandings  have  arisen  con- 
cerning how  local,  state  and  federal  relief  money 
should  be  used;  particularly  what  portion  of  it 


could  be  used  for  furnishing  medical  care  and 
hospitalization  for  the  indigent  sick. 

Reconstruction  Finance  Funds  must  be  used 
for  “work  relief”  and  “direct  relief”.  “Work  re- 
lief” has  been  interpreted  by  administrators  of 
the  R.  F.  C.  to  mean  wages  or  other  compensation 
in  cash  or  in  kind  for  labor  on  public  projects. 
“Direct  relief”  has  been  interpreted  to  mean  the 
furnishing  of  food,  clothing,  fuel  and  shelter  to 
indigents  and  the  needy  unemployed. 

The  State  Relief  Commission  has  adopted  a 
similar  policy  for  the  use  of  state  funds.  There- 
fore, neither  federal  nor  state  money  may  be 
used  for  the  payment  of  physicians  and  hospitals 
for  care  of  the  poor. 

However,  the  State  Relief  Commission  has 
ruled  that  the  furnishing  of  medical  and  hospital 
care  for  the  indigent  is  an  obligation  and  function 
of  townships,  counties  and  cities  at  all  times,  even 
in  normal  periods,  and  that  adequate  local  provi- 
sion must  be  made  first  for  poor  relief  of  this 
nature. 

To  enable  townships,  counties  and  cities  to 
finance  their  usual  poor  relief  activities,  the 
Legislature  re-enacted  the  legislation  summaried 
previously. 

It  has  been  pointed  out  that  subdivisions  should 
have  little  difficulty  raising  money  to  pay  physi- 
cians and  hospitals  for  services  to  indigents  if 
local  officials  make  use  of  the  enabling  emergency 
legislation  just  enacted. 

Local  officials  are  expected  to  make  provision 
first  for  institutional  care,  medical  and  nursing 
services,  mothers’  pensions,  blind  relief  and  sol- 
diers’ burial — regular  functions  of  local  govern- 
ment. Funds  for  these  activities  should  come  out 
of  the  general  revenue  fund  or  can  be  supple- 
mented by  issuance  of  bonds,  a tax  on  utilities  or 
by  diversion  of  gasoline  tax  money. 

If,  after  these  obligations  have  been  met,  a town- 
ship, county  or  city  is  unable  to  provide  “work” 
and  “direct”  relief  for  the  unemployment,  it 
should  apply  to  the  State  Relief  Commission  for 
state  or  fedei’al  funds. 

The  State  Relief  Commission  has  insisited  that 
all  subdivisions  do  everything  possible  to  meet 
their  local  needs  before  asking  for  state  and  fed- 
eral funds.  A careful  check  is  kept  on  the  relief 
activities  of  all  townships,  counties  and  cities.  All 
must  submit  a budget  to  the  Commission  when 
applying  for  state  and  federal  funds.  No  state 
or  federal  funds  are  supplied  to  subdivisions 
which  have  local  funds  available  for  relief  pur- 
poses. In  checking  the  budgets,  the  State  Relief 
Commission  also  makes  sure  that  adequate  provi- 
sion is  made  for  regular  poor  relief  activities, 
such  as  medical,  hospital  and  nursing  services. 

As  matters  stand  at  present,  the  State  Relief 


258 


The  Ohio  State  Medical  Journal 


April,  1938 


Commission  is  of  the  opinion  that  all  communities 
should  be  able  to  adequately  provide  for  the  pay- 
ment of  medical  fees  and  hospital  bills  for  service 
rendered  to  indigents,  especially  by  increasing 
their  poor  relief  funds  as  authorized  by  the  spe- 
cial legislation  above  analyzed.  In  most  cases,  it 
is  simply  a question  of  judgment  on  the  part  of 
local  officials  who  should  see  that  services  which 
are  an  integral  part  of  the  poor  relief  activities 


of  the  subdivision  at  all  times  are  supplied  with 
adequate  funds  before  steps  to  finance  activities 
to  meet  the  present  emergency  are  taken,  since 
state  and  federal  funds  can  be  obtained  to  meet 
“emergency  relief”  after  local  funds  have  been 
exhausted. 

Statutes  and  regulations  for  local  medical  re- 
lief were  construed  and  quoted,  at  some  length,, 
pages  203  to  207  of  the  March,  1932,  Journal. 


News 

N® 

County  Soq 

ities 

•s  From 

id  Academies 


First  District 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(George  B.  Topmoeler,  M.D.,  Secretary) 

March  6 — General  Session.  Program:  “Tech- 
nique of  the  Modern  Treatment  of  Paresis”,  by 
Dr.  C.  E.  Shinkle;  discussions  by  Drs.  H.  D.  Mc- 
Intyre and  J.  F.  Bateman.  “A  Study  of  300  Cases 
of  Errors  of  Carbohydrate  Metabolism  Occurring 
in  Private  Practice”,  by  Dr.  Cecil  Striker;  dis- 
cussion by  Drs.  L.  G.  Heyn  and  Oscar  Berghausen. 

March  13 — General  Session.  Program:  “En- 

darteritis Obliterans  With  Unusual  Ocular  Find- 
ings”, by  Dr.  Adolph  0.  Pfingst,  Louisville,  Ken- 
tucky. “The  Treatment  of  Hay  Fever”,  by  Dr. 
Joseph  Stein. 

March  20 — General  Session.  Program:  (a) 

“The  Clinical  Interpretation  of  the  Schilling 
Hemogram”,  by  Dr.  Oscar  Berghausen ; discussion 
by  Dr.  Stanley  E.  Dorst.  (b)  “Venous  Blood 
Pressure  and  Vital  Capacity  Determinations  as  a 
Measure  of  Circulatory  Fitness”,  by  Dr.  Berg- 
hausen; discussion  by  Dr.  Julien  E.  Benjamin. 
“The  Diagnosis  and  Treatment  of  Pancreatitis”, 
by  Dr.  M.  M.  Zinninger;  discussion  by  Drs.  Leon 
Sehiff  and  L.  B.  Johnston. 

March  27 — General  Session.  Program:  “Puer- 
peral Psychosis”,  by  Dr.  William  Ravine;  dis- 
cussion by  Drs.  Frank  A.  Kautz  and  James  M. 
Pierce;  “Bacterial  Asthma:  Its  Diagnosis  and 

Treatment”,  by  Dr.  Stanley  E.  Dorst;  discussion 
by  Drs.  Alfred  Friedlander  and  A.  G.  Mitchell. 
- — Bulletin. 

Clinton  County  Medical  Society  met  in  regular 
session  at  Wilmington  Library,  Tuesday  after- 
noon, February  7.  Case  reports  were  presented 
as  follows:  Dr.  S.  A.  Crabtree:  Unusual  res- 

piratory infection  with  good  end  results;  Dr. 
Robert  Conard:  Diverticulosis  of  colon  differen- 
tiated from  malignancy  by  means  of  Y-ray;  Dr. 
Kelley  Hale:  Final  microscopic  report  of  col- 

loidal thyroid.  This  case  previously  microscopi- 
cally reported  as  intra-thoracic  thyroid;  Dr.  V.  E. 
Hutchens:  Bandl’s  ring,  complicating  delivery 
with  resultant  craniotomy  with  recovery  of 
mother;  Dr.  A.  C.  Roberts:  Puerperal  sepsis  with 
complete  recovery  under  serum  treatment;  Dr.  E. 


D.  Peele:  Successful  instrumental  delivery  of 
placenta  previa  lateralis  following  tracheloplasty 
and  perineoplasty;  Dr.  Elizabeth  Shrieves:  Be- 
nign cauliflower  growth  of  cervix;  Dr.  W.  B. 
Yoakley:  Sapremia  following  delivery  with  re- 
covery; Dr.  Regan:  Acute  alcoholism  with  fatal 
termination.  Ten  minute  talks  were  presented  by 
Dr.  Crabtree,  on  Anemia;  by  Dr.  Conard  on  The 
Endocrines;  and  by  Dr.  Hutchens,  on  the  Use  and 
Abuse  of  Pituitrin. — W.  E.  Regan,  M.D.,  Secre- 
tary. 

The  March  meeting  of  the  Clinton  County 
Medical  Society  was  held  at  the  General  Denver 
Hotel,  Wilmington,  March  7.  Following  a lunch- 
eon, Dr.  J.  E.  Griewe  of  Cincinnati,  spoke  on 
“The  New  Physiology  of  the  Heart”. — News  Clip- 
ping. 

Fayette  County  Medical  Society  held  its  regu- 
lar meeting  on  Thursday  afternoon,  March  2,  at 
the  Y.M.C.A.,  Washington  C.  H.  All  but  three  of 
those  who  could  be  there,  were  present.  Dr. 
George  T.  Harding,  III,  of  Columbus,  gave  a 
very  practical  and  interesting  talk  on  “Psych- 
oneurosis”, with  illustrative  case  reports.  An  in- 
teresting discussion  followed  his  address. — James 
F.  Wilson,  M.D.,  Secretary. 

Second  District 

Clark  County  Medical  Society  met  February  8 
at  the  City  Hospital,  Springfield,  for  its  regular 
luncheon  meeting.  A paper  on  “Renal  Infections”, 
illustrated  with  lantern  slides,  was  presented  by 
Dr.  Stanford  W.  Mulholland. 

On  February  22,  the  Society  held  a luncheon 
meeting  at  the  City  Hospital,  Springfield.  “Skull 
Fractures”  was  the  subject  of  an  address  by  Dr. 
Roy  D.  Am.  Dr.  F.  P.  Anzinger,  member  of  the 
local  legislative  committee,  discussed  pending 
bills  in  both  state  and  federal  legislative  bodies. 
Dr.  D.  C.  Houser,  Urbana,  past  president  of  the 
Ohio  State  Medical  Association,  was  a guest,  and 
spoke  briefly  on  legislative  and  organization  mat- 
ters.— News  Clipping. 

Darke  County  Medical  Society  held  its  regular 
meeting  on  Friday  evening,  February  17,  at  the 
Christian  Church,  Greenville,  with  a six  o’clock 
dinner.  Guest  speaker  for  the  evening  was  Dr. 


April,  1933 


State  News 


259 


George  M.  Curtis,  head  of  the  Department  of 
Surgical  Research,  College  of  Medicine,  Ohio 
State  University.  His  subject  was  “Research 
Surgery  and  the  Thyroid”. — Bulletin. 

Greene  County  Medical  Society  met  Thursday, 
March  2,  in  their  room  at  the  Court  House,  Xenia. 
Following  the  regular  business  session,  City  Man- 
ager Smith  gave  a short  talk  on  the  management 
of  the  poor  relief  in  the  city.  Dr.  Benedict  Olch, 
of  Dayton,  spoke  on  “Treatment  of  Diabetic 
Coma”.  His  address  was  well  received.  Society 
adjourned,  with  luncheon. — H.  C.  Schick,  M.D., 
Secretary. 

Miami  County  Medical  Society  held  its  March 
meeting  at  Stouder  Memorial  Hospital,  Troy,  on 
Friday  afternoon,  March  3.  Dr.  C.  L.  Hartsock, 
of  the  Cleveland  Clinic,  spoke  on  “The  Treatment 
of  Some  of  the  Common  Gastro-Intestinal  Dis- 
orders”. An  interesting  discussion  followed, 
opened  by  Drs.  A.  B.  Brower  and  Walter  Simp- 
son, of  Dayton.  In  addition  to  local  members,  a 
representative  group  of  visitors  were  present  from 
Sidney  and  Shelby  County  and  from  Dayton. — 
News  Clipping. 

Montgomery  County  Medical  Society  met  Fri- 
day evening,  March  3,  in  the  auditorium  of  the 
Fidelity  Medical  Building,  Dayton.  The  speaker 
of  the  evening  was  Dr.  M.  W.  Coleman,  who  dis- 
cussed the  subject  of  “Removal  of  Vesical  Neck 
Obstructions  by  Trans-urethral  Resection”.  His 
talk  was  illustrated  with  motion  pictures. 

The  program  for  the  regular  meeting  of  the 
Society,  Friday  evening,  March  17,  was  given  by 
Dr.  Charles  A.  Doan,  Professor  of  Medical  Re- 
search, College  of  Medicine,  Ohio  State  Uni- 
versity. His  subject  was  “The  Present  Day  Prob- 
lem of  Radio  Activity  in  Medicine”. — Bulletin. 

Preble  County  Medical  Society  met  at  Seven 
Mile  Tavern,  Eaton,  on  Thursday  evening,  Feb- 
ruary 16.  Dinner  at  seven  o’clock  was  followed 
by  an  address  on  “Infant  Feeding  and  Problems 
of  Interest  to  the  General  Practitioner”,  by  Dr. 
C.  Clarkson  Payne,  Dayton. — News  Clipping. 

Third  District 

Auglaize  County  Medical  Society  met  in  regular 
session  at  the  High  School  building  in  New 
Bremen,  Thursday  evening  March  9.  This  meet- 
ing had  been  deferred  from  the  regular  date,  Feb- 
ruary 9,  because  of  extremely  cold  weather  at  that 
time.  A large  attendance  of  members  was  present 
to  hear  the  address  of  Dr.  Harry  S.  Noble  of  St. 
Marys  on  “Functional  Diseases”.  The  speaker  con- 
sidered the  relation  of  the  sympathetic  nervous 
system  and  the  endocrines  upon  the  disturbed 
function  of  the  various  bodily  organs;  and  evoked 
a very  animated  discussion  from  the  various  mem- 
bers. Dr.  E.  F.  Heffner  in  assuming  the  presidency 
of  the  Society  for  this  year,  resigned  his  place  on 
the  Board  of  Censors,  and  Dr.  George  B.  Faulder 
was  elected  to  fill  his  unexpired  term  for  1933  and 
1934. — Chas.  C.  Berlin,  M.  D.,  Secretary. 


Hancock  County  Medical  Society  held  its  regu- 
lar monthly  meeting  at  the  Elks’  Club,  Findlay, 
Thursday  evening,  March  2.  The  guest  speaker, 
Dr.  George  M.  Curtis,  Research  Professor  of 
Surgery,  Ohio  State  University,  Columbus,  gave 
a very  interesting  paper  on  “Indications  and  Re- 
sults of  Thoracoplasty”.  In  addition  to  members 
of  the  Society,  doctors  were  present  from  Tiffin, 
Fostoria,  Toledo,  Leipsic,  Deshler  and  Dunkirk. — 
H.  0.  Crosby,  M.D.,  Secretary. 

Hardin  County  Medical  Society  held  a dinner 
meeting  at  the  Kenton  Cafe  dining  room,  Thurs- 
day evening,  February  16.  Dr.  R.  E.  Bushong, 
superintendent  of  the  Lima  Hospital  for  the 
Criminal  Insane,  was  the  guest  speaker. — News 
Clipping. 

Logan  County  Medical  Society  met  at  Hotel 
Ingalls,  Bellefontaine,  on  Friday  evening,  Feb- 
ruary 3,  for  a dinner  meeting.  Dr.  C.  K.  Startz- 
man,  of  Bellefontaine,  presented  an  excellent 
paper  on  “Some  Observations  in  Medical  Econo- 
mics”. 

Guest  speaker  for  the  March  dinner  meeting  of 
the  Society,  held  Friday  evening,  March  3,  .was  R. 
O.  Ruch,  of  Lima,  who  gave  an  illustrated  address 
on  “Common  Skin  Diseases”. — News  Clipping. 

Marion  County  Academy  of  Medicine  met  at  the 
City  Hospital,  Marion,  on  Tuesday  evening,  Feb- 
ruary 7.  Dr.  W.  B.  Morrison,  of  Columbus,  spoke 
on  “Surgical  Treatment  of  Benign  and  Malignant 
Lesions  of  the  Stomach  and  Duodenum”,  and 
demonstrated  his  talk  with  lantern  slides.  At  the 
business  session,  Dr.  Floyd  Yeager  was  admitted 
to  membership. — News  Clipping. 

Seneca  County  Medical  Society  held  a well-at- 
tended meeting  at  the  Shawhan  Hotel,  Tiffin,  on 
Thursday  evening,  February  16.  “Principles  Un- 
derlying the  Treatment  of  Bone  and  Joint  In- 
juries” was  the  subject  of  an  address  by  Dr.  Ed- 
ward P.  Gillette,  of  Toledo.  A general  discussion 
followed. — News  Clipping. 

Van  Wert  County  Medical  Society  held  its  regu- 
lar meeting  Tuesday  evening,  February  7,  at  the 
Van  Wert  County  Hospital.  A letter  from  Dr.  H. 
M.  Platter,  President  of  the  Ohio  State  Medical 
Association,  concerning  the  recent  report  of  the 
Committee  on  Costs  of  Medical  Care,  was  read. 
A proposition  whereby  the  physicians  received 
pay  for  care  of  the  indigent  was  favorably  con- 
sidered. The  scientific  program  on  “Growths  of 
the  Breast”,  was  presented  by  Drs.  B.  L.  Good 
and  O.  F.  Cress.  The  meeting  was  very  well  at- 
tended.— News  Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO 
AND  LUCAS  COUNTY 

(A.  P.  Hancuff,  M.D.,  Secretary) 

March  3— General  Meeting.  Academy  Building. 
Program:  Symposium  on  “The  Hospital  Situa- 

tion in  Toledo”.  1.  The  Problem  of  the  Private 
Hospitals,  by  Dr.  H.  H.  Heath;  2.  The  Problem 


260 


The  Ohio  State  Medical  Journal 


April,  1933 


of  Lucas  County  Hospital,  by  Dr.  N.  W.  Gillette; 

3.  The  Problem  of  the  Relationship  of  the  Physi- 
cians to  the  Hospitals,  by  Dr.  E.  J.  McCormick; 

4.  The  Solutions  of  the  Problems,  by  Dr.  W.  W. 
Beck.  Discussion  opened  by  members  of  the  Hos- 
pital Relations  Committee. 

March  10 — Section  of  Pathology,  Experimental 
Medicine  and  Bacteriology.  Program:  “Liver 

Functions — Classifications,  Tests,  Clinical  Inter- 
pretations— including  Jaundice”,  by  Dr.  S.  R. 
Salzman;  “Inclusion  of  Parathyroid  Tissue  in 
Thymus”,  Dr.  L.  A.  Brewer,  III  (by  invitation)  ; 
“Infestation  with  Strongylus  Stercoralis”,  Case 
Report,  by  Dr.  L.  A.  Miller. 

March  17 — Medical  Section.  Symposium  on 
“Lung  Abscess — A Review  of  Twenty-five  Cases”. 
1.  Medical  Aspects,  by  Dr.  Foster  Myers;  discus- 
sant, Dr.  Howard  Holmes;  2.  Bronchoscopic  As- 
pects, by  Dr.  Wm.  0.  Bonser;  discussant,  Dr.  J. 
A.  Lukens;  3.  Surgical  Aspects,  by  Dr.  W.  A. 
Neill;  discussant,  Dr.  W.  W.  Stone. 

March  2k — Surgical  Section.  Program : “Hema- 
turia”, by  Dr.  E.  W.  Huffer;  “Significance  of 
Pyuria”,  by  Dr.  A.  Rees  Klopfenstein ; “Ureteral 
Transplantation”,  by  Dr.  J.  A.  H.  Magoun ; 
“Treatment  of  Vesicle  Neck  Obstruction”,  a.  The 
Open  Operation;  b.  Transurethral  Resection,  by 
Drs.  L.  P.  Dolan,  and  A.  S.  Avei'y. 

March  31 — Eye,  Ear,  Nose  and  Throat  Section. 
Program:  “Acute  Suppurations  of  the  Pharnyx, 
Mouth  and  Cervical  Region”,  by  Dr.  A.  C.  Furs- 
tenberg,  Professor  of  Oto-Laryngology,  Univer- 
sity of  Michigan  Medical  School,  Ann  Arbor, 
Michigan. — Bulletin. 

Four-County  Medical  Society  met  at  the  Parish 
House,  Napoleon,  on  Thursday  afternoon,  Feb- 
ruary 23.  Dr.  Reed  M.  Nesbit,  Chief  Genito- 
urinary Surgeon,  University  of  Michigan,  Ann 
Arbor,  addressed  the  Society  on  “Transurethral 
Resection  of  the  Prostate”.  A six-o’clock  dinner 
was  served  to  members  following  the  program. — 
Bulletin. 

Sandusky  County  Medical  Society  held  its  regu- 
lar monthly  meeting  in  the  mayor’s  office,  city 
hall,  Fremont,  on  Thursday  evening,  February 
23,  with  a good  attendance.  Dr.  F.  M.  Kent,  of 
Bellevue,  presented  a paper  on  “Spinal  Anes- 
thesia”. Dr.  H.  K.  Shumaker,  also  of  Bellevue, 
gave  a fine  talk.  Dr.  J.  C.  Boyce  was  appointed 
to  meet  with  members  of  the  hospital  board  to 
consider  plans  for  care  of  indigents. — News  Clip- 
ping. 

Wood  County  Medical  Society  met  Thursday, 
February  16,  at  the  Women’s  Club,  Bowling 
Green.  After  a dinner,  Dr.  C.  S.  Ordway,  of  To- 
ledo, presented  some  interesting  moving  pictures 
on  miscellaneous  subjects.  Dr.  B.  J.  Hein,  To- 
ledo, Councilor  of  the  Fourth  District,  reviewed 
the  report  of  the  Committee  on  the  Costs  of  Medi- 
cal Care.  Several  members  participated  in  the 
general  discussion  which  followed. — Ralph  E. 
Rasor,  M.D.,  Correspondent. 


Fifth  District 

ACADEMY  OF  MEDICINE  OF  CLEVELAND 

(C.  H.  Heymarij  M.D.,  Secretary) 

March  3 — Clinical  and  Pathological  Section, 
Charity  Hospital.  Program:  “Toxic  Goiter  Com- 
plicating Post  Encephalitic  Parkinson’s  Disease”, 
by  Dr.  E.  P.  Neary;  “Banti’s  Disease  (six  years 
following  splenectomy)”,  by  Dr.  I.  H.  Einsel; 
“Periphral  Vascular  Disease  with  Potentiometer 
Studies”,  by  Dr.  C.  G.  Barber;  “Bone  Syphilis”, 
by  Dr.  C.  L.  Cummer;  “Evulsion  of  the  Scalp”, 
by  Dr.  C.  H.  Kuhlman;  “Congenital  Anomalies  of 
the  Gut”,  by  Dr.  J.  E.  Hallisy;  (a)  “Thyro-Glos- 
sal  Cyst.”  (b)  “Cancer  of  the  Tongue”,  by  Dr. 

S.  H.  Large;  “Early  Miliary  Pulmonary  Tuber- 
culosis (A-ray  films)”,  by  Dr.  John  Osmond;  “Re- 
current Jejunal  Ulcers”,  by  Dr.  F.  C.  Herrick. 

March  10-  -Experimental  Medicine  Section  of 
the  Academy  of  Medicine  and  the  Cleveland  Sec- 
tion of  the  Society  for  Experimental  Biology  and 
Medicine.  (Program  arranged  by  Department  of 
Anatomy) . “The  Human  Dorsalis  Pedis  Artery”, 
by  Dr.  Rudolph  S.  Reich;  “Development  of  the 
Nasal  Passages  During  Childhood”,  by  Dr.  Harry 
C.  Rosenberger;  “The  Infant’s  Growing  Control 
over  Thumb  Movements”,  by  L.  Dewey  Anderson, 
Ph.D.,  by  invitation;  “Roentgenographic  Observa- 
tions on  the  Growth  of  Long  Bones”,  by  William 
B.  Seymour,  A.B.,  presented  by  Dr.  Carl  C.  Fran- 
cis; “Post- Amputation  Bone  Textures  and  Di- 
mensions”, by  Dr.  C.  Glenn  Barber;  “The  Meas- 
urement of  Aberrant  Developmental  Growth”,  by 
Dr.  Theodore  T.  Zuck,  by  invitation. 

March  17 — Regular  Academy  Meeting.  Pro- 
gram: “The  Treatment  of  Pneumonia”,  by  Dr. 
Russell  L.  Cecil,  New  York,  Associate  Professor 
of  Clinical  Medicine  in  Cornell  Medical  School, 
and  editor  of  Cecil’s  Practice  of  Medicine.  Dis- 
cussion opened  by  Dr.  Gerald  L.  Shibley. 

March  21 — Inauguration  Meeting  of  Section  on 
Military  Medicine.  Program:  Election  of  Chair- 
man and  Secretary.  “Some  Phases  of  the  Or- 
ganized Reserves”,  by  Col.  David  Baker.  Preced- 
ing the  meeting  at  the  Academy,  a complimen- 
tary dinner  for  Col.  Baker  was  held  at  the  Cleve- 
land Club,  to  which  all  Academy  members  were 
invited. 

March  29 — Obstetrical  and  Gynecological  Sec- 
tion. Program:  “Modern  Obstetric  Practice  in 

the  Home  and  at  the  Hospital”,  by  Dr.  A.  J. 
Skeel;  “Maternal  Mortality  in  Cleveland  for 
1931”,  by  Dr.  R.  A.  Bolt.  Discussion  by  Drs. 
Theodore  Miller,  J.  J.  Thomas,  and  H.  J.  Knapp. 

Ashtabula  County  Medical  Society  and  the 
Ashtabula  County  Dental  Society  held  a joint 
dinner-dance  at  Hotel  Ashtabula,  on  Tuesday  eve- 
ning, February  14. — News  Clipping. 

Lorain  County  Medical  Society  met  Tuesday 
evening,  February  14,  at  the  First  Congregational 
Church,  Lorain,  for  its  regular  monthly  meeting. 
Following  a dinner  at  five  o’clock,  Dr.  John  P. 


April,  1933 


State  News 


261 


Rankin,  of  Elyria,  presented  a paper  on  “Chest 
Complications  Following  Operations”. 

The  March  meeting  of  the  Society  was  held  in 
the  parlors  of  the  Second  Congregational  Church, 
Elyria,  commencing  with  a five-o’clock  dinner. 
Dr.  Harold  J.  Knapp,  formerly  of  Elyria,  now 
Commissioner  of  Health,  Cleveland,  Ohio,  gave  an 
address  on  health  mattei’s. — Bulletin. 

Medina  County  Medical  Society  held  its  monthly 
meeting  at  the  Evanon,  Medina,  on  Thursday 
afternoon,  February  16.  Dr.  J.  M.  Hayman,  Lake- 
side Hospital,  Cleveland,  addi’essed  the  Society  on 
the  subject  of  “Nephritis”.  Dinner  was  served  at 
the  conclusion  of  the  program. — News  Clipping. 

Sixth  District 

Ashland  County  Medical  Society  met  at  the 
Samaritan  Hospital,  Friday  evening,  February 
10,  with  fifteen  members  present.  Di\  John  P. 
Anderson,  of  Cleveland,  addressed  the  society  on 
the  subject  of  “Congestive  Heai*t  Failure”.  He 
gave  lantern  slides,  also,  showing  numerous 
electro-cardiograph  tracings  of  vax-ious  heai't 
lesions.  He  also  gave  us  a comprehensive  outline 
of  the  indications  and  contraindications  of  various 
heart  medication.  His  paper  was  followed  by  a 
general  discussion. 

The  March  meeting  of  the  Society  was  held  at 
the  Samai-itan  Hospital,  Ashland,  on  Fi-iday  eve- 
ning, March  10.  Fourteen  members  were  present 
to  hear  Dr.  Bernard  H.  Nichols,  of  Cleveland 
Clinic,  speak  on  “X-ray  and  Upper  Right  Ab- 
dominal Pain”.  The  lecture  was  illustrated  by 
lantern  slides.  He  gave  us  a l’eview  of  many  cases 
showing  the  importance  of  using  X-ray  as  an  aid 
in  diagnosis  of  abdominal  pain.  After  the  meet- 
ing, lunch  was  served,  thi-ough  the  compliments 
of  the  Samaritan  Hospital. — Paul  E.  Kellogg, 
M.D.,  Secretary. 

Mahoning  County  Medical  Society  held  its  regu- 
lar meeting  on  Tuesday  evening,  March  21,  at 
the  Youngstown  Club.  Dr.  Louis  J.  Kamosh, 
Cleveland,  Assistant  Clinical  Pi’ofessor  of  Neur- 
ology, Western  Reserve  University,  addressed  the 
society  on  “High  Lights  of  Brain  Function”. 

Nearly  300  physicians  of  eastern  Ohio  and 
western  Pennsylvania  were  guests  of  the  Ma- 
honing County  Medical  Society  at  the  monthly 
meeting  held  February  23  at  the  Youngstown 
Club.  The  guest  speaker  was  Dr.  E.  Starr  Judd, 
Professor  of  Sui’gery,  Mayo  Foundation,  Uni- 
versity of  Minnesota,  and  a past  pi-esident  of  the 
American  Medical  Association.  His  lecture  on 
“Acute  Cholecystitis”,  was  illustrated  with  lan- 
tern slides.— -News  Clipping. 

Portage  County  Medical  Society  invited  den- 
tists of  Poi*tage  County  to  attend  the  monthly 
meeting  at  the  residence  of  Dr.  Bernard  H.  Nich- 
ols, Ravenna,  on  Thursday  evening,  Max-ch  2.  Dr. 
Russell  L.  Haden,  chief  of  the  Medical  Staff, 
Cleveland  Clinic,  spoke  on  “Dental  Infection  and 
Systemic  Disease”,  and  illustrated  his  remarks 
with  lantern  slides.  At  the  business  session,  Dr. 


George  J.  Waggoner,  Ravenna,  was  appointed  as 
delegate  to  the  annual  meeting  of  the  State  Asso- 
ciation, and  Dr.  Emily  J.  Widdecombe,  of  Kent, 
was  appointed  as  alternate. — Bulletin. 

Stark  County  Medical  Society  met  Tuesday  eve- 
ning, March  14,  at  the  Elks’  Club,  Canton.  Dr.  E. 
F.  Henderson,  New  Castle,  Pennsylvania,  ad- 
dressed the  Society  on  “A  General  Consideration 
of  the  Symptoms  and  Ti’eatment  of  Peptic  Ulcers. 
— Bulletin. 

Summit  County  Medical  Society  held  its  regular 
monthly  meeting  at  the  Mayflower  Hotel,  Akron, 
on  Tuesday  evening,  March  7.  Di\  C.  A.  Doan, 
Director  of  Medical  and  Sui-gical  Research,  Ohio 
State  University,  Columbus,  spoke  on  “The 
Newer  Immunological  Concepts  in  the  Control  of 
Communicable  Diseases”. — Bulletin. 

Seventh  District 

Belmont  County  Medical  Society  held  its  regu- 
lar monthly  meeting  at  Kilkenny  Inn,  Bellaire, 
on  Thursday  afternoon,  March  2.  Dr.  J.  T.  Bel- 
grade, Wheeling,  West  Virginia,  addressed  the 
society  on  the  subject  of  “Intradermal  and 
Cutaneous  Method  of  Testing  in  Food  Allergy— 
a Comparative  Study”. — Bulletin. 

Columbiana  County  Medical  Society  met  in  Lis- 
bon, Tuesday  evening,  March  7.  Dr.  E.  W.  Mis- 
kall,  East  Liverpool,  presented  a paper  on  “Spinal 
Anesthesia”.  Discussion  was  opend  by  Drs.  C.  E. 
Bailey  and  V.  E.  McEldowney. — Bulletin. 

Coshocton  County  Medical  Society  held  its  regu- 
lar meeting  on  Thursday  evening,  February  24,  at 
the  City  Hospital,  Coshocton.  Dr.  J.  C.  Bi'iner, 
of  West  Lafayette,  presented  a paper  on  “In- 
fantile Eczema”. — News  Clipping. 

Jefferson  County  Medical  Society  met  Tuesday, 
February  28  in  Steubenville.  Dr.  Joseph  T.  Bel- 
gx-ade,  of  Wheeling,  West  Virginia,  gave  an  in- 
sti-uctive  talk  on  “Methods  of  Testing  in  Allergic 
Conditions”.  The  January  meeting  of  the  Society 
was  held  at  the  Ohio  Valley  Hospital,  Steuben- 
ville, January  31.  Pi’ogram  was  devoted  to  a dis- 
cussion of  the  report  of  the  Committee  on  Medical 
Economics,  and  local  economical  problems.  The 
meeting  was  well  attended. — John  Y.  Bevan, 
M.D.,  Secretary. 

Tuscarawas  County  Medical  Society  met  Thurs- 
day evening,  February  9,  in  the  council  chamber, 
city  hall,  Dover.  Di\  Wm.  J.  Engler,  of  the  Cleve- 
land Clinic,  presented  a very  interesting  illus- 
trated paper  on  “Treatment  of  Pxustatic  Obstruc- 
tion by  Transurethral  Resection”.  The  March 
meeting  of  the  Society,  held  Thursday,  March  9, 
was  addressed  by  Di-s.  R.  L.  Barnes,  and  W.  B. 
Morrison,  of  Columbus,  who  discussed  “Treatment 
of  Ai*thi*itis”  and  “Gasti'ic  Surgei'y”,  l-espectively. 
Both  papers  were  iixstructive  and  stimulating. — 
Geoi-ge  L.  Sackett,  M.D.,  Secretary. 

Eighth  District 

Athens  County  Medical  Society  met  Monday, 
February  6, at  Sheltering  Arms  Hospital,  Athens, 


262 


The  Ohio  State  Medical  Journal 


April,  1933 


with  Dr.  C.  H.  Creed,  presiding.  The  secretary’s 
report  was  presented  by  Dr.  T.  A.  Copeland,  and 
Miss  Mary  Smith,  chief  nurse  at  the  hospital, 
gave  a brief  history  of  the  institution.  Guest 
speakers  for  the  meeting  were  Dr.  L.  L.  Bigelow, 
Columbus,  past  president  of  the  Ohio  State  Medi- 
cal Association,  and  Dr.  C.  M.  Shepard,  of  Co- 
lumbus, who  discussed  “Disadvantages  of  State 
Medicine”.  Preceding  the  program,  members  were 
guests  of  Dr.  J.  R.  Sprague,  at  a luncheon  served 
by  the  Ladies’  Aid  Society  of  the  Central  Avenue 
Methodist  Church.— News  Clipping. 

Fairfield  County  Medical  Society  held  a lunch- 
eon meeting  Thursday,  February  23,  at  the  Music 
Box,  in  Lancaster.  A brief  business  session  pre- 
ceded the  presentation  of  a paper  on  “Pneumonia 
and  Children”,  by  Dr.  Carl  J.  Ochs,  of  Columbus. 
- — News  Clipping. 

Guernsey  County  Medical  Society  met  Thurs- 
day, February  16,  at  the  Romance  Restaurant, 
Cambridge.  Following  luncheon,  Willard  D. 
Campbell,  prosecuting  attorney  of  Guernsey 
County,  spoke  on  “Medical  Jurisprudence”.  Once 
a year  the  society  invites  an  attorney  to  discuss 
this  subject  with  them  to  leam  of  any  changes  in 
the  statutes. 

Latest  developments  in  the  treatment  of  cancer 
by  the  use  of  X-ray  and  radium  was  discussed  by 
Dr.  Edward  C.  Kirkendall,  of  Columbus,  at  the 
luncheon  meeting  of  the  Society  held  Thursday, 
March  3,  at  the  Romance  Restaurant,  Cambridge. 
— News  Clipping. 

Muskingum  County  Academy  of  Medicine  met 
Wednesday  evening,  March  1,  at  the  Zane  Hotel, 
Zanesville.  Dinner  at  8 o’clock,  was  followed  by 
an  address  by  Dr.  George  I.  Nelson,  Columbus,  on 
the  subject  of  “Coronary  Vessel  Disease”. 

Perry  County  Medical  Society  held  its  regular 
meeting  on  Monday,  February  20,  at  the  Park 
Hotel,  New  Lexington,  with  Dr.  James  Miller, 
presiding.  Dr.  C.  B.  McDougal  read  a discussion 
of  Dr.  Wilbur  Williams,  and  Dr.  Miller  presented 
a paper  on  “Shoulder  Dislocations  and  Frac- 
tures”.— News  Clipping. 

Washington  County  Medical  Society  met  at 
Memorial  Hospital,  Marietta,  on  Wednesday  eve- 
ning, February  8.  Dr.  E.  R.  Brush,  Zanesville, 
Councilor  of  the  Eighth  District,  spoke  on  “Medi- 
cal Economics”,  and  Dr.  Robert  S.  Martin,  also  of 
Zanesville,  presented  a paper  on  “Ophthalmology 
for  the  General  Practitioner”. — News  Clipping. 

Ninth  District 

Meigs  County  Medical  Society  met  at  Hotel 
Marten,  Pomeroy,  on  Thursday,  February  16. 
Economic  and  legislative  matters  were  the  sub- 
jects of  discussion.  Dr.  H.  M.  Crumley,  of  Pom- 
eroy, was  elected  delegate  to  the  state  meeting, 
and  Dr.  E.  F.  Maag  was  appointed  alternate. — 
H.  M.  Crumley,  M.D.,  Secretary. 

Scioto  County — Regular  meeting  of  the  Hemp- 
stead Academy  of  Medicine  was  held  Monday  eve- 


ning, February  13,  at  the  residence  of  Dr.  George 
W.  Martin,  Portsmouth.  Dr.  P.  H.  Benson,  of 
Columbus,  spoke  on  “Artificial  Pneumothorax”, 
and  Dr.  J.  P.  Farson,  also  of  Columbus,  discussed 
“Infant  Feeding”. 

Program  for  the  regular  meeting  held  Monday 
evening,  March  13,  at  Recreational  Hall,  Nurses’ 
Home,  Portsmouth,  consisted  of  an  illustrated  lec- 
ture on  “Hemorrhages ; Their  Cause  and  Control”, 
by  Dr.  C.  A.  Mills,  Professor  of  Experimental 
Medicine,  University  of  Cincinnati.— Bulletin. 

Tenth  District 

COLUMBUS  ACADEMY  OF  MEDICINE 

(John  H.  Mitchell,  M.D.,  Secretary) 

March  6 — Columbus  Public  Library,  8:30  P.M. 
Program:  Symposium  on  “Diseases  of  the  Chest”. 
1.  Clinical  Diagnosis,  by  Dr.  Louis  Mark;  2. 
X-ray  Diagnosis,  by  Dr.  H.  V.  Weirauk;  3. 
Laboratory  Diagnosis,  by  Dr.  R.  S.  Fidler. 

March  13 — At  the  Library.  Program:  “Pre- 

ventive Medicine  for  the  Pre-school  Child”,  by 
Dr.  A.  G.  Helmick;  discussion  by  Drs.  E.  H. 
Baxter  and  A.  Cowan;  “The  California  Plan  of 
Group  Insurance  by  the  Local  Medical  Society”, 
by  Dr.  C.  C.  Sherburne. 

March  20 — At  St.  Francis  Hospital,  Nurses’ 
Home.  Clinic  by  the  Staff. 

March  27 — At  the  Library.  Program:  by  Gen- 
eral Practitioners  Section.  “Care  of  the  Aged 
Patient”,  by  Dr.  Ralph  Taylor;  discussion  by  Drs. 
W.  S.  Rhodes  and  C.  H.  Wells.— Bulletin. 

Crawford  County  Medical  Society  held  its  regu- 
lar monthly  meeting  at  Bucyrus  City  Hospital, 
Monday  night,  March  6.  “Treatment  of  Cancer” 
was  the  subject  of  an  address  by  Dr.  Charles  F. 
Bowen,  of  Columbus. — Bulletin. 

Ross  County  Medical  Society  met  Thursday  eve- 
ning, March  2 at  the  Warner  Hotel,  Chillicothe. 
Dr.  Joseph  DeCourcy,  of  Cincinnati,  discussed 
Surgical  Technique  in  Gallbladder  Operations”. 

- — News  Clipping. 


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Alleyne  M.  Baldwin,  M.D.,  Cleveland;  Western 
Reserve  University  School  of  Medicine,  1891;  aged 
64;  died  February  4 following  a long  illness.  For 
many  years  he  was  surgeon  of  the  Cleveland  Rail- 
way Company,  and  was  on  the  staffs  of  the 
Women’s  Hospital  and  St.  Clair  Hospital.  His 
widow  and  one  daughter  survive  him. 

Aaron  F.  Basinger,  M.D.,  Lima;  Western  Re- 
serve University,  School  of  Medicine,  1909;  aged 
51 ; member  of  the  Ohio  State  Medical  Associa- 
tion, and  Fellow  of  the  American  Medical  Asso- 
ciation; died  February  24  of  heart  disease,  while 
visiting  at  the  home  of  his  father  near  Columbus 
Grove.  Dr.  Basinger  sexved  his  internship  at  St. 
Alexis  Hospital,  Cleveland,  and  as  physician  in 
a tuberculosis  hospital  at  Colorado  Springs,  Colo- 
rado, before  locating  in  Lima  in  1907,  where  he 
continued  to  practice  until  his  death.  He  was 
former  chief  of  staff  of  St.  Rita’s  and  City  hos- 
pitals, Lima.  He  is  survived  by  his  widow,  three 
daughters,  his  father,  three  sisters  and  four 
brothers,  one  of  whom  is  Dr.  Harvey  L.  Basinger, 
of  Lima. 

George  K.  Beyer,  M.D.,  Lorain;  Cleveland  Med- 
ical College,  Homeopathic,  1897;  aged  68;  mem- 
ber of  the  Ohio  State  Medical  Association  and  the 
American  Medical  Association;  died  February  20 
of  heart  disease.  Dr.  Beyer  had  practiced  in 
Lorain  for  the  past  37  years,  and  was  a member 
of  staff  of  St.  Joseph’s  Hospital.  Surviving  him 
are  his  widow,  one  son,  Dr.  Harold  Beyer,  of 
Lorain,  one  daughter;  three  brothers  and  three 
sisters. 

Orison  Falor,  M.D.,  New  Baltimore;  Columbus 
Medical  College,  1883;  aged  74;  died  at  Alliance 
City  Hospital,  March  2.  Dr.  Falor  had  resided  in 
New  Baltimore  most  of  his  life.  He  is  survived 
by  one  son  and  one  daughter;  a brother  and  one 
sister. 

Martin  E.  Harrell,  M.D.,  New  Madison;  Eclectic 
Medical  College,  Cincinnati,  1917;  aged  44;  died 
February  7,  following  injuries  received  in  a grade 
crossing  accident  six  weeks  ago.  He  was  a 
veteran  of  the  World  War.  Dr.  Harrell  practiced 
in  Milford  Center  and  Burkettsville  before  locat- 
ing in  New  Madison.  JUs  widow,  one  son  and  one 
brother  survive  him. 

Jacob  Bruce  Patterson,  M.D.,  Wooster;  Wash- 
ington University  School  of  Medicine,  St.  Louis, 
Missouri,  1907;  aged  57;  member  of  the  Ohio 
State  Medical  Association  and  Fellow  of  the 
American  Medical  Association;  died  February  15 
in  Berea  Hospital,  a few  hours  after  he  was  in- 
jured when  his  automobile  collided  with  another. 
Dr.  Patterson  was  a medical  missionary  in  Korea 


for  a number  of  years  before  he  and  Mrs.  Patter- 
son returned  to  Wooster  to  educate  their  children. 
Besides  his  widow,  he  is  survived  by  one  son  and 
three  daughters. 

Edwin  H.  McKinney,  M.D.,  Doylestown;  Ohio 
Medical  University,  Columbus,  1905;  aged  56; 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died 
March  1 following  a heart  attack.  Dr.  McKinney 
had  practiced  in  Doylestown  since  his  graduation. 
He  was  serving  his  second  term  as  president  of 
the  Wayne  County  Medical  Society.  Surviving 
him  are  his  widow,  two  sons  and  a daughter. 

Elmer  O.  Peterson,  M.D.,  Canton;  Cleveland 
College  of  Physicians  and  Surgeons,  1907;  aged 
47 ; member  of  the  Ohio  State  Medical  Associa- 
tion, the  American  Medical  Association,  and  the 
American  Roentgenological  Society;  died  Febru- 
ary 23  following  several  weeks’  illness.  Dr.  Peter- 
son served  his  internship  at  St.  Clair  and  St. 
John’s  hospitals,  Cleveland.  He  practiced  at 
Monongahela,  Pennsylvania,  until  the  outbreak  of 
the  World  War  when  he  enlisted  with  the  British 
army,  holding  the  rank  of  major.  On  his  return 
he  located  in  Canton.  He  is  survived  by  his  widow, 
one  daughter,  his  mother,  one  brother  and  two 
sisters. 

Alexander  E.  Stepfield,  M.D.,  Doylestown; 
Cleveland  University  of  Medicine  and  Surgery, 
1883;  aged  75;  member  of  the  Ohio  State  Medical 
Association  and  the  American  Medical  Associa- 
tion; died  Februax-y  24,  at  Aki*on  City  Hospital, 
of  pneumonia  which  developed  following  an 
operation.  With  the  exception  of  one  year  spent 
at  Big  Flats,  New  York,  Dr.  Stepfield  had  prac- 
ticed in  Doylestown  for  nearly  fifty  years.  He 
was  active  in  civic  affaii-s,  and  had  served.  as 
coroner  of  Wayne  County  for  one  term,  and  as  a 
member  of  the  Doylestown  board  of  education  for 
four  years.  He  is  survived  by  one  son,  and  two 
daughters. 

James  Edgar  Townsley,  M.D.,  Cincinnati;  Co- 
lumbus Medical  College,  1889;  aged  77;  former 
member  of  the  Ohio  State  Medical  Association; 
died  Febniary  6.  Di\  Townsley  had  practiced  for 
43  yeai’s,  in  Linwood. 

James  P.  Wortman,  M.D.,  Crooksville;  Ohio 
Medical  University,  Columbus,  1898;  aged  66; 
member  of  the  Ohio  State  Medical  Association 
and  Fellow  of  the  American  Medical  Association ; 
died  March  1 from  injuries  received  in  a fall.  Dr. 
Wortman  had  practiced  at  Eaglepoi't  and  Deavei-- 
town  before  locating  at  Crooksville.  Suxviving 
him  are  his  widow,  a sister  and  two  brothers. 


264 


State  News 


April,  1933 


Mental  Health  of  Nation  Affected  by 
Depression 

“In  times  like  the  present  there  is  much  talk 
about  widespread  mental  and  nervous  disturb- 
ances, due  to  the  stresses  and  strains  induced  by 
economic  distress,”  declares  the  American  Journal 
of  Public  Health  editorially. 

“It  is  natural  to  assume,”  it  is  pointed  out, 
“that  conditions  such  as  those  created  by  the  cur- 
rent depression,  which  is  so  severely  taxing  the 
adaptive  capacities  of  a large  section  of  the  popu- 
lation, would  tend  to  unbalance  many  of  the  more 
poorly  adjusted  and  result  in  a higher  frequency 
of  mental  and  nervous  disorders”. 

Continuing,  the  editorial  says  in  part : 

“It  is  true  that  the  depression  is  adversely 
affecting  the  mental  and  emotional  lives  of  a great 
many  of  us  and  is  causing  all  sorts  of  maladjust- 
ments in  individual,  family,  and  social  life,  espe- 
cially among  those  whom  the  depression  has  hit 
the  hardest — the  unemployed.  There  is  ample 
evidence  to  this  effect.  There  is  no  evidence  that 
it  is  greatly  increasing  admissons  to  mental  hos- 
pitals, and  there  is  little  ground  for  alarming 
statements,  such  as  have  recently  appeared  in  the 
press,  that  point  to  a tremendous  rise  in  insanity, 
crime  and  suicide  ‘all  the  outcome  of  nervous  dis- 
orders induced  by  present-day  conditions’.  There 
is  little  in  the  way  of  first-hand  information,  based 
on  impartial,  objective  study,  to  warrant  such  a 
generalization.  A preliminary  inquiry  by  the  Na- 
tional Committee  on  Mental  Hygiene  reveals  no 
country-wide  rise  in  mental  disease  of  institu- 
tional severity,  although  here  and  there  mental 
hospitals  do  report  increases  in  admissions  and  re- 
admissions. It  is  not  likely  that  conditions  would 
reflect  themselves  so  soon  in  this  way.  * * * Even 
if  there  should  be  a marked  increase,  it  will  be 
difficult  to  isolate  the  economic  factor  as  a major 
determining  cause.  The  problem  of  mental  dis- 
ease is  too  complex;  there  are  too  many  unknown 
factors. 

“While  we  may  not  be  heading  for  an  epidemic 
of  mental  disorders  of  such  proportions  as  to 
swamp  our  hospitals  with  mental  cases,  it  is  evi- 
dent, nevertheless,  that  the  depression  is  creating 
serious  mental  problems.  There  is,  for  example, 
a decided  increase  in  admissions  and  readmissions 
to  institutions  for  the  feebleminded,  indicating  a 
marked  tendency  to  eliminate  the  lower  grades  of 
the  mentally  defective  from  industrial  and  social 
life.  As  there  are  institutional  facilities  for  only 
a fraction  of  the  number  of  mental  defectives  in 
the  community,  enforced  idleness  in  this  group 
may  well  be  complicating  the  problem  of  crime, 
delinquency  and  dependency. 

“Nearly  all  state  institutions  report  a reduction 
in  their  discharges  and  paroles,  another  result  of 
unemployment  conditions,  which  is  making  it  diffi- 
cult to  retur’n  patients  to  the  community.  It  is 
here  that  the  depression  will  have  one  of  its  worst 
effects.  Added  to  the  chronic  overcrowding  of 
mental  hospitals  and  the  lack  of  adequate  facili- 
ties and  personnel  for  individualized  attention, 
this  swelling  of  institutonal  populations  will  make 
it  all  the  more  difficult  to  maintain  standards  of 
care  and  treatment  above  the  custodial  level. 
There  is  little  money  available  for  institutional  ex- 
pansion. Many  curable  cases  will  become  incur- 
able, due  to  the  curtailment  of  treatment  facili- 
ties. 

“Preventive  work  is  being  retarded,  by  the  re- 


striction of  clinical  and  other  mental  hygiene  ac- 
tivities. There  i sa  temptation  to  provide  only  for 
the  immediate  necessities,  and  to  cut  down  on  pro- 
visions for  active  treatment  and  forward-looking 
preventive  measures.  The  depression  is  accentu- 
ating problems  in  human  adjustment  which  make 
mental  hygiene  work  all  the  more  necessary,  yet 
budgets  are  being  drastically  reduced. 

“These  problems  are  reacting  on  the  younger 
generation  in  many  ways.  Marked  changes  in 
family  life  have  been  noted.  Among  the  destruc- 
tive effects  of  economic  distress  are,  for  example, 
those  observed  in  children  who  develop  extreme 
anxiety  because  of  lowered  morale  in  the  home  and 
the  fear  as  to  what  may  happen  to  that  home. 
This,  in  turn,  engenders  hostility  toward  society, 
which  is  blamed  for  allowing  such  a situation  to 
occur.  The  depression  is  undoubtedly  undermin- 
ing individual  and  family  security;  and  a sense  of 
security  psychological  and  economic,  is  essential 
to  the  maintenance  of  good  mental  health.  The 
experience  of  our  mental  hygiene  clinics  may 
have  something  to  show  in  this  connection  in  the 
next  year  or  two. 

“Child  guidance  workers  report  that  offenses 
against  property  have  increased  during  the  past 
two  years,  and  that  conditions  are  favorable  to  a 
rise  in  the  number  of  youthful  offenders.  Adoles- 
cents who  in  normal  times  would  be  working  out 
their  problems  in  healthful  emancipation  are  now 
balked  in  making  the  normal  adjustments,  because 
of  their  difficulty  in  finding  work,  and  psycho- 
logically speaking,  their  place  in  life.  They  are 
developing  habits  of  idleness  and  other  personality 
traits  that  augur  ill  for  later  life. 

“Thus  we  see  many  by-products  of  the  depres- 
sion that  are  aggravating  the  mental  health  prob- 
lem in  various  ways.  The  mental  hospital  is  not 
the  only  barometer  of  the  effects  of  the  depres- 
sion on  mental  health.  We  expect  to  see  not  so 
much  a large  increase  in  hospital  cases  of  mental 
disease  as  in  the  incidence  of  the  milder  mental 
and  nervous  conditions,  of  personality  disorders 
and  maladjustments  of  various  kinds  and  degrees, 
not  only  among  the  underprivileged  but  in  all 
classes  of  the  population.” 


Samaritan  Hospital,  Ashland,  will  receive  ap- 
proximately $30,000  under  the  terms  of  the  will 
of  the  late  Mrs.  Amanda  Fox  Horning  to  be  used 
for  the  worthy  sick  who  are  unable  to  pay  for 
hospital  service. 


April,  1933 


State  News 


265 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

THE  PIONEER  POST-GRADUATE  MEDICAL 
INSTITUTION  IN  AMERICA 


PROCTOLOGY,  GASTRO-ENTEROLOGY 
and  ALLIED  SUBJECTS 


For  Information  Address 

MEDICAL  EXECUTIVE  OFFICER 

345  West  50th  Street  NEW  YORK  CITY 


COOK  COUNTY  GRADUATE  SCHOOL  OF  MEDICINE 

(In  affiliation  with  Cook  County  Hospital) 

ANNOUNCES  CONTINUOUS  COURSES 

"MEDICINE — General  and  Intensive  Courses,  all  branches 

PEDIATRICS — (Special)  Intensive  Course,  Four  Weeks  starting  May  1st 
OBSTETRICS — Extensive  Courses — Two  Weeks  Intensive  Course 

GYNECOLOGY — Three  Months  Course — Two  Weeks  Course 

ORTHOPEDICS — Three  Months  Course — Two  Weeks  Course 

UROLOGY — Two  Months  Course — Two  Weeks  Course 
CYSTOSCOPY — Intensive  Two  Weeks  Course 

SURGERY — Three  Months  General  Course — Two  Weeks  Intensive  Review  Course  Surgical  Technique  (Laboratory) 
General,  Intensive  or  Special  Courses,  Tuberculosis,  Fractures  and  Traumatic  Surgery,  Roentgenology,  Dermatology 
and  Syphilis,  Ophthalmology,  Ear,  Nose  and  Throat,  Anatomy,  Pathology,  Nervous  and  Mental  Diseases. 

Teaching  Faculty — Attending  Staff  of  Cook  County  Hospital 

Address:  Registrar,  427  South  Honore  Street,  CHICAGO,  ILLINOIS 


LANGDON- MEYER  LABORATORIES 

ESTABLISHED  1919 


Complete  Clinical  and  Chemical  Laboratory  Service  for  Physicians 

FOURTEEN  YEARS  OF  LABORATORY  EXPERIENCE  ARE  AT 

YOUR  SERVICE 


Friedman  Pregnancy  Tests 
Toxicological  Analyses 
Expert  Legal  Testimony 
Blood  Chemistry 
Vaccines 
Etc. 


A post  card  will  bring  you 
containers  without  charge 


Wasserman  and  Kahn  Tests 
Bacteriological  Analyses 
Pneumococcus  Typing 
Urinalyses 
Tissues 
Etc. 


519  MAIN  STREET 


CINCINNATI,  OHIO 


L/VEWSNOTES^OfflO 


Wilkinsville — Dr.  J.  W.  Clark,  former  health 
commissioner  of  Jackson  county,  has  opened  of- 
fices here. 

Cleveland- — Leave  of  absence  for  six  months  has 
been  granted  Dr.  James  A.  Doull,  professor  of 
hygiene  and  public  health,  Western  Reserve  Uni- 
versity, School  of  Medicine,  who  has  sailed  for  the 
Philippines  where  he  will  organize  an  epidemo- 
logical  study  for  the  Leonard  Wood  Memorial  for 
the  eradication  of  leprosy. 

Gallipolis — Dr.  Lewis  Brown,  who  recently  com- 
pleted his  internship  in  Philadelphia,  has  opened 
offices  here. 

Canton — Dr.  F.  P.  Bennett,  Alliance,  addressed 
the  Y Men’s  Club  on  his  observations  on  his  re- 
cent trip  to  Europe. 

Wellston — Dr.  H.  W.  Gillen  has  been  appointed 
surgeon  for  the  eastern  and  western  division  of 
the  Baltimore  & Ohio  Railroad. 

Shelby — Dr.  M.  T.  Love  was  given  a dinner  re- 
cently by  physicians  of  Shelby  and  Mansfield  hon- 
oring him  upon  completion  of  50  years  in  active 
practice. 

Cuyahoga  Falls — Dr.  J.  L.  McEvitt,  Akron,  de- 
scribed his  trip  to  Czecho-Slovakia  in  an  address 
before  the  local  Lions’  Club. 

Columbus — Dr.  J.  F.  Baldwin  recently  cele- 
brated his  82nd  birthday.  A unique  birthday 
present  was  presented  him  in  the  form  of  a great- 
great  granddaughter.  One  of  Dr.  Baldwin’s 
daughters  was  also  born  on  his  birthday. 

Woodsfield — Dr.  O.  C.  Jackson  has  been  ap- 
pointed medical  examiner  for  the  U.  S.  Veterans’ 
Administration  for  Monroe  and  Noble  counties. 

Finding — Dr.  W.  N.  Mundy,  Forest,  addressed 
the  local  Parent-Teacher  Association  on  “Public 
Health  and  the  School”. 

Lima — Dr.  F.  C.  Waite,  professor  of  histology, 
Western  Reserve  University,  School  of  Medicine, 
recently  addressed  the  Northwestern  Ohio  Dental 
Society  in  session  here  on  “Relation  of  Medicine 
and  Dentistry”. 

Steubenville — Announcement  has  been  made  of 
the  marriage  of  Miss  Madeline  Gordon,  Bellaire, 
and  Dr.  S.  A.  Harris,  of  this  city. 


Fremont — Dr.  Malcolm  Boylan,  graduate  of  the 
University  of  Michigan  Medical  School  and  re- 
cently a resident  physician  at  Henry  Ford  Hospi- 
tal, Detroit,  has  opened  offices  here. 

Wapakoneta — Annual  meeting  of  the  local 
Chamber  of  Commerce  was  addressed  by  Dr. 
Harry  Noble,  St.  Marys. 

Toledo — Dr.  George  B.  Booth  has  been  pro- 
moted to  the  rank  of  colonel  in  the  Medical  Re- 
serve Corps. 

Quaker  City — Dr.  F.  J.  Jackson,  recently  on  the 
staff  of  the  Wells  Hospital,  Cambridge,  has 
opened  offices  here. 

Sylvania — Dr.  John  Spooner,  Toledo,  addressed 
the  local  Exchange  Club  on  “Personal  Health”. 

Piqua — “Medicine  as  a Vocation”  was  the  sub- 
ject of  an  address  made  by  Dr.  W.  W.  Trostel  to 
the  students  of  Piqua  High  School. 

Dayton — Dr.  Sterling  H.  Ashmun  addressed  the 
Adult  School  of  Education  at  Fairview  High 
School  on  “The  Health  of  Babies”. 

Osborn — The  local  Rotary  Club  was  addressed 
by  Dr.  Ben  R.  McClellan,  Xenia,  on  social  and 
economic  problems. 

New  Philadelphia — Dr.  J.  M.  Smith,  who  has 
been  in  active  practice  almost  55  years,  rcently 
celebrated  his  77th  birthday  anniversary. 

Columbus — The  50th  anniversary  of  his  en- 
trance into  medicine  was  celebrated  recently  by 
Dr.  Lee  H.  Mann. 

Marion — Dr.  H.  H.  Mouser  was  a recent  speaker 
befoi-e  the  weekly  dinner  meeting  of  the  Y Men’s 
Club. 

Chillicothe — Drs.  L.  T.  and  John  Franklin  and 
Dr.  M.  D.  Scholl  have  been  appointed  by  the 
county  commissioners  to  care  for  the  indigent  sick 
of  the  county. 

Sjrt'ingfield — Dr.  N.  L.  Burrell  has  resumed  act- 
ive practice  following  an  appendicitis  operation. 

Grand  Rapids — Dr.  D.  R.  Barr  has  been  taking 
post-graduate  work  at  Cook  County  Hospital 
Clinics,  Chicago. 

Ashland — Dr.  George  Riebel  will  serve  as  phy- 
sician at  the  county  home  during  1933. 


POSTGRADUATE  COURSE 


LABORATORY  COURSE 


For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

A house  doctor  is  appointed  July  1st  and 
January  1st 


For  Nurses  and  Graduates  of  High  School 
CLASSES  LIMITED  TO  SIX 
X-ray,  Basal  Metabolism,  Electro-cardiography  and 
Physical  Therapy 


150  clinical  patients  daily  provide  material  for  classes. 

Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 

For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


266 


April,  1933 


State  News 


267 


Edward  Reinert 

Ph.G.,  M.D. 

247  East  State  Street  Columbus,  Ohio 

Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 


FRANK  G ALLEN,  M.D., 
Dermatology 

Tel.  Main  1537 


LEE  A.  HAYS,  M.D., 

Roentgenology 
University  5842 


W.  H.  MILLER,  M.  D. 


328  East  State  St. 

Office  Telephone,  MAin  3743 


Columbus,  Ohio 
Residence,  EVergreen  5644 


<LTS) 


Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

^n> 

Prompt  and  Full  Report 


268 


The  Ohio  State  Medical  Journal 


April,  1938 


PUBLIC  HEALTH  NOTES 


— The  total  population  of  Ohio,  according  to  the 
1930  census,  was  6,646,697,  of  which  4,989,999 
lived  in  the  110  cities  and  752  villages  of  the  state. 
Records  show  that  72  per  cent  of  the  total  popu- 
lation, or  96  per  cent  of  the  population  within  the 
municipalities  of  the  state,  are  provided  with  pub- 
lic water  supplies.  Of  the  total  population  sup- 
plied, 74  per  cent  are  furnished  with  water  from 
surface  sources  and  26  per  cent  with  well  water. 
All  surface  waters  and  many  well  waters  require 
purification  in  order  to  be  satisfactory  for  the 
consumers.  These  data  emphasize  the  necessity 
for  health  department  and  water  works  officials 
constantly  to  maintain  a close  check  on  the  water 
furnished  through  public  water  supplies. 

Other  interesting  data  show  the  number  of 
small  villages  provided  with  public  water  supplies. 
Excluding  the  suburban  villages  which  secure 
their  water  from  an  adjacent  city,  there  are  48 
villages  between  2500  and  5000,  104  villages  be- 
tween 1000  and  2500,  60  villages  between  500  and 
1000,  and  12  villages  less  than  500  in  population 
which  have  their  own  public  water  supplies. 

Of  the  total  of  752  villages  in  the  state  only  287 
are  provided  with  public  water  supplies.  How- 
ever, most  of  the  villages  without  a public  water 
supply  are  quite  small,  only  36  being  over  1000  in 
population. 

The  number  of  privately  owned  water  works 
systems  is  relatively  low,  there  being  16  cities  and 
20  villages  which  are  supplied  by  private  com- 
panies. These  36  municipalities  have  a total 
population  of  about  232,000. 

The  importance  of  the  public  water  supplies  of 
Ohio  as  a factor  affecting  health  is  recognized  by 
statute.  Following  a severe  typhoid  epidemic  at 
an  Ohio  city  in  1920,  the  legislature  in  1921  passed 
Sections  1251—1  to  1252-4,  inclusive,  charging  the 
State  Department  of  Health  with  the  responsibil- 
ity of  inspecting  and  investigating  all  public 
water  supplies  to  insure  that  satisfactory  water 
is  being  delivered.  These  sections  of  the  code  to- 
gether with  the  Bense  Act  (Sections  1249  to  1261 
O.  C.,  inclusive)  govern  the  methods  for  correct- 
ing unsatisfactory  water  supplies,  and  Section 
1240  G.  C.  requires  the  approval  of  the  State  De- 
partment of  Health  for  improvements  and  changes 
ill  water  works  systems. 

— The  State  Department  of  Health  has  an- 
nounced plans  for  the  issurance  of  a semi-monthly 
news  bulletin  to  health  commissioners  from  which 
he  may  prepare  articles  for  publication  in  his 
Ideal  newspapers. 

I — Dr.  W.  K.  Ruble  has  resigned  after  12  years 
of  service  as  health  commissioner  of  Wilmington. 

; - — Dr.  E.  S.  Shane  has  been  appointed  a mem- 
ber of  the  Circleville  Board  of  Health. 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 

LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Association. 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Coup,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


April,  1933 


State  News 


269 


The  Wendt- Bristol 
Company 

Two  complete  ethical  stores  in 
Columbus 

51  E.  State  St.  721  No.  High  St. 

for  the  convenience  of  the  Physicians  and 
Surgeons— and  the  many  people  they  serve 

Two  Prescription  Departments 
maintained  in  a high  class  manner  with 
eight  registered  Pharmacists 
Other  Complete  Departments 
OFFICE  EQUIPMENT 

PHYSIO  THERAPY  APPARATUS 
HOSPITAL  SUPPLIES 

HEALTH  FOODS 

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W-B  Pharmaceutical  Supplies 
JOBBING  STOCKS  ALL  LEADING 
MANUFACTURERS 

Antitoxins  and  Vaccines  in  Special 
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Prompt  Service  on  Phone  Order i 


Service 
Exclusively 
Ethical 

Constant  research,  and  over 
Fifty  Years  experience  in 
manufacturing  pharmaceuti- 
cals for  physicians  is  the  basis 
of  our  honored  reputation. 

We  are  proud  and  appreciative 
of  the  confidence  reposed 
in  us.  ❖ •>  •> 

Write  for  our  complete  catalog. 

The  Columbus  PharmacalCo. 

330  OAK  ST.  , COLUMBUS,  OHIO' 


AS  PURE, 

SAFE  and  WHOLESOME 
AS  MILK  CAN  HE 


Evaporated  milk  is  considered  by  many 
pediatricians  to  be  the  best  form  of  cow’s 
milk  for  the  baby’s  formula.  And  many 
baby  specialists  recommend  that  the  pa- 
tient get  Wilson’s  when  they  prescribe  evap- 
orated milk.  This  is  because  Wilson’s  is  a 
standard  brand  of  evaporated  milk  that 
conforms  to  the  highest  known  standards. 
You  can  depend  on  Wilson’s  to  be  always 
the  same — as  pure  and  safe  and  wholesome 
as  cow’s  milk  can  be — with  all  the  other 
known  qualities  that  make  evaporated  milk 
so  desirable  for  the  feeding  formulas  of 
many  infants.  It  is  convenient  and  econom- 
ical for  the  mother  to  use  — and  always 
available  from  a nearby  grocer.  Clinical 
samples,  also  information  and  literature 
sent  to  physicians  upon  request. 

A Product  of 

The  Indiana  Condensed  Milk 

Indianapolis  Company  Indiana 


270 


The  Ohio  State  Medical  Journal 


April,  1933 


Decrease  Shown  in  Birth  and  Infant 
Mortality  Rates  in  U.  S.  During 
Year  1931 

The  U.  S.  Department  of  Commerce  has  an- 
nounced that  in  1931  there  were  2,084,443  births, 
128,645  deaths  of  infants  under  1 year  of  age, 
and  80,248  stillbirths  among  an  estimated  popu- 
lation on  July  1 of  116,948,000  in  the  United 
States  birth  registration  area,  exclusive  of  Utah, 
from  which  complete  transcripts  for  the  year 
have  not  been  received.  The  rates  for  births 
were  17.8  per  1,000  population,  infantile  mor- 
tality, 61.7  per  1,000  live  births,  and  for  still- 
births, 3.8  per  100  live  births.  Corresponding 
figures  for  1930  were  2,191,012  births,  141,670 
deaths  under  1 year  of  age,  and  86,182  stillbirths, 
with  respective  rates  of  18.9,  64.7,  and  3.9.  The 
birth  registration  area  includes  all  but  two  states 
and  comprises  94.7  per  cent  of  the  total  popula- 
tion of  continental  United  States. 

The  urban  area  of  the  birth  registration  states 
is  composed  of  938  cities,  towns,  and  townships, 
with  an  estimated  population  of  57,560,000  on 
July  1,  1931.  In  this  area  there  were  1,005,687 
births,  61,114  deaths  of  infants  under  1 year  of 
age,  and  39,798  stillbirths,  and  a birth  rate  of 
17.5,  an  infant  mortality  rate  of  60.8,  and  a still- 
birth rate  of  4.0.  The  rural  part  of  the  birth 
registration  area  had  a population  of  59,338,000, 
among  which  were  1,078,756  births,  67,531  deaths 
of  infants  under  1 year  of  age,  and  40,450  still- 
births, the  respective  rates  being  18.2,  62.6, 
and  3.7. 

The  birth  rate  (17.8  per  1,000  population)  for 
the  birth  registration  area  (exclusive  of  Utah) 
is  the  lowest  since  the  establishment  of  this 
area  in  1915.  The  same  is  true  for  the  infant 
mortality  rate,  and,  except  for  the  years  1925 
and  1926,  the  stillbirth  rate  (3.8)  is  the  lowest 
since  1922,  when  the  annual  collection  of  still- 
birth records  was  begun. 

The  greatest  number  of  births  naturally  oc- 
curred in  the  most  populous  states  of  New  York, 
Pennsylvania,  Illinois,  and  Ohio,  but  the  highest 
birth  rates  were  in  New  Mexico  (28.4),  North 
Carolina  (23.0),  and  Alabama  (22.9).  The  few- 
est number  of  births  occurred  in  Nevada  (1,215), 
and  this  state  also  had  the  lowest  birth  rate  of 
13.2,  closely  followed  by  Oregon,  13.6,  and  Cali- 
fornia and  Washington  tied  with  13.9.  The  Ohio 
birth  rate  was  16.1,  compared  to  17.7  in  1930. 

The  greatest  number  of  infant  deaths  in  1931 
occurred  in  Pennsylvania  (11,905),  New  York 
(11,587),  Illinois  (6,957),  and  Ohio  (6,448),  but 
the  highest  infantile  mortality  rates  (deaths  of 
infants  under  one  year  of  age  per  1,000  live 
births)  were  in  New  Mexico  (125.8)  and  Ari- 
zona (111.3) — the  only  states  with  rates  in  ex- 
cess of  100. 


HYCLORITE 


Accepted  by  the  Council  on  Pharmacy  and 
Chemistry  of  the  American  Medical 
Association  (N.N.R.) 

ANTISEPTIC 

To  Prevent  Infection  of  Ringworm 

For  irrigating,  swabbing  and  dressing 
infected  cases  wherever  an  anti- 
septic is  needed. 

For  Hand  and  Skin  Sterilization. 

To  Make  a Dakin’3  Solution  of  Correct 
Hypochlorite  Strength  and  Alkalinity. 

NON-POISONOUS 

NON-IRRITATING 

Write  for  Literature 

BETHLEHEM  LABORATORIES 

INCORPORATED 

300  Century  Building, 
PITTSBURGH,  PENNA. 


LABORATORY  APPARATUS 

Coors  Porcelain  Pyrex  Glassware 

R.  & B.  Calibrated  Ware 
Chemical  Thermometers 
Hydrometers  Sphygmomanometers 


J.  T.  Baker  & Co.’s  C.  P.  Chemicals 

Stains  and  Reagents 
Standard  Solutions 


BIOLOGICALS 

Serums  Bacterins  Media 

Antitoxins  Vaccines  Pollens 


We  are  completely  equipped,  and  solicit 
your  inquiry  for  these  lines  as  well  as  for 
Pharmaceuticals,  Chemicals  and  Supplies, 
Surgical  Instruments  and  Dressings. 


The  Rupp  & Bowman  Co. 

319  Superior  St.  Toledo,  Ohio 


April,  1933 


State  News 


271 


^Hixson^*  Biologicals 

for  human  use 

PREVENTION 

DIPHTHERIA  TOXOID  (Hixson) 

(One  complete  treatment  consists  of  two  one-cc.  doses) 

A product  of  exceptionally  high  immunizing  value;  undiluted  and 
conforming  in  all  respects  with  the  requirements  of  The  National 
Institute  of  Health,  Washington,  D.  C.  Contains  no  serum  of  any 
kind  and  cannot  sensitize  patients  to  serum  proteins. 

In  packages  containing  one  treatment  (two  one-cc.  vials) 

Five  treatments  ( ten  cc.  vials ) 

Fifteen  treatments  (thirty  cc.  vials) 


DIPHTHERIA  TOXIN  ANTITOXIN 
(Hixson) 

(One  complete  treatment  consists  of  three  one-cc.  doses) 

Prepared  from  either  horse  or  sheep  antitoxin  and  supplied  in  vial 
packages  containing  one,  three  and  ten  complete  immunizations. 


CURE 

DIPHTHERIA  ANTITOXIN  (Hixson) 

our  method  of  purification  gives  a product  low  in  total  solids, 
small  in  bulk,  clear  and  free  from  precipitate.  Rapid  absorption  and 
therapeutic  action  are  insured  because  of  its  freedom  from  the  less 
soluble  non-antitoxic  fractions  of  the  horse  proteins. 

Marketed  in  syringe  and  vial  packages  containing  1000,  5000,  10,000 
and  SO, 000  units. 


PROFESSIONAL  CONSULTATION 
SERVICE 

on  Biologicals  is  at  the  disposal  of  physicians  without  cost 
through  a medical  member  of  our  staff.  Your  request  will  re- 
ceive prompt  attention. 


U.  S.  Government  License  No.  104  BIOLOGICALS 


272 


The  Ohio  State  Medical  Journal 


April,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

John  B.  Alcorn,  Chairman,  (1933) 

Columbus 

J.  H.  J.  Upham  (1934) Columbus 

C.  W.  Stone  (1935) Cleveland 

H.  M.  Platter,  (ex-officio) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

D.  C.  Houser,  (special) __ Urbana 

C.  W.  Waggoner,  (special)— Toledo 

A.  H.  Freiberg,  (special) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

A.  B.  Denison,  (1933) Cleveland 

Gilbert  Micklethwaite,  (1935).... Portsmouth 

MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

W.  H.  Snyder,  (1933) Toledo 

F.  P.  Anzinger,  (1935) Springfield 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) Toledo 

R.  H.  Birge,  (1935) Cleveland 

MEDICAL  ECONOMICS 
J.  Craig  Bowman,  Chairman,  (1933) 

Upper  Sandusky 
A.  B.  Brower,  (1934) Dayton 

E.  0.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 

V.  C.  Rowland,  Chairman Cleveland 

Jonathan  Forman  Columbus 


Beatrice  T.  Plagen  . 

. ..Zanesville 

R.  R.  Hendershott ... 

Tiffin 

C.  I.  Stephen Ansonia 


MILITARY  AND  VETERANS’ 

AFFAIRS 

C. 

W.  Stone,  Chairman.... 

Cleveland 

Fred  K.  Kislie- __  .. 

. Dayton 

A. 

E.  Brant 

Youngstown 

COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

S. 

J.  Goodman,  Chairman 

Columbus 

John  A.  Caldwell  

. .Cincinnati 

I. 

P.  Seiler 

Piketon 

ARRANGEMENTS  1933  ANNUAL 

MEETING 

H. 

S.  Davidson,  Chairman 

Akron 

E.  M.  Huston Dayton 


E.  B.  Shanley New  Philadelphia 

PROGRAM  1933  ANNUAL  MEETING 

C.  L.  Cummer,  Chairman Cleveland 

B.  J.  Hein Toledo 

E.  R.  Brush Zanesville 


SECTION  OFFICERS  FOR  1932-1933 


MEDICINE 

Carll  s.  Mundy ..Chairman 

125  15th  St.,  Toledo 

Cecil  Striker Secretary 

700  Provident  Bank  Bldg.,  Cincinnati 

SURGERY 

Carl  R.  Steinke  Chairman 

1027  Second  Natl.  Bldg.,  Akron 

Norris  Gillette Secretary 


320  Michigan  St.,  Toledo 
OBSTETRICS  AND  PEDIATRICS 


B.  H.  Carroll Chairman 

240  Michigan  St.,  Toledo 

Edward  A.  Wagner Secretary 


2560  Grandin  Rd.,  Cincinnati 


EYE,  EAR,  NOSE  AND  THROAT 


W.  V.  Mullin Chairman 

Euclid  at  93rd  St.,  Cleveland 

Ivor  G.  Clark Secretary 

188  E.  State  St.,  Columbus 

NERVOUS  AND  MENTAL  DISEASES 

J.  Fremont  Bateman Chairman 

Box  36,  Elmwood  Place 

Henry  C.  Schumacher Secretary 

2525  Euclid  Ave.,  Cleveland 

PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 

R.  H.  Markwith.... Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 


J.  P.  DeWitt,  (1933) Canton 

C.  E.  Kiely,  (1933) Cincinnati 

C.  W.  Waggoner,  (1933) Toledo 

Wells  Teachnor,  Sr.,  (1934) Columbus 

Ben  R.  McClellan,  (1934) Xenia 

E.  R.  Brush,  (1934) Zanesville 

C.  W.  Stone.  (1934) Cleveland 


ALTERNATES 


G.  F.  Zinninger,  (1933) : Canton 

L.  H.  Schriver,  (1933) Cincinnati 

John  Sprague,  (1933) Athens 

D.  H.  Morgan,  (1934) — Akron 

A.  C.  Messenger,  (1934) Xenia 

A.  Howard  Smith,  (1934) Marietta 

C.  L.  Cummer,  (1934) Cleveland 


Eighty-Seventh  Annnual  Meeting,  Akron,  October,  1933 


May,  1933 


Advertisements 


273 


THE  SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 

Treats  Nervous  and  Mental  Diseases 


Send  For  House 


+ 

TOXIC  DISTURBANCES  and 
mental  and  physical  factors  are 
sought  out  and  treated  at  the 
Sawyer  Sanatorium. 

* 

Book.  Address 


Sawyer  Sanatorium,  White  Oaks  Farm,  Marion,  Ohio 


The  Ohio  State  Medical  Association 

Officers  1932-1933 

PRESIDENT 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


H.  M.  Platter,  M.D. Columbus 

PRESIDENT-ELECT 

C.  L.  Cummer,  M.D Cleveland 

TREASURER 

James  A.  Beer,  M.D Columbus 

EXECUTIVE  SECRETARY 
Don  K.  Martin Columbus 


State  Council 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year ; single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 


Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1933) Cleveland 

Gilbert  Micklethwaite,  M.D.  (1935) Portsmouth 


EXECUTIVE  STAFF 


Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager 


First  District 

John  A.  Caldwell,  M.D Cincinnati 

Second  District 

E.  M.  Huston,  M.D Dayton 

Third  District 

0.  P.  Klotz,  M.D Findlay 

Fourth  District 

B.  J.  Hein,  M.D Toledo 

Fifth  District  . 

H.  V.  Paryzek,  M.D.  Cleveland 

Sixth  District 

H.  S.  Davidson,  M.D Akron 

Seventh  District 

E.  B.  Shanley,  M.D. ...New  Philadelphia 

Eighth  District 

E.  R.  Brush,  M.D Zanesville 

Ninth  District 

1.  P.  Seiler,  M.D.  Piketon 

Tenth  District 

S.  J.  Goodman,  M.D Columbus 

Ex-Officio,  The  Ex-President 
gg  D.  C.  Houser,  M.D Urbana 


274 


The  Ohio  State  Medical  Journal 


May,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies 


President 


Secretary 


First  District 

Adams U.  L.  Lawwell,  Seaman O.  T.  Sproull,  West  Union 

Brown R.  B.  Hannah,  Georgetown Geo.  P.  Tyler,  Jr.,  Ripley 

Butler H.  O.  Lund,  Middletown Walter  Roehl,  Middletown 

Clermont J.  K.  Ashburn,  Batavia Allan  B.  Rapp,  Owensville 

Clinton F.  A.  Peele,  Wilmington Wm.  L.  Regan,  Wilmington-. 

Fayette S.  E.  Boggs,  Washington  C.  H. J.  F.  Wilson,  Washington  C.  PI.  . 

Hamilton Parke  G.  Smith,  Cincinnati Geo.  B.  Topmoeller,  Cincinnati — 

Highland J.  C.  Bohl,  Hillsboro W.  B.  Roads,  Hillsboro 


3d  Wednesday  in  April,  June,  Aug. 
Oct. 

4th  Wednesday  in  Feb..  May  and 
Nov. 

2d  Wednesday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Monday  evening  of  each  week 
1st  Wednesday,  monthly. 


Warren J.  E.  Witham,  Waynesville James  Arnold,  Lebanon 1st  Tues.  Apr.,  May,  June. 

Sept.,  Oct.,  and  Nov. 


Second  District  Cyril  Hussey,  Sidney H.  R.  Huston,  Dayton 

Champaign N.  M.  Rhodes,  Urbana L.  A.  Woodburn,  Urbana 

Clark C.  W.  Evans,  Springfield Roger  Marquart,  Springfield 

Darke W.  T.  Fitzgerald,  Greenville W.  D.  Bishop,  Greenville 

Greena L.  L.  Taylor,  Yellow  Springs H.  C.  Schick,  Xenia 

Miami  F.  D.  Kiser,  Tippecanoe  City G.  A.  Woodhouse,  Pleasant  Hill — 


Montgomery A.  F.  Kuhl,  Dayton Miss  M.  E.  Jeffrey,  Dayton 

Preble C.  M.  Treffinger,  Eaton C.  J.  Brian,  Eaton 

Shelby R.  E.  Paul,  Botkins A.  B.  Lippert,  Sidney 


2d  Thursday,  monthly 
2d  and  4th  Wednesday  noon. 

2nd  Friday,  monthly. 

1st  Thursday,  monthly 

1st  Friday,  monthly,  except  July 
and  August. 

1st  and  3d  Friday  each  month. 

3d  Thursday,  monthly 
1st  Friday,  monthly 


Third  District 

Lima,  1932. 

Allen 

3d  Tuesday,  monthly 

Auglaize 

E.  F.  Heffner,  Wapakoneta 

2nd  Thursday,  bi-monthly. 

Hancock- 

1st  Thursday,  monthly. 

Hardin 

17th  of  each  month. 

Logan  

Marion 

0.  C.  Amstutz,  Bellefontaine 

-W.  H.  Carey,  Bellefontaine 

1st  Friday,  monthly. 
1st  Tuesday,  monthly 

Mercer 

2d  Thursday,  monthly. 

Seneca 

Paul  Leahy,  Tiffin 

3rd  Thursday,  monthly 

Van  Wert 

R H Good  Van  Wert 

1st  Tuesday,  monthly. 

Wyandot 

B.  A.  Moloney,  Upper  Sandusky 

,W.  L.  Naus,  Upper  Sandusky 

1st  Thursday,  monthly 

Fourth  District 
Defiance . 

(With  Third  District  in  Northwestern  Ohio  District) 

3d  Thursday,  monthly,  except 

Fulton 

July,  August,  December. 
2nd  Thursday  monthly. 

Henrv 

_T.  P.  Delventhal,  Napoleon,.— 

1st  Wednesday,  monthly. 

Lucas 

Friday,  each  week. 

2d  Thursday,  monthly 

Ottawa 

Paulding 

3d  Wednesday,  monthly 

Putnam 

1st  Tuesday,  monthly. 

Sandusky  _ 

Last  Thursday,  monthly 

Williams 

3d  Thursday,  monthly. 

Wood 

F.  L.  Sterling,  Bowling  Green 

-R.  N.  Whitehead,  Bowling  Green- 

3d  Thursday,  monthly. 

Fifth  District  _ 

-H.  V.  Paryzek,  Councilor 

— Chrm.  Com.  on  Arrangements 

Cleveland 

Ashtabula 

J.  F.  Docherty,  Conneaut.. 

A.  M.  Mills,  Ashtabula 

2nd  Tuesday,  monthly. 

Cuyahoga  

H.  V.  Paryzek,  Cleveland-  ...  _ 

3d  Fri.  Feb.,  March,  May,  Sept., 

Nov.,  Dec. 

Erie 

Last  Wednesday,  monthly,  except 

July,  Aug.,  Sept. 

Geauga 

Last  Wednesday,  Apr. 

to  Oct. 

Huron  . 

3d  Tuesday,  Feb.,  May, 
August,  Nov. 

I .aka  _ 

4th  Tuesday,  monthly. 
2d  Tuesday,  monthly 
1st  Thursday,  monthly. 

3d  Thursday,  monthly. 
June,  July,  August. 

Lorain 

Medina 

I'rumhull  _ 

E.  P.  Adams,  Warren- 

•xcapt 

May,  1933 


The  Ohio  State  Medical  Journal 


275 


Societies 


President 


Secretary 


Sixth  District A.  E.  Brant,  Youngstown J.  H.  Seiler.  Akron 

ABhland H.  M.  Gunn,  Ashland  Paul  E.  Kellogg.  Ashland 

Holmes L.  E.  Anderson,  Mt.  Hope C.  T.  Bahler,  Walnut  Creek 

Mahoning J.  P.  Harvey,  Youngstown W.  M.  Skipp,  Youngstown 

Portage S.  U.  Sivon,  Ravenna E.  J.  Widdecombe,  Kent 

Richland C.  H.  Bell,  Mansfield Mabel  Emery,  Mansfield — 

8tark .. H.  Welland,  Canton F.  S.  VanDyke,  Canton — 

Summit J.  H.  Selby,  Akron A.  S.  McCormick,  Akron 

Wayne W.  A.  Morton,  Wooster R.  C.  Paul,  Wooster 


2d  Wed.,  Jan.,  April  & Oct. 

2nd  Friday,  Sept,  to  May. 

1st  Tuesday,  quarterly,  Jan.,  April. 

July,  October. 

3d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Last  Thursday,  monthly. 

2d  Tuesday,  monthly. 

1st  Tuesday,  monthly. 

2d  Tuesday,  monthly. 


Hevenlh  District 

Belmont G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire 1st  Thurs.,  monthly,  4 p.  m., 

except  July  and  August. 

Carroll (With  Stark  Co.  Society) 

Columbiana J.  W.  Robinson,  Lisbon T.  T.  Church,  Salem 2d  Tuesday,  monthly. 

Coshocton Floyd  Craig,  Coshocton^ J.  D.  Lower,  Coshocton . Last  Thursday,  monthly. 

HarriBon A.  C.  Grove,  Jewett W.  C.  Wallace,  Hopedale 3d  Wednesday,  monthly. 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville Last  Thursday,  monthly. 

Monroe G.  W.  Steward,  Woodsfield A.  R.  Burkhart,  Woodsfield 2d  Wednesday,  monthly. 

Tnecarawaa  F.  B.  Larimore,  New  Phila. G.  L.  Sackett,  New  Phila 2d  Thursday,  monthly. 


Eighth  District  _ 


Athena C.  E.  Welch,  Nelsonville T.  A.  Copeland,  Athens 1st  Monday,  monthly. 

Fairfield E.  B.  Roller,  Lithopolis C.  W.  Brown,  Lancaster 2d  Tuesday,  monthly. 

Guernsey C.  C.  Headley,  Cambridge E.  F.  Hunter,  Cambridge 1st  and  3rd  Thursday  each  month 

Licking Geo.  W.  Sapp,  Newark G.  A.  Gressle,  Newark Last  Friday,  monthly. 

Morgan D.  G.  Ralston,  McConnelsville ,_C.  E.  Northrup,  McConnelsville — 3d  Wednesday,  monthly. 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 1st  Wednesday,  monthly 


Parry James  Miller,  Corning _ __F.  J.  Crosbie,  New  Lexington Sd  Monday,  monthly. 

Washington  W.  W.  Sauer,  Marietta G.  M.  James,  Marietta 2d  Wednesday,  monthly 


Ninth  District 


Gallia O.  A.  Vornholt,  Gallipolis Milo  Wilson,  Gallipolis 

Hocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 

Lawrence Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 

Pike L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 

Vinton O.  S.  Cox,  McArthur H.  S.  James.  McArthur 


1st  Wed.,  Feb.,  May,  Sept,  and  Dec. 
Quprterly. 

2nd  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  bi-monthly. 

1st  Monday,  monthly. 

2d  Monday,  monthly. 

3d  Wednesday,  monthly 


Tenth  District 


Crawford E.  C.  Brandt,  Crestline R.  L.  Solt,  Bucyrus . 1st  Monday,  monthly. 

Delaware Geo.  D.  Lowry,  Delaware J.  G.  Parker,  Delaware — ist  Tuesday,  monthly. 

Franklin Jonathan  Forman,  Columbus .John  H.  Mitchell,  Columbus Every  Monday,  8:30  p.  m. 

Knox . S.  O.  Gantt,  Centerburg R.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly. 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  Jefferson 4th  Wednesday,  monthly. 

Morrow F.  M.  Hartsook,  Cardington ._T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly. 

Pickaway C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville 1st  Friday,  monthly. 

Kobs Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 1st  Thursday,  monthly. 

Union  E.  J.  Marsh.  Broadway Angus  Maclvor.  Marysville 2d  Tuesday,  monthly 


276 


ADVERTISEMENTS 


May,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 

This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL,  M.D. 

Medical  Directors. 

Dayton,  Ohio 

MRS.  GEORGE  V.  SHERIDAN. 

President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

WILLIAM  LYNDON  CROOKS 
Resident  General  Manager 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


WHITING  MINERAL  SPRINGS 

SANITARIUM  AND  BATHS 

L.  A.  WHITING,  Owner 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and  allied  diseases, 
together  with  cases  for  elimination  and  rest  cure. 

Medical  department  thoroughly  proficient  and  STRICTLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

WHITING  SANITARIUM  » » M A R T I N S VI L L E,  I N D . 

VAN  W.  WHITING,  Manaser  DR.  R.  H.  RICHARDS,  Medical  Director 


THE  MERCER  SANITARIUM  » MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristown,  Pa.) 


THE  OXFORD  RETREAT 

Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 
FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


A N approved  and  fully  equipped  Sanitarium 
for  convalescence,  diagnosis,  physical 
therapy,  and  medical  attention  under  recog- 
nized physicians. 

Created  like  a country  estate,  28  miles  south 
of  Pittsburgh.  No  mental  or  drug  cases. 
Admission  by  letter  from  physician  is  desired. 
Reports  will  be  made  to  him  on  request. 
Specially  interested  in  diabetes,  arthritis,  neu- 
ritis, anemias,  cardiovascular  diseases,  gen- 
eral orthopedic  conditions.  Isolation  for  nerv- 
ous cases.  Physical  therapy  in  all  phases. 
Address  professional  mail  to  G.  H.  McKinstry, 
M.D.,  Box  483  i;  Hillsview  Farms,  Washing- 
ton, Pa.  Phone:  Washington  2650. 


PUBLIC  HEALTH- SOCIAL WBLFA1R: 
MEDICAL  EC©!* 

&nd  ©K.CAM I FATHOM  PR' 

‘Itfttk  Editorial  Comment  by  D.K.M. 


As  announced  in  the  April  issue  of  The  Journal,  the  Council  of  the  Ohio  State 
Medical  Association,  acting  through  a special  Execcutive  Committee,  postponed  the 
87th  Annual  Meeting  of  the  State  Association,  scheduled  to  be  held  in  Akron,  May  2 
and  3,  1933. 

At  the  time  this  action  was  taken,  it  was  felt  that  it  would  be  more  feasible  to 
hold  the  State  Association  gathering  in  the  Fall. 

However,  at  the  present  time  there  seems  to  be  growing  belief  among  some  of 
the  members,  at  least,  that  the  Annual  Meeting  should  be  held  before  Fall,  possibly 
within  the  next  month  or  two  if  suitable,  and  if  desirable  dates  can  be  arranged. 

The  Council  is  giving  serious  consideration  to  this  matter  and  hopes  to  determine 
definitely  in  the  near  future  when  and  where  the  meeting  will  be  held. 

Announcement  of  the  Council’s  decision  on  the  question  will  be  made  to  the  mem- 
bership as  promptly  as  possible  after  it  acts.  All  members  are  urged  to  watch  The 
Journal,  keep  in  touch  with  their  County  Society  secretary,  and  be  on  the  look-out  for 
post-card  or  other  mail  announcements  from  the  State  Association,  so  that  they  will 
receive  this  information  and  can  make  their  plans  to  attend  the  meeting. 


Two  weeks  hence  the  Ohio  General  Assembly, 
in  recess  since  March  30,  will  reconvene  for  the 
purpose  of  enacting  legislation  designed  to  solve 
some  of  the  major  prob- 
lems confronting  the 
state  and  its  citizens. 
Dui-ing  the  recess, 
Still  Serious  which  will  end  officially 

on  May  15,  special  and 
regular  committees  of  the  Legislature  have  held 
numerous  conferences  and  heai’ings  on  questions 
of  taxation,  unemployment,  relief,  finance,  budget, 
appropriations,  schools,  and  other  vital  questions. 

Just  what  program,  or  programs,  dealing  with 
these  important  matters  will  evolve  from  the  de- 
liberations of  the  legislative  committees  could  not 
be  forecast  at  the  time  this  was  written.  Tre- 
mendous pressure  has  been  exerted  on  the  mem- 
bers of  the  committees  by  numerous  individuals 
and  groups  directly  interested  in  the  problems 
considered.  Clashes  of  sentiment  concerning  the 
solution  of  the  problems  studied  have  been  fre- 
quent. Maneuvering  to  jockey  members  of  the 
Legislature  into  line  for  or  against  proposals  has 
been  in  evidence  and  undoubtedly  will  continue 
until  the  General  Assembly  concludes  its  de- 
liberations. 

Considerable  confusion  has  resulted  from  the 
decision  of  the  Legislature  before  it  recessed  not 
to  “kill  off”  incidental  legislation  pending  before 
it  at  that  time  and  clear  its  decks  for  considera- 
tion solely  of  major  problems.  As  a result,  the 


proponents  of  some  of  the  highly  controversial 
and  undesirable  measures  before  the  General  As- 
sembly are  exerting  pressure  for  consideration  of 
their  pet  bills  and  in  some  cases  refusing  to  “line- 
up” for  the  constructive  proposals  to  meet  the 
present  emergency  unless  they  have  the  assurance 
that  their  measures  will  be  revived  and  placed 
before  the  Assembly  for  action. 

The  legislative  situation  at  present  is  such  that 
the  medical  profession  as  well  as  all  other  groups 
interested  in  sound  and  constructive  legislation 
must  not  relax  nor  assume  an  attitude  of  indif- 
ference toward  development  at  the  Capitol.  Since 
the  legislative  course  will  be  “wide  open”  when 
the  Legislature  reconvenes,  it  is  just  as  necessary 
now  as  heretofore  that  members  of  the  medical 
profession  keep  in  close  and  constant  touch  with 
the  legislators  fi-om  their  respective  communities. 
Physicians  should  express  approval  and  apprecia- 
tion to  those  members  of  the  Legislature  who  have 
refused  to  be  swayed  by  the  influences  hostile  to 
sound  public  health  principles  and  scientific  medi- 
cal practice. 

The  legislators  should  be  advised  by  their  phy- 
sician constituents  concerning  the  attitude  of 
medical  organization  toward  measures  now  pend- 
ing before  the  General  Assembly  and  others  which 
may  be  introduced.  Members  should  insist  that 
the  legislative  chairmen  of  their  component  so- 
cieties discuss  thoroughly  with  them  the  informa- 
tion and  suggestions  conveyed  to  them  frequently 
by  the  headquarters  office  and  the  Policy  Corn- 


289 


290 


The  Ohio  State  Medical  Journal 


May,  1933 


mittee  of  our  State  Association.  Moreover,  it  is 
entirely  correct  for  each  physician  as  a citizen 
and  taxpayer  to  express  his  personal  views  on 
proposals  not  directly  affecting  public  health  ad- 
ministration and  medical  practice. 

Naturally,  the  medical  profession  is  very  much 
interested  in  the  direction  which  may  be  taken  by 
the  programs  to  be  developed  during  the  recess 
for  meeting  questions  of  taxation,  poor  relief,  un- 
employment, finances,  schools,  etc. 

The  difficult  situation  confronting  members  of 
the  Legislature  in  their  consideration  of  these  and 
other  major  questions  is  exemplified  by  the  con- 
fusion surrounding  attempts  being  made  to  de- 
velop a program  which  will  meet  the  financial 
crisis  confi'onting  the  state,  political  subdivisions 
and  the  public  generally. 

The  income  of  the  state  and  its  political  sub- 
divisions has  decreased  materially  during  the  past 
two  years  and  probably  will  show  an  even  greater 
decrease  during  the  coming  biennium.  At  the 
same  time,  the  financial  burden  of  state  and  local 
governments  has  been  increased  because  of  the 
pressing  demands  for  funds  to  feed,  clothe  and 
shelter  the  unemployed.  In  addition,  many  school 
districts  have  been  compelled  to  seek  financial  aid 
from  the  state  in  order  to  keep  schools  open  and 
pay  their  teachers.  That  the  state  has  been  fac- 
ing a financial  crisis  is  admitted.  How  to  meet 
it  is  a question  which  has  brought  forth  a varie- 
gated array  of  suggested  solutions. 

Considerable  sentiment  has  been  developed  to- 
ward no  new  taxes.  Those  favoring  this  sug- 
gestion have  advanced  the  theory  that  by  slashing 
operating  budgets  and  placing  a moratorium  on 
road  building  which  would  make  available  for 
general  revenue  funds  the  proceeds  of  the  state 
gasoline  tax,  the  state  and  the  different  political 
subdivisions  might  be  able  to  meet  their  ordinary 
expenses  and  emergency  obligations. 

On  the  other  hand,  strong  sentiment  has  arisen 
in  favor  of  raising  additional  necessary  revenue 
through  the  levying  of  taxes  on  certain  types  of 
luxuries,  a program  similar  to  the  one  advocated 
by  Governor  White  shortly  after  the  General  As- 
sembly convened  last  January. 

A third  proposal  which  has  won  strong  support 
is  for  the  levy  of  a general  sales  tax,  perhaps  to 
include  the  sale  of  personal  service  which  would 
include  medical  service — in  effect  a gross  income 
tax. 

In  addition,  there  have  been  many  proposals 
for  various  kinds  of  income  taxes  and  providing 
for  increases  in  the  present  tax  rates  on  in- 
tangible personal  property — income  from  securi- 
ties. 

There  is  little  indication  now  just  what  pro- 
gram will  be  worked  out  or  what  attitude  the 
General  Assembly  will  take  toward  the  sugges- 
tions which  will  be  made  by  the  special  committees 
now  laboring  with  the  problem. 

However,  the  Legislature  undoubtedly  will  fol- 


low the  course  indicated  by  the  strongest  public 
opinion  whatever  that  may  turn  out  to  be.  For 
that  reason,  it  is  imperative  that  members  of  the 
Legislature  be  kept  informed  of  the  views  of 
their  constituents. 

Physicians  as  individuals  have  a pei'fect  right 
to  express  to  members  of  the  Legislature  their 
views  on  all  questions,  including  questions  of 
taxation,  finances,  schools,  etc.  Assuredly,  medi- 
cal organization  has  the  right  to,  and  should, 
vigorously  protest  any  and  all  programs  which 
would  be  discriminatory  insofar  as  the  medical 
profession  is  concerned  or  impose  inequitable  and 
unjust  burdens  on  physicians,  who  as  a class,  are 
unusually  hard  hit  at  this  time. 

It  is  obvious  that  what  is  undoubtedly  the 
crucial  period  in,  the  life  of  the  90th  General  As- 
sembly is  about  to  make  its  debut.  Medical  or- 
ganization must  continue  to  function  as  effectively 
as  it  has  in  the  past.  Unless  it  has  the  active 
support  and  cooperation  of  every  one  of  its  mem- 
bers, it  cannot  cope  with  the  important  issues 
with  which  it  is  immediately  confronted. 


Recent  announcements  in  Washington  concern- 
ing plans  being  developed  for  radical  changes  in 
the  banking  field,  leading  ultimately  to  the  forma- 
tion of  a central- 
ized banking  sys- 
tem, regulated  and 
controlled  to  a large 
extent  by  the  Fed- 
eral Government, 
have  led  some  to  observe  that  “medicine  will  be 
next”. 

Right  or  wrong,  the  observation  deserves 
thoughtful  consideration  on  the  part  of  the  medi- 
cal profession,  especially  because  of  the  present 
unsettled  state  of  affairs  and  the  rapidity  with 
which  fundamental  changes  in  our  social  and 
economic  life  are  taking  place. 


Investigations  have  revealed  that  the  underly- 
ing causes  of  the  present  banking  situation  are 
many  and  varied.  Some  of  them  are  significant 
from  the  standpoint  of  the  medical  profession 
which  is  confronted  with  the  problem  of  prevent- 
ing in  the  field  of  medicine  certain  evils  which 
have  brought  about  the  downfall,  as  it  were,  of 
the  banking  system  of  better  days. 

An  observation  quite  in  point  is  that  made  re- 
cently in  the  editorial  columns  of  The  Bulletin  of 
the  Wayne  County  (Detroit)  Medical  Society,  to- 
wit: 


“If  one  were  to  make  a survey  of  calm  opinion 
as  to  the  underlying  cause  of  our  present  banking 
debacle,  the  prevailing  thought  would  be  that 
financial  institutions  had  grown  too  big  and  had 
lost  contact  with  those  whom  they  were  designed 
to  serve.  In  short,  banking  had  become  a big 
business  instead  of  a profession. 

“Henry  Ford  is  quoted  as  saying  that  ‘banking 
(to  the  old  type  of  banker)  was  a profession  like 


May,  1933 


Editorial 


291 


medicine  is  to  a doctor’.  That  type  of  banking  and 
medicine  are  parallel  in  many  respects.  Both  de- 
pend for  their  success  on  an  intimate  knowledge 
of  the  individual  with  whom  they  deal.  Both  build 
respect  and  gain  favor  through  service  rendered 
to  the  community.  Both  must  adhere  rigidly  to  a 
code  of  ethics  if  they  are  to  maintain  the  trust 
that  is  placed  in  them.  Each  of  the  two  lines  of 
endeavor  is  a profession  in  the  true  sense  of  the 
word  and  those  engaged  in  their  practice,  from 
the  highest  to  the  lowest,  must  be  properly 
minded,  adequately  trained  and  seasoned,  and 
thoroughly  imbued  with  the  seriousness  of  the 
responsibilities  they  assume. 

“Looked  at  in  this  light,  it  becomes  at  once 
obvious  that  when  either  banking  or  medicine  be- 
come too  highly  organized,  too  big,  it  neglects  the 
individual  and  his  problems,  and  generally  for- 
sakes its  obligations  to  the  community.  As  either 
develops  into  ‘big  business’  it  forgets  that  there 
is  such  a thing  as  ethics  and  adopts  tactics  which 
in  lush  times  are  considered  smart  and  in  hard 
times  highly  questionable.” 

The  striking  similarity  between  the  abstract, 
impersonal,  super-organized,  mechanical  and  com- 
mercialized methods  which  have  brought  forth 
caustic  criticism  of  the  banking  field  and  many 
of  the  schemes  now  being  promoted  to  “modern- 
ize” the  practice  of  medicine  is  obvious.  There  is 
an  apparent  deliberate  movement  afoot  to  trans- 
plant into  the  field  of  medicine  many  of  the  evils 
which  the  banking  field  is  now  being  forced  to 
eliminate. 

Strangely  enough,  it  seems  as  if  those  who  seek 
to  revise  the  present  individualistic  system  of 
distributing  medical  care  have  either  lost  sight  of 
or  have  refused  to  recognize  the  changing  trends 
of  public  sentiment.  After  all,  the  trend  may  be 
more  and  more  away  from  standardization,  cen- 
tralization, mass  production,  super-organization, 
and  the  sometime  questionable  practices  of  big 
business,  and  toward  a revival  of  human  values 
and  the  spirit  of  brotherhood  among  men  gen- 
erally. 

While  it  must  be  conceded  that  during  the 
present  emergency  more  dependency  upon  govern- 
ment for  the  solution  of  immediate  problems  has 
taken  place,  we  are  not  so  sure  that  this  will  be 
the  case  after  the  corner  of  the  depression  has 
been  turned.  The  fact  that  government  has 
proven  ineffectual  in  many  instances  in  meeting 
the  existing  emergency  may  quicken  the  realiza- 
tion that  even  government  cannot  do  for  us  what 
we  cannot  do  for  ourselves. 

As  Dr.  Virgil  Jordan,  president  of  the  National 
Industrial  Conference  Board,  has  pointed  out: 

“The  only  revolution  today  is  in  the  direction 
of  great  individualism  exemplified  by  the  back-to  - 
the-land  movement  and  the  decay  of  big  business, 
the  growth  of  small  enterprises.  It  is  a decen- 
tralizing movement  . . . the  greatest  period  of 
individualistic  enterprise  ever  seen  lies  just 
ahead.” 

The  danger  of  present  attempts  to  rob  medicine 
of  its  individualism — the  very  element  which  can 
assure  close  and  continuing  personal  relation  be- 


tween physician  and  patient,  a fundamental  in 
good  medical  care — and  substitute  for  it  the  un- 
desirable and  fallacious  methods  of  which  other 
public  services  are  now  being  purged,  are  so  ob- 
vious that  they  need  no  elaboration. 

Will  the  medical  pi'ofession  sit  idly  by  and  per- 
mit outsiders,  perhaps  a few  of  its  own  number, 
to  tear  down  the  structure  which  has  survived 
for  centuries?  We  believe  not.  The  fight  which 
the  profession  is  now  making  to  keep  from  being 
maneuvered  into  the  very  pitfalls  into  which 
others  have  tumbled  with  fatal  results  can  be 
won.  Courage,  sacrifice,  untiring  effort  and 
united  activity  will  be  required.  However,  there 
must  be  a strict  adherence  to  the  sound  policies 
and  principles  of  medicine.  Surely  it  is  not  ask- 
ing too  much  of  any  physician  to  do  all  within  his 
power  to  make  it  possible  for  medicine  to  carry 
on  as  something  more  than  a quasi  governmental 
function? 


Interest 

In  Organization 


“What  Is  the  Young  Physician  Worth?” 

Writing  on  this  subject  in  a recent  issue  of 
The  Milwaukee  Medical  Times,  Dr.  William  A. 

Ryan  makes  a stir- 
ring appeal  on  be- 
half of  the  young 
practitioners  of  med- 
icine for  the  privi- 
lege of  assisting  in  a 
solut’on  of  the  important  problems  now  confront- 
ing the  medical  profession. 

“What  lies  ahead  for  the  young  practitioner 
breaking  into  the  field  of  medicine  today?”  Dr. 
Ryan  asks. 

“If  we  are  to  accept  the  prophecies  found  in 
current  literature  on  this  subject,  it  would  ap- 
pear that  the  young  physician  is  confronted  with 
problems  of  real  magnitude.  Disturbing  as  his 
future  may  appear,  however,  his  chief  concern  is 
with  conditions  as  they  exist  today. 


“It  is  often  quite  evident  that  the  medical  pro- 
fession does  not  agree  on  its  present-day  needs. 
As  one  reads  the  various  articles  written  by 
medical  men,  the  confusion  in  the  minds  of  many 
of  them  is  apparent.  Too  often  the  writer  views 
the  situation  from  a purely  personal  angle.  * * * 
The  young  physician  sees  in  it  all  a Gordian  knot 
that  ties  him  hopelessly  from  the  free  and  easy 
competition  that  would  at  least  give  him  a chance 
to  work  out  his  destiny. 


“It  has  been  stated  that  were  the  majority  of 
medical  practitioners  free  from  the  influence  of 
tradition  and  immediate  professional  necessities 
they  would  be  in  favor  of  state  medicine.  Per- 
haps such  a statement  was  directed  to  the  young 
practitioner;  if  so,  nothing  is  farther  from  the 
truth.  I believe  expressions  of  feeling  from  many 
young  physicians  would  show  that  we  believe  we 
should  be  farther  from  a satisfactory  solution  to 
our  problems  by  accepting  state  medicine  than  by 


292 


The  Ohio  State  Medical  Journal 


May,  1933 


striving  to  succeed  under  the  present  system  of 
medical  practice.” 

Voicing  regret  at  the  tendency  on  the  part  of 
some  older  physicians  to  belittle  the  younger  prac- 
titioners of  medicine  and  at  the  apparent  wide 
breach  which  has  been  engendered  by  some  older 
men  between  themselves  and  their  younger  col- 
leagues, Dr.  Ryan  said: 

“Thex-e  should  be  no  distinction  except  that 
which  is  naturally  to  be  expected,  between  the 
young  and  the  old.  Closer  association  between  the 
older  and  younger  physicians  is  gi-eatly  needed. 
Thei'e  is  enough  in  common  to  di'aw  both  gene- 
rations together  and  thereby  allay  considerable 
comment  fi’om  the  lay  public  who  ai*e  all  too  l’eady 
to  criticize. 

‘‘We  must  meet  together  the  economic  unrest 
which  certainly  is  a gi'eat  factor  in  the  inter- 
ference with  medical  pi’actice  today.  If  only  a 
small  percentage  of  pi’essure  wei’e  brought  to 
bear  upon  industry  which  is  being  brought  upon 
the  medical  profession,  the  economists  of  the 
country  would  no  longer  find  time  to  attempt  to 
correct  an  art  such  as  medicine  and  much  of  the 
hue  and  cxy  about  medical  costs  and  state  medi- 
cine would  soon  sink  into  insignificance. 

“The  physician  of  today  has  not  l-etrogressed 
either  in  ability  or  in  the  ethics  of  the  ai-t  of 
medicine.  Regardless  of  the  inroads  of  outside 
agencies,  the  physician  will  continue  to  care  for 
the  sick  as  long  as  the  individual  patient  is 
capable  of  confiding  in  the  physician  of  his  choice. 
The  young  physician  of  today  is  not  looking  for 
special  favors;  he  does  not,  however,  want  the 
practice  of  medicine  to  retrograde  to  where  it  was 
fifty  yeai's  ago.  He  believes  that  scientific  ad- 
vancement— mechanical  and  otherwise — has  a 
sound  basis  of  fact.  He  wants  only  to  be  an  in- 
tegral part  of  a vast  profession  working  for  a 
common  good,  with  less  intei-ference  from  out- 
side agencies  and  a more  unified  plan  of  action 
between  the  older  and  younger  members  of  the 
profession.” 

With  their  desire  for  unity  of  thought  and 
action  within  the  profession  in  order  to  preserve 
the  traditions  and  principles  which  have  made 
medicine  what  it  is  today,  the  present-day  leaders 
of  the  profession  realize  the  soundness  and  logic 
of  the  sentiments  expressed  in  the  foregoing  com- 
ments. 

Especially  from  an  organization  standpoint,  it 
is  highly  important  that  more  responsibility  be 
placed  on  the  shoulders  of  those  who  are  destined 
to  become  the  future  leaders  in  medical  organi- 
zation. Although  leadership  can  still  be  assumed 
by  the  seasoned  members  of  the  profession,  whose 
expei'ience  and  judgment  is  a vital  cog  in  or- 
ganization activities,  there  is  a need  for  division 
of  responsibility  and  effort  in  many  coxxxmunities. 
The  younger  practitioners  have  a right  to  expect 
an  opportunity  to  voice  their  views  concerning 


professional  and  oi’ganization  activities,  and  to 
play  an  active  pai*t  in  the  solution  of  present 
pressing  problems.  The  existing  lack  of  interest 
in  oi’ganization  matters  displayed  by  some  of  the 
younger  men  in  the  profession  may  in  part  be 
due  to  the  failure  on  the  part  of  their  older  as- 
sociates to  provide  them  with  the  incentive  and 
the  opportunity  to  put  their  talent  to  work. 


As  another  example  of  the  possible  unwilling- 
ness of  the  lay  public  to  have  the  medical  pro- 
fession “dressed  in  brass  buttons”  and  the  prac- 
tice of  medicine  subser- 
Am  Interesting  vient  to  bureaucracy,  we 
quote  the  following  edi- 
torial  from  the  Ohio 
State  Medicine  State  Journal  (Colum- 
bus) on  the  subject  of 

“State  Medicine”: 

“Although  thei’e  seems  to  be  a gi’owing  belief 
among  the  medical  profession  that  state  medicine 
is  coming  and  inevitably  will  be  adopted  in  this 
country  we  believe  the  people  who  require  the 
services  of  physicians  are  strong  enough  to  step 
in  and  prevent  any  such  subsidizing  of  medicine 
or  willy-nilly  regulation  of  where  a patient  shall 
go  when  he  requires  treatment. 

“In  the  first  place,  nearly  everybody  has  his 
individual  idea  and  preference  as  to  given  doctors. 
Under  state  medicine  the  person  who  became  ill 
would  arbitrai’ily  be  expected  to  go  to  a specific 
physician  for  treatment.  All  the  world  knows 
that  this  is  a haphazard  scheme  which  will  not 
woi’k  acceptably  for  the  patient,  regai-dless  of 
how  nice  it  might  be  for  some  doctors. 

“The  medical  profession  has  been  likened  to  a 
footrace  in  that  if  a group  of  young  men  enroll  in 
school  one  usually  comes  out  with  the  highest 
honors  and  eventually  develops  into  the  best  doc- 
tor, just  as  one  runner  always  wins  his  race. 
Under  state  medicine  who  is  to  say  that  the 
patient  would  not  fi’equently  draw  the  also-rans 
of  the  profession  and  thus  receive  incompetent, 
inadequate  service  and  treatment?  Moreover, 
with  nothing  to  gain  except  whatever  stipend 
state  regulation  meant,  who  is  to  say  the  attend- 
ing physician  Would  be  as  interested  in  his  pa- 
tient as  is  the  case  now? 

“People  prefer  choosing  their  own  physicians 
and  undoubtedly  will  continue  doing  so.  If  state 
medicine  comes  it  may  woi’k  with  the  poverty- 
ridden  few  who  will  accept  any  physician  sent; 
it  may  succeed  with  the  unimaginative  few  who 
believe  all  doctors  are  on  par  as  to  ability,  but 
with  the  great  body  of  people  who  know  physi- 
cians are  as  far  apart  in  ability  as  day  from 
night  in  illumination,  it  will  not  be  acceptable. 
We  shall  always  prefer  our  own  doctors  and  that 
is  something  no  government  can  ever  regulate 
from  our  charactei’istics.” 


ILay  View 


.The  Modern  Management  of  Fractures  of  the  Skull  and 

Intracranial  Injuries 

E.  R.  Arn,  M.D.,  Dayton,  Ohio,  and  Roy  D.  Arn,  M.D.,  Springfield,  Ohio 


WHILE  the  surgical  management  of  frac- 
tures of  the  skull,  with  or  without  brain 
damage,  is  one  of  the  oldest  subjects  in 
medical  history,  recent  advances  make  this  topic- 
one  of  lively  interest  to  all  practitioners  of  medi- 
cine. Since  prehistoric  man  developed  the  art  of 
trephining  the  skull  in  the  case  of  skull  fractures, 
we  have  had  two  main  schools  of  thought  relative 
to  the  proper  treatment  of  skull  fractures,  namely, 
the  conservative  and  the  radical.  As  in  many 
other  fields,  each  school  has  had  its  period  of  un- 
due emphasis  and  exploitation.  Thus  in  the  first 
decade  of  this  century,  there  were  fewer  opera- 
tions performed  in  the  case  of  skull  fracture  than 
in  the  second.  In  the  second  decade,  subtemporal 
decompression  was  literally  performed  in  a whole- 
sale manner.  Traumatism  to  the  head,  no  matter 
how  slight,  was  regarded  as  sufficient  indication 
for  immediate  operation.  Needless  to  say,  the 
mortality  rate  during  that  period  was  exceedingly 
high.  The  pendulum  has  now  swung  again  to  the 
side  of  conservatism.  There  is  still,  unfortunate- 
ly, very  little  unanimity  of  opinion  in  the  manage- 
ment of  these  cases. 

In  any  discussion  of  this  type,  it  is  essential  to 
consider  co-existing  brain  damage  and  fracture  of 
the  skull  together.  In  the  past,  too  much  emphasis 
undoubtedly  has  been  placed  on  the  fracture  of 
the  skull,  with  little  or  no  attention  paid  to  the 
concomitant  injury  to  the  brain.  The  modern 
treatment  of  fracture  of  the  skull  gives  first  con- 
sideration to  the  treatment  of  the  resulting  intra- 
cranial injury  or  is  designed  to  prevent  intra- 
cranial infection.  One  must  always  remember 
that  the  degree  of  injury  to  the  skull  provides  no 
index  of  the  extent  of  the  damage  to  the  brain 
tissue. 

In  order  to  simplify  the  outline  of  treatment  of 
fractures  of  the  skull,  we  shall  classify  skull 
fractures  as  follows:  linear  (basilar  and  vault), 
depressed,  and  compound.  This  classification  is 
an  old  one,  but  it  is  sufficiently  inclusive  to  meet 
all  practical  demands. 

A careful  history  must  be  taken  in  every  case. 
In  most  cases  it  is  quite  impossible  to  obtain  the 
history  from  the  patient.  The  relatives  or  eye 
witnesses  of  the  accident,  however,  usually  can 
give  a sufficiently  accurate  history.  The  examiner 
should  ascertain  the  nature  of  the  object  produc- 
ing the  trauma  and  the  amount  of  force  exerted. 
For  example,  the  so-called  “meningeal  syndrome” 

Read  before  the  Surgical  Section,  Ohio  State  Medical 
Association,  at  the  86th  Annual  Meeting,  Dayton,  Ohio,  May 
3-4,  1932. 


From  the  Surgical  Division  of  the  Dayton  Clinic  and  the 
Department  of  Neurosurgery  of  the  Miami  Valley  Hospital, 
Dayton. 


which  characteristically  occurs  in  four  periods 
(period  of  unconsciousness,  period  of  marked  ir- 
ritability, normal  period,  period  of  deep  coma), 
can  usually  be  diagnosed  from  the  history  alone. 

A careful  general  physical  examination  as  well 
as  a neurological  examination  is  equally  desirable. 
The  earlier  a neurological  examination  can  be  per- 
formed the  better,  for  only  by  this  method  can  one 
have  an  index  as  to  the  amount  of  brain  damage 
present.  One  should  never  lose  sight  of  the  pres- 
ence of  shock,  for  the  majority  of  cases  with 
severe  traumatism  to  the  head  present  the  symp- 
toms and  signs  of  profound  shock.  Not  infre- 
quently the  presence  of  shock  is  entirely  over- 
looked, and  immediate  surgical  intervention  in- 
situted.  Undoubtedly,  this  is  one  of  the  main 
reasons  for  the  high  mortality  rate  in  this  group 
of  cases.  Needless  to  say,  if  shock  is  present,  the 
routine  symptomatic  treatment  of  the  shock 
should  be  instituted  at  once,  and  the  existing 
trauma  largely  disregarded  until  the  patient  has 
recovered  from  the  stage  of  shock. 

The  treatment  of  shock  in  cases  of  skull  frac- 
ture is  essentially  the  same  as  the  treatment  of 
any  type  of  shock,  with  a few  important  excep- 
tions. The  patient  should  be  kept  warm  by  hot- 
water  bottles  to  the  extremities  and  body.  Lower- 
ing of  the  head  of  the  bed  and  the  administration 
of  glucose  and  saline  solutions  intravenously  is 
most  important.  The  patient  must  be  kept  quiet 
at  all  times.  Morphine,  however,  should  never  be 
given  in  this  type  of  case,  because  morphine  masks 
the  symptoms  and  one  is  unable  to  determine  the 
existence  of  cerebral  edema  or  hemorrhage.  Also 
in  many  cases  morphine  fails  to  quiet  the  patient 
at  all.  In  this  type  of  case  chloral  hydrate,  in  30 
to  60  grain  doses  per  rectum,  is  the  drug  of  choice. 

Y-ray  examinations  of  the  skull  are  of  un- 
doubted value,  but  their  indiscriminate  employ- 
ment often  produces  gi-eat  harm.  Y-ray  examina- 
tions should  not  be  made  until  the  patient  has 
entirely  recovered  from  the  stage  of  shock.  In 
some  hospitals,  it  appears  to  be  the  common  prac- 
tice to  rush  every  patient  with  a serious  head  in- 
jury to  the  Y-ray  room,  no  matter  how  deep  the 
shock  or  coma.  Needless  to  say,  one  does  not  need 
an  Y-ray  film  to  make  a diagnosis  in  such  cases. 
As  a matter  of  fact,  Y-ray  studies  are  relatively 
valueless  at  this  stage.  They  will  merely  show 
the  presence  or  absence  of  a depressed  or  linear 
fracture  and  will  not  reveal  the  degree  of  brain 
damage  present.  Treatment  must  not  depend 
upon  the  presence  or  absence  of  a demonstrable 
fracture  but  upon  the  clinical  condition  present. 
When  the  patient’s  clinical  condition  warrants 
transporting  him  to  the  Y-ray  laboratory,  stereo- 


293 


294 


The  Ohio  State  Medical  Journal 


May,  1933 


scopic  lateral  films  of  both  sides  of  the  skull, 
anteroposterior  and  posteroanterior  films  are 
usually  sufficient.  However,  one  must  remember 
that  certain  fractures  of  the  skull  do  not  show  in 
the  X-ray  film.  This  latter  consideration  is 
especially  true  in  fractures  through  the  cribri- 
form plate  of  the  ethmoid  bone.  In  this  latter  in- 
stance, the  discharge  of  cerebrospinal  fluid  and 
blood,  or  even  brain  tissue,  through  the  nose, 
makes  the  diagnosis  relatively  easy. 

As  to  the  treatment  of  linear  fractures  of  the 
skull,  those  of  the  base  are  usually  considered  as 
more  serious  than  those  occurring  in  the  vault. 
From  the  standpoint  of  the  actual  fracture,  this 
is  not  true.  The  most  serious  factor  in  linear 
fractures  of  the  skull  is  that  they  are  apt  to  be 
compounded.  Thus  a linear  fracture  of  the  an- 
terior fossa  involving  the  cribriform  plate  of  the 
ethmoid  is  liable  to  be  compounded  into  the  nose, 
or  a fracture  in  the  middle  or  posterior  fossa  in- 
volving the  petrous  portion  of  the  tempoi*al  bone 
into  the  external  auditory  canal.  Lineal  fracture 
of  the  vault,  aside  from  the  type  which  results  in 
a tear  of  the  middle  meningeal  artery  or  one  of 
its  branches,  requires  no  special  treatment,  aside 
from  the  general  treatment  of  the  increased  in- 
tracranial pressure. 

In  the  case  of  basilar  fracture  involving  the 
petrous  portion  of  the  temporal  bone,  rupture  of 
the  tympanic  membrane  and  discharge  of  cerebro- 
spinal fluid  and  blood  from  the  external  auditory 
canal  often  occurs.  The  subarachnoid  space  is  in 
free  communication  with  the  outside  of  the  body 
and  it  is  very  easy  for  pathogenic  micro-organ- 
isms to  enter  from  the  outside  and  result  in  fatal 
meningitis.  We  believe  that  the  form  of  treat- 
ment outlined  by  Peet13,  is  ideal  in  this  type  of 
fracture.  The  external  auditory  canal  is  mechani- 
cally cleansed  of  blood  clot,  wax  and  other  debris 
by  means  of  an  ear  spoon  or  cotton  applicators, 
under  sterile  precautions.  The  entire  canal  is  then 
filled  with  the  3.5  per  cent  solution  of  iodin  and 
the  pinna  cleansed  with  the  same  solution.  The 
head  is  then  rotated  in  all  directions,  the  iodin 
allowed  to  run  out  and  a sterile  dressing  applied 
to  the  entire  ear.  Under  no  circumstances  is  the 
external  auditory  canal  plugged,  since  free  drain- 
age is  desired.  The  dressing  should  be  changed  as 
often,  as  it  becomes  saturated  and  if  the  discharge 
of  cerebrospinal  fluid  is  marked  an  acriflavin 
dressing  may  be  used  and  it  is  only  necessary  to 
change  the  dressing  once  daily. 

Linear  fractures  through  the  anterior  fossa, 
especially  those  which  pass  through  the  cribri- 
form plate  of  the  ethmoid,  are  always  of  serious 
import.  Such  fractures  usually  establish  a com- 
munication between  the  subarachnoid  space  and 
the  nasal  cavity.  Thus,  micro-organisms  in  the 
nose  can  easily  gain  access  to  the  subarachnoid 
space  and  produce  meningitis. 

This  type  of  fracture  is  often  difficult  to  recog- 
nize. X-ray  examinations  are  of  little  avail,  be- 


cause the  evidence  of  fracture  does  not  appear  on 
the  X-ray  film.  The  essential  diagnostic  criteria 
are  the  free  d;scharge  of  blood,  cerebrospinal 
fluid  and  even  brain  tissue,  from  the  nose.  This 
type  of  case,  we  believe,  calls  for  early  operation, 
not  from  the  standpoint  of  the  fracture  but  to 
prevent  intracranial  infection. 

The  operative  technique  which  we  employ  in 
such  cases  is  briefly  as  follows:  The  skull  is 

opened  up  above  the  frontal  sinuses,  preferably 
by  turning  down  a small  osteoplastic  flap  or  by  a 
transverse  incision  and  opening  the  skull  with  a 
Hudson  burr.  The  opening  is  then  enlarged  to  the 
size  of  a silver  dollar,  and  the  dura  is  carefully 
elevated  until  the  point  of  the  dural  laceration  is 
reached.  The  tear  in  the  dura  may  be  closed  with 
black  silk,  or  a small  muscle-  or  fascial-graft  may 
be  placed  against  the  tear.  However,  in  the  latter 
method,  infection  is  very  apt  to  follow;  hence,  we 
strongly  advise  against  this  method.  Finally,  an 
acriflavin  or  iodoform  pack  may  be  placed  direct- 
ly against  the  tear  in  the  dura  and  the  wound 
closed  tight  around  the  pack.  The  pack  is  then 
removed  within  a period  of  six  to  seven  days. 
The  principle  behind  this  procedure  is  to  allow 
firm  adhesions  to  form  between  the  dura  and 
brain,  and  thus  obliterate  the  subarachnoid  space 
and  prevent  the  entrance  of  micro-organisms  from 
the  nose. 

We  wish  to  direct  particular  attention  to  the 
linear  fractures  of  the  vault  of  the  skull,  asso- 
ciated with  small  and  apparently  insignificant 
lacerations  of  the  scalp.  In  this  group  of  cases, 
the  laceration  is  usually  repaired  immediately  and 
no  attention  is  given  to  the  possibility  of  an 
underlying  fracture.  Needless  to  say,  such  frac- 
tures are  compound  fractures,  and  at  the  time  of 
impact,  when  there  is  a slight  separation  at  the 
fracture  line,  dirt,  hair,  and  other  foreign  ma- 
terials are  driven  into  the  bone.  This  foreign 
material  must  be  removed  if  we  desire  to  prevent 
meningitis  or  brain  abscess.  The  laceration  should 
be  widely  exercised  and  the  foreign  material 
which  is  caught  in  the  fracture  line  should  be  re- 
moved. This  is  best  accomplished  by  the  removal 
of  the  adjacent  outer  table  of  the  skull,  and  oc- 
casionally the  inner  table  as  well,  with  a rongeur. 
The  resultant  wound  should  then  be  tightly 
closed  in  layers,  without  drainage. 

Simple  linear  fractures  of  the  vault,  without 
scalp  lacerations,  constitute  an  entirely  different, 
and  much  simpler,  problem.  In  the  absence  of 
local  pressure  symptoms,  the  treatment  is  merely 
that  of  combatting  the  increased  intracranial  pres- 
sure. Radical  surgery  is  distinctly  contra-indi- 
cated, because  the  increased  intracranial  pressure 
can  be  adequately  controlled  by  more  conservative 
measures. 

The  treatment  of  a depressed  fracture  of  the 
vault  of  the  skull  with  associated  contusion  and 
laceration  of  the  underlying  brain  tissue,  must 
include  measures  which  limit  the  amount  of  scar 


May,  1933 


Modern  Management  of  Skull  Fractures — Arn 


295 


tissue  formation  in  the  brain.  Penfield  has  pointed 
out  that  if  this  damaged  and  devitalized  brain  is 
not  removed,  a scar  forms  rapidly  which  contains 
connective  tissue  and  fibrous  astrocytes  and  which 
is  firmly  adherent  to  the  overlying  meninges.  A 
rich  plexus  of  newly  formed  blood  vessels  appears 
in  the  scar.  This  plexus  anastomoses  with  both 
the  vascular  meninges  and  with  the  blood  vessels 
of  the  scalp.  As  this  scar  contracts,  a definite  pull 
is  exerted  on  the  cerebral  cortex  and  ventricular 
system,  and  the  final  result  often  manifests  itself 
in  the  symptoms  of  traumatic  epilepsy.  To  pre- 
vent this  unfortunate  sequel,  removal  to  the  de- 
vialized  and  damaged  brain  tissue  by  irrigation 
and  suction,  with  careful  hemostasis,  is  advocated. 

Surgical  intervention  is  required  in  all  cases  of 
comminuted  and  compound  fractures  of  the  skull. 
The  operation  should  be  performed  as  soon  as  the 
patient  has  recovered  from  the  stage  of  shock,  if 
infection  in  the  brain  is  to  be  prevented.  Local 
anesthesia  is  desirable  since  ether,  ethylene,  ox- 
nitrous  oxide  inhalation-anesthesia  causes  a 
marked  increase  in  blood  pressure  as  well  as  in 
intracranial  pressure.  Thus,  an  operation  which 
is  of  minor  proportions  under  local  anesthesia, 
may  become  a very  serious  undertaking  under  a 
general  anesthetic.  The  lacerations  of  the  scalp 
should  be  excised,  and  the  underlying  contami- 
nated bone  fragments  discarded.  Only  in  the 
brain  does  debridement  differ  fi-om  that  per- 
foi-med  elsewhere  in  the  body.  The  damaged  bi-ain 
tissue  should  not  be  excised,  but  gently  removed 
by  ii-rigation  and  suction.  All  bleeding  points 
should  be  carefully  ligated  and  the  wound  closed 
tightly,  without  drainage.  The  institution  of 
drainage  in  this  type  of  case  mex-ely  opens  up  an- 
other avenue  for  the  development  of  infection. 

The  usual  classification  of  traumatic  brain  in- 
jury is  one  based  upon  an  admixtui-e  of  disturbed 
anatomy  and  physiology.  Most  writers  grade  the 
cerebral  damage  as:  1.  concussion,  2.  contusion, 
3.  laceration,  and  4.  compx-ession.  We  agree  with 
Rodman7,  who  states  that  it  would  be  much  better 
to  discai-d  the  time-honored  tex-ms  and  think  of 
these  cases  in  tex-ms  of  increased  intracranial  ten- 
sion. Max-ked  edema  will  result  from  any  of  the 
above  mentioned  grades  of  injux-y  and  a nxax-ked 
increase  in  the  intracranial  px-essure  x-esults  in 
medullary  edema,  and  compx-ession.  It  is  due 
largely  to  these  disturbances  in  the  medulla,  where 
the  vital  respiratox-y  and  cardiac  centers  ax-e 
located,  that  the  death  rate  is  so  high  following 
head  injuries. 

To  accux-ately  define  concussion  is  impossible. 
From  the  time  that  Hippocrates  and  Galen  com- 
mented upon  “commotio  cerebri,”  much  confusioi: 
has  arisen  from  the  use  of  the  term,  since  it  has 
been  vai-iously  defined  and  intex-px-eted.  As  the 
tex-m  is  ordinax-ily  employed,  concussion  px-oduces 
the  mildest  manifestations  of  intracx-anial  damage. 
Following  the  traumatism  to  the  head,  thex-e  is  a 
brief  period  of  unconsciousness,  mental  confusion 


and  disorientation,  followed  by  a return  to  lxor- 
mal,  with  little  evidence  of  cerebral  injux-y  other 
than  headache.  Treatment  in  such  cases  should 
consist  of  immediate  lumbar  puncture  and  the 
administx-ation  of  one  hundi-ed  cubic  centimetei’s 
of  50  per  cent  glucose  intravenously.  Fluid  intake 
should  be  limited  and  the  patient  kept  pexffectly 
quiet.  The  fluid  intake  must  be  limited  for  several 
days  and  50  per  cent  glucose  administered  daily. 
If  the  fluid  intake  is  not  x-esti’icted,  the  dehydrat- 
ing influence  of  the  hypertonic  glucose  solutioix  is 
without  effect.  If  this  fox-m  of  tx-eatment  is  not 
discontinued  too  eax-ly,  the  patient  will  ordinarily 
make  an  early  and  satisfactory  recovex-y,  without 
the  subsequent  development  of  late  sequelae. 

Contusion  and  lacex-ations  of  the  brain  will  be 
discussed  together  because  both  repx-esent  dif- 
ferent degrees  of  the  same  pathological  px-ocess. 
The  lacex-ations  of  the  cortex  may  be  so  minute  as 
to  be  recognized  only  by  micx-oscopic  examinations 
or,  on  the  other  hand,  extensive  tx-aumatic  necrosis 
may  occur.  Mai'ked  edema  soon  results  following 
laceration  of  the  cex-ebx-al  cox-tex  and  we  then  fiixd 
the  typical  signs  of  increased  intracx-anial  px-es- 
sui-e,  namely,  a px-ogi-essive  slowing  of  the  cax-diac 
and  respiratory  rates,  an  elevation  of  the  blood 
pressure  and  a x-ise  in  temperatux-e.  The  tx-eat- 
ment  in  such  cases  is  entix-ely  consex-vative,  and 
must  be  directed  towax-d  x-eduction  of  the  in- 
cx-eased  intracranial  px-essure.  It  should  be  recog- 
nized, also,  that  sevex-e  traumatic  necx-osis  of 
brain  tissue  may  occur  without  skull  fx-acture  ox- 
scalp  lacerations. 

Cerebral  compression  may  be  the  result  of:  1. 
cerebral  edema  of  severe  degree,  2.  multiple 
lacerations  of  the  cox-tex,  3.  subdux-al  or  extra- 
dural hemorx'hage.  The  management  in  the  first 
two  is  entix-ely  consex-vative,  employing  methods 
which  will  be  discussed  later,  while  the  last  calls 
for  immediate  x-adical  surgery.  It  may  be  very 
difficult  to  distinguish  between  cerebral  edema  and 
and  middle  meningeal  hemorxTiage.  However,  the 
“meningeal  syndx-ome”  is  ordinarily  quite  chax-- 
actei-istic : a period  of  unconsciousness  and  irri- 
tability; normal  period;  second  pex-iod  of  uncon- 
sciousness and  irritability,  with  gradual  develop- 
ment of  deep  coma.  With  the  appearance  of  the 
second  pex-iod  of  unconsciousness,  attacks  of  Jack- 
sonian epilepsy  develop  on  the  side  opposite  the 
lesion ; spasticity  and  abnormal  reflexes  ax-e  found 
on  neux-ological  examination.  When  this  symptom- 
complex  is  present,  subtemporal  decompx-ession  is 
indicated.  This  constitutes  the  only  indication  fox- 
subtemporal  decompression  following  injuries  to 
the  brain. 

The  marked  increase  in  intracx-anial  pressure 
following  traumatism  to  the  head  can  be  com- 
bated by  lumbar  punctux-e,  and  hypex-tonic  solu- 
tions by  the  intravenous  route,  preferably  glucose 
solution. 

As  far  as  lumbar  punctux-e  is  concerned,  thei-e 
is  no  uniformity  of  opinion.  Dandy'9  believes  that 


296 


The  Ohio  State  Medical  Journal 


May,  1933 


lumbar  puncture  in  this  type  of  case  serves  but 
to  retraumatize  the  brain,  while  Fay"  advocates 
total  drainage.  However,  we  believe  that  lumbar 
puncture  is  a valuable  adjunct  to  the  treatment  in 
indicated  cases.  Puncture  should  be  performed  as 
soon  as  possible,  for  it  is  also  a diagnostic  meas- 
ure of  great  value.  The  pressure  should  be  care- 
fully determined  by  means  of  a mercury-  or 
water-manometer.  Reduction  of  the  pressure  to 
approximately  one-half  the  level  found  at  the  time 
of  puncture  is  a perfectly  safe  procedure.  If  gross 
blood  is  present  in  the  fluid,  puncture  should  be 
performed  daily,  for  there  is  no  doubt  that  the 
presence  of  red  blood  cells  in  the  spinal  fluid 
stimulates  the  production  of  chronic  pachymenin- 
gitis or  arachnoiditis  at  a later  date.  Removal  of 
this  bloody  fluid  also  results  in  better  circulation 
of  the  cerebrospinal  fluid  and  hence  the  cerebral 
edema  is  reduced.  There  is  little  evidence  that 
spinal  puncture  in  such  cases  is  capable  of  pro- 
ducing sudden  death  because  of  the  herniation  of 
the  tonsils  of  the  cerebellum  into  the  foramen 
magnum.  Such  herniation  does  occur  in  cases  of 
brain  tumor,  especially  those  involving  the  pos- 
terior fossa  or  third  ventricle,  but  in  such  cases 
the  increased  intracranial  pressure  is  slowly  pro- 
gressive over  a long  period,  while  in  traumatic 
cases,  it  is  only  of  a few  hours’  duration,  at  the 
most. 

The  demonstration  by  Weed  and  his  co-workers 
of  the  marked  influence  of  hypertonic  solutions  on 
brain  volume  inaugurated  a new  era  in  the  treat- 
ment of  cerebral  edema  and  increased  intracranial 
pressure  of  traumatic  origin.  All  of  the  hyper- 
tonic solutions  cause  dehydration  by  withdrawal 
of  fluid  from  the  body  tissues  into  the  blood 
stream  by  the  process  of  osmosis.  As  a conse- 
quence, the  brain  is  likewise  depleted,  thus  re- 
lieving the  edema  which  has  followed  the  cerebral 
injury.  Hypertonic  solution  have  many  advan- 
tages over  the  old  procedure  of  subtemporal  de- 
compression. They  can  be  given  by  mouth,  in- 
travenously and  per  rectum  with  little  or  no  dis- 
comfort to  the  patient. 

Magnesium  sulphate  results  in  a very  rapid  re- 
duction in  cerebral  edema.  It  can  be  given  by 
mouth,  duodenal  tube,  or  per  rectum.  A saturated 
solution  is  advocated;  that  is,  one  ounce  of  mag- 
nesium sulphate  in  six  ounces  of  water  per  rec- 
tum. If  the  magnesium  sulphate  is  given  slowly 
as  for  a retention  enema,  it  may  be  repeated 
every  four  to  six  hours  during  the  first  few  days 
following  the  head  injury  with  perfect  safety. 
Ringer’s  solution,  given  intravenously,  is  also  an 
excellent  dehydrating  agent,  and  should  be  given 
in  doses  of  0.5  to  1 cc.  per  kilo  of  body  weight.  It 
results  in  a very  marked  reduction  of  pressure 
but  its  main  objection  is  that  the  action  persists 
for  only  a very  short  period.  Sodium  chloride  also 
has  many  advocates  and  is  undoubtedly  a good 
agent  for  reducing  increased  intracranial  pres- 
sure. The  same  dosage  is  used  as  in  the  case  of 


Ringer’s  solution.  However,  sodium  chloride  has 
several  disadvantages  which  one  should  keep  in 
mind.  Sodium  chloride  diffuses  into  the  tissues, 
where  it  attracts  water,  and  produces  secondary 
water-logging  of  the  structures  primarily  dehy- 
drated. The  sodium  also  has  a toxic  action  on 
the  tissues  if  it  is  given  over  a long  period  of 
time,  and  a few  cases  of  poisoning  have  resulted 
from  its  use. 

Glucose,  in  50  per  cent  solution,  given  intra- 
venously, is  without  doubt  the  best  agent  at  our 
command  for  the  reduction  of  increased  intra- 
cranial pressure  of  traumatic  origin.  It  is  easy  to 
administer  and  does  not  produce  any  toxic  effects. 
It  also  has  a distinct  advantage  over  the  other 
hypertonic  solutions  in  that  it  has  nutritional 
value,  which  is  of  great  importance  when  the 
patient  is  unable  to  take  any  food  by  mouth. 
There  is  no  danger  of  the  development  of  pul- 
monary complications,  such  as  pulmonary  edema, 
even  when  given  over  a long  period,  which  is  a real 
danger  if  salt  solutions  are  used.  A careful  ex- 
amination of  the  urine  should  be  performed  be- 
fore glucose  therapy  is  instituted,  for  one  must 
remember  that  diabetics  are  not  immune  to  head 
injuries. 

Dehydration  can  also  be  effectively  carried  out 
by  limitation  of  the  fluid  intake,  a point  which  is 
all  too  frequently  overlooked  in  the  treatment  of 
head  injuries.  The  intake  should  be  restricted  to 
1000  to  1500  cc.  daily.  More  fluid  than  this  re- 
sults in  an  excessive  production  of  cerebrospinal 
fluid  and  thus  the  intracranial  pressure  is  in- 
creased. Large  dos'es  of  physiologic  saline  solution 
or  weak  glucose  solution  should  not  be  given  in- 
travenously or  by  infusion,  since  the  addition  of 
these  fluids  defeats  the  purposes  of  the  hypertonic 
dehydrating  agents.  Fluid  intake  should  not  only 
be  restricted  during,  the  period  of  hospitalization, 
but  for  at  least  three  months  after  discharge,  if 
unfortunate  sequelae  are  to  be  prevented. 

Absolute  rest  for  a period  of  three  to  four 
weeks  in  the  mild  cases,  and  six  to  eight  weeks  or 
longer  in  the  more  severe  cases,  is  one  of  the  most 
important  features  of  the  treatment.  Inadequate 
rest  usually  results  in  traumatic  neurosis  or 
other  unfortunate  syndromes,  such  as  headaches, 
dizziness,  and  mental  depression.  As  mentioned 
before,  morphine  is  always  distinctly  contrain- 
dicated; chloral,  luminal  and  bromides  are  the 
drugs  of  choice  in  these  cases.  If  upon  return  to 
activity,  headache,  ringing  in  the  ears,  or  any 
other  symptoms  of  cerebral  irritation  return,  the 
patient  should  again  be  strictly  confined  to  bed 
and  the  dehydration  methods  together  with  ab- 
solute quietness  reinstituted. 

The  unfortunate  late  sequelae  following  severe 
traumatism  to  the  skull  are  traumatic  epilepsy 
(10  to  38  per  cent  of  the  cases),  traumatic  en- 
cephalitis, brain  abscess,  meningitis,  cysts  of  the 
brain,  chronic  pachymeningitis  or  arachnoiditis. 
Such  late  complications  may  occur  weeks  or  even 


May,  1933 


Medicine  in  Retrospect — Doan 


297 


years  after  the  traumatism  to  the  skull  and  then 
give  rise  to  signs  of  increased  intracranial  pres- 
sure, especially  stupoi’,  coma  and  papilledema. 
Encephalography  is  of  great  importance  in  the 
diagnosis  and  often  produces  definite  improve- 
ment in  the  symptoms.  Surgical  intervention, 
however,  is  usually  required  for  the  alleviation  of 
these  late  sequelae. 

SUMMARY  AND  CONCLUSIONS 

1.  All  head  injuries  should  be  considered  as 
serious  until  proved  otherwise. 

2.  The  patient  should  never  be  rushed  to  the 
AT-ray  room  immediately  upon  admission  to  the 
hospital  to  see  if  one  can  demonstrate  the  pres- 
ence or  absence  of  a fracture. 

3.  The  first  consideration  should  be  the  treat- 
ment of  the  shock.  Further  measures  should  not 
be  carried  out  until  the  patient  has  reacted  from 
the  stage  of  shock. 

4.  Depressed,  comminuted  and  compound  skull 
fractures  should  be  operated  upon,  not  for  the 
purpose  of  treating  the  fracture,  but  in  order  to 
prevent  intracranial  infection. 

5.  Conservative  treatment  is  indicated  in  the 
treatment  in  increased  intracranial  pressure,  by 
means  of  hypertonic  solutions,  preferably  50  per 
cent  glucose. 

6.  Surgical  treatment  for  increased  intracranial 
pressure  is  indicated  only  in  those  cases  present- 
ing local  pressure  manifestations. 


7.  The  development  of  late  sequelae,  such  as 
brain  abscess  or  chronic  pachymeningitis,  re- 
quires surgical  intervention. 


BIBLIOGRAPHY 

1.  Glaser,  M.  A. : Skull  and  Brain  Trauma.  J.A.M.A., 

1932,  98,  271-277. 

2.  Ireland,  J.:  Fracture  of  the  Skull  in  Children,  Arch. 

Surg.,  1932,  24,  24-40. 

3.  Dretzka,  L. : Foreign  Bodies  in  the  Brain.  Am. 

Jour.  Surg.,  1930.  8,  819-825. 

4.  Swanson,  J.  C. : Foreign  Body  in  the  Brain. 

J.A.M.A.,  1931,  96,  1382-1383. 

5.  Le  Fever,  H.  E. : A Consideration  of  Craniocerebral 

Injuries.  Ohio  St.  Med.  J.,  1931,  27,  371-375. 

6.  Fay,  T. : Economic  Readjustment  Following  Head  In- 

juries. Surg.  Gyn.  and  Obst.,  1932,  54,  362-371. 

7.  Rodman,  J. : Surgical  Management  of  Head  Injuries. 

Ann.  Surg.,  1931,  94,  1017-1026. 

8.  Dickenson,  J. : Cranial  Cerebral  Injuries.  Ohio  St. 

Med.  J.,  1932,  28,  33-41. 

9.  Parker.  H.  and  Kernohan,  M.  B. : The  Relation  of 

Injury  and  Glioma  of  the  Brain. 

10.  Coleman,  C.  C. : The  Management  of  Acute  Brain 

Injuries  with  Especial  Reference  to  Indications  for  Opera- 
tion. J.A.M.A.,  1931.  97,  1696-1701. 

11.  Brown,  E.  J. : Head  Injuries.  Extracranial  and  In- 

tracranial. Ohio  St.  Med.  J.,  1931,  27,  627-634. 

12.  Rand,  C. : Acute  Head  Injuries.  Am.  J.  Surg., 

1930,  8,  722. 

13.  Peet,  M. : Symptoms,  Diagnosis  and  Treatment  of 

Acute  Cranial  Injuries.  Ind.  Doctor,  1927,  July,  5. 

14.  Mock,  H.  : The  Management  of  Skull  Fractures  and 

Intracranial  Injuries.  J.A.M.A.,  1931,  97,  1430-1436. 

15.  Abramson,  P.  : Injuries  to  the  Head.  Am.  J.  Surg., 

1931,  13,  47-56. 

16.  Kennedy,  F. : Modern  Teratment  of  Increased  In- 

tracranial Pressure.  J.A.M.A.,  1931,  96,  1284-1286. 

17.  Fay,  T. : Head  Injuries,  Results  Obtained  with 

Dehydration  in  Forty-eight  Consecutive  Cases.  J.  Iowa  St. 
M.  Soc.,  1930.  20,  447-466. 

18.  Hassin,  G. : Changes  in  the  Brain  in  Increased  In- 

tracranial Pressure.  Arch.  Neurol,  and  Psychiat.,  1928,  20, 
1172-1189. 

19.  Dandy,  W. : Injuries  to  the  Head.  J.  New  Jersey 

M.  Soc.,  1930,  27.  91-97. 

20.  Frazier,  C. : Surgical  Management  of  Cerebral 

Trauma.  Pa.  M.  J..  1930,  33,  466-471. 


Medicine  in  Retrospect  and  Prospect 


A Resume  of  Medical  Accomplishment  as  Reviewed  at  the  Beginning  of  the 

New  Year  A.  D.  1933 

Charles  A.  Doan,  M.D.,*  Columbus,  Ohio 


“It  is  only  in  disease  that  we  tremble  at  our 
own  incredible  complexity  and  that  harmony 
becomes  a problem  ....  the  level  of 
mechanism  is  so  deep  that  it  is  better  revealed 
in  cataclysms,  miracles  and  diseases,  than  in 
the  placid  course  of  superficial  experience 

ff 

Sanatayana,  The  Realm  of  Matter  (158) 

DURING  the  past  year  of  unprecedented  eco- 
nomic distress  and  international  misunder- 
standing and  unrest,  the  practice  of  medi- 
cine has  continued  nevertheless  to  advance  worth- 
ily in  its  acquisition  of  an  increasing  factual  and 
scientific  basis  for  the  better  understanding  and 
treatment  of  disease;  at  the  same  time  it  has  con- 
sciously and  consistently  attempted  to  conserve 
those  humanistic  essentials  which  must  always 

Annual  dissertation  delivered  before  the  Columbus  Academy 
of  Medicine,  January  9,  1933. 

♦Director,  Department  of  Medical  and  Surgical  Research, 
Ohio  State  University. 


make  medicine  quite  as  much  an  Art  as  a Science. 

Quite  irrespective  of  the  relative  merits  of  the 
recent  divergent  minority  and  majority  reports 
of  the  Committee  on  the  Cost  of  Medical  Care, 
which  deal  largely  with  the  mode  of  application 
of  our  knowledge,  there  must,  I believe,  be  an 
unanimity  of  opinion  among  both  laity  and  pro- 
fession as  to  the  continuing  need  for  more  knowl- 
edge, and  a more  successful  method  of  promptly 
disseminating  its  beneficent  potentialities  to  the 
human  race.  That  the  leaders  of  medical  thought 
and  education  in  this  country  fully  appreciate 
the  need  for  a reappraisal  and  readjustment  of 
medical  education  and  practice  in  a rapidly  chang- 
ing world,  is  abundantly  affirmed  by  the  scholarly 
report  following  a five-year  study  by  the  Com- 
mission on  Medical  Education  headed  by  President 
A.  Lawrence  Lowell  of  Harvard  University,  which 
has  just  been  published  (December,  1932).  Con- 
tinuing to  come  from  the  press  throughout  1932 
and  into  1933  are  the  highly  authentic  and  sig- 
nificant volumes  of  the  scientific  findings  of  the 


298 


The  Ohio  State  Medical  Journal 


May,  1933 


White  House  Conference  on  Child  Health  and 
Protection.  All  of  these  studies  centering  about 
the  health  of  the  nation  are  but  a reflection  of  the 
critical  analysis  which  is  being  made  today  of 
every  phase  of  modern  life,  with  a view  to  con- 
centrating the  highest  intelligence  upon  the  so- 
lution of  the  complex  problems  which  have  arisen 
in  the  transition  from  a pastoral-agrarian-artisan 
era  to  a highly  mechanized  industrial  civilization. 

In  the  present  hour  of  searching  inquiry  as  to 
the  adequacy  of  the  whole  basic  structure  of  civi- 
lized society,  men  of  medicine  must  give  a good 
account  of  themselves,  not  only  as  the  co-leaders 
and  co-directors,  in  the  body  politic  of  mature  so- 
cial judgment  and  of  culture  in  the  best  sense,  but 
also  as  the  chief  guardians  of  sound  minds  in 
healthy  bodies — essentials  basic  to  right  thinking. 
“It  is  impossible  to  combine  a high  grade  culture 
of  the  mind  with  a low  grade  culture  of  the 
body”,  says  Hon.  L.  P.  Jacks,  former  Principal 
of  Manchester  College,  Oxford,  in  his  recent  Lloyd 
Roberts  Lecture  before  the  Royal  College  of  Phy- 
sicians, London.  “A  rising  public  intelligence  and 
a falling  public  physique  cannot  be  made  to  go 
together”. 

That  significant  theoretical,  as  well  as  practical, 
advances  have  been  made  all  along  the  line  in  the 
field  of  medicine  during  the  past  year  cannot  but 
be  apparent  to  all  who  have  kept  in  touch  with 
things  medical  through  the  various  journal  and 
society  communications.  As  evidence  of  practical 
accomplishment,  Hugh  S.  Cumming,  Surgeon 
General  of  the  Public  Health  Service,  reported  on 
December  10  last  a declining  disease  rate  in  the 
United  States  with  a lowered  mortality  rate  of 
10.6  per  thousand  population  for  the  first  nine 
months  of  1932  as  contrasted  with  11.2  and  11.9 
for  similar  periods  during  1931  and  1928,  respec- 
tively. As  a further  evidence  of  general  nutri- 
tional and  hygienic  progress,  and  of  the  impli- 
cations beginning  to  come  from  the  highly  organ- 
ized chemico-biological  investigations3’ 3 con- 
ducted in  recent  years  under  the  direction  of  the 
Research  Committee  of  the  National  Tuberculosis 
Association,  is  a new  low  record  for  the  death 
rate  from  tuberculosis  reported  for  1931,  66.3  per 
thousand. 

The  more  remote  effects,  however,  of  the  present 
economic  crisis  upon  both  mental  and  physical 
well-being  cannot  be  evalulated  as  yet.  This  seem- 
ingly good  report  covering  the  first  two  and  a 
half  years  of  the  economic  depression  may  well  be 
but  the  lull  before  the  storm,  in  so  far  as  nutri- 
tional and  other  diseases  are  concerned,  as  was 
the  case  in  Europe  during  the  years  immediately 
following  the  deprivations  of  the  period  of  the 
Great  War.  Because  of  the  increased  fund  of  in- 
formation which  we  now  have  relative  to  the  pro- 
phylaxis and  prevention  of  both  epidemiologic  and 
nutritional  diseases,  it  may  be  possible  to  avert 
many  of  the  physical  consequences  in  the  future, 
which  have  always  heretofore  followed  in  the 


wake  of  great  calamities.  Most  certainly  the 
medical  profession  at  this  moment  is  facing  such 
a challenge. 

EPIDEMIOLOGY 

Among  the  more  important  and  far-reaching  of 
the  recent  fundamental  advances  in  the  field  of 
internal  medicine  are  the  implications  carried  in 
the  current  publication  of  the  conclusions  of  a 
decade  of  fascinating  study  in  experimental  epi- 
demiology by  Leslie  T.  Webster4  and  his  as- 
sociates at  the  Rockefeller  Institute.  A total  of 
nine  enteric  and  respiratory  diseases  of  rodents 
and  fowls  have  been  studied.  With  reference  to 
the  inciting  microbic  agents,  it  has  been  deter- 
mined from  these  studies  that  the  virulence  is 
relatively  constant.  In  no  instance  were  signifi- 
cant differences  in  the  virulence  of  pre-epidemic, 
epidemic,  and  post-epidemic  strains  of  bacteria  de- 
tected. Nor  was  there  any  difference  in  the  viru- 
lence of  strains  isolated  from  healthy  carriers  and 
from  cases  resulting  fatally  in  the  same  epidemic. 
The  morbidity  and  mortality  in  the  respective 
epidemics  were  found  to  be  proportionate  to  the 
dose  rather  than  to  the  virulence. 

Thus,  it  was  found  that  the  number  of  organ- 
isms per  individual  in  a given  community  in- 
creased prior  to  outbreaks  and  decreased  prior 
to  the  subsidence  of  the  epidemic  by  a time  in- 
terval which  approximated  that  of  the  incuba- 
tion period  of  the  disease. 

Host  resistance,  on  the  other  hand,  was  found 
to  be  the  resultant  of  two  components — the  one 
non-specific,  the  other  specific.  There  was  found 
to  be  both  a racial  and  an  individual  variation 
in  the  non-specific  resistance  factors  which  are 
the  direct  result  of  inheritance.  Segregations 
of  the  progeny  of  individuals  surviving  an  epi- 
demic, from  the  progeny  of  parents  succumbing 
to  infection  in  the  same  epidemic  and  the  same 
community,  revealed  a mortality  of  95  per  cent  in 
the  susceptible  lines  as  contrasted  with  a mortal- 
ity of  only  5 per  cent  in  the  resistant  lines, 
whereas  the  average  mortality  to  the  pathogenic 
organism  in  unselected  controls  was  35  to  40 
per  cent. 

Specific  resistance  is,  of  course,  the  well-rec- 
ognized humoral  or  antibody  reaction  of  the  body 
to  some  specific  foreign  antibody,  usually  a pro- 
tein, or  a fat  or  carbohydrate  linked  to  a pro- 
tein molecule,  the  so-called  hapten-linkage  anti- 
gen of  Landsteiner.  Webster’s  experiments,  as 
well  as  those  of  Greenwood  and  Topley5  assign 
greater  importance  to  the  non-specific  resistance 
factors,  at  least  in  so  far  as  certain  of  the 
communicable  diseases  are  concerned. 

These  non-specific  components  of  resistance  are 
of  decided  interest  and  importance  to  the  phy- 
sician quite  aside  from  their  dependence  upon 
inheritance.  They  have  been  found  to  be  affected 
by  environmental  factors  such  as  season  and 
diet.  We  now  have  definite  data  which  permit 
us  to  recognize  the  difference  between  a so-called 


May,  1933 


Medicine  in  Retrospect — Doan 


299 


adequate  maintenance  diet  and  an  optimum 
dietary.  This  distinction  is  quite  as  important 
as  that  between  an  adequate  and  a grossly  in- 
adequate diet.  Using  three  different  diets,  the 
first  a basic  diet  of  bread  and  milk,  the  second 
and  third  the  McCollum  and  Steenbock  modi- 
fied rations,  respectively,  Webster  found  marked 
differences  in  the  group  resistance  of  white  rats 
to  as  varied  insults  as  botulinus  toxins,  mer- 
cury bichloride  poisoning  and  mouse  typhoid. 
However,  by  adding  butter  fat  and  codliver  oil 
(essentially  vitamin  A)  to  the  bread  and  milk 
diet,  Webster  found  that  the  individuals  in  his 
colonies  could  be  changed  from  a relatively  sus- 
ceptible to  a relatively  resistant  state. 

VITAMIN  RESEARCH 

Maurer  and  Tsai6  have  also  reported  differ- 
ences resulting  from  dietary  substitutions.  Rats 
maintained  upon  a barely  adequate  diet  showed 
a mortality  of  71  per  cent  in  their  offspring 
within  three  days  after  birth,  whereas  rats  main- 
tained upon  an  optimum  dietary  showed  an  in- 
fant mortality  of  only  8.5  per  cent.  Analyzing 
further  the  mortality  statistics  for  the  state  of 
Illinois,  these  investigators  determined  that  44 
per  cent  of  the  deaths  occurring  during  the  first 
year  of  life  in  human  infants  occurred  during 
the  first  week  of  life.  Within  this  group,  fur- 
thermore, the  infant  mortality  was  higher  during 
the  months  from  December  to  June  than  in  the 
period  from  August  to  November.  Goldberger 
has  shown  that  the  food  consumption  of  wage- 
earners  during  the  winter  months  of  highest  in- 
fant mortality  contains  less  than  the  optimal 
amounts  of  vitamin  B complex.  Furthermore, 
the  ordinary  essential  quantity  of  this  constituent 
must  be  doubled  during  pregnancy  to  assure 
sound  offspring. 

Th:s  leads  us  directly  into  the  subject  of  the 
increasing  appreciation  of  the  importance  of  the 
vitamins  in  their  relationship  to  health  and  dis- 
ease, a fertile  field  which  is  continuing  to  yield 
a large  volume  of  information  of  a most  funda- 
mental character.  The  importance  of  nutritional 
balance  for  the  maintenance  of  health  and  happi- 
ness, in  the  best  and  fullest  sense,  is  a very 
recent  realization  of  medical  science.  That  it 
must  be  carefully  studied  and  meticulously  ap- 
plied, if  the  optimum  efficiency  and  longevity  are 
to  be  enjoyed,  has  come  into  our  consciousness 
still  more  recently.  The  body  does  have  a tre- 
mendous resourcefulness  in  adjusting  to  wide  en- 
vironmental variations.  Fortunately  for  most  of 
us,  this  automatic  interplay  of  physiological  “give 
and  take”  maintains  the  body  economy  on  an 
even  keel  without  much  conscious  thought  or 
effort.  Cannon7  has  called  this  the  “wisdom 
of  the  body”,  or  in  more  technical  phraseology, 
“homeostasis”.  We  are  apt  to  hear  the  lay- 
man question  somewhat  the  emphasis  which 
is  being  placed  on  diet  these  days,  and  it  is  true 
that  commercial  exploitation  has  rendered  it  diffi- 


cult for  the  uninitiated  to  separate  fact  from 
fiction.  But  the  evidence  accumulates  daily  in 
substantiation  of  the  contention  that  many  of 
the  ills  and  ailments  of  mankind,  major  as  well 
as  minor,  are,  and  always  have  been,  wholly  re- 
lated to  food  indiscretions,  deficiencies,  indul- 
gences, either  intrinsic  or  extrinsic. 

The  basic  outstanding  pathology  of  vitamin  A 
deficiency  is  reflected  in  the  general  atrophy  fol- 
lowed by  the  keratinization  and  desquamation  of 
the  epithelial  structures  of  the  body.  Thus,  many 
important  glands  of  the  body  are  affected,  and 
growth  is  retarded  by  an  interference  with  the 
normal  skeletal  development  at  the  epiphyses. 
Rapid  progress  has  been  made  in  the  past  few 
months  in  the  understanding  of  the  chemisti'y  of 
vitamin  A.  It  is  definitely  known  that  carotene, 
such  as  used  in  the  Cambridge  University  experi- 
ments, is  the  precursor  of  vitamin  A.  In  addition 
to  the  knowledge  that  this  yellow  pigment  may 
be  converted  into  vitamin  A by  the  action  of  ultra- 
violet light,  and  that  within  the  body  this  con- 
version takes  place  within  the  liver,  Professor 
J.  C.  Drummond  of  University  College,  London, 
early  this  year  obtained  vitamin  A by  splitting 
carotene  into  two  products,  one  of  which  was  the 
vitamin.  Professor  Paul  Karrer,  of  the  Uni- 
versity of  Zurich,  recently  derived  a formula  for 
vitamin  A showing  it  to  be  a close  chemical  rela- 
tive of  a certain  artificial  (violet)  perfume. 

In  addition  to  the  well-recognized  pathologic 
changes  dependent  upon  a deficiency  of  vitamin 
A,  is  the  most  recent  suggestion  that  it  may  be 
a contributing  cause  of  kidney  stone.  Elvehjem 
and  Neus  of  the  University  of  Wisconsin,  Os- 
born and  Mendel,  at  Yale,  and  Dr.  Robert  Mc- 
Carrison  in  England,  have  all  observed  a rela- 
tion between  kidney  stones  and  lack  of  vitamin 
A particularly  prevalent  among  the  peoples  of  the 
far  East.  One-fifth  of  the  animals  fed  by  Mc- 
Carrison  on  diets  composed  of  foods  common  in 
India  developed  kidney  stones.  When  vitamin  A 
was  added  to  their  East  Indian  diet,  the  animals 
no  longer  developed  renal  calculi. 

The  vitamin  B complex  is  the  most  interesting 
of  all  the  vitamins.  There  are  at  present  five 
components  recognized  as  existing  under  this 
general  designation.  First,  the  heat  labile  anti- 
neuritic  component  which  in  its  most  extreme 
pathologic  manifestation  produces  beri-beri.  Sec- 
ond, the  heat  stabile  BL  or  G anti-pellagra  factor. 
Third,  an  element  necessary  for  normal  growth  in 
pigeons.  Fourth,  a relatively  labile  element  neces- 
sary for  growth  in  rats.  Fifth,  a more  stabile 
element  necessary  for  growth  in  rats.  Cowgill 
and  Smith9  have  found  vitamin  B essential  for 
the  maintenance  of  a good  appetite  in  dogs. 
Contained  as  it  is  in  relatively  few  of  the  ordi- 
nary foodstuffs,  wheat  germ  and  yeast  being  the 
most  abundant  sources  of  supply,  a negative  bal- 
ance is  more  apt  to  occur  in  this  essential  ele- 
ment in  an  otherwise  normal  average  dietary 


300 


The  Ohio  State  Medical  Journal 


May,  1933 


than  in  any  other  of  the  vitamins.  Vague,  neu- 
ritie  conditions  in  middle-aged  and  elderly  adults 
have  been  definitely  relieved  by  vitamin  B supple- 
mentary to  the  dietary.  Professor  Adolf  Win- 
daus,  of  the  University  of  Gottingen,  isolated  the 
vitamin  in  pure  form  during  the  year  and  gave  it 
the  chemical  formula,  Ci-HuNsOS. 

The  fundamental  pathology  underlying  a de- 
ficiency in  vitamin  C includes  the  cessation  of 
formation  and  maintenance  of  intercellular  sub- 
stance. Malnutrition,  invasion  of  the  mucous 
membrane  by  pathogenic  bacteria,  hemorrhage 
from  increased  vascular  permeability,  and  hyper- 
trophy of  the  heart  may  occur.  The  anemia  which 
develops  under  these  circumstances  responds  spe- 
cifically to  an  adequate  intake  of  vitamin  C and 
will  not  yield  to  either  iron  or  liver  medication 
as  demonstrated  by  Minot  and  Mettier10  during 
the  past  year. 

The  chief  pathology  in  vitamin  D deficiency 
is  a failure  of  cartilage  to  hold  calcium.  There 
is  a disturbance  of  the  calcium-phosphorus  ratio 
with  rickets  or  osteomalasia  resulting.  Agnew 
and  Agnew11  have  reported  within  the  past  three 
months  studies  started  at  the  West  China 
Union  University  and  subsequently  developed  in 
Toronto  suggesting  the  chief  cause  of  dental  de- 
cay to  be  a lack  of  phosphorus  and  vitamin  D in 
the  diet.  The  natural  source  of  vitamin  D is 
found  in  the  skin  when  activated  by  the  ultra- 
violet rays  of  the  sun.  It  is  found  chiefly  in 
fish  oils  and  may  be  pi’oduced  by  the  irradiation 
of  ergosterol.  Vitamin  D,  in  the  form  of  an 
extract  of  codliver  oil  so  potent  that  ten  drops 
are  of  equal  vitamin  D value  with  three  tea- 
spoonfuls of  standard  codliver  oil  and  stated  to 
be  free  from  objectionable  taste,  has  been  de- 
veloped this  year  by  Professor  Theodore  F. 
Zucker,  of  the  College  of  Physicians  and  Sur- 
geons at  Columbia  University.  This  natural 
viamin  D is  an  extract  of  the  rickets-preventing 
principle  of  the  oil. 

The  work  relating  to  vitamin  E,  the  fertility 
or  anti-sterility  vitamin,  has  been  limited  thus 
far  to  animal  studies  and  there  is  no  clinical 
evidence  as  yet  that  there  is  a vitamin  E prob- 
lem in  so  far  as  humans  are  concerned.  This 
work  had  its  inception  and  much  of  its  subse- 
quent development  in  the  laboratories  of  Dr. 
Herbert  M.  Evans,  of  the  University  of  California. 

Vitamin  G,  or  B»,  as  usually  designated  in  the 
British  medical  literature,  has  been  recently 
shown  by  Sherman  and  Stiebeling  of  Colum- 
bia University,  to  consist  of  two  factors,  tenta- 
tively called  X and  Y.  Both  are  necesary  to  pro- 
duce the  vitamin  G effect.  It  has  been  held  that 
deficiencies  in  the  vitamin  B complex  alone  are  re- 
sponsible for  lesions  of  the  nervous  system,  but 
the  experimental  work  of  Pappenheimer  and 
Goettsch  with  vitamin  E,  of  Zimmerman  and  Bu- 
rack  with  vitamin  G,  and  of  Mellanby  with  vita- 
min A,  in  all  of  which  degenerative  changes  in  the 


form  of  demyelination  of  the  nerve  fibers  of  the 
spinal  cord  similar  to  the  lesions  seen  in  subacute 
combined  degeneration  have  been  described,  make 
it  more  than  likely  that  changes  in  the  nervous 
system  associated  with  deficiency  in  the  human 
represent  multiple  deficiencies. 

Complete  resumes  covering  the  fundamental 
work  in  the  field  of  vitamin  research  have  ap- 
peared during  the  year  both  in  the  Journal  of  the 
Americal  Medical  Association  and  in  the  volume 
devoted  to  Nutrition  of  the  Report  of  the  Com- 
mittee on  Growth  and  Development  of  the  White 
House  Conference  on  Child  Health  and  Protection. 

THE  ANEMIAS 

The  most  recent  suggestion  by  Castle12  as  to 
the  identity  of  the  extrinsic  factor  necessary  for 
hemoglobin  synthesis  is  that  it  may  be  vitamin 
B-  or  G.  Every  substance  thus  far  which  will 
bring  about  a remission  in  pernicious  anemia,  even 
the  purest  chemical  fractions  obtained  by  West  at 
the  Medical  Center  in  New  York  City,  contains 
this  principle.  Castle  and  his  co-workers  have 
definitely  established  the  essential  importance  also 
of  an  intrinsic  factor  which  is  supplied  by  the  nor- 
mal stomach.  Thus,  three  possible  mechanisms 
may  be  responsible  for  producing  the  syndrome  of 
pernicious  anemia.  First,  a lack  of  the  extrinsic 
factor  in  the  diet.  Second,  the  absence  of  the 
necessary  interacting  intrinsic  factor  to  be  sup- 
plied by  the  stomach.  And  thii-d,  given  the  two 
preceding  essentials,  there  still  might  develop  an 
insufficiency  in  the  elaboration  of  hemoglobin  due 
to  a lack  of  absorption  from  the  intestinal  tract 
into  the  body  itself  of  the  product  of  this  inter- 
action. 

The  volume  of  communications  bearing  upon 
the  anemic  state  initiated  by  the  experimental 
work  of  Whipple  and  the  clinical  studies  of  Minot 
and  Murphy  has  continued  to  grow  during  the 
past  year.  Many  new  preparations,  including 
various  fractions  of  liver  in  combination  with  iron 
and  copper,  have  been  studied  and  in  most  in- 
stances found  in  properly  selected  cases  to  have  a 
definite  beneficial  effect  upon  hemopoiesis. 

The  announcement  of  Morris13  and  his  asso- 
ciates from  the  University  of  Cincinnati  of  the 
discovery  of  a new  “hemopoietic  hormone”  in 
gastric  juice  which  they  have  christened  “addisin” 
is  of  interest  in  so  far  as  the  phenomenon  of  in- 
tramuscular injection  of  gastric  juice  followed  by 
a reticulocyte  response  and  hemoglobin  regenera- 
tion in  patients  with  pernicious  anemia  is  con- 
cerned. However,  explanations  other  than  that 
of  a specific  hormonal  action  of  the  gastric  juice 
may  perhaps  be  advanced  in  explanation  of  the 
effect  observed. 

The  studies  of  Ivy11  and  his  associates  at 
Northwestern  University  have  definitely  shown 
that  the  importance  of  liver  to  remission  in  per- 
nicious anemia  is  that  of  a reservoir  or  store- 
house of  the  materials  essential  to  hemoglobin  syn- 
thesis. There  is  nothing  indigenous  in  the  liver 


May,  1933 


Medicine  in  Retrospect — Doan 


301 


cells  of  liver  tissues  per  se  which  will  promote  red 
cell  formation.  Ivy  proved  this  by  feeding  to  per- 
nicious anemia  patients  the  liver  from  an  indi- 
vidual dying  during  an  acute  relapse  in  the  dis- 
ease. No  benefit  was  derived.  When,  on  the  other 
hand,  human  liver,  obtained  from  a patient  dying 
of  other  causes  during  a remission  in  the  disease, 
was  given,  it  promptly  initiated  a reticulocyte  re- 
sponse in  other  pernicious  anemia  patients. 

It  would  seem  quite  clear  that  in  secondary 
anemia,  a depletion  of  the  essential  reserves  of 
iron  is  quite  frequently  a prominent  etiologic  fac- 
tor. In  some  of  our  own  studies,  as  well  as  in 
those  reported  by  others,  it  has  been  necessary  to 
continue  the  administration  of  rather  large  quan- 
tities of  iron  (6-8  grams  daily)  over  indefinite 
periods  of  time  in  order  to  maintain  the  hemo- 
globin within  the  limits  of  normal.  The  frequency 
with  which  achlorhydria  has  been  found  to  accom- 
pany a low  color-index-anemia  led  Minot  and  Met- 
tier15  to  study  the  effect  of  an  alkaline  versus 
an  acid  medium  in  the  absorption  of  iron  from  the 
gastro-intestinal  tract.  They  conclude  that  iron 
is  more  readily  absorbed  from  an  acid  medium. 
Thus  we  have  a close  parallelism  between  per- 
nicious anemia  and  certain  types  of  secondary 
anemia  with  reference  to  gastric  function,  intes- 
tinal absorption,  and  reserve  depots  for  essential 
materials. 

Interesting  comparative  studies  by  Castle  and 
Rhoads  between  the  anemia  of  hook-worm  disease 
and  that  of  sprue  in  Porto  Rico  were  reported  at 
the  Atlantic  City  meetings  last  May.  In  the 
former,  anemia  of  severe  grade  with  low  color  in- 
dex was  promptly  relieved  by  large  doses  of  iron 
ammonium  citrate  regardless  of  whether  vermi- 
fuge treatment  accompanied  or  preceded  the  iron 
medication.  It  was  found,  furthermore,  that  a 
dosage  of  six  grams  per  day  was  definitely  more 
effective  than  one  of  only  two  grams.  In  a study 
of  one  hundred  cases  of  sprue,  findings  closely 
comparable  to  those  in  pernicious  anemia  are  re- 
ported. A megaloblastic  sternal  bone  marrow  with 
a hyperchromic  blood  picture  presented  a clear 
indication  for  liver  therapy  which  promptly  cor- 
rected the  existing  anemia.  Unlike  pernicious 
anemia,  free  hydrochloric  acid  was  demonstrated 
in  the  gastric  contents  after  the  usual  test  meal 
in  fully  fifty  per  cent  of  the  sprue  patients,  with 
an  additional  20  per  cent  showing  hydrochlor’c  acid 
after  histamine.  In  a few  cases  autolyzed  yeast 
preparations  produced  reticulocyte  crises  and  im- 
provement of  the  blood  values.  In  those  cases 
showing  an  hypochromic  anemia,  the  further  addi- 
tion of  iron  was  essential  to  full  recovery.  No 
correlation  between  Monilia  psylosis  infection  and 
sprue  was  observed  in  cultures  of  the  stool  in  vari- 
ous types  of  anemia,  as  has  been  frequently  sug- 
gested in  the  past. 

Before  leaving  the  subject  of  anemia  it  may  be 
pertinent  to  sound  a note  of  caution  with  reference 
to  copper  as  a therapeutic  agent.  Four  years  ago 


Hart  and  his  associates  at  the  University  of  Wis- 
consin reported  experiments  suggesting  that  cop- 
per as  well  as  iron  was  necessary  to  raise  the 
level  of  homoglobin  in  the  blood  of  milk-fed, 
young,  white  rats.  Elvehjem  and  Sherman16 
from  the  same  group  have  this  year  reported  fur- 
ther studies  elucidating  the  role  of  copper  in  the 
mechanism  under  investigation.  When  iron  alone 
is  fed  to  young  rats  that  have  become  anemic,  it 
is  stored  in  liver  and  spleen  in  proportion  to  the 
amount  fed,  but  the  hemoglobin  of  the  blood  is  not 
increased.  If  a little  copper  is  then  added,  some 
of  the  stored  iron  is  released  for  conversion  into 
hemoglobin.  If  iron  and  copper  are  given  to- 
gether the  formation  of  hemoglobin  takes  place 
at  once,  and  only  the  excess  of  iron  is  stored  in 
the  liver.  Thus,  the  Wisconsin  workers  seem  to 
have  demonstrated  that  copper  is  necessary  not  for 
the  assimilation  of  iron  but  for  its  utilization  un- 
der the  conditions  of  their  experiments. 

When  it  comes  to  an  application  of  this  knowl- 
edge to  the  human  individual,  however,  certain 
qualifying  and  modifying  circumstances  must  be 
considered.  Copper  is  far  more  widespread  in  food 
than  may  be  commonly  supposed.  The  body’s  need 
for  copper  is  quantitatively  far  smaller  than  the 
requirement  of  iron.  The  observations  of  Josephs11 
of  the  Pediatrics  Department  at  the  Johns  Hop- 
kins Hospital  more  nearly  parallel  those  of 
the  Wisconsin  workers  on  experimental  animals 
than  any  other  human  studies.  He  found  that  in 
some  children  copper  seemed  definitely  to  catalyze 
the  utilization  of  iron,  after  liver  and  iron,  alone 
or  together,  had  proved  ineffective.  Abt15  re- 
ported better  results  with  liver  plus  iron  in  pre- 
mature infants  than  with  other  measures.  It  is 
conceivable  that  the  new-born  infant  may  occa- 
sionally lack  an  adequate  deposition  of  copper  in 
the  tissues  and  thus  require  a specific  supple- 
mentary supply  when  the  diet  does  not  contain 
copper.  Hemopoiesis,  however,  is  something  more 
than  the  mobilization  of  iron  and  copper.  The 
studies  of  Scott  and  Erf19  suggest  an  heat 
labile  factor  in  milk,  dependent  upon  the  dietary 
of  the  cow,  which  is  important  for  hemopoiesis  in 
the  experimental  animal.  The  whole  story  of  milk 
anemia  is  not  yet  told!  And  with  Mallory’s 
demonstration  of  the  etiologic  relationship  be- 
tween copper  and  hemochromatosis  of  the  liver, 
the  possibility  of  copper  poisoning  must  always 
be  kept  in  mind. 

LEUCOCYTIC  DYSCRASIAS 

With  reference  to  the  white  blood  cell  dyscra- 
sias,  interest  continues  to  be  manifest  in  the 
Schultz  syndrome  of  agranulocytosis  or  malig- 
nant neutropenia.  Full  discussions  of  the  pres- 
ent status  of  the  diagnosis  and  treatment  of  this 
condition  have  been  published  during  the  year — 
Doan20,  Jackson21,  ReznikofT'2.  The  underlying 
pathology  may  include  either  bone  marrow 
aplasia  or  hyperplasia23.  When  l’egeneration 
from  the  hypoplastic  state  is  initiated,  a care- 


302 


The  Ohio  State  Medical  Journal 


May,  1933 


ful  study  of  the  myeloid  elements  in  the  peri- 
pheral blood  will  reveal  a myelocyte  “peak”  pre- 
liminary to  the  increase  in  total  granulocytes, 
comparable  to  the  reticulocyte  response  observed 
in  pernicious  anemia”.  Carefully  controlled 
studies  with  the  nucleotide  therapy  continue  to 
indicate  that  it  has  a definite  place  in  the  intera- 
ist’s  therapeutic  armamentarium  in  properly  se- 
lected cases,  and  that  a direct  myelopoietic  stimul- 
lus  is  carried  by  the  nucleic  acid  derivatives. 

Wiseman20  is  placing  the  lymphocyte  and  the 
diseases  involving  the  lymphatic  tissues  on  a new 
basis  and  the  immediate  future  should  see  real 
progress  in  this  field. 

THE  STREPTOCOCCUS 

Within  the  infectious  disease  field,  the  strepto- 
coccus and  its  resultant  disease  manifestations 
continue  to  beckon  and  baffle. 

Although  hemolytic  streptococci  cause  diseases 
as  varied  as  scarlet  fever,  erysipelas,  pneumonia, 
heart  disease,  puerperal  fever,  and  sepsis  after 
accident  or  surgical  operation,  and  as  secondary 
invaders,  moreover,  kill  multitudes  by  giving  a 
fatal  end  to  temporary  weakness,  the  identifica- 
tion of  given  streptococci  with  particular  varie- 
ties of  disease  is  very  difficult. 

Sir  Frederick  Andrewes,  for  many  years  until 
his  death  last  February  a member  of  the  Medical 
Research  Council,  devoted  the  last  working  years 
of  his  life  to  promoting  advance  in  this  direction, 
hoping  by  using  the  most  refined  methods  of 
analysis  to  improve  the  classification  of . the 
streptococci.  The  Medical  Research  Council  has 
just  issued  the  report  of  the  work  carried  on  dur- 
ing more  than  seven  years  by  him  and  his  col- 
laborators, which  concludes  with  the  statement 
that  “the  more  one  studies  Haemolytic  streptococci 
the  more  strongly  is  the  impression  gained  that 
they  are  in  a state  of  constant  flux  in  which  it  is 
difficult  to  find  any  firm  foundation  for  a perma- 
nent systematic  classification”. 

The  serious  and  many-sided  danger  of  the 
haemolytic  streptococcus  to  human  life  seems  to 
arise  from  the  very  instability  of  its  physico- 
chemical behavior,  for  the  organism  as  an  invad- 
ing parasite  seems  to  have  special  facility  in 
adapting  the  refinements  of  its  living  chemistry 
to  the  particular  host  environment  in  which  it 
finds  itself.  Studies  of  different  “types”  in  terms 
of  formal  definition  become  fruitless  or  meaning- 
less, the  Medical  Research  Council  points  out,  if 
each  type  is  a passing  chemical  phase  quickly  as- 
sumed and  readily  abandoned.  Progress  would 
seem  to  lie  in  gaining  deeper  knowledge  of  the 
exact  chemical  events  involved  in  the  interplay 
of  the  parasitic  organism  and  the  environment  of 
the  invaded  host. 

Coburn""',  at  the  Medical  Center,  has  done 
just  this  in  his  remarkable  contribution  to  the 
knowledge  of  acute  rheumatic  fever  and  its  strep- 
tococcus etiology,  in  studies  covering  the  past 
three  years.  Joint  and  cardiac  exacerbations  of 


the  disease  are  practically  limited  to  the  winter 
months  and  always  are  preceded  by  sore  throat  or 
upper  respiratory  infection  of  streptococcus  origin. 
The  removal  of  susceptible  individuals  from  the 
inclemency  of  temperate  zone  winters  to  tropical 
or  semi-tropical  climates  completely  eliminates  the 
streptococcus  and  all  clinical  and  physical  signs 
and  symptoms  of  the  condition.  The  interaction 
of  constitution,  environment  and  microorganism 
as  here  revealed  points  the  way  for  future 
studies,  whose  objective  will  be  the  ultimate  con- 
quest of  the  diseases  dependent  upon  this  malig- 
nant group  of  bacteria. 

THE  VIRUS  DISEASES 

Another  field  of  medicine  closely  allied  to  the 
bacterial  infections,  in  which  a growing  interest 
is  reflected  by  an  increasing  volume  of  productive 
research,  is  that  of  the  virus  diseases.  Kendall’s 
revolutionary  announcement  of  a year  and  a half 
ago  of  a new  un-denatured  protein  and  amino 
acid  medium  with  which  he  could  at  will  change 
a visible  pathogenic  microorganism  into  an  invis- 
ible filter-passing  form  has  not  been  confirmed. 
Nevertheless,  the  instability  under  varying  en- 
vironmental conditions  of  many  bacterial  forms  is 
being  increasingly  appreciated.  Granting  this, 
there  still  remain  definite  criteria  such  as  the 
clinical  course  of  the  disease,  the  blood  picture, 
and  the  pathological  finding  of  intra-nuclear  or 
intra-cytoplasmic  inclusion  bodies  which  tend  to 
separate  the  so-called  virus  diseases  from  those 
caused  by  organisms  which  can  ordinarily  be  seen 
and  identified  with  the  microscope  and  by  sero- 
logical laboratory  procedures20.  Excellent  and 
complete  studies  of  the  blood  changes  in  measles 
and  yellow  fever,  emphasizing  the  initial  leuco- 
penia  and  lymphopenia,  have  been  published  this 
year  from  the  Rockefeller  Institute  by  Benja- 
min27 and  by  Berry  and  Kitchen28,  originating  from 
our  own  blood  studies  and  in  which  we  had  an  in- 
itial part. 

The  problem  of  contagion  in  the  virus  disease 
field  has  been  studied  during  the  past  year  by 
Colvin  of  the  Yale  Medical  School.  Working  with 
bacteriophage  because  of  its  approximate  size  to 
that  of  the  pathologic  viruses  and  its  ease  of 
handling  and  recognition,  Colvin  found  that  it 
may  travel  through  the  air  at  least  at  the  rate  of 
thirty-five  feet  every  five  minutes.  His  conclu- 
sions are  that  these  ultra-microscopic  particles 
may  be  air-borne  without  dependence  upon  other 
means.  This  would  explain  in  part  why  the  virus 
diseases,  such  as  chicken  pox  and  measles,  are  so 
very  contagious. 

Interest  in  the  cause  and  control  of  the  common 
cold  continues  to  absorb  the  workers  in  a number 
of  laboratories.  Earlier  reports  bearing  upon  the 
etiologic  relationship  between  a specific  virus  and 
this  commonest  of  upper  respiratory  infections, 
without  the  inter-position  of  known  visible  bac- 
teria, reported  independently  by  Dochez  and  Per- 
rin Long,  have  received  additional  confirmation 


May,  1933 


Medicine  in  Retrospect — Doan 


303 


during  the  past  year.  Cultivation  of  the  virus  in 
a tissue  medium  has  been  accomplished  by 
Dochez20,  fifteen  generations  covering  a period 
of  seventy-four  days  and  seventeen  generations 
during  seventy-three  days,  having  been  followed 
in  his  laboratory.  At  the  end  of  these  periods  of 
in-vitro  cultivation  nasal  spraying  of  the  end  cul- 
ture caused  a development  of  typical  cold  in  two 
of  three  volunteer  test  subjects.  Similar  results 
were  obtained  by  Powell  and  Clowes30  from 
another  laboratory  after  twenty-seven  in-vitro 
generations  of  the  filterable  virus  obtained  from 
an  acute  cold  subject.  The  recent  studies  of 
Long,  Bliss  and  Carpenter  on  influenza,  using  cri- 
teria and  methods  developed  in  the  study  of  the 
common  cold  relieve  the  Pfeiffer  bacillus  of  re- 
sponsibility for  this  epidemiologic  scourge  and 
place  the  etiologic  agent  definitely  within  the 
virus  group.  Both  the  laboratories  at  the  Medi- 
cal Center  in  New  York  City  and  those  in  Balti- 
more at  the  Johns  Hopkins  Medical  School  are 
continuing  experimental  studies  in  the  hope  that 
some  means  of  prophylaxis  may  be  developed. 

That  prophylaxis  may  be  accomplished  for  the 
virus  diseases  and  that  it  is  not  an  impossible  at- 
tainment has  been  attested  by  the  accomplish- 
ments in  Rocky  Mountain  spotted  fever,  typhus, 
yellow  fever  and  canine  distemper.  Drs.  Pinker- 
ton and  Hass  have  recently  shown  the  germs  of 
typhus  fever  and  spotted  fever  to  be  very  much 
alike  except  in  one  important  respect:  the  spotted 
fever  inclusion  bodies  are  intra-nuclear,  whereas 
the  typhus  fever  inclusion  bodies  are  found  only 
in  the  cytoplasm.  A vaccine  made  from  the 
bodies  of  infected  ticks  for  Rocky  Mountain  spot- 
ted fever  and  from  the  bodies  of  rat-fleas  in 
typhus  fever,  due  largely  to  the  researches  of 
Drs.  Spencer  and  Dyer  of  the  United  States  Pub- 
lic Health  Service,  give  promise  of  reducing  the 
morbidity  and  mortality  in  these  two  diseases  as- 
toundingly. 

Dr.  W.  A.  Sawyer  of  the  Rockefeller  Founda- 
tion reported  last  April  before  the  Society  for 
Experimental  Pathology  in  Philadelphia  the  suc- 
cessful vaccination  of  ten  individuals  against  yel- 
low fever.  This  end  result  was  based  upon  the  dis- 
covery by  Dr.  Theiler  that,  when  accompanied  by 
some  irritating  chemical,  virulent  yellow  fever 
virus  can  be  made  pathogenic  for  mice.  After  100 
consecutive  passages  of  this  virus  through  mice 
the  virulence  became  so  attenuated  that  subcuta- 
neous injection  into  monkeys  resulted  only  in  a 
slight  fever.  If  the  virus  were  injected  together 
with  immune  serum  from  a recovered  case  of  yel- 
low fever  no  clinical  manifestations  were  observed, 
but  immunity  subsequently  developed.  From  these 
animal  studies  a vaccine  consisting  of  10  per  cent 
emulsion  of  mouse  brain  tissue  containing  the 
yellow  fever  virus,  suspended  in  immune  serum, 
together  with  an  additional  quantity  of  immune 
serum,  has  been  used  in  ten  human  individuals. 
Within  seven  to  twenty-one  days  specific  immune 


bodies  were  demonstrable  in  the  blood  plasma  of 
these  individuals  and  at  the  end  of  ten  months,  at 
which  time  this  report  was  made,  the  immunity 
persisted,  as  might  be  anticipated. 

Laidlaw,  the  English  pathologist  and  his  asso- 
ciates have  just  successfully  completed  a ten-year 
study  of  distemper,  a virus  disease  prevalent 
among  dogs,  and  have  developed  a prophylactic 
vaccine  which  reduces  the  morbidity  from  prac- 
tically 100  per  cent  to  less  than  5 per  cent.  A 
therapeutic  serum  has  also  been  produced.  The 
foundation  under  which  this  classical  study  was 
made  has  just  been  dissolved,  its  problem  solved. 
It  is  clear  that  rapid  progress  in  the  understand- 
ing and  control  of  the  virus  diseases  is  being 
made. 

The  studies  of  McCordock  reported  before  the 
Society  for  Experimental  Biology  and  Medicine 
in  June,  1932,  suggesting  whooping  cough  to  be 
of  virus  etiology  because  of  the  finding  of  intra- 
nuclear inclusions  in  certain  of  his  tissue  studies, 
were  refuted  by  Rich,  Long  and  their  associates 
at  Johns  Hopkins  in  studies  which  were  reported 
in  the  October  7,  1932,  issue  of  Science.  The  cur- 
rent assumption  that  whooping  cough  is  caused 
by  the  Bordet-Gengou  bacillus  and  that  prophy- 
lactic immunization  with  the  corresponding  vac- 
cine is  justifiable,  is  based  solely  on  clinical  im- 
pression. Chimpanzees  were  used  in  the  experi- 
mental work  at  Baltimore.  Inoculation  was  by 
throat  spraying  with  early  human  whooping 
cough  sputum,  unfiltered  and  filtered,  and  with 
freshly  isolated  pure  culture  Bordet-Gengou  ba- 
cilli. Typical  whooping  cough  developed  only  in 
those  apes  receiving  either  the  pure  cultures  of 
bacillus  pertussis  or  whole  human  sputum.  The 
transitory  catarrhal  condition,  without  cough, 
which  developed  in  the  champanzees  inoculated 
with  the  filtrates  was  probably  the  reflection  of 
an  accompanying  “common-cold”  filterable  virus 
in  the  human  sputum. 

Jungeblut  and  Engle  of  Columbia  Univer- 
sity recently  suggested  before  the  Meltzer  Verein 
(April,  1932)  that  immunity  from  poliomyelitis 
is  the  result  of  a normal  physiologic  maturation. 
Their  tentative  conclusion  is  that  the  fall  of 
poliomyelitis  morbidity  and  the  rising  level  of 
serologic  activity  with  incr’easing  age  is  predomi- 
nantly a function  of  normal  physiological  matura- 
tion and  to  a large  extent  seems  to  develop  inde- 
pendently of  previous  contacts  with  the  specific 
antigen.  Rhesus  monkeys  were  kept  under  the 
strictest  quarantine  conditions  from  birth.  Tests 
showed  an  inability  on  the  part  of  any  immature 
Rhesus  serum  to  neutralize  the  virus  of  polio- 
melitis  in  vitro,  whereas  two-thirds  of  the  mature 
Rhesus  serums  were  markedly  virucidal.  Park 
and  his  associates  of  the  New  York  Board  of 
Health  Laboratories  in  a carefully  studied  epi- 
demic of  poliomyelitis  in  New  York  City  last  year 
found  no  striking  difference  in  the  severity  and 
extent  of  paralytic  lesions  between  a control 


304 


The  Ohio  State  Medical  Journal 


May,  1933 


group  and  a group  receiving  convalescent  serum. 
Shaughnessy,  Aycock  and  others  have  demon- 
strated that  normal  adult  human  serum  usually 
neutralizes  the  virus  of  poliomyelitis  in  vitro.  It 
would  seem  that  two  practical  points  may  be  sal- 
vaged from  the  variety  of  opinions31  which  ex- 
ist today  with  reference  to  this  disease  First, 
that  prophylaxis  with  immune  serum  will  pre- 
vent, even  though  it  may  not  cure,  poliomyelitis. 
Second,  that  supposedly  normal  adult  blood  serum 
is  very  frequently  approximately  as  effective  as 
convalescent  serum  in  whatever  measure  of  pas- 
sive protection  can  be  conveyed  by  serum  treat- 
ment. Simon  Flexner  reported  a few  weeks  ago 
the  gradual  attenuation  of  poliomyelitis  virus 
carried  for  many  years  through  monkeys  at  the 
Rockefeller  Institute,  which  gives  hope  of  a safe 
prophylaxis  for  “polio”  similar  to  that  just  at- 
tained for  yellow  fever,  before  very  long.  As  has 
been  shown  in  the  classical  studies  of  John 
Paul32  at  New  Haven,  the  chief  problem  at  the 
present  time  is  the  differential  diagnosis  of  cases 
showing  acute  upper  respiratory  and  digestive 
symptoms,  and  an  early  recognition  of  those  in- 
dividuals in  whom  an  invasion  of  the  central 
nervous  system  will  occur.  The  challenge  to  the 
medical  profession  today  in  my  opinion,  is  the 
challenge  of  early  diagnosis,  even  as  it  is  in 
cancer. 

THE  CANCER  QUESTION 

The  two  perennial  questions,  with  which  the 
medical  profession  is  constantly  confronted,  are: 
Is  the  increase  of  cancer  incidence,  real  or  appar- 
ent; and,  will  early  diagnosis,  and  surgery  or 
other  therapeutic  measures,  cure?  It  is  of  inter- 
est in  this  connection  to  note  two  news  reports 
which  appeared  in  the  October  21,  1932,  issue  of 
the  New  York  Times.  The  one  reported  the  St. 
Louis  Symposium  on  the  Curability  of  Cancer  at 
which  meeting  31  of  the  leading  cancer  special- 
ists in  the  United  States  reported  a total  of  4344 
cures  of  five  years  standing  and  more.  The  other 
was  a report  of  a lecture  on  Cancer  Research  at 
the  New  York  Academy  of  Medicine  by  Francis 
Carter  Wood.  While  recogonizing  the  value  of 
surgery  and  irradiation,  Dr.  Wood  emphasized  the 
only  hope  of  the  future  to  be  in  “fundamental  re- 
search as  to  the  nature  of  the  disease  or  diseases, 
to  determine  why  cancer  begins,  how  it  grows,  and 
what  will  check  that  growth”. 

We  turn,  therefore,  to  certain  suggestive  studies 
on  cancer  cells,  which  have  been  reported  during 
recent  months.  What  promises  to  be  a new  method 
of  approach  to  a better  understanding  of  tissues 
and  cells  in  general  but  more  particularly  to  those 
of  neoplastic  origin,  is  a survey  of  the  distribu- 
tion and  kinds  of  inorganic  salts  as  revealed  by 
micro-incineration.  This  technique  first  described 
by  Policard33  has  been  recently  developed  and 
modified  especially  by  Gordon  Scott34  in  Cow- 
dry’s  laboratory  at  Washington  University,  St. 
Louis.  Experience  in  this  technique,  it  is  said, 


makes  it  possible  to  identify  various  cell  types  as 
accurately  by  their  mineral  skeletons  as  when 
fixed  and  stained  by  the  orthodox  methods.  Pre- 
liminary observations  on  the  incinerated  tumors 
of  medullary  duct  carcinoma  of  the  breast  and  of 
certain  transplantable  mouse  tumors  show  a rela- 
tively greater  content  of  ash  from  similar  amounts 
of  tumor  tissue  as  contrasted  with  normal  tissue. 
The  ash  increase  is  both  nuclear  and  cytoplasmic 
in  origin,  and  it  has  been  determined  that  of  the 
nuclear  salts  present  at  least  calcium  and  iron 
oxide  are  present  in  excess  when  compared  with 
the  ashed  nuclei  of  normal  cells.  It  has  been  de- 
termined further  that  there  is  a striking  similar- 
ity between  developing  embryonic  cells  and  cancer 
cells  with  respect  to  the  distribution  and  ar- 
rangement of  certain  mineral  salts.  This  finding 
is  of  interest  in  connection  with  Cohnhein’s  em- 
bryonal theory  of  tumor  origin.  Additional  com- 
munications and  results  with  micro-incineration 
should  be  anticipated  with  interest. 

The  Lewises  at  Johns  Hopkins  have  suggested 
in  a recent  issue  of  the  American  Journal  of  Can- 
cer that  malignancy  may  be  linked  with  perma- 
nent changes  in  the  cell  centrosome  rather  than 
with  abnormal  behavior  of  the  chromosomes.  By 
further  study  with  moving  pictures  of  the  actual 
process  of  cell  multiplication  in  both  normal  and 
cancer  cells,  it  is  hoped  to  throw  more  light  on 
this  fundamental  phase  of  the  problem. 

Zakrzewski  of  the  Institute  of  Pathology, 
Kracow,  Poland,  and  Fischer  of  Berlin  have  found 
in  tissue  culture  studies  that  the  cancer  cell  while 
retaining  the  property  of  unlimited  multiplica- 
tion has  lost  all  power  of  differentiation  as  con- 
trasted with  normal  embryonic  tissue  cultures. 

Favorable  reports  bearing  upon  the  Fuchs  test 
for  malignancy  continue  to  appear  in  the  current 
literature.  The  reaction  is  based  upon  the  appar- 
ent fact  that  fibrin  in  the  blood  of  a person  with- 
out cancer  is  digested  by  the  serum  of  a cancer  in- 
dividual with  the  production  of  non-protein  nitro- 
gen constituents  which  are  then  determined  quan- 
titatively. The  latest  report  upon  this  method  is 
by  Professor  Von  Falkenhausen  from  Breslau, 
who — by  introducing  refinements  in  the  technique 
— reports  no  diagnostic  failures  in  a series  of  80 
cases.  Work  with  the  Fuchs  test  appears  worthy 
of  continued  attention. 

GASTRIC  ULCER 

Mucin  therapy  for  peptic  ulcer  has  been  sug- 
gested and  has  received  fair  preliminary  trial  by 
Ivy,  Fogelson,  Mann,  Bollman  and  others.  Brown 
and  his  coworkers33  at  Northwestern  Univer- 
sity Medical  School  report  36  out  of  37  patients 
who  suffered  partial  or  complete  disability  on 
previous  strict  ulcer  management  to  have  been  re- 
lieved objectively  and  subjectively  by  mucin.  The 
disappearance  of  occult  blood  in  the  stomach  and 
stool  and  the  effective  control  of  massive  hemor- 
rhages from  the  stomach  were  accomplished  by 


May,  1933 


Medicine  in  Retrospect — Doan 


305 


the  mucin  treatment.  While  any  local  palliative 
treatment  cannot  in  itself  change  the  constitution 
or  the  vegetative  nervous  system  of  the  patient, 
who  is  an  ulcer-bearing  individual,  mucin  has 
seemed  to  help  at  least  a portion  of  the  more  in- 
tractable cases. 

SYPHILIS 

Over  10,000  cases  of  general  paralysis  treated 
with  malaria  have  been  reported  in  the  medical 
literature  since  1917.  Since  Professor  Wagner- 
Jauregg  of  Vienna  began  to  treat  this  advanced 
stage  of  syphilitic  infection,  25  per  cent  of  these 
patients  have  been  practically  cured  and  returned 
to  their  homes  and  jobs,  according  to  the  statistics 
of  the  United  States  Public  Health  Service  just 
released.  Before  the  malaria  treatment  only  one 
or  two  per  cent  of  the  victims  had  complete  re- 
mission and  patients  usually  died  within  three  or 
four  years.  Professor  Jauregg’s  original  hypothe- 
sis was  based  upon  the  thought  that  the  fever  in- 
duced was  the  principal  curative  factor. 

Walter  Breutsch36  last  July  reported  in  the 
American  Journal  of  Psychiatry  on  the  histo- 
pathology  of  therapeutic  tertian  malaria.  He  finds 
that  therapeutic  malaria  produces  an  activation 
of  the  mesodermal  tissues  in  which  the  stimula- 
tion of  the  histiocyte  and  the  activation  of  the 
undifferentiated  mesenchymal  cells  are  outstand- 
ing features.  In  the  nervous  system  the  macro- 
phagic  response  was  greatest  in  the  leptomenin- 
ges.  In  the  arachnoid,  the  malaria-stimulated 
histiocytes  stood  out  distinctly  from  the  less  active 
arachnoidal  lining  cells.  In  the  perivascular 
spaces  of  the  large  vessels  in  the  white  matter 
and  in  the  striatum  and  in  the  pons,  stimulated 
histiocytes  were  numerous.  Thus,  the  cellular  re- 
sponse to  malaria  is  similar  to  that  observed  by 
Cunningham  and  Morgan  of  Vanderbilt  Univer- 
sity, when  a successful  limitation  of  experimental 
syphilis  in  the  rabbit  is  accomplished  by  trypan 
blue  dye  injections.  Is  it,  therefore,  the  fever  or 
the  cellular  reaction  which  is  primarily  responsi- 
ble for  the  improvement  in  cases  of  general  paraly- 
sis? Or,  may  it  not  be  a happy  combination  of 
both? 

Whitney,  of  the  General  Electric  Laboratories, 
noted  the  temperature-elevating  potentialities  of 
high  frequency,  short-wave  radio  transmitters. 
Being  aware  of  Von  Jauregg’s  hypothesis  of  the 
therapeutic  effectiveness  of  fever  temperatures  in 
the  human  body,  he  fathered  some  clinical  experi- 
ments with  this  electrical  energy  fever  in  syphi- 
lis. It  would  now  appear  from  the  clinical  studies 
of  Kyrle  in  Vienna  and  workers  at  the  Albany 
Medical  College  that  a combination  of  fever  and 
the  now  known  cellular  reaction  which  results, 
coupled  with  intensive  ai’senic  therapy,  offers  the 
most  hopeful  approach  to  the  control  of  syphilis 
which  the  human  race  has  seen  since  the  spread 
of  this  plague  through  the  white  race  upon  its  in- 
troduction into  Europe  following  Columbus’  re- 
turn from  the  New  World  in  1493.  Walter  Simp- 


son37 at  Dayton  is  making  interesting  experi- 
mental studies  on  the  effects  of  this  energy  fever 
on  the  human  body  which  we  shall  follow  with 
interest. 

RADIOACTIVITY  DANGERS 

The  assertion  has  been  made  that  the  use  of 
thorium  dioxide  as  a diagnostic  medium  both  for 
pyelocystography  and  as  material  for  intravenous 
injection  to  render  spleen,  liver,  bone  marrow  and 
intracranial  tissues  visible  in  roentgen  films  is 
fraught  with  no  danger.  Manufactured  commer- 
cially under  the  trade  name  of  “thorotrast”  this 
colloidal  suspension  of  thorium  dioxide,  25  per 
cent  by  weight,  is  recommended  by  Radt,  in  Ger- 
many, its  originator;  Wallace  M.  Yater,  of 
Georgetown  University,  School  of  Medicine, 
Kadrnka  and  others  for  diagnostic  purposes.  The 
thorium  particles  are  taken  up  by  the  endothelial- 
lined  sinuses  of  the  liver  and  spleen,  thus  render- 
ing these  organs  radio-opaque.  Granted  readily 
that  such  visualization  is  possible,  the  justifica- 
tion of  its  use  in  the  light  of  what  we  know  of  the 
remote  effects  upon  the  body  tissues  of  radio- 
active material,  is  decidedly  questionable.  Shih 
and  Jung3S  produced  thrombocytopenic  purpura 
hemorrhagica  experimentally  with  thorium.  Sabin, 
Doan  and  Forkner39  found  that  after  very 
small,  5 microgram,  dosages  of  mesothorium 
or  radium  chloride  given  over  periods  of  from 
several  months  to  a year,  there  developed  marked 
changes  in  marrow  and  lymphatic  tissues  with,  in 
some  animals,  the  development  of  osteogenic  sar- 
comata. The  dangers  inherent  in  the  taking  of 
so-called  radio-active  waters  are  now  well- 
recognized. 

Flinn  and  Maryland  have  studied  extensively 
the  late  effects  produced  by  the  deposition  of 
radio-active  substances  in  bone.  The  necrosis  of 
bone  which  followed  the  tipping  of  brushes  for 
the  painting  of  watch  dials  is  a sad  chapter  in  in- 
dustrial hazards.  In  the  face  of  this  evidence,  it 
should  take  an  unusually  careless  or  bold  individ- 
ual to  inject  intravenously  a substance  of  such 
potential  danger  as  thorotrast.  I was,  therefore, 
very  much  gratified  to  note  in  the  December  24, 
1932,  issue  of  the  Journal  of  the  American  Medical 
Association,  the  decision  of  the  Council  on  Phar- 
macy and  Chemistry  to  defer  acceptance  of  this 
substance  for  intravenous  administration  be- 
cause of  “the  very  imperfect  elimination  of  thor- 
ium dioxide  from  the  body,  its  fairly  high  alpha 
ray  activities,  the  possibility  of  further  increase 
in  radio-activity  by  partial  conversion  to  meso- 
thorium and  radio-thorium  and  the  possibility  of 
the  sensitization  of  tissues  to  r’oentgen  rays”. 

ALLERGY 

A very  significant  contribution  in  the  field  of 
the  allergic  dyscrasias  is  that  of  the  Asthma  Re- 
search Council  of  Great  Britain  in  its  study  of 
the  urinary  proteose  as  a specific  desensitizing 
agent  in  hay  fever  and  asthma.  It  has  been  de- 


306 


The  Ohio  State  Medical  Journal 


May,  1933 


termined  that  all  asthmatic  patients  excrete  a 
highly  specific  proteose  during  paroxysms,  large 
doses  of  which  subsequently  will  induce  attacks, 
but  which  when  administered  in  small  doses  fre- 
quently can  be  used  to  desensitize  the  patient. 
Barber  and  Oriel  began  their  publications  in  this 
field  in  1928,  with  a gradually  accumulating  ex- 
perience since  that  time.  Darley  and  White- 
head40,  of  the  University  of  Denver  School  of 
Medicine,  have  recently  confirmed  much  of  this 
work.  Eight  of  thirteen  patients  studied  by  them 
were  afforded  complete  relief,  the  remainder  par- 
tial relief,  with  proteose  desensitizing  injections. 
The  work  is  promising  and  should  be  extended 
wherever  the  allergic  state  presents,  with  its  dis  - 
tressing manifestations. 

CORTIN 

The  adrenal  glands  are  indispensable  in  the 
maintenance  of  life  processes.  The  remarkably 
rapid  dissolution  following  adrenalectomy  is  due 
specifically  to  cortical  loss.  The  chemical  and 
clinical  studies  of  Swingle,  Pfiffner,  F.  A.  Hart- 
man, Harrop,  Rowntree  and  others  have  heralded 
another  triumph  for  scientific  medicine.  Britton 
and  Silvette"  from  the  Pathological  Laboratory 
of  the  University  of  Virginia,  have  brought 
further  evidence  recently  suggesting  the  primary 
mechanism  in  Addison’s  disease  to  be  a failure  in 
the  ability  of  the  body  to  store  liver  glycogen.  The 
adrenal  cortex  appears  to  be  indispensably  im- 
portant in  maintaining  in  cooperation  with  other 
organs  the  normal  metabolism  of  carbohydrates. 
This  represents  the  so-termed  prepotent  function 
of  the  adrenal  cortex  in  the  organism. 

CYANIDE  AND  CO-POISONING 

Matilda  Brooks,  a zoologist  of  the  University 
of  California,  has  been  studying  for  many  years 
the  diffusability  of  dyes  into  living  cell  mem- 
branes. She  and  Marian  Irwin  of  the  Rockefeller 
Institute  have  contributed  many  basic  observa- 
tions relating  to  this  exceedingly  important  fund- 
amental physico-chemico-biological  phenomenon. 
Dr.  Brooks  has  used  methylene  blue  extensively 
in  her  studies.  She  knew  that  earlier  investiga- 
tors, chief  among  them  Professor  Otto  Warburg, 
of  the  Kaiser  Wilhelm  Institute  for  Biology  in 
Berlin,  had  found  in  connection  with  work  on 
yeast  cells  and  other  organisms,  that  methylene 
blue  counteracts  the  effect  of  cyanide  and  of  car- 
bon monoxide  on  living  tissues.  Taking  the  next 
step,  Dr.  Brooks  found  in  the  smaller  mammals, 
such  as  mice  and  guinea  pig£,  a successful  anti- 
dote in  methylene  blue  for  cyanide  and  carbon 
monoxide  poisoning.  In  a report  of  this  work  to 
the  Society  for  Experimental  Biology  and  Medi- 
cine in  April,  1S32,  she  suggested  the  use  of  this 
dye  in  human  cases  of  such  poisoning. 

Dr.  Geiger,  Director  of  Public  Health,  has  suc- 
cessfully applied  this  treatment  at  the  Park 
Emergency  Hospital  in  San  Francisco  during  the 
past  summer.  A one  per  cent  sterile  aqueous  so- 


lution of  methylene  blue  (U.  S.  P.  methylthionine 
chloride)  is  injected  intravenously  in  as  much  as 
50  cc.  quantities.  Several  thousand  persons  are 
killed  each  year  by  carbon  monoxide  gas  and  by 
cyanide.  It  is  suggested,  if  the  preliminary  re- 
ports are  substantiated  by  further  successes,  that 
methylene  blue  be  included  as  a part  of  profes- 
sonal  first  aid  kits  where  such  emergencies  are 
frequently  encountered. 

l’envoi 

Finally,  in  surveying  broadly  the  innumerable 
ills  which  ebb  and  flow  about  the  human  race,  one 
is  prompted  to  wonder  just  how  much  progress  is 
being  made  actually  in  the  understanding  and 
control  of  disease.  Paul  de  Kruif  has  under- 
taken, in  a very  human  and  thrilling,  albeit,  an 
entirely  accurate  factual  story,  to  outline  some  of 
the  more  outstanding  current  medical  triumphs  in 
his  “Men  Against  Death”,  a most  vivid  and  en- 
tertaining and  thought-provoking  book.  “Ka- 
monga”,  by  the  young  physiologist  Homer  Smith 
is  another  worth-while  semi-popular  little  book  cf 
the  year,  of  great  fascination  and  charm,  present- 
ing the  philosophical  by-product  of  a life  of  scien- 
tific search  after  “the  meaning  of  life”. 

Professor  Gregory42,  complacently  optimistic 
tic  “in  view  of  the  nearly  world-wide  distribution 
of  Homo  sapiens”,  finds  it  “hard  to  imagine  any 
purely  terrestrial  epidemic  or  insect  scourge  that 
could  wipe  him  out  over  his  entire  range”.  In 
fact,  “man,  in  respect  to  the  high  development  of 
his  brain  and  other  characters,  may  well  repre- 
sent an  early  stage  in  the  differentiation  of  a 
virtually  new  class  of  vertebrates.  The  paleon- 
tological record  shows  repeatedly  that,  in  the  long 
past,  once  a new  class  gets  started,  it  runs  for 
hundreds  of  millions  of  years.  So  that,  taking 
the  available  evidence  into  consideration,  it  seems 
safe  to  predict  that  Homo  sapiens  will  eventually 
muddle  through  this  depression  and  survive  to 
endure  others  in  the  future”.  As  Dr.  Clark 
Wissler  has  pointed  out,  particular  cultures  may 
disappear,  but  culture  itself  goes  on. 

Returning  to  the  individual,  Madge  Macklin  in 
the  September  number  of  the  American  Journal 
of  Cancer,  states  her  belief  that  while  there  is  a 
real  increase  in  cancer,  more  ground  has  been 
won  from  the  ravages  of  infectious  disease  than 
has  been  lost  to  those  disorders  which  are  depend- 
ent on  inherent  qualities  in  the  chemical  and 
physical  make-up  of  the  individual.  Cancer  is  in- 
creasing because  by  preventive  methods  there  has 
been  created  a larger  population  to  grow  old; 
and,  having  grown  old,  they  are  kept  from  dying 
of  those  ills  from  which  they  formerly  suffered. 
Excellent  public  health  measures  and  high  cancer 
rates  are  inseparable,  at  least  for  the  present. 

That  Doctor  Macklin  is  not  unduly  discouraged 
by  her  findings  is  evident  from  her  concluding 
sentence,  which  is  also  mine,  the  philosophy  of 
which  should  prevent  our  taking  too  gloomy  a 


May,  1933 


Medicine  in  Retrospect — Doan 


307 


view  of  the  situation — “We  must  all  die  of  some- 
thing, and  it  is  inevitable,  as  we  eliminate  one 
cause  of  death  after  another,  that  we  increase  the 
death  rate  from  the  causes  that  remain;  for  while 
we  may  increase  the  length  of  life,  we  do  not  de- 
crease the  certainty  of  death”. 

BIBLIOGRAPHY 

1.  Jacks,  L.  P.  The  Liberal  Education  of  the  Body. 
Lancet , 1932,  223,  1145. 

2.  Sabin,  F.  R.  Cellular  Reactions  to  Fractions  Isolated 
from  Tubercle  Bacilli.  Physiological  Reviews , 1932,  12,  141. 

3.  Anderson,  R.  J.  The  Chemistry  of  the  Lipoids  of 
Tubercle  Bacilli.  Physiological  Reviews,  1932,  12,  166. 

4.  Webster,  L.  T.  Experimental  Epidemiology.  Medi- 
cine, 1932,  11,  321. 

5.  Greenwood,  Major.  Epidemiology : Historical  and 

Experimental.  The  Herter  Lectures  for  1931.  Oxford  Uni- 
versity Press,  1932. 

6.  Maurer,  S.,  and  Tsai,  L.  S.  Effect  of  Vitamin  B 
Complex  Depletion  on  Infant  Mortality.  Experimental  and 
Statistical  Study.  Illinois  Medical  Journal,  1932,  61,  30. 

7.  Cannon,  W.  B.  The  Wisdom  of  the  Body.  W.  W. 
Norton  and  Company,  1932. 

8.  Elvehjem,  C.  A.,  and  Neu,  V.  F.  Studies  on  Vitamin 
A Avitaminosis.  Journal  of  Biological  Chemistry,  1932, 

97,  71. 

9.  Cowgill,  G.  R.,  and  Smith,  A.  H.  Quantitative  As- 
pects of  Relation  Between  Vitmain  B and  Appetite  in  Dog. 
American  Journal  of  Physiology,  1925,  73,  106  ; 

Block,  R.  J.,  Cowgill,  G.  R.,  and  Klotz,  B.  H.  The 
Anti-Neuritic  Vitamin.  Journal  of  Biological  Chemistry, 
1932,  9U,  765. 

10.  Mettier,  S.  R.,  Minot,  G.  R.,  and  Townsend,  W.  C, 
Scurvy  in  Adults,  Especially  the  Effect  of  Food  Rich  in  Vi- 
tamin C on  Blood  Formation.  Journal  of  the  American  Med- 
ical Association,  1930,  95,  1089. 

11.  Agnew,  R.  G.  Science,  1932,  76,  8. 

12.  Strauss,  M.  B.,  and  Castle,  W.  B.  The  Nature  of  the 
Extrinsic  Factor  of  the  Deficiency  State  in  Pernicious  Ane- 
mia and  in  Related  Macrocytic  Anemias.  New  England 
Journal  of  Medicine,  1932,  207,  55. 

13.  Morris,  R.  S.,  Schiff,  L.,  Burger,  G.,  and  Sherman, 
J.  E.  Journal  of  the  American  Medical.  Association,  1932, 

98,  1080 ; American  Journal  of  Medical  Sciences,  1932,  181+, 
778. 

14.  Richter,  O.,  Ivy,  A.  C.,  and  Kim,  M.  S.  Human  Per- 
nicious Anemia  Liver  Extract.  Proceedings  of  the  Society 
for  Eperimental  Biology  and  Medicine,  1932,  29,  1093. 

15..  Mettier,  S.  R.,  and  Minot,  G.  R.  Effect  of  Iron  on 
Blood  Formation  as  Influenced  by  Changing  Acidity  of  Gas- 
trointestinal Contents  in  Certain  Cases  of  Anemia.  Ameri- 
can Journal  of  Medical  Sciences,  1931,  181,  25. 

16.  Elvehjem,  C.  A.,  and  Sherman,  W.  C.  The  Action 
of  Copper  in  Iron  Metabolism.  Journal  of  Biological  Chem- 
istry, 1932,  98,  309. 

17.  Josephs,  H.  W.  Treatment  of  Anemia  of  Infancy 
with  Iron  and  Copper.  Johns  Hopkins  Hospital  Bulletin, 
1931,  19,  246  ; Studies  on  Iron  Metabolism  and  the  Influence 
of  Copper.  Journal  of  Biological  Chemistry,  1932,  96,  559  ; 
Nutritional  Anemia,  its  Prevention  and  Treatment.  Ameri- 
can Journal,  of  Diseases  of  Children,  1932,  1+3,  1035. 

18.  Abt,  A.  F.,  and  Nagel,  B.  R.  Prophylaxis  of  the 
Anemia  of  Premature  Infants.  Journal  of  the  American 
Medical  Association,  1932,  98,  2270. 

19.  Scott,  Ernest,  and  Erf,  L.  Nutritional  Anemia. 
Paper  Read  Before  the  Ohio  State  Medical  Association,  Day- 
ton,  Ohio,  May  4,  1932. 

20.  Doan,  C.  A.  The  Neutropenic  State:  Its  Signifi- 

cance and  Therapeutic  Rationale.  Journal  of  the  American 
Medical  Association,  1932,  99,  194. 

Nucleinate  Induced  Extramedullary  Myelopoiesis.  Pro- 
ceed'nqs  of  the  Society  for  Experimental  Biology  and 
Medicine,  1932,  39,  1038. 

21.  Jackson,  Henry  F.,  Parker,  F.,  and  Taylor.  F.  H.  L. 
Studies  of  Diseases  of  the  Lymphoid  and  Myeloid  Tissues. 
VII.  The  Neucleotide  Therapy  of  Agranulocytic  Angina, 
Malignant  Neutropenia  and  Allied  Conditions.  American 
Journal  of  Medical  Sciences,  1932,  181+,  297. 

22.  Reznikoff,  P.  The  Treatment  of  Agranulocytosis  with 
Adenine  Sulphate.  Journal  of  Clinical  Investigation,  1933, 
xii,  45. 

23.  Fitzhugh,  T.,  and  Krumbhaar,  E.  B.  Myeloid  Cell 
Hyperplasia  of  the  Bone  Marrow.  American  Journal  of 
Medical  Sciences,  1932,  183,  104. 


24.  Wiseman,  B.  K.  The  Identity  of  the  Lymphocyte. 
Folia  Haematologica,  1932,  1+6,  346. 

25.  Coburn,  A.  F.  The  Factor  of  Infection  in  the  Rheu- 
matic State.  Williams  and  Williams  Company,  Baltimore, 
Md.,  1931. 

— and  Pauli,  R.  H.  Studies  on  the  Relation- 
ship of  Streptococcus  Hemolyticus  to  the  Rheumatic  Pro- 
cess. Journal  of  Experimental  Medicine,  1932,  56,  609. 

26.  Rivers,  T.  M.  Viruses.  Science,  1932,  75,  654.  Na- 
ture of  Viruses,  Physiological  Reviews,  1932,  12,  423. 

27.  Benjamin,  B.,  and  Ward,  S.  M.  L eucocytic  Response 
to  Measles.  American  Journal  of  Diseases  of  Children,  1932, 
1+1+,  921. 

28.  Berry,  G.  P.,  and  Kitchen,  S.  F.  Yellow  Fever  Ac- 
cidentally Contracted  in  the  Laboratory.  American  Journal 
of  Tropical  Medicine,  1931,  11,  365. 

29.  Dochez,  A.  R.,  Mills,  K.  C.,  and  Kneeland,  J.  Y. 
Viruses  of  Common  Cold,  Proceedings  of  the  Society  for 
Experimental  Biology  and  Medicine,  1931-32,  29,  64. 

30.  Powell,  H.  M.,  and  Clawes,  G.  H.  A.  Virus  of  Com- 
mon Cold.  Proceedings  of  the  Society  for  Experimental 
Biology  and  Medicine,  1931-32,  29,  332. 

31.  Poliomyelitis.  International  Committee  for  the  Study 
of  Infantile  Paralysis.  The  Williams  and  Wilkins  Company, 
Baltimore,  Md.,  1932. 

32.  Paul,  John  R.,  and  Trask,  J.  D.  Detection  of  Polio- 
myelitis Virus  in  So-Called  Abortive  Types  of  the  Disease. 
Journal  of  Experimental  Medicine,  1932,  56,  319. 

33.  Policard,  A.  Some  New  Methods  in  Histochemistry. 
The  Harvey  Lectures,  1931-32,  Series  XXXVII  ; Williams 
and  Wilkins,  Baltimore,  Md.,  1932. 

Morel  and  Revault,  P.  Application  u la 

graphie  a l’etude  histochimique  de  l’aorte  normale  et  path- 
ologique  de  I’hormone.  Bulletin  Histologie  appliquea,  1932, 
9,  22. 

34.  Scott,  G.  H.  and  Horning,  E.  S.  Study  of  Normal  and 
Malignant  Tissues  by  Microincineration.  Proceedings  of  the 
Society  for  Experimental  Biology  and  Medicine,  1932,  29,  349 
and  708. 

35.  Brown,  C.  S.  G.,  Cromer,  S.  P.,  Jenkinson,  E.  L. 
and  Gilbert,  N.  C.  Mucin  Therapy  for  Peptic  Ulcer.  Journal 
of  the  American  Medical  Association,  1932,  99,  98. 

36  Breutsch,  W.  L.  Activation  of  the  Mesenchyme  with 
Therapeutic  Malaria.  Journal  of  Nervous  and  Mental  Dis- 
eases, 1932,  76,  209. 

The  Histopathology  of  Therapautic  (Tertian)  Malaria. 
American  Journal  of  Psychiatry,  1932,  12,  19. 

37.  Simpson,  Walter  M.  Influence  of  Radiotherm  Pyre- 
totherapy  on  Chloride  Metabolism.  Read  Before  the  Central 
Society  for  Clinical  Investigation,  1932,  Nov.  4. 

Radiotherm  Therapy  in  Neurosyphilis.  To  be  Read  Be- 
fore the  American  College  of  Physicians,  Montreal  Canada, 
February,  1933. 

38.  Shila,  H.  E.,  and  Jung,  T.  S.  Thrombocytopenic  Pur- 
pura Hemorrhagica  Produced  Experimentally  with  Thorium. 
Proceedings  of  the  Society  for  Experimental  Biology  and 
Medicine,  1931,  29,  243. 

39.  Sabin,  F.  R.,  Doan,  C.  A.,  and  Forkner,  C.  E.  The 
Production  of  Osteogenic  Sarcomata  and  the  Effects  on 
Lymph  Nodes  and  Bone  Marrow  of  Intravenous  Injections 
of  Radium  Chloride  and  Mesothorium  in  Rabbits.  Journal 
of  Experimental  Medicine,  1932,  56,  267. 

40.  Darley,  W.,  and  Whitehead,  R.  W.  Studies  on  the 
Urinary  Proteose ; II  Skin  Reactions  and  Therapeutic  Ap- 
plications in  Hay  Fever.  Annals  of  Internal  Medicine, 

1932,  6,  389. 

41.  Britton,  S.  W.,  and  Silvette,  H.  The  Apparent  Pre- 
potent Function  of  the  Adrenal  Glands.  Science,  1932,  75, 
644. 

42.  Gregory,  Wm.  K.  The  New  Anthropogeny.  Science, 

1933,  77,  29. 


The  Committee  on  Foods  of  the  American  Medi- 
cal Asosciation  has  denounced  the  use  of  ques- 
tionnaires for  obtaining  information  and  data 
from  the  medical  profession  or  the  public  for  food 
advertising  purposes.  Such  information  and  data, 
the  Committee  declares,  are  given  undue  and  un- 
warranted importance  and  significance  by  the 
public,  are  misunderstood  as  to  their  real  value 
and  worth,  and  therefore  are  misinformation  and 
misleading. 


Congestive  Heart  Failure 

A Report  of  Thirty-Seven  Cases  Treated  With  Digitalis  and  Pentamethylenetetrazol 
Bernard  A.  Schwartz,  M.D.,  Cincinnati,  Ohio 


DIGITALIS  is  the  best  known  and  most  uni- 
versally used  drug  in  cardiac  therapy.  The 
drug  has  justly  maintained  its  pre-eminent 
position  practically  since  its  introduction  to  the 
profession  by  Withering1  in  1785  so  that  it  is  not 
necessary  to  present  here  either  its  history  or  to 
stress  its  therapeutic  value. 

Nevertheless,  there  are  some  cases  of  cardiac 
disease,  especially  of  chronic  congestive  heart 
failm-e,  where  digitalis  does  not  prove  effective  or 
where  the  patient’s  gastro-intestinal  or  even 
nervous  system2  is  partially  or  wholly  intolerant 
to  this  drug.  In  such  cases  a substitute  must  be 
found.  My  own  choice  has  been  metrazol  because 
I have  read  several  European  papers  giving  fav- 
orable reports,  and  I want  to  devote  most  of  the 
time  at  my  disposal  today  to  a report  of  its  action 
as  I have  found  it.  Metrazol  has  had  extensive 
use  abroad  but  in  America  little  has  been  written 
as  to  its  value  in  cardiac  therapy,  however,  such 
clinical  results  that  have  been  published  seem  to 
warrant  a further  study  of  metrazol  both  for  its 
effects  when  used  alone  and  in  combination  with 
digitalis. 

A brief  description  of  the  chemistry  is  in  place. 
Pentamethylenetetrazol  (metrazol)  is  a synthetic 
chemical  compound  in  the  form  of  a white  crystal- 
line powder,  odorless  and  somewhat  bitter.  It  is  a 
pentamethylene  group  combined  with  a nitrogen 
containing  a tetrazol  radical  and  therefore  not  re- 
lated to  the  volatile  oils  of  the  terpene  family. 
It  has  an  unusual  bicyclical  chemical  structure  in 
which  the  tetrazol  (4  nitrogen  ring)  is  connected 
with  the  hydrocarbon  ring. 

Solis-Cohen3  states  that  pentamethylenetetrazol 
was  introduced  into  medicine  in  1925  by  Krehl. 
He  reports  that  Hildebrandt  and  others  find  it  has 
a stimulating  action  on  the  heart  muscle.  Small 
doses  cause  an  elevation  of  the  rate  and  an  in- 
crease in  the  force  of  the  heart  beat  by  stimula- 
tion of  the  heart  muscles  and  the  vasomoter  cen- 
ter. Large  doses  excite  the  respiratory  center. 
Lethal  doses  cause  a central  nervous  system 
stimulation  with  convulsions  and  death. 

According  to  the  findings  of  Hildebrandt4,  the 
pharmacological  effects  of  pentamethylenetetrazol 
are  similar  to  those  of  camphor,  and  of  those 
preparations  intended  to  replace  it.  Among  its 
advantages  over  camphor  is  its  solubility  in  water, 
which  insures  a very  rapid  absorption,  and  a 
greater  stimulation  of  the  heart’s  action  in  regard 
to  both  the  stroke  level  and  to  the  frequency. 
Damage  to  the  heart  is  caused  only  by  extremely 
high  doses. 

In  a more  recent  work,  Hildebrandt'  has  demon- 

•Presented  at  a meeting  of  the  Cincinnati  Heart  Council. 


strated  that  the  drug  excites  certain  regions  of 
the  central  nervous  system,  and  especially  the 
motor  and  respiratory  centers.  Injection  of  small 
doses  into  animals  cause  an  acceleration  of  the 
breathing  as  well  as  restlessness;  with  massive 
doses  convulsions  set  in.  The  heart’s  action  is 
positively  inotrop  and  positively  chronotrop.  In 
animals,  circulatory  damages  by  chloroform  and 
chloral  hydrate  are  effectively  combated  by  met- 
razol. 

Barker  and  Levine"  show  pentamethylenetetra- 
zol to  be  well  tolerated  with  but  little  if  any 
cumulative  action.  From  their  pharmacologic  ex- 
periments they  conclude  that  normal  animals  and 
those  in  states  of  depression  show  no  beneficial 
effects  on  the  cardio-respiratory  mechanism. 

The  clinical  experiences  of  metrazol  are  con- 
cerned particularly  with  conditions  of  acute  cir- 
culatory collapse.  A review  of  the  literature 
shows  that  there  are  only  a few  and  rather  limited 
series  of  cases  reported  where  the  drug  was  used 
in  patients  with  chronic  cardiovascular  disease. 

Johnston7  reports  a series  of  nine  cases  of 
myocardial  insufficiency.  These  patients  were  hos- 
pitalized and  all  were  cases  of  long  standing.  He 
concludes  that  there  were  no  harmful  effects  noted 
from  the  administration  of  metrazol.  Three  of  the 
cases  showed  decided  improvement.  While  he  be- 
lieves that  the  chief  use  of  the  drug  was  probably 
in  acute  circulatory  collapse,  he  also  feels  it  can 
be  used  at  times  to  advantage  in  treating  chronic 
myocardial  insufficiency.  Waldbott8  gave  metra- 
zol with  digitalis  in  an  auricular  fibrillation  which 
had  developed  during  pneumonia  and  in  a case  of 
chronic  myocarditis.  In  the  latter  case  the  drug 
was  given  primarily  to  carry  the  patient  along 
until  the  digitalis  medication  became  effective. 

Wolf  and  Sherwin9  report  six  cases  of  myo- 
cardial impairment,  which  were  taken  off  digitalis 
and  placed  on  metrazol  medication,  with  definite 
improvement  in  the  course  of  the  disease. 

Krayer10  in  discussing  the  combination  of 
digitalis  and  stimulants  of  the  type  of  centrally 
acting  convulsive  poisons  states  that:  “The  one 
point  that  must  be  considered  is  the  action  on  the 
vessels  by  means  of  the  center,  or  that  an  added 
stimulation  through  the  vasomotor  centers  is  a 
favorable  influence.”  It  is  his  opinion  that  one 
rarely  encounters  a pure  cardiac  insufficiency 
that  can  be  sharply  separated  from  a pure  vas- 
cular insufficiency.  In  circulatory  insufficiency  it 
is  largely  a matter  of  which  is  the  more  pro- 
nounced, the  cardiac  or  the  vascular  disturbance. 
Thus  when  we  have  a definite  cardiac  insufficiency 
together  with  a definite  vascular  insufficiency  the 


308 


May,  1933 


Congestive  Heart  Failure — Schwartz 


309 


favorable  action  of  digitalis  and  metrazol  becomes 
quite  understandable. 

Pribram11  points  out  that  the  dose  of  strophan- 
thine may  be  reduced  when  combined  with  these 
newer  medicaments  that  act  on  the  vasomotor 
centers.  He  further  states  that  the  action  of  one 
of  these  combined  with  digitalis  is  more  than  a 
simple  summation  of  effects.  He  notes  that  the 
importance  of  the  primary  attack  of  these  drugs 
is  on  the  vasomotor  center,  thus  supporting  the 
cardiac  stimulation  by  their  capacity  to  stimulate 
the  vasomotor  apparatus.  Herzog  and  Aub12  com- 
bined digitalis  with  metrazol  and  glucose. 

Schaeffer13  evidently  found  a definite  synergistic 
action  of  digitalis  and  metrazol  in  his  clinical  ex- 
perience, as  first  noted  by  Fahrenkamp14.  This 
action  is  not  regarded  as  a direct  synergistic  ac- 
tion on  the  heart;  it  is  rather  assumed  that  the 
atcion  of  the  digitalis  is  made  more  effective  be- 
cause the  lowered  blood  pressure  is  increased  by 
the  metrazol  thereby  restoring  the  normal  vago- 
tonus  through  the  blood  pressure  inhibitors.  The 
combination  of  digitalis  and  metrazol  would  then 
be  especially  indicated  in  cases  of  cardiac  in- 
sufficiency with  low  blood  pressure. 

We  began  our  clinical  study  of  digitalis  and 
metrazol  therapy  in  September,  1930.  The  group 
under  consideration  consisted  of  thirty-seven 
cases,  eight  of  which  were  from  private  practice 
and  the  rest  from  clinics  maintained  by  the  Heart 
Council  of  Cincinnati.  All  but  two  patients  had 
chronic  congestive  failure.  Because  the  majority 
of  the  cases  were  ambulatory  and  of  low  mental 
caliber,  out-put  and  intake  could  not  be  recorded. 
Nevertheless,  the  observations  made  warrant  this 
collection  of  data.  The  etiological  factor  in  the 
majority  of  patients  was  arteriosclerotic  hyper- 
tensive heart  disease  with  a few  cases  of  luetic 
insufficiency  and  old  rheumatic  heart  disease.  The 
average  age  was  63  years. 

To  determine  the  efficacy  of  metrazol  alone  and 
in  combination  with  digitalis,  we  limited  its  use 
to : 

(a)  Cases  with  chronic  congestive  failure  due 
to  marked  myocardial  damage  which  were  re- 
ceiving digitalis  but  showing  no  apparent  im- 
provement. 

(b)  Cases  with  congestive  failure  including 
some  with  heart  block  which  did  not  tolerate 
digitalis  very  well. 

(c)  Cases  with  acute  cardiovascular  conditions 
such  as  digitalis  poisoning,  pneumonia,  etc. 

The  points  observed  were : The  amount  of 

dyspnea,  the  degree  of  edema  of  the  ankles  and 
the  presence  of  fluid  in  the  lungs  as  determined 
by  auscultation.  A patient  when  first  seen  was 
put  on  digitalis  IV2  grains,  four  times  a day  for 
two  weeks  and  was  given  the  usual  instructions 
about  frequent  bowel  elimination,  moderation  of 
physical  exercise,  etc.  If  the  dyspnoea,  the  pul- 
monary congestion  and  the  edema  showed  no  im- 
provement within  two  weeks,  digitalis  was  dis- 
continued and  the  patient  placed  on  metrazol,  two 
tablets  of  IV2  gi'ain  each,  four  times  a day.  If, 


after  two  weeks,  no  improvement  was  shown,  the 
patient  was  then  put  on  a combination  of  digitalis 
grains  IV2  and  metrazol  grains  3,  four  times  a 
day. 

Maintenance  doses  of  digitalis  and  metrazol 
were  given  in  cases  showing  definite  improvement. 
In  twenty  of  the  thirty-seven  cases,  improvement 
was  noticed  either  in  the  lessening  of  edema  of 
the  ankles  or  the  intensity  of  the  dyspnoea.  Eight 
of  the  twenty  patients  who  benefited  by  the  com- 
bination of  digitalis  and  metrazol  showed  no  im- 
provement on  either  drug  alone  but  did  show  a 
gradual  decrease  in  the  amount  of  edema  of  the 
ankles  and  relief  from  the  shortness  of  breath 
when  the  two  drugs  were  combined.  A few  of  the 
patients  who  did  not  show  any  signs  of  a reduc- 
tion of  the  edema  were  relieved,  nevertheless,  of 
their  air  hunger. 

No  marked  ill  effects  were  observed  from  the 
administration  of  metrazol  alone  or  in  combina- 
tion with  digitalis.  A few  patients  complained  of 
a “nervous  feeling”  and  lightheadedness  and  only 
one  reported  any  epigastric  distress. 

A FEW  TYPICAL  CASES 

J.  H. — white  male,  age  62  years.  Seen  first  on 
July  12,  1930.  Diagnosis — Arteriosclerotic  heart 
disease  with  congestive  heart  failure  and  auricular 
fibrillation.  Complaint — dyspnoea.  Examination 
— heart  sound  distant,  rate  88.  Blood  pressure 
175/105.  Irregular  irregularity  present.  Rales  at 
base  of  lungs.  Considerable  edema  of  ankles. 
Treatment — digitalis  grains  one,  five  times  a day 
for  one  week  and  three  times  a day  thereafter. 

August  16,  1930 — Dyspnoea  persists  but  is  de- 
creased. Edema  of  ankles  is  marked.  Fibrillation 
persists.  Heart  rate  approximately  88.  Treat- 
ment— metrazol  grains  three  Q.I.D. 

August  23,  1930 — No  dyspnoea.  Edema  of  ank- 
les persists.  Heart  rate  69.  Patient  states  he  feels 
better.  Treatment  continued. 

November  8,  1930 — Edema  of  ankles  still  pres- 
ent. Heart  rate  115 — fibrillation  persists.  Blood 
pressure  175/100.  Complains  of  some  dyspnoea. 
Treatment — digitalis  and  metrazol. 

November  15,  1930 — Ankles  less  edematous. 
Dyspnoea  improved. 

November  22,  1930 — Edema  greatly  reduced. 
Complains  of  slight  dyspnoea  and  some  cardiac 
distress.  Treatment  continued. 

December  20,  1930 — Patient  not  doing  so  well 
as  heretofore.  Edema  of  ankles  about  the  same. 
Heart  rate  88 — regular  in  rhythm.  Treatment 
continued. 

January  20,  1931 — States  there  is  some  edema  of 
ankles  since  he  “ran  out  of  metrazol”.  Treatment 
with  the  two  drugs  continued. 

February  21,  1931 — Edema  of  ankles  greatly 
reduced.  Occasional  dyspnoea.  Heart  rate  90 — 
still  irregular.  Patient  greatly  improved. 


L.  F. — white  woman  of  82  years.  First  seen 
June  10,  1930.  Diagnosis — Arteriosclerotic  heart 
disease.  Complaints  of  slight  shoidness  of  breath 
and  slight  edema  of  ankles.  Heart  rate  76 — regu- 
lar. Digitalis  in  small  doses,  either  in  liquid  or 
tablet  form  were  not  well  tolerated  as  evidenced 
by  vomiting.  Metrazol  over  a long  period  of  time 
reduced  the  edema  of  ankles  and  relieved  the 
dyspnoea. 


310 


The  Ohio  State  Medical  Journal 


May,  1933 


0.  B. — white  male  of  50  years.  Seen  first  on 
November  18,  1930.  Diagnosis — Two-to-one  heart 
block  possibly  on  an  arteriosclerotic  basis.  Com- 
plains of  not  feeling  right.  Examination — heart 
rate  40 — regular  in  rhythm.  Treatment — metra- 
zol  one  tablet  three  times  a day. 

December  15,  1930 — Doing  well. 

January  8,  1931 — Feels  considerably  better. 
Extrasystoles  every  other  beat.  Rate  at  apex  75. 
Pulse  38. 

January  20,  1931 — Doing  well,  heart  rate  48. 
No  medication.  Return  in  two  months. 

March  31,  1931 — Complains  of  dyspnoea  and 
weakness  since  metrazol  was  discontinued.  Rhythm 
coupled.  Extrasystole  every  other  beat.  Pulse  50. 
Blood  pressure  210/100.  Treatment — metrazol 
one  tablet,  Q.I.D. 

April  21,  1931 — Patient  feeling  a great  deal 
better.  Heart  rate  46 — regular  in  rhythm. 


C.  W.  L. — White  male  of  67  years.  Had  arterio- 
sclerotic heart  disease  with  chronic  nephritis. 
Some  dyspnoea.  Moderate  edema  of  ankles. 
Heart  rate  110.  Large  doses  of  digitalis  slowed 
the  pulse  but  there  was  no  definite  improvement 
of  dyspnoea  and  edema.  Metrazol  caused  no  par- 
ticular change  but  its  combination  with  digitalis 
enabled  patient  to  become  ambulatory.  The  pa- 
tient was  on  this  combination  for  three  months. 
Finally  generalized  anasarca  set  in,  causing 
death. 


V.  S. — Patient  first  seen  April  29,  1931.  Diag- 
nosis— Arteriosclerotic  heart  disease  with  subse- 
quent acute  digitalis  poisoning.  Suffering  with 
congestive  heart  failure,  marked  air  hunger,  mas- 
sive edema  of  the  ankles  and  considerable  con- 
gestion at  bases. 

Heart  sounds  distant — rate  132 — irregular  ir- 
regularity present.  Patient  taken  to  hospital  at  8 
P.  M.  By  mistake  he  was  given  two  ampules  of 
digifolin  hypodermically  for  sixteen  injections 
whereby  he  received  48  grains  of  digifolin  in  less 
than  24  hours. 

On  examination  at  noon  the  following  day  he 
complained  of  marked  nausea  and  numbness  of 
lower  extremities.  The  heart  rate  was  about  160 
to  the  minute.  There  was  a phasic  irregularity  in 
the  intensity  of  the  heart  sounds.  In  desperation 
the  patient  was  purged  and  two  ampules  of  metra- 
zol were  administered  every  hour  for  five  doses. 

Electrocardiogram  at  this  time  showed  an 
auricular  ventricular  dissociation  with  notched 
Q-R-S  complexes  in  the  first  lead. 

The  numbness  of  his  extremities  gradually  re- 
ceded, the  pulse  rate  became  reduced,  a normal 
rhythm  was  restored  and  the  patient  subsequently 
recovered. 

SUMMARY 

1.  Our  clinical  experience  with  digitalis  and 
pentamethylenetetrazol  (metrazol)  in  this  group 
of  cardiac  patients  with  congestive  failure,  leads 
us  to  conclude  that  there  is  a definite  synergistic 
relation  between  the  two  stimulants.  In  those 
cases  where  normal  doses  of  digitalis  had  been 
found  to  be  toxic  or  ineffective,  smaller  doses  of 
this  drug  in  conjunction  with  metrazol  often 
proved  of  value  in  obtaining  the  desired  results. 
Where  digitalis  is  not  tolerated  at  all,  metrazol 
alone  has  been  used  with  success. 

2.  In  cases  of  acute  digitalis  poisoning  metra- 
zol has  proved  of  definite  value. 


3.  In  acute  cardioscascular  collapse  the  use  of 
metrazol  is  especially  beneficial. 

BIBLIOGRAPHY 

1.  Witherington — An  Account  of  the  Foxglove  and  some 
of  its  Medicinal  Uses.  Birmingham,  1785. 

2.  Moench.  Med.  J.  & Rec.,  Oct.  2,  1929. 

3.  Solis-Cohen  S.  and  Githens,  T.  S.  txt.  Pharma-Therap. 
p.  928. 

4.  Hildebrandt.  Klin.  Wchnschr.  35:1678  (1925). 

5.  Hildebrandt.  Arch.  f.  Exper.  Path.  u.  Pharmakol. 
116  :y2  (1926). 

6.  Barker,  M.  H.  and  Levine,  S.  A.  Arch.  Int.  Med. 
Vol.  42,  pp.  14-42  (1928). 

7.  Johnston.  Johns  Hopkins  Bull.  44,  pp.  32-39,  Jan. 
(1929). 

8.  Waldbott,  G.  L.  Med.  Jour. -Rec.,  June  16  ,(1926). 

9.  Wolf,  Wm.  and  Sherwin,  C.  P.  Clin.  Med.  August 
(1926). 

10.  Krayer.  Verhandlungen  der  Deutschen  Gesellschaft 
fuer  Kreislaufforschung — Breslau — 1931.  p.  188. 

11.  Pribram.  Do.  pp.  31-34. 

12.  Herzog  and  Aub.  Dtsch.  Arch.  Klin.  Med.  166,  %, 
1930. 

13.  Schaeffer.  Do.  8 and  9,  p.  215. 

14.  Fahrenkamp.  Wien,  med.  Wchnschr.  38:  1082  (1928). 


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False  hope  has  been  created  among  many  of 
the  blind,  their  families  and  their  friends  through- 
out the  United  States  by  the  widespread  news- 
paper publicity  given  to  the  announcement  in 
Chicago  that  telescopic  spectacles  have  been  per- 
fected which  can  restore  vision  to  40  per  cent  of 
the  present  classified  blind  population,  according 
to  a statement  by  the  American  Foundation  for 
the  Blind  and  the  National  Society  for  the  Pre- 
vention of  Blindness. 

The  experience  of  ophthalmologists  who  have 
done  much  work  with  telescopic  spectacles  in- 
dicates that  the  true  percentage  of  those  now 
classified  as  blind  who  can  be  helped  by  the  use 
of  this  device — but  who  cannot  be  helped  by  or- 
dinary spectacles — is  not  40  per  cent,  but  much 
less  than  five  per  cent,  it  is  pointed  out. 


Calcification  of  Cysto Adenoma  of  the  Thyroid  with  Sinus 
Formation;  Calcification  of  Adenoma  of  Thyroid; 

Two  Case  Reports 

J.  F.  Beachler,  M.D.,  Piqua,  G.  A.  Woodhouse,  A.B.,  M.D.,  Pleasant  Hill,  Ohio 


CALCIFICATION  of  a thyroid  cyst  or  en- 
tire lobes  of  the  thyroid  is  a comparatively 
rare  condition  there  having  been  only  nine 
such  cases  reported  in  recent  medical  literature. 
However,  a review  of  the  litei’ature  and  text- 
books fails  to  reveal  any  case  of  calcified  adeno- 
matous cyst  with  sinus  formation.  In  this  article 
we  wish  to  report  such  a condition  and  also  to 
add  one  more  case  to  the  list  of  calcified  adenomas 
recorded  in  the  literature  of  the  past  fifteen  years. 

PenneP  reported  a case  of  calcified  adenoma 
which  he  believed  to  be  a calcified  parathyroid. 
This  case  had  symptoms  of  aphonia.  Clark'  dis- 
covered a case  which  was  X-rayed  but  not 
operated  upon  and  which  had  symptoms  of  hyper- 
thyroidism. Arens  and  Bloom3  had  a case  dis- 
covered thi'ough  routine  radiological  examination 
but  was  not  operated  upon  and  had  no  symptoms. 
Plummer4  reported  five  cases  which  were  X-rayed 
but  not  operated  upon  and  were  diagnosed  as  cal- 
cified adenomata.  In  this  series  the  calcification 
occurred  beneath  the  capsule.  Rambo  and  Levi5 
reported  a case  of  calcified  cyst  of  the  thyroid  in 
a patient  who  complained  of  progressive  dyspnoea, 
but  had  no  thyroid  dysfunction;  this  case  was 
operated  upon  and  a cyst  whose  walls  were  in- 
filtrated with  lime  salts  and  which  weighed  150 
gm.  was  recovered. 

The  method  of  production  of  these  calcified 
cysts  is  not  completely  understood.  Hueper”  re- 
ported finding  metastatic  calcification  in  various 
organs  of  a dog  by  the  injection  of  overdoses  of 
parathyroid  extract,  and  found  calcium  pre- 
cipitated in  the  colloid  of  the  thyroid  gland.  Watt7 
advanced  the  theory  concurred  in  by  Barille  and 
Wells  that  calcium  salts  were  precipitated  in 
areas  where  the  amount  of  carbon  dioxide  was 
decreased.  This  occui's  in  places  of  low  grade  ac- 
tivity, like  necrotic  areas,  regions  of  fibrosis, 
thrombosed  vessels  and  the  colloid  of  the  thyroid 
gland ; and  that  any  fluids  infiltrating  these  areas 
would  have  their  concentration  of  carbon  dioxide 
reduced  and  calcium  salts  would  be  precipitated. 
Calcification  in  the  thyroid  may  be  produced  by 
both  these  factors  since  there  is  a direct  relation- 
ship between  the  parathyroid  bodies  and  the  ac- 
tivity of  the  gland. 

While  a definite  sinus  tract  draining  from  the 
thyroid  gland  has  never  been  reported,  Garven 
and  Pai8  reported  a case  of  thyroid  cyst  which 
was  situated  in  the  supra-sternal  notch  just  below 
the  thyroid  gland,  the  upper  border  of  which  was 
attached  to  the  isthmus  of  the  gland;  this  cyst 


contained  clear  fluid  and  section  of  it  revealed 
thyroid  tissue  inside  a connective  tissue  mass 
which  had  undergone  hyaline  degeneration  and 
some  calcification.  They  concluded  that  a small 
part  of  the  embryonic  thyroid  had  been  carried 
down  with  the  thymus  stock  and  was  partially 
disconnected  with  the  developing  thyroid. 

HISTORY 

W.  R.,  male,  age  49,  presented  himself  in 
August,  1932,  complaining  of  a mass  in  right  side 
of  neck  with  a draining  sinus  in  the  mid  line 
half  way  between  the  thyroid  cartilage  and  the 
supra-sternal  notch.  This  enlargement  was  first 
noted  about  29  years  previous  when  it  was  in  the 
form  of  a circumscribed  mass  of  soft  consistency 
about  the  size  of  a walnut  in  the  right  side  of  the 
neck.  In  January,  1925,  the  mass  was  found  to  be 
gradually  increasing  in  size  and  was  producing 
some  pressure  symptoms.  At  this  time  a small 
cystic  area  was  noted  beneath  the  skin  in  the 
suprasternal  notch,  this  apparently  contained 
fluid.  In  February,  1925,  one  of  us  (G.A.W.)  in- 
cised this  small  circumscribed  tumor  which  was 
about  the  size  of  a walnut  and  a small  amount  of 
seropurulent  material  was  evacuated.  This  drained 
for  a few  days  and  then  closed.  At  that  time  a 
definite  adenoma  was  palpated  in  the  thyroid  and 
operation  was  advised  but  refused.  During  the 
following  five  years  the  sinus  drained  a sero- 
purulent material  at  intermittent  periods  and  the 
adenoma  became  larger  and  more  firm.  The  sinus 
has  drained  constantly  for  the  past  two  years, 
and  he  noted  that  when  the  drainage  ceased  a 
definite  sense  of  fullness  with  resulting  dyspnoea 
was  experienced;  he  also  observed  that  during 
these  periods  he  was  nervous  and  some  slight 
mental  symptoms  occurred.  These  symptoms 
were  relieved  when  the  sinus  tract  which  had 
partially  healed  on  the  outside  would  burst  and 
discharge  its  contents. 

Past  and  Family  History:  Essentially  negative. 

Heart  and  Lungs:  Occasional  cough  and  dys- 
pnoeic  attacks  when  the  sinus  tract  was  filled  up 
and  not  draining. 

Gastro-Intestinal : Appetite  poor  for  past  two 
years. 

Neuro-Muscular : During  the  past  two  years 

he  has  been  depressed  mentally  at  times  and  was 
easily  exhausted  following  exertion.  It  was  ob- 
served that  this  condition  coincided  with  the  sup- 
pression of  drainage  from  the  sinus. 

Examination:  Patient  is  a white  male,  weight 
122  pounds,  (best  previous  weight  150),  tempera- 
ture, normal,  pulse  regular,  rate  75,  good  quality, 
respiration  20,  teeth  carious,  gums  retracted  and 
pyorrhoeic. 

Neck:  A sinus  situated  in  mid-line  in  supra- 
sternal notch  and  draining  a sero-purulent  ma- 
terial is  noted.  There  is  also  a hard  mass  the  size 
of  an  egg  to  the  right  of  mid-line  corresponding 
to  the  location  of  the  right  lobe  of  the  thyroid. 
This  mass  moves  with  deglutation,  is  partially  in- 


311 


312 


The  Ohio  State  Medical  Journal 


May,  1933 


Figure  1 

compressible  and  of  bony  hardness;  a smaller 
mass  size  of  walnut  of  similar  consistency  is 
noted  just  above  the  larger  one.  When  pressure  is 
made  on  the  tumor,  patient  complains  of  pressure 
on  trachea.  Both  masses  are  apparently  closely 
attached  to  the  surrounding  structures.  Pressure 
on  the  mass  produces  an  exudation  of  purulent 
material  from  the  sinus  tract. 

Chest  and  Heart:  Essentially  negative.  Ad- 

domen:  Negative.  Extremities:  Some  wasting  of 
muscles. 

Nervous  System:  Slight  tremor  of  fingers  when 
extended,  patient  appears  slightly  depressed,  re- 
flexes slightly  exaggerated. 

Laboratory  Examination:- — ■ 

W-ray.  The  draining  sinus  tract  was  injected 
with  bismuth  paste  and  both  lateral  and  anterior- 
posterior  pictures  were  taken.  These  are  shown 
in  Figs.  1 and  2.  The  sinus  tract  is  visible  in  Fig. 
1 and  is  definitely  surrounded  with  a relatively 
dense  calcium  deposit  which  is  well  circumscribed 
to  an  area  corresponding  to  the  periphery  of  the 
gland.  A smaller  calcified  mass  is  seen  just  above 
the  larger  one  apparently  not  connected.  This 
reveals  the  sinus  extending  definitely  into  the 
larger  calcified  mass.  In  Fig.  2 an  anterior-pos- 
terior picture,  the  calcified  mass  while  not  so  well 
defined  as  in  Fig.  1,  due  to  its  position  and  masked 
by  the  cervical  vertebrae  and  clavicle,  reveals  the 
bismuth  paste  in  the  center  of  the  area  of  cal- 
cification. In  this  picture  a slight  enlargement  of 
the  arch  of  the  aorta  is  noted  and  the  trachea  is 
deviated  to  the  left.  The  calcification  is  shown 
around  the  periphery  of  the  tumor  mass. 

Metabolism:  The  B.  M.  R.  was  plus  20,  after 

ten  days  Lugolization  it  dropped  to  plus  14. 

Urine:  Negative;  Blood:  W.B.C.  10,150,  R.B.C. 
4,300,000. 

Smear  of  sinus  discharge:  Occasional  diplo- 

coccus,  many  pus  cells. 

Operative  Record:  Before  operating  the  sinus 


Figure  2 

was  injected  with  methylene  blue  and  clamped. 
Usual  thyroidectomy  incision  was  made  and  the 
sinus  tract  was  carefully  dissected  down  to  a very 
firm  mass  the  size  of  an  egg  which  was  well  cir- 
cumscribed and  corresponded  to  the  right  lobe  of 
the  thyroid  gland.  This  was  surrounded  by  dense 
fibrous  tissue  and  was  closely  attached  to  the 
trachea  in  the  mid-line  by  firm  adhesions.  The 
lower  pole  of  the  adenoma  extended  about  an  inch 
below  the  clavicle,  while  the  external  surface  of 
the  mass  was  attached  beneath  the  carotid  sheath. 
There  was  definite  thyroid  gland  tissue  around 
the  edges  of  the  mass.  It  was  very  difficult  to  de- 
liver the  large  mass  due  to  the  adhesions,  and  it 
was  accidently  punctured  on  its  posterior  surface 
which  resulted  in  the  discharge  of  a caseous  ma- 
terial stained  with  methylene  blue,  which  proved 
that  the  cyst  connected  directly  with  the  adenoma. 
The  sinus  tract  was  accidently  disconnected  from 
the  adenoma  following  its  dislocation.  After  the 
large  mass  was  removed  a smaller  calcified  tumor 
the  size  of  a walnut,  not  connected  with  the  larger 
one  and  without  adhesions  or  infective  fibrosus, 
was  removed.  The  wound  was  closed  in  usual 
manner,  with  right  side  drainage  tubes  in  place. 

Pathological:  (Note:  The  contents  of  the  cyst 
had  been  removed.) 

Fig.  3.  Shows  the  gross  appearance  of  the 
specimens. 

Thyroid  tissue  45  grams  consisting  of  two  oval 
masses  measuring  6x5x3  cm.,  and  3x2. 5x2. 5 cm. 
Both  adenomas  show  extensive  calcification,  par- 
ticularly at  the  periphery  with  extensive  choles- 
terol deposits  and  liquefaction  necrosis.  Attached 
to  the  adenoma  are  small  grayish  islands  of 
thyroid  tissue  proper,  of  soft  consistency. 

Microscopic:  The  tissue  consists  of  an  un- 
usually cellular  colloid  adenoma  of  the  thyroid 
gland  showing  marked  connective  tissue  hyalani- 
zation  and  calcification  with  cholesterol  deposits. 
Localized  areas  are  very  cellular  and  show  dis- 
tinct anaplasia  and  hyperchromatism. 


May,  1933 


Two  Case  Reports — Beachler  & Woodhouse 


313 


Figure  3 


HISTORY,  CASE  NO.  2 

Mrs.  C.  R.  White,  age  54  years,  housewife. 
Complains  of  enlargement  of  the  neck,  choking 
sensation,  nervousness,  weakness,  palpitation  of 
heart,  and  loss  of  weight. 

Past  History:  Usual  diseases  of  childhood, 
typhoid  in  early  adolescence. 

Menstrual  History:  Passed  normal  climateric 

at  age  50. 

Present  Illness:  About  the  age  of  fifteen  years 
patient  noticed  gradual  enlargement  of  neck, 
which  was  slow  and  unattended  with  constitu- 
tional symptoms.  The  process  was  quiescent  for 
a few  years  and  patient  gave  little  attention  to 
the  condition  and  observed  no  untoward  symptoms 
save  a choking  sensation  and  pressure  in  the  neck 
for  the  past  few  years.  About  one  and  one-half 
years  prior  to  operation  patient  developed  a 
clinical  syndrome  typified  by  nervousness,  pal- 
pitation of  heart  upon  slight  physical  exertion; 
and  loss  of  weight  despite  a good  appetite.  Aver- 
age weight  160  pounds  present  weight  145  pounds. 
Patient  fatigues  easily,  is  easily  excited  and 
sleeps  poorly.  Though  the  condition  is  character- 
ized by  exacerbations  and  remissions  the  trend  of 
circumstances  is  growing  progressively  worse. 

Physical  Examination:  Head — eyes  react  to 

light  normally;  pupils  equal  size.  Teeth  and 
throat  negative.  Neck — Definite  enlargement, 

particularly  of  the  right  side.  On  palpation  the 
tumefaction  manifests  the  characteristic  find- 
ings of  an  enlarged  thyroid,  and  moves  with 
deglutation.  At  the  lower  pole  of  the  right 
side  a stony-like  mass  about  the  size  of  hen’s 
egg  is  palpated.  The  upper  border  of  this  mass 
is  on  a level  with  the  clavical  of  the  same  side. 
When  the  patient’s  head  was  turned  to  the  right 
side  a choking  sensation  and  coughing  was  ex- 
perienced. The  left  thyroid  lobe  was  barely  pal- 
pable. There  was  moderate  thickening  of  the 
isthmus. 

Chest — Pulmonary  sounds  are  normal.  Heart — 
size  and  position  normal,  no  murmurs,  slight  ac- 
centuation of  second  aortic  sound. 

Abdomen — No  tender  areas  or  palpable  masses. 

Extremities — Fine  tremor  of  hands,  patellar  re- 
flexes slightly  exaggerated  on  both  sides. 

Laboratory  Findings:  Urine — Negative.  Blood 
— W.B.C.  7600,  R.B.C.  4,440,000,  H.B.  80  per 
cent;  Blood  Pressure  156/80. 

Metabolism — Reading  2/13/32  plus  41 ; 2/23/32 
plus  7. 

PaL'ent  admitted  to  hospital  and  operated  upon 
February  25,  1932. 


Operative  Record:  Usual  incision  for  thyroid- 
ectomy was  made  under  local  anesthesia.  After 
dividing  muscles  the  thyroid  gland  was  exposed. 
The  right  side  was  adherent  to  the  trachea  and 
lower  pole  was  of  stony  hardness.  In  freeing  the 
gland  from  the  trachea  caution  was  exercised 
against  the  possibility  of  a tracheal  collapse,  since 
the  pressure  of  the  calcified  tumor  had  dislodged 
it  markedly  toward  the  left  side.  The  left  lobe 
was  less  than  half  the  size  of  the  right,  and  con- 
tained small  areas  of  calcification  scattered 
through  it,  but  was  not  adherent  to  the  trachea. 
All  of  the  gland  was  removed  except  a small  por- 
tion close  to  the  trachea  and  the  posterior  capsule. 
Incision  was  closed  in  usual  manner  with  drain- 
age tubes  in  place. 

Pathological:  In  Fig.  4 an  X-ray  photograph 
of  the  gland  taken  soon  after  removal  is  shown. 
The  comparative  size  of  the  calcified  area  can  be 
noticed  by  making  comparison  with  the  ordinary 
straight  pin  which  was  inserted  to  hold  the  two 
lobes  together. 

Right  thyroid  lobe — 12  cm.  long,  2 cm.  wide  at 
upper  pole,  5 cm.  at  lower  pole.  The  lower  pole  is 
the  seat  of  a calcified  mass  5 cm.  in  width  and  6 
cm.  in  length.  This  mass  is  of  stony  hardness  and 
could  not  be  cut  with  a knife.  The  thyroid  tissue 
proper  is  nodular  in  outline  and  on  cross  section 
shows  areas  of  small  involutionary  bodies  scat- 
tered throughout.  Microscopical  examination  re- 


Figure  4 

veals  extensive  epithelial  hyperplasia  and  hyper- 
trophy with  mai'ked  lymphoid  hypertrophy.  Ex- 
tensive calcification  of  lower  lobe. 

Right  Lobe — 5 cm.  long  by  4 cm.  wide.  Micro- 
scopically the  tissue  findings  are  similar  to  the 
right  lobe  showing  marked  areas  of  calcification. 

Diagnosis:  Lugolized  Graves’  disease  occur- 

ring in  an  adenomatous  colloid  goiter  undergoing 
calcification. 

REMARKS 

Both  these  cases  made  an  uneventful  recovery 
following  their  operation.  In  the  first  case  it  is 
possible  that  there  was  a thyroid  tissue  rest  dur- 
ing embryological  development  which  came  down 
as  suggested  previously  with  the  thymus  gland 
but  which  was  directly  connected  with  the  right 
lobe  of  the  gland.  It  is  possible  that  after  the 


314 


The  Ohio  State  Medical  Journal 


May,  1933 


first  incision  into  this  cyst  a secondary  low  grade 
infection  was  produced  in  the  adenoma,  which 
accounted  for  the  extensive  fibrosis  and  for  the 
sero-purulent  drainage  over  the  long  period  of 
time. 

BIBLIOGRAPHY 

1.  Pennel  V.  Lancet,  Mar.  24,  1917,  Vol.  I,  p.  459. 

2.  Clark,  J.  J.,  South.  Med.  Jour.,  March,  1920,  Vol. 
XIII,  p.  183. 

3.  Arens,  Robert  A.  and  Bloom,  Arthur  R.,  Radiology, 
Vol.  IX,  pp.  333-334.  10/27. 

4.  Plummer,  W.  A.,  Proc.  Staff  Meetings,  Mayo  Clinic, 
Vol.  Ill,  p.  191. 

5.  Rambo,  C.  M.  and  Levi,  Leo  M.,  Ohio  State  Med. 
Jour.,  Mar.,  1930,  pp.  230-231. 

6.  Hueper,  Wilhelm,  Arch,  of  Path,  and  Lab.  Med.,  Vol. 
Ill,  pp.  14-25. 

7.  Watt,  J.  C.,  Arch,  of  Surgery,  Vol.  XV,  pp.  89-101. 

8.  Garven,  H.  S.  and  Pai,  H.  C.,  China  Med.  Jour., 
Vol.  45,  pp.  257-258. 


Decrease  Noted  in  Occupational  Disease 
Claims  During  1932 

An  analysis  of  occupational  disease  claims  filed 
with  the  State  Industrial  Commission  in  1932  has 
been  made  by  the  Division  of  Safety  and  Hygiene 
of  the  State  Department  of  Industrial  Relations. 

A comparison  of  the  figures  for  1931  and  1932 
shows  that  in  1931  the  total  number  of  claims 
filed  was  1,240  with  1,108  being  filed  for  com- 
pensable conditions  and  132  for  conditions  other 
than  those  listed  in  the  Occupational  Disease  Law. 
In  1932  the  total  number  of  claims  filed  was  1,135 
with  984  being  filed  for  compensable  conditions 
and  151  for  non-compensable  diseases.  It  is  evi- 
dent, therefore,  that  there  were  105  less  claims 
field  in  1932  and  when  claims  for  compensable 
conditions  are  considered,  the  total  number  was 
124  less  than  for  1931.  In  the  comparison  this  last 
figure,  namely  124,  is  considered  as  being  a better 
index  of  the  real  reduction  in  occupational  dis- 
eases, for  there  was  an  increase  in  the  number  of 
claims  filed  for  non-compensable  diseases  which 
usually  include  tuberculosis,  bronchitis,  asthma, 
arthritis,  neuritis,  heart  conditions  and  a number 
of  various  diseases  which  are  not  occupational  in 
origin  and  should  not  be  considered  as  developing 
from  industry. 

In  considering  the  984  claims  for  compensable 
diseases  it  is  found  that  648  were  due  to  some 
skin  disease.  Of  this  number  561  were  for  der- 
matitis, which  is  an  inflammatory  condition  of  the 
skin.  These  were  divided  as  follows:  25  were 
attributed  to  the  handling  of  oils,  63  to  cutting 
compounds  or  lubricants,  253  to  dust,  205  to 
liquids,  13  to  fumes,  2 to  gases  or  vapors.  One 
case  of  epithelioma  or  skin  cancer  was  attributed 
to  the  handling  of  carbon.  Eighty-six  cases  were 
described  as  chrome  ulceration  of  the  skin  or 
nasal  passages.  This  chromium  ulceration  is  a re- 
cent addition  to  the  occupational  disease  law, 
which  became  effective  July  8,  1931.  Prior  to  that 
date  ulceration  of  the  nasal  passages,  even  though 
due  to  the  action  of  chromium  acid,  could  not  be 
considered  as  coming  within  the  provisions  of  the 


law.  During  1932  there  were  70  cases  of  nasal 
ulceration  filed. 

With  a few  exceptions  the  period  of  disability 
resulting  from  skin  diseases  is  short  as  compared 
with  some  of  the  other  industrial  diseases;  the 
total  number  of  days  lost  for  the  648  claims 
totalling  8,254  days.  For  the  cases  of  dermatitis 
the  total  number  of  days  lost  was  7,673  for  a total 
of  561  claims,  making  an  average  of  13.6  days 
per  claim. 

Under  the  classification  of  industrial  poisons, 
174  claims  were  filed  with  a total  of  61,226  days 
lost.  In  this  group  lead  poisoning  is  the  most 
prominent  cause  of  disability.  During  the  year 
there  were  138  claims  filed  for  lead  poisoning 
with  6 fatalities  or  death  claims.  Investigation  of 
the  files  shows  that  none  of  these  death  claims 
has  as  yet  been  allowed  as  compensable  by  the 
Commission.  Four  have  been  definitely  disallowed 
due  to  the  fact  that  in  each  instance  death  was 
found  to  be  due  to  some  condition  other  than  lead 
poisoning  and  in  the  other  cases  the  proof  has 
not  been  completed  sufficiently  for  the  claims  to 
be  presented  for  decision.  Exclusive  of  the  six 
death  claims  it  is  found  that  the  average  period  of 
disability  in  the  cases  of  lead  poisoning  filed  was 
35  days  per  claim. 

Other  claims  filed  for  industrial  poisonings  are 
as  follows:  brass  or  zinc  5,  with  one  death;  mer- 
cury 2;  phosphorous  2;  arsenic  2;  benzol  or  de- 
rivatives 13,  with  one  death;  aniline  3,  with  one 
death;  carbon  bisulphide  2;  wood  alcohol  1;  car- 
bon dioxide  1 ; volatile  petroleum  products  4 ; sul- 
phur dioxide  1. 

From  the  above  it  is  evident  that  the  industi’ial 
poisonings,  while  fewer  in  number  than  the  skin 
diseases,  are  responsible  for  a much  greater  loss 
of  time.  Excluding  the  nine  deaths  which  are 
filed  in  this  group,  it  is  found  that  the  average 
period  of  disability  is  about  100  days  per  claim  as 
compared  with  13,6  days  per  claim  for  dermatitis. 

In  July,  1931,  tenosynovitis  and  prepatellar 
bursitis  were  added  to  the  list  of  compensable 
conditions  and  during  the  year  142  claims  were 
filed  for  these  conditions,  120  for  tenosynovitis 
and  22  for  prepatellar  bursitis. 


The  beating  of  a new-born  infant’s  heart  con- 
stitutes life  even  though  the  baby  never  breathes, 
the  Nebraska  Supreme  Court  ruled  recently  in 
the  suit  against  the  estate  of  the  child’s  father 
who  was  killed  in  an  accident  previous  to  the 
birth  of  the  baby,  filed  by  the  parents  of  the  de- 
ceased father  of  the  child.  The  court  held  that 
where  the  vital  functions  of  a child  had  not  ir- 
revocably ceased  it  could  not  lawfully  be  pro- 
nounced dead  at  birth  and  for  every  legal  purpose 
the  child  was  alive  at  birth,  even  though  the  child 
at  no  time  voluntarily  breathed,  made  no  sound 
and  moved  no  muscle,  but  whose  heart  beat  in  re- 
sponse to  artificial  respiration. 


V 


The  Presidents  P&ge 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


THE  enforced  postponement  of  our  May  meeting  because  of  uncertain  economic 
conditions  brings  to  county  and  district  medical  societies  the  additional  obliga- 
tion to  provide  the  membership  with  attractive  programs.  The  county  societies 
and  the  district  societies  must  carry  on  in  the  field  of  graduate  medical  education. 

There  will  be  many  excursions  into  the  “No  Man’s  Land”  of  economics  before  our 
people  find  the  road  leading  back  to  prosperity.  These  efforts  or  attempts  are  neces- 
sary but  they  must  not  be  permitted  to  change  the  individual  character  of  medical 
service.  It  is  extremely  doubtful  if  the  various  attempts  by  economists  to  improve  the 
quality  of  medical  care  will  prove  successful.  In  fact,  there  probably  will  be  no 
scheme  devised  which  can  .interfere  with  the  confidential  and  intimate  relationship  be- 
tween the  doctor  and  the  patient  which  at  all  times  should  exist. 

Rational  living  and  conduct  aided  by  intelligent  medical  supervision  has  added  to 
the  span  of  life  and  contributed  to  human  comfort.  No  individual  or  group  concerned 
in  health  service  makes  greater  contribution  than  the  family  physician  who  practices 
preventive  as  well  as  curative  medicine.  His  practice  is  an  intregal  part  of  him  for 
he  delights  to  be  personal  and  is  interested  not  only  in  the  disease  but  in  the  man  who 
has  it. 

It  seems  logical  that  during  this  period  of  enforced  economy  the  opportunity  is 
present  for  the  physician  and  the  patient  to  become  more  intimate  and  interdependent, 
and,  too,  that  a type  of  public  service  will  be  evolved  which  will  be  limited  to  adminis- 
tration, education,  and  care  of  indigents.  Yet  there  will  remain  for  us  books,  journals, 
and  society  meetings  to  keep  us  abreast  of  the  times. 

To  those  of  our  members  in  need  of  encouragement  and  comfort  I would  call 
attention  to  the  following  quotation  from  the  writings  of  Doctor  William  Osier: 

“I  have  had  three  personal  ideals.  One  to  do  the  day’s  work  well  and  not  to 
bother  about  tomorrow.  It  has  been  urged  that  this  is  not  a satisfactory  ideal.  It  is; 
and  there  is  not  one  which  the  student  can  carry  with  him  into  practice  with  greater 
effect.  To  it,  more  than  anything  else,  I owe  whatever  success  I have  had — to  this 
power  of  settling  down  to  the  day’s  work  and  trying  to  do  it  to  the  best  of  one’s  ability 
and  letting  the  future  take  care  of  itself. 

The  second  ideal  has  been  to  act  the  Golden  Rule,  as  far  as  in  me  lay,  toward 
my  professional  brethren  and  toward  the  patients  committed  to  my  care. 

And  the  third  has  been  to  cultivate  such  a measure  of  equanimity  as  would  enable 
me  to  bear  success  with  humility,  the  affection  of  my  friends  without  pride,  and  to  be 
ready  when  the  day  of  sorrow  and  grief  came  to  meet  it  with  courage  befitting  a man.” 


315 


316 


The  Ohio  State  Medical  Journal 


May,  1933 


Govemmeiit's  Administrative  Policy  on  Veterans'7  Benefits 
Establishes  Merit  System  With  Proper  Preference 
Toward  Service^Connected  Disabilities 


Using  the  power  granted  to  him  by  Congress  in 
the  so-called  “Economy  Bill”  (summarized  in  the 
April,  1933,  issue  of  The  Journal) , President 
Roosevelt  has  decreed  new  regulations  governing 
expenditures  for  veterans’  relief,  effective  July  1. 

The  new  regulations  supercede  all  existing 
statutes  and  regulations  governing  veterans’  ex- 
penditures and  will  result,  it  is  estimated,  in  an 
annual  saving  of  $400,000,000  to  the  Federal 
Government. 

Under  President  Roosevelt’s  readjustment  of 
the  Federal  program  of  benefits  for  former  ser- 
vice men,  provision  is  made  for  all  veterans  dis- 
abled as  a result  of  injuries  or  disabilities  sus- 
tained in  line  of  duty  in  the  military  or  naval 
service  and  for  the  dependents  of  those  who  died 
in  the  service  or  of  service-connected  disabilities. 

On  the  other  hand,  benefits  for  veterans  of  the 
non-service-connected  class  are  cut  to  a minimum 
and  in  some  cases  eliminated,  including  medical 
and  hospital  care.  Numerous  changes  are  made 
in  the  basic  rates  of  compensation  and  pensions. 
Benefits  of  various  kinds  are  limited  almost  en- 
tirely to  those  who  can  trace  their  present  disa- 
bilities to  war-time  service. 

Some  of  the  high  spots  of  the  President’s  regu- 
lations under  which  the  Veterans’  Administration 
will  function  after  July  1,  the  beginning  of  a new 
fiscal  year  for  the  Federal  Government,  ai‘e  sum- 
marized in  subsequent  paragraphs. 

COMPENSATION  RATES  CUT 

The  regulations  authorize  payment  of  compen- 
sation to  former  members  of  the  military  or  naval 
service  who  are  disabled  as  a result  of  disease  or 
injury  incurred  or  aggravated  in  line  of  duty  dur- 
ing the  Spanish-American  War,  the  Boxer  Re- 
bellion, the  Philippine  Insurrection  and  the  World 
War.  The  basic  provisions  are  that  the  injury  or 
disease  must  have  been  contracted  or  aggravated 
in  the  line  of  duty  and  without  misconduct,  and 
in  the  case  of  those  who  served  in  the  Boxer  and 
Philippine  disturbances  it  is  further  required  that 
they  must  have  actually  participated  in  hos- 
tilities. In  all  cases  it  is  required  that  the  person 
to  be  entitled  to  compensation  must  have  been 
honorably  discharged  from  the  service.  A pre- 
sumption of  service  connection,  for  chronic  dis- 
eases becoming  manifest  to  a 10  per  cent  degree 
or  more  within  one  year  from  separation  from 
active  service,  is  allowed,  but  the  government  is 
authorized  to  rebut  such  presumption  where  there 
is  affirmative  evidence  to  the  contrary  or  evidence 
to  estabh'sh  that  an  inter-current  injury  or  dis- 
ease which  is  a recognized  cause  of  such  chronic 
disease  has  been  suffered  between  the  date  of 


discharge  and  the  onset  of  the  chronic  disease,  or 
in  case  the  disability  is  due  to  the  person’s  own 
misconduct. 

Substantial  reductions  in  the  rates  of  compen- 
sation for  war-time  disabilities  are  ordered.  The 
new  rates  are  $8  per  month  for  10  per  cent  disa- 
bility; $20  to  25  per  cent  disability;  $40  to  50 
per  cent  disability;  $60  for  75  per  cent  disability, 
and  $80  for  100  per  cent  disability,  in  compari- 
son to  present  rates  of  $10,  $25,  $50,  $75  and  $100 
for  these  classes  of  disability. 

The  new  rating  schedule  for  compensation  of 
all  kinds  provides  for  only  five  disability  classi- 
fications. Heretofore  the  rating  schedules  were 
from  10  to  100  per  cent  at  1 per  cent  intervals. 


Due  to  a mechanical  error  in  making  up 
the  April,  1933,  issue  of  The  Joui~nal,  part 
of  the  article  dealing  with  the  Economy  Bill 
enacted  by  Congress  was  continued  from 
Page  254  to  Page  256  instead  of  to  Page 
255,  the  page  opposite  the  one  on  which  the 
article  started. 


DEPENDENTS  PROVIDED  FOR 

Pensions  to  widows,  children  and  dependent 
parents  of  veterans  who  died  in  line  of  duty  in 
war-time  service  are  authorized,  the  rates  being 
the  same  as  those  now  provided  under  existing 
law  for  the  same  class  of  dependents  of  de- 
ceased World  War  veterans. 

Compensation  is  authorized  for  former  mem- 
bers of  the  military  or  naval  forces  who  incurred 
disability  in  the  service  in  time  of  peace  but  it 
must  be  proved  that  the  disability  was  contracted 
in  line  of  duty,  that  there  was  no  misconduct,  and 
that  the  recipient  was  honorably  discharged. 

The  rates  of  compensation  set  for  such  ex- 
service  men  are:  $6  per  month  for  10  per  cent 
disability;  $12  for  25  per  cent  disability;  $18  for 
50  per  cent  disability;  $24  for  75  per  cent  dis- 
ability, and  $30  for  100  per  cent  disability. 

The  rates  of  pensions  payable  to  widows,  chil- 
dren or  dependent  parents  of  persons  who  died  in 
line  of  duty  in  time  of  peace  are  approximately 
75  per  cent  of  the  rates  authorized  for  the  de- 
pendents of  those  who  died  from  war-time  dis- 
abilities. 

If  persons  disabled  in  the  service  have  suffered 
an  anatomical  loss  or  the  loss  of  the  use  of  one 
foot  or  one  hand,  or  one  eye,  the  rate  prescribed 
is  increased  by  $20  per  month  in  the  case  of  those 
disabled  in  war-time  service  and  by  $10  per 


May,  1933 


State  News 


317 


month  in  the  case  of  those  disabled  in  peace-time 
service. 

A 50  per  cent  reduction  in  pensions  being  paid 
to  the  widow  or  other  dependents  of  a deceased 
veteran  of  the  Spanish- American  War,  the  Boxer 
Rebellion  and  the  Philippine  Insurrection  is 
ordered,  leaving  approximately  $15  per  month  for 
a widow  with  allowance  for  dependent  children. 

All  veterans  of  the  Spanish-American  War  62 
years  of  age  or  more  will  be  paid  a pension  of 
$6  per  month. 

In  cases  of  persons  who  were  so  seriously  dis- 
abled in  wartime  service  as  to  require  regular  aid 
and  attendance,  the  total  rate  of  compensation  is 
increased  to  $100  per  month  and  in  the  cases  of 
those  similarly  disabled  in  peace-time  service  ap- 
proximately $50  per  month. 

NON-SERVICE  BENEFITS  SLASHED 

Drastic  restrictions  are  made  on  the  payment 
of  compensation  or  disability  allowance  to  former 
service  men  suffering  from  non-service-connected 
disabilities. 

To  qualify  for  compensation,  a person  suffering 
from  a non-service-connected  disability  must 
prove:  (1)  that  he  is  permanently  and  totally 
disabled,  (2)  that  he  was  in  the  service  90  days 
or  more,  (3)  that  he  entered  the  service  prior  to 
the  cessation  of  hostilities,  (4)  that  he  Was  hon- 
orably discharged,  and  (5)  that  the  disability 
was  not  the  result  of  misconduct.  In  addition, 
veterans  of  the  Boxer  and  Philippine  disturbances 
must  show  that  they  actively  participated  in  these 
engagements. 

Compensation  payable  to  those  qualifying  under 
the  non-service-connected  section  of  the  regula- 
tions is  $20  per  month.  However,  such  compensa- 
tion cannot  be  paid  to  any  unmarried  person 
whose  annual  income  exceeds  $1000  or  to  any 
married  person  or  any  person  with  minor  chil- 
dren whose  annual  income  exceeds  $2500.  This 
excepts  the  payment  of  compensation  to  Spanish- 
American  War  veterans  62  years  of  age  or  over. 

Among  the  most  important  changes  made  in  the 
program  of  veterans’  relief  are  those  relating  to 
the  furnishing  of  medical  and  hospital  care  for 
former  service  men. 

Authorization  is  made  for  the  furnishing  of 
medical  and  hospital  care  to  veterans  suffei'ing 
from  service-connected  diseases  and  injuries,  dnd 
domiciliary  care  for  those  veterans  who  served  in 
the  active  military  or  naval  service  for  a period 
of  90  days  or  more  who  are  suffering  with  perma- 
nent disabilities,  or  tuberculosis  or  neuropsychia- 
tric ailments  which  incapacitate  them  from  earn- 
ing a living.  It  is  further  required  as  to  this 
latter  class  of  veterans  that  they  have  no  ade- 
quate means  of  support. 

ONLY  DESERVING  TO  GET  AID 

This  section  of  President  Roosevelt’s  regula- 
tions in  effect  does  the  following: 

1.  Assures  adequate  medical  and  hospital  care 


for  all  veterans  suffering  from  service-connected 
disabilities. 

2.  Provides  domiciliary  care  for  veterans  suf- 
fering from  permanent  disabilities,  tuberculosis 
or  neuropsychiatric  ailments  if  they  cannot  earn 
a living  because  of  their  disabilities  and  have  no 
adequate  means  of  support. 

3.  Eliminates  hospital  and  medical  care  for 
veterans  suffering  from  non-service  connected 
temporary  conditions. 

Furnishing  of  clothing  to  indigent  veterans  in 
veterans’  hospital's  or  to  veterans  requiring  spe- 
cial clothing  is  authorized.  Authorization  is  made 
for  the  payment  of  traveling  expenses  to  and 
from  veterans’  administration  hospitals  for  those 
suffering  with  service-connected  diseases  but  no 
expenses  are  authorized  for  non-service-connected 
cases  or  in  connection  with  medical  examinations. 
No  medical,  hospital  or  domiciliary  care  is  au- 
thorized for  persons  residing  outside  the  con- 
tinental limits  of  the  United  States  or  its  ter- 
ritories or  possessions. 

It  is  provided  that  the  compensation  of  any 
person  suffering  from  a service-connected  dis- 
ability who  is  being  furnished  hospital  treatment, 
institutional  or  domiciliary  care  by  the  United 
States  or  any  political  subdivision  thereof  shall 
not  exceed  $15  per  month,  but  that  if  there  is  a 
dependent  wife,  child  or  children,  or  dependent 
parent  or  parents,  the  difference  between  $15  and 
the  amount  othei’wise  payable  shall  be  paid  to 
such  dependents.  As  to  veterans  suffering  with 
non-service-connected  disabilities,  it  is  provided 
that  the  amount  of  compensation  shall  be  reduced 
to  $6  and  that  the  difference  between  $6  and  the 
amount  otherwise  payable  shall  be  paid  to  the 
dependents. 

One  section  of  the  regulations  deals  with 
emergency  officers’  retirement  pay.  It'  provides 
that  any  emergency  officer  heretofore  granted  re- 
tirement pay  shall  be  entitled  to  continue  to  re- 
ceive such  retirement  pay  if  he  is  properly  rated 
30  per  cent  disabled  and  the  disability  for  which 
he  had  been  retired  resulted  from  the  actual  per- 
formance of  military  or  naval  duty,  or  if  the  dis- 
ability for  which  he  has  been  retired  with  pay  re- 
sulted from  disease  or  injury  incurred  in  line  of 
duty  during  war  service. 

MAY  CLOSE  SOME  HOSPITALS 

Following  promulgation  of  the  new  regulations 
by  the  Chief  Executive,  Brig.  Gen.  Frank  T. 
Hines,  administrator  of  vetei-ans’  affairs,  an- 
nounced to  the  press  that  veterans’  hospitals  au- 
thorized by  Congress  but  on  which  work  has  not 
been  started,  would  not  be  built  unless  the  need 
for  them  is  imperative.  The  same  policy,  he  said, 
would  be  applied  to  additions  to  veterans’  hos- 
pitals. Structures  nearing  completion  will  be 
finished,  he  declared.  News  dispatches  carried  the 
unofficial  statement  that  some  field  stations  and 
some  veterans’  hospitals  undoubtedly  would  be 


318 


The  Ohio  State  Medical  Journal 


May,  1933 


closed,  since  a large  part  of  the  present  veterans’ 
hospital  load  consists  of  veterans  with  non-service- 
connected  disabilities  who,  under  the  new  regula- 
tions, will  not  be  entitled  to  hospitalization,  ex- 
cept in  a few  instances.  Under  the  regulations, 
hospitalization  ig  confined  to  existing  veterans’ 
hospitals,  no  provision  being  made  for  hospitaliza- 
tion in  “contract”  private  institutions  or  institu- 
tions operated  by  states  or  political  subdivisions 
therein. 

A paper  saving  of  more  than  $1,000,000,000 
will  accrue  from  the  reduction  in  hospital  and 
domiciliary  construction  no  longer  to  be  carried 
on,  General  Hines  has  estimated.  In  a statement 
explaining  this  statement,  he  said: 

“Had  the  Federal  Government  continued  its 
policy  to  build  both  hospital  and  domiciliary  fa- 
cilities to  meet  the  estimated  maximum  require- 
ments for  these  services  under  the  laws  in  effect 
prior  to  the  Act  of  March  20,  1933,  an  additional 
construction  program,  involving  appropriations  of 
approximately  $160,000,000  would  have  been  re- 
quired. Further,  the  opportunity  of  these  in- 
creased facilities  up  to  and  including  the  peak 
year  for  each  class  of  service  would  have  en- 
tailed an  estimated  expenditure  of  $1,043,000,000. 

“The  Act  of  March  20,  1933,  by  eliminating  the 
necessity  for  any  further  construction  of  hospital 
and  domiciliary  facilities,  will  effect  estimated 
future  savings  in  construction  and  operating  costs 
of  $1,203,000,000  in  the  amount  which  would  have 
been  needed  to  meet  the  estimated  maximum  re- 
quirements for  these  services  under  laws  in  effect 
prior  thereto.  The  savings  indicated  are  over  and 
above  those  in  connection  with  the  operation  of 
both  hospital  and  domiciliary  facilities  which  will 
prospectively  accrue  through  material  reductions 
in  the  present  load  for  these  services  by  reason 
of  the  provisions  of  the  Act  of  March  20,  1933, 
and  regulations  issued  thereunder.” 

The  policy  to  be  pursued  by  the  Veterans’  Ad- 
ministration in  carrying  out  the  provisions  of  the 
regulations  issued  by  the  President  will  be  one  of 
“patience  and  kindness”,  General  Hines  stated  in 
a circular  addressed  to  the  field  force  of  the  Ad- 
ministration. In  that  circullar  he  said: 

“The  new  laws  and  the  regulations  issued  in 
pursuance  thereto  are  based  upon  new  principles. 
It  is  essential  that  they  be  carefully  interpreted 
and  properly  applied. 

“The  basic  principle  upon  which  the  law  is 
founded  and  the  regulations  issued  contemplates 
that  the  pension  roll  will  be  always  an  honor  roll 
and  that  the  veteran  who  has  honorably  served 
his  country  and  has  suffered  injury  or  disease  in 
line  of  duty  will  be  cared  for,  and  when  he  has 
passed  on,  that  his  dependents  will  be  cared  for, 
in  keeping  with  the  ability  of  our  country  to  do 
so.  It  is,  of  course,  the  desire  of  the  President 
that  these  regulations  and  instructions  issued  in 
connection  with  them,  will  be  justly,  equitably, 
and  humanely  applied.” 


A physician  employed  by  the  county  commis- 
sioners to  furnish  medical  service  to  inmates  of  a 
county  infirmary  is  not  a civil  service  employe, 
according  to  an  opinion  handed  down  recently  by 
Attorney  General  John  W.  Bricker. 


Exaggeration  in  Advertising  and  Label- 
ling Many  Food  Products 

Tests  of  so-called  vitamin  foods  and  confec- 
tions by  the  Federal  Food  and  Drug  Administra- 
tion have  shown  that  there  is  “a  great  deal  of 
exaggeration”  in  the  labeling  of  many  of  these 
products  and  a considerable  number  of  seizures 
have  been  made  in  cases  where  definite  misbrand- 
ing was  believed  to  exist,  according  to  a recent 
statement  by  Dr.  P.  D.  Dunbar,  Assistant  Chief 
of  the  Administration. 

The  public  has  been  mulcted  of  large  sums  and 
the  health  of  many  individuals  doubtless  has  been 
endangered  by  deceptive  or  false  labeling  of  such 
products,  Dr.  Dunbar  said.  As  a result,  the  Ad- 
ministration shortly  will  add  another  bioassayist 
to  its  staff  to  devote  his  time  to  tests  of  food  pro- 
ducts and  drugs  labeled  as  containing  vitamins, 
he  added. 

Tests  made  by  the  Administration  indicate  that 
there  are  some  valuable  vitamin  concentrates  on 
the  market,  but  that  there  are  other  preparations 
put  out  as  valuable  nutritional  adjuncts  which 
are  only  ordinary  food  products,  or,  in  some  cases, 
are  even  less  than  that.  Tests  of  aqueous  alco- 
holic cod  liver  oil  extract  tonics,  for  instance, 
have  failed  so  far  to  show  a single  preparation 
which  contains  a significant  amount  of  the  cod 
liver  oil  vitamins  A or  D.  These  preparations 
are  generally  referred  to  as  cod  liver  extracts. 

The  public  is  decidedly  “health  conscious,”  es- 
pecially so  when  feeling  a little  “under  the 
weather.”  Unscrupulous  manufacturers  take  ad- 
vantage of  this  especially  when  some  new  de- 
velopment has  entered  the  field  of  health  such  as 
the  discovery  of  vitamins. 

In  many  cases,  the  manufacture  will  describe 
the  well-known  symptoms  of  “Spring  fever,” 
which  affects  nearly  everyone,  or  some  other 
common  ailment,  and  the  public  buys  his  product 
to  cure  the  condition,  when  the  real  need  is  a 
well-balanced  diet,  sunshine  and  exercise. 

The  Administration  has  repeatedly  pointed  out, 
and  reiterates,  that  an  ordinary  diversified  diet 
provides  all  the  vitamins  needed  for  the  average 
person  who  is  not  distinctly  ill.  Cases  of  vitamin 
deficiency  diseases  are  comparatively  rare  in  this 
country,  occurring  usually  only  in  the  poorer  sec- 
tions where  fresh  vegetables  often  are  lacking 
from  the  diet  over  long  periods. 


A recent  statement  by  the  U.  S.  Public  Health 
Service  shows  that  there  has  been  a pronounced 
decrease  in  smallpox  incidence  in  this  country  in 
the  last  two  years.  The  number  of  cases  of  small- 
pox reported  in  1932  was  27.8  per  cent  of  the 
average  for  the  preceding  four  years.  The  cases 
reported  for  1928  to  1932,  inclusive,  totaled  re- 
spectively: 39,396,  42,282,  48,907,  30,232,  and 

11,168. 


May,  1933 


State  News 


319 


Radical  Changes  in  Near  Future  in  Federal  and  State  Regu^ 
iations  on  Prescribing  of  Medicinal  Liquor 


Enactment  by  the  Ohio  General  Assembly  of 
legislation,  subsequently  approved  by  Governor 
White,  modifying  the  state  prohibition  statutes 
relating  to  medicinal  liquor  assures  to  the  phy- 
sicians of  this  state  greater  freedom  in  the  exer- 
cise of  their  scientific  judgment  concerning  the 
prescribing  of  medicinal  liquor  when  therapeuti- 
cally indicated  and  when  deemed  beneficial  to 
their  patients. 

However,  at  present  there  is  some  confusion  as 
to  the  exact  status  of  the  medicinal  liquor  ques- 
tion in  this  state  because  of  action  taken  recently 
by  Congress  in  removing  from  the  Federal 
statutes  the  one-pint  limitation  on  the  amount  of 
medicinal  liquor  a physician  may  prescribe. 

The  Smolka-McNamee  Act,  introduced  by  Sena- 
tor John  F.  Smolka,  Cleveland,  who  steered  it 
successfully  through  the  Senate,  and  handled  in 
the  House  by  Representative  Hugh  A.  McNamee, 
Cleveland,  was  signed  by  Governor  White  on 
March  15  and  will  become  effective  on  June  14. 
The  act  as  passed  by  the  General  Assembly  and 
signed  by  the  Governor  amends  Section  6212-15a 
of  the  General  Code  of  Ohio  to  read  as  follows: 

“Notwithstanding  the  provisions  of  Section 
6212-15  of  the  General  Code,  no  intoxicating 
liquor  except  pure  grain  or  ethyl  alcohol,  vinous 
or  spiritous  liquor  in  quantities  now  permitted  by 
federal  statutes  and  regulations,  for  the  aged, 
infirm  and  known-sick  or  alcoholic  medicinal 
preparations  which  have  been  named  or  hereafter 
shall  be  named  by  the  federal  prohibition  com- 
missioner and  held  to  be  fit  for  beverage  pur- 
poses and  listed  in  the  U.S.P.  and  N.F.  shall  be 
manufactured,  sold,  prescribed  or  dispensed  for 
medicinal  purposes.” 

The  amendment  eliminates  from  the  old  law 
the  quantity  limitation  of  “one-half  pint  in  any 
period  of  ten  days”  and  sets  the  quantity  of 
medicinal  liquor  which  may  be  prescribed  as  that 
“now  per*mitted  by  federal  statutes  and  regu- 
lations”. 

At  the  time  the  Smolka-McNamee  Act  was 
signed  by  the  Governor,  on  March  15,  the  Federal 
statutes  provided  that  the  quantitative  limitation 
on  the  amount  of  medicinal  liquor  that  a physi- 
cian might  pi'escribe  was  one  pint  in  any  period 
of  ten  days. 

However,  sixteen  days  after  the  Ohio  act  was 
signed,  on  March  31,  President  Roosevelt  signed 
the  Celler-Copeland  medicinal  liquor  bill  enacted 
by  Congress  which  eliminates  from  the  Federal 
statutes  any  quantitative  limitation  on  the  amount 
of  medicinal  liquor  a physician  may  prescribe, 
substituting  the  provision  that  “no  more  liquor 
shall  be  prescribed  to  any  one  person  than  is 
necessary  to  supply  his  medicinal  needs”.  The 


Federal  law,  effective  immediately,  authorizes  the 
Attorney  General  of  the  United  States  and  the 
Secretary  of  the  Treasury  jointly  to  promulgate 
regulations  to  govern  the  details  of  prescribing, 
which  regulations  may  be  changed  and  revised 
from  time  to  time  in  the  light  of  experience  and 
medical  evidence. 

In  view  of  the  action  which  has  been  taken  by 
Congress,  the  question  arises: 

Will  Ohio  physicians  be  permitted  to  prescribe 
for  any  one  person  any  amount  of  medicinal 
liquor  wh:ch  they  deem  necessary  to  supply  his 
medicinal  needs,  as  provided  now  in  the  Federal 
statutes,  under  such  regulations  as  may  be  laid 
down  by  the  Attorney  General  of  the  United 
States  and  the  Secretary  of  the  Treasury,  or  will 
they  be  permitted  to  prescribe  but  one  pint  of 
medicinal  liquor  in  any  period  of  ten  days,  as  was 
provided  by  the  Federal  statutes  at  the  time  the 
Smolka-McNamee  Act  was  signed  by  the  Gov- 
era  or? 

One  interpretation  of  the  act  is  that  inasmuch 
as  the  Federal  limitation  was  one  pint  at  the 
time  the  Smolka-McNamee  Act  was  enacted,  that 
the  Ohio  limitation  will  be  one  pint  after  June 
14,  when  the  act  becomes  effective,  unless  the 
Legislature  changes  the  phrasing  of  the  act  after 
it  reconvenes  May  15. 

Another  forceful  argument  which  has  been  pre- 
sented is  that  since  the  Smolka-McNamee  Act 
eliminates  from  the  Ohio  law  any  reference  to 
quantitative  limitation  except  that  which  may  be 
provided  by  Federal  statutes  and  regulations, 
and  inasmuch  as  definite  restrictions  on  amount 
have  been  removed  from  the  Federal  statutes, 
that  the  only  restrictions  governing  the  pre- 
scribing of  medicinal  liquor  in  Ohio  after  the 
Smolka-McNamee  Act  goes  into  effect  will  be 
those  which  may  be  provided  for  in  new  regula- 
tions to  be  promulgated  by  the  Attorney  General 
of  the  United  States  and  the  Secretary  of  the 
Treasury,  as  authorized  by  the  Cellei'-Copeland 
Act. 

It  has  been  pointed  out  that  it  is  extremely 
doubtful  if  the  Smolka-McNamee  Act  could  be 
interpreted  to  imply  that  the  provisions  of  that 
act  should  revert  to  a former  Federal  statute  as 
to  amount,  but  that  it  should  be  construed  to 
mean  any  period  dating  from  the  time  when  the 
prevailing  Federal  restrictions  on  prescribing 
medicinal  liquor  became  effective. 

In  order  to  clear  up  this  point,  Senator  Smolka 
has  requested  an  official  opinion  from  Attorney 
General  John  W.  Bricker.  Up  to  the  time  Thn 
Journal  went  to  pi’ess,  no  opinion  had  been  ren- 
dered by  Mr.  Bricker  but  he  is  expected  to  do  so 
in  the  near  future. 


320 


The  Ohio  State  Medical  Journal 


May,  1933 


Should  the  attorney  general  hold  that  the 
Smolka-McNamee  Act  should  be  construed  to 
mean  that  the  quantitative  amount  of  medicinal 
liquor  which  may  be  prescribed  in  Ohio  is  one 
pint,  the  amount  provided  for  in  the  Federal 
statute,  recently  repealed,  Senator  Smolka  has 
announced  he  will  ask  the  Legislature  when  it  re- 
convenes to  amend  the  Smolka-McNamee  Act  in 
such  a way  that  there  will  be  no  misunderstand- 
ing or  misinterpretation  of  its  provisions,  making 
the  Ohio  restrictions  on  prescribing  of  medicinal 
liquor  conform  to  whatever  restrictions  may  now 
or  hereafter  be  placed  on  prescribing  by  the  Fed- 
eral Government. 

Regardless  of  the  outcome  of  this  legal  con- 
troversy, Ohio  physicians  should  at  this  time  re- 
member that: 

First,  the  Smolka-McNamee  Act  does  not  be- 
come effective  until  June  14.  Until  then  the  legal 
limitation  on  the  amount  of  medicinal  liquor  may 
be  prescribed  in  Ohio  for  any  person  in  any 
period  of  ten  days  is  one-half  pint. 

Second,  although  the  Celler-Copeland  Act  elimi- 
nating Federal  restrictions  on  prescribing  became 
effective  March  31,  the  Attorney  General  of  the 
United  States  and  the  Secretary  of  the  Treasury, 
delegated  by  the  act  to  draft  new  regulations 
governing  prescriptions,  have  not  as  yet  promul- 
gated new  regulations  and  have  ordered  con- 
tinued in  force  the  Federal  limitations  on  pre- 
scribing that  have  heretofore  been  in  effect. 

In  other  words,  until  June  14  Ohio  physicians, 
to  comply  with  the  Ohio  law,  should  not  write 
prescriptions  for  more  than  one-half  pint  of 
medicinal  liquor.  After  June  14,  Ohio  physi- 
cians may  write  prescriptions  for  one  pint.  If  by 
June  14  the  new  Federal  regulations  have  been 
announced  and  the  Smolka-McNamee  Act  has 
interpreted  as  making  the  Ohio  law  conform  to 
whatever  new  Federal  regulations  may  be  prom- 
ulgated, Ohio  physicians  will  be  permitted  to  pre- 
scribe an  amount  of  medicinal  liquor  deemed 
necessary  to  supply  the  medicinal  needs  of  their 
patients  under  whatever  regulations  the  Attorney 
General  of  the  United  States  and  the  Secretary 
of  the  Treasury  may  decide. 

In  a recent  editorial,  The  Journal  of  the  Ameri- 
can Medical  Association  analyzes  some  of  the 
provisions  of  the  Celler-Copeland  Federal  act  and 
offers  some  sound  advice  to  physicians  on  the 
question  of  prescribing  medicinal  liquor.  Part  of 
the  editorial  is  quoted  herewith  as  a matter  of 
information  and  caution  for  Ohio  physicians: 

“While  The  Journal  has  constantly  maintained 
the  right  of  the  physician  to  prescribe  at  any 
time  anything  which  he  considers  necessary  for 
the  health  of  his  patient,  it  has,  at  the  same  time, 
repeatedly  urged  physicians  to  respect  the 
privilege  conferred  on  them  by  the  government 
in  permitting  them  to  prescribe  alcoholic  liquors 
even  when  the  law  of  the  land  attempted  to  re- 
strict the  use  of  such  beverages  from  the  point  of 
view  of  social  interest. 

“Now  the  Celler-Copeland  medicinal  liquor  bill 


has  been  passed  by  the  Senate  and  the  House  of 
Representatives  and  was  approved  by  President 
Roosevelt,  March  31.  The  bill  became  effective 
immediately  except  for  the  provisions  directing 
the  discontinuance  of  the  use  of  official  pre- 
scription blanks.  Thus  comes  to  a successful  con- 
clusion the  long  battle  waged  by  the  American 
Medical  Association  to  procure  for  qualified 
physicians  the  right  to  prescribe  whatever  they 
deem  necessary  and  in  any  amount  that  may  be 
shown  to  be  necessary  in  the  best  interest  of  their 
patients. 

“In  place  of  the  former  arbitrary  limits  on  the 
quantities  of  alcoholic  liquors  that  a physician 
might  prescribe,  on  the  alcoholic  strength  of  the 
vinous  liquor,  and  on  the  number  of  prescriptions 
that  might  be  issued,  the  law  now  provides  that 
“no  more  liquor  shall  be  pi*escribed  to  any  per- 
son than  is  necessary  to  supply  his  medicinal 
needs.”  Within  the  limits  of  sound  professional 
practice,  the  judgment  of  the  attending  physician 
is  supreme.  The  prohibition  on  the  medicinal  use 
of  malt  liquor  remains  in  effect.  Under  the  re- 
cently enacted  law  regulating  the  sale  of  beer, 
nothing  in  the  National  Prohibition  Act  now  ap- 
plies to  fermented  malt  and  vinous  liquors  that 
contain  not  more  than  3.2  per  cent  of  alcohol  by 
weight.  Malt  and  vinous  liquors  of  this  type  may 
be  prescribed  without  federal  restriction. 

“While  there  are  now  no  federal  limitations  on 
the  quantities  of  spirituous  and  vinous  liquors 
that  a physician  may  prescribe,  except  the  limita- 
tions imposed  by  sound  professional  practice,  the 
manner  of  prescribing  is  governed  by  new  regu- 
lations. If  the  diversion  of  medicinal  liquor  to 
beverage  purposes  is  to  be  prevented,  unscrupu- 
lous physicians  cannot  be  left  at  liberty  to  order 
in  a single  prescription  all  the  liquor  that  any 
patient  might  need  throughout  the  entire  period 
of  his  illness  and  convalescence.  Indeed,  a.  patient 
might  apply  to  several  physicians,  concealing 
from  each  the  fact  that  he  was  under  treatment 
by  the  others,  and  thus  obtain  an  excessive  quan- 
tity of  liquor.  This  possibility  has  been  antici- 
pated by  the  new  law.  Any  person  who  by  mis- 
representation obtains  a greater  quantity  of 
liquor  than  is  necessary  for  his  medicinal  needs 
is  liable  to  fine  and  imprisonment.  The  abuses 
that  might  arise  if  physicians  should  customarily 
prescribe  quantities  of  liquor  sufficient  to  last 
through  the  weeks,  months  and  years  of  chronic 
illness  are  apparent.  Therefore  the  maximum 
quantity  that  may  normally  be  prescribed  at  one 
time  will  be  fixed,  as  well  as  the  normal  maximum 
frequency  of  prescribing.  Moreover,  special  pro- 
vision may  be  made  for  prescribing  additional 
quantities  in  cases  of  actual  necessity. 

“The  Attorney  General  and  the  Secretary  of 
the  Treasury  are  authorized  jointly  to  promul- 
gate regulations  to  govern  the  details  of  prescrib- 
ing. They  are  already  consulting  with  representa- 
tives of  the  Association  and  with  others  in  an 
effort  to  formulate  fair,  reasonable  and  effective 
regulations.  In  order  to  bridge  the  gap  between 
the  old  and  the  new  oi’der,  however,  they  have 
continued  in  force  the  limitations  on  prescribing 
that  have  heretofore  been  in  effect.  Notice  of  the 
promulgation  of  the  new  regulations  will  appear 
in  The  Journal,  and  official  information  will  be 
available  at  the  offices  of  supervisors  of  permits 
throughout  the  country. 

“On  the  discontinuance  of  the  use  of  official 
prescription  blanks,  about  January  1,  physicians 
will  be  supplied  free  by  the  government  with  en- 
graved stamps  of  a convenient  size  and  design, 
suitable  for  affixing  to  a physician’s  ordinary  pre- 
scription blanks.  A physician  who  wishes  to  pre- 


May,  1933 


State  News 


321 


scribe  liquor  will  then  be  required  to  write  his 
prescription  on  his  ordinary  prescription  blank, 
in  such  form  and  detail  as  may  be  prescribed  by 
regulations,  and  then,  in  order  to  validate  his 
prescription,  to  affix  and  to  cancel  such  a stamp. 
Until  the  date  determined  on  for  initiating  the 
use  of  such  stamps,  physicians  are  to  continue  to 
use  the  present  official  forms  with  which  they 
have  been  supplied. 

“While  the  new  law  provides  that  a physician 
shall  not  be  called  on  to  file  in  any  government 
office  any  statement  of  the  nature  of  the  ailments 
from  which  his  patients  are  suffering,  physicians 
must  continue  to  keep  in  their  offices  the  book 
records  now  required,  stating  the  nature  of  such 
ailments.  These  office  records  will  assume  an  in- 
creased importance  with  the  discontinuance  of  the 
filing  of  prescription  stubs  with  supervisors  of 
permits.  These  book  records  continue  to  be  open 
to  inspection  by  officers  charged  with  enforcing 
federal  prohibition  laws. 

“The  adoption  of  this  new  law  places  on  phy- 


sicians a greater  responsibility  than  has  been 
theirs  heretofore.  The  Journal  has  maintained 
that  the  honor  of  the  profession  warrants  the 
granting  of  such  a responsibility.  The  physicians 
of  this  country  must  demonstrate  that  this  con- 
fidence has  not  been  misplaced.  The  fact  that  the 
prescription  of  alcoholic  liquors  is  still  not  per- 
mitted in  several  states,  the  fact  that  numerous 
physicians  in  states  in  which  prescribing  is  per- 
mitted have  refused  to  take  out  the  necessary 
license  or  to  avail  themselves  of  the  privilegie,  the 
fact  that  many  physicians  find  the  possession  of 
this  privilege  a serious  annoyance  in  their  re- 
lationships to  both  patients  and  friends,  are  in- 
dications that  the  right  to  prescribe  alcohol  has 
never  been  an  unmixed  blessing.  We  believe  that 
the  physicians  of  this  country  can  so  administer 
the  new  situation  in  which  they  find  themselves 
as  to  continue  to  merit  the  high  honor  in  which 
both  the  public  and  the  government  have  held 
them.” 


County  Soci 


First  District 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(George  B.  Topmoeller,  M.D.,  Secretary) 

Apinl  3 - — General  Session.  Program:  “Trige- 

minal Neuralgia  and  Other  Painful  Conditions 
About  the  Face”,  Dr.  John  A.  Caldwell;  discus- 
sion by  Dr.  B.  M.  Cater  and  Dr.  Harris  Vail; 
“Free  Dispensary  Service  and  the  Private  Prac- 
titioner”, Dr.  R.  S.  Austin. 

April  10 — Joint  meeting  with  the  Cincinnati 
Dental  Society.  Address,  “Dental  Infection  and 
Systemic  Disease”,  Dr.  Russell  L.  Haden,  Cleve- 
land. 

April  17 — General  Session.  Report  of  commit- 
tee to  investigate  telephone  exchange  service  and 
report  of  committee  to  investigate  medical  credit 
and  material  services. 

April  24 — General  Session.  Program:  “Bacter- 
iologic  Studies  in  the  Etiology  of  Poliomyelitis”, 
Dr.  Merlin  L.  Cooper;  discussion  by  Dr.  William 
B.  Wherry;  “Symptomatology  of  Acute  Anterior 
Poliomyelitis”,  Dr.  Frank  L.  Stevenson;  discus- 
sion by  Dr.  David  A.  Tucker,  Jr.;  “Orthopedic 
Care  in  Anterior  Poliomyelitis”,  Dr.  J.  W.  Mc- 
Cammon;  discussion,  Dr.  Joseph  Freiberg. 

Clinton  County  Medical  Society  was  addressed 
on  March  7 at  the  General  Denver  Hotel,  Wil- 
mington, by  Dr.  John  Griewe,  Cincinnati,  on  The 
New  Physiology  of  the  Heart”.  A round-table 
discussion  followed  the  address. — News  Clipping. 

Fayette  County  Medical  Society  met  April  6 at 
the  Washington  C.  H.  Y.  M.  C.  A.  The  principal 
speaker  was  Dr.  W.  B.  Morrison,  Columbus.  His 
subject  was  “Modern  Surgical  Treatment  of  Can- 


cer and  Ulcer  of  the  Stomach  and  Duodenum”. — - 
News  Clipping. 

Warren  County  Medical  Society  at  its  meeting 
April  4 at  Harmon  Hall,  Lebanon,  was  addressed 
by  Dr.  T.  F.  Myler,  Xenia. — News  Clipping. 

Second  District 

Clark  County  Medical  Society  held  its  semi- 
monthly meetings  on  March  8 and  22  at  the 
Springfield  City  Hospital.  At  the  March  8 meet- 
ing, papers  were  read  by  Dr.  J.  H.  Riley  and  Dr. 
I.  H.  Boesel.  Dr.  Riley  spoke  on  “General  Anes- 
thesia” and  Dr.  Boesel  on  “Spinal  Anesthesia”. 
At  the  March  22  meeting,  Dr.  Charles  B.  Kingry, 
pathologist  at  the  hospital,  addressed  the  society 
on  “Clinical  Pathological  Conference”. — News 
Clipping. 

Greene  County  Medical  Society  met  April  6 in 
the  Court  House  at  Xenia.  After  a short  business 
session,  Dr.  James  C.  Walker,  Dayton,  addressed 
the  society  on  “After  Care  of  Fractures  of  the 
Long  Bones”.  Dr.  Walker  pointed  out  some  valu- 
able procedures  which  should  be  observed.  His 
paper  was  well  received.  After  a general  discus- 
sion, luncheon  was  served. — H.  C.  Schick,  M.D., 
Secretary. 

Miami  County  Medical  Society  met  on  April  14 
at  the  Piqua  Memorial  Hosiptal.  Dr.  J.  F.  Beach- 
ler,  Piqua,  gave  an  illustrated  talk  on  “The  Treat- 
ment of  Acute  Intestinal  Obstruction”.  Dinner 
was  served  after  the  meeting. — Bulletin. 

Montgomery  County  Medical  Society  was  host 
to  many  physicians  of  the  Second  Councilor  Dis- 
trict at  its  meeting  on  April  7 at  the  Dayton 
Biltmore  Hotel.  The  principal  speaker  of  the 


322 


The  Ohio  State  Medical  Journal 


May,  1933 


evening  was  Dr.  J.  H.  J.  Upham,  member  of  board 
of  trustees  of  the  American  Medical  Association 
and  dean  of  the  College  of  Medicine,  Ohio  State 
University,  who  spoke  on  “The  Reports  of  the 
Committee  on  the  Costs  of  Medical  Care”. — Bul- 
letin. 

Preble  County  Medical  Society  met  in  regular 
session  March  23  at  Seven  Mile  Tavern,  Eaton. 
Dr.  Warren  C.  Breidenbach,  Dayton,  addressed 
the  society  on  “The  Present  Status  of  Compres- 
sion Therapy  in  Pulmonary  Tuberculosis”. — 
News  Clipping. 

Third  District 

Auglaize  County  Medical  Society  held  its  regu- 
lar meeting  in  the  Court  House  at  Wapakoneta  on 
Wednesday  evening,  April  12,  with  an  excellent 
attendance  of  members  and  a number  of  guests 
from  Lima,  and  from  Shelby  County.  The  So- 
ciety was  addressed  by  Dr.  Frank  C.  Clifford  of 
Toledo,  upon  “Coronary  Disease”,  giving  con- 
sideration to  the  associated  heart  and  blood  ves- 
sel lesions  and  the  pathology  concerned  in  the 
causation  of  the  condition.  This  was  profusely 
illustrated  by  blackboard  demonstrations  and 
stereopticon  views  of  electro-cardiograms  found 
in  coronary  trouble.  The  address  was  followed 
by  an  hour’s  rapid  fire  questionnaire  from  the 
audience,  which  brought  out,  chiefly,  the  in- 
dicated treatment  in  the  various  forms  and 
manifestations  of  the  disease.  The  next  meeting 
will  be  held  at  Minster  in  June. — Chas.  C.  Berlin, 
M.D.,  Secretary. 

Hancock  County  Medical  Society  held  its 
monthly  meeting  April  6 at  the  Elks’  Club,  Find- 
lay. The  program  was  presented  by  Dr.  M.  N. 
Mundy,  Forest,  and  Dr.  J.  J.  Sutter,  Lima. — 
News  Clipping. 

Hardin  County  Medical  Society  was  addressed 
by  Dr.  C.  S.  Mundy,  Toledo,  at  its  regular  meet- 
ing on  March  16  at  the  Kenton  Cafe.  Dr.  Mundy 
spoke  on  “Arthritis”. — News  Clipping. 

Logan  County  Medical  Society  had  as  its  guest 
speaker  at  its  meeting  April  7 at  Bellefontaine, 
Dr.  Harold  Swanberg,  Quincy,  Illinois,  editor  of 
The  Radiological  Review.  Dr.  Swanberg  spoke  on 
“Radium  Therapy  in  General  Practice”. — News 
Clipping. 

Marion  County  Academy  of  Medicine  was  ad- 
dressed by  Dr.  J.  T.  Murphy,  Toledo,  president  of 
the  American  Roentgenological  Society,  and  Dr. 
C.  E.  Hufford,  also  of  Toledo,  at  its  regular  meet- 
ing March  7 at  the  Marion  City  Hospital.  Dr. 
Murphy  spoke  on  the  treatment  of  abdominal  con- 
ditions with  the  X-ray  and  Dr.  Hufford  discussed 
the  differential  diagnosis  of  bony  new  growths. — 
News  Clipping. 

Seneca  County  Medical  Society  entertained  the 
members  of  the  Hancock  County  Medical  Society 
at  its  regular  meeting  March  16  at  the  Hays 
Hotel,  Fostoria.  Following  a steak  dinner,  an  in- 
teresting program  was  presented.  The  guest 


speakers  were  Dr.  Lester  Kobacher  and  Dr.  Mar- 
tin W.  Diethelm,  both  of  Toledo.  A general  dis- 
cussion was  held  following  the  addresses.  A reso- 
lution of  sorrow  concerning  the  death  of  Dr.  E. 
L.  Overholt,  a member  of  the  Seneca  County  So- 
ciety was  adopted. — News  Clipping. 

Wyandot  County  Medical  Society  was  enter- 
tained March  23  at  the  home  of  Dr.  W.  L.  Naus, 
Upper  Sandusky.  Dr.  B.  A.  Moloney  was  elected 
president  for  the  ensuing  year;  Dr.  C.  W.  Mont- 
gomery, vice  president,  and  Dr.  Naus,  secretary- 
treasurer.- — News  Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO 
AND  LUCAS  COUNTY 

(A.  P.  Hancuff,  M.D.,  Secretary) 

April  7 — General  Session.  Program:  “Acute 

Suppurations  of  the  Pharynx,  Mouth  and  Cer- 
vical Region”,  Dr.  A.  C.  Furstenberg,  University 
of  Michigan. 

April  1U — Section  of  Pathology,  Experimental 
Medicine  and  Bacteriology.  Program:  “Brain 

Tumors  in  Children,  with  Case  Reports”,  Dr.  I.  R. 
Cohn;  “The  Blood  Cell  Sedimentation  Test  in 
Tuberculosis”,  Dr.  I.  Krishna. 

April  21 — Medical  Section.  Program:  Sympos- 
ium on  Scarlet  Fever;  Papers:  “Diagnosis  and 
Epidemiology”,  Dr.  P.  F.  Orr;  “Therapeutics”, 
Dr.  L.  E.  Payne;  “Bacteriology”,  Dr.  T.  L.  Ram- 
sey; discussants,  Drs.  Berman  S.  Dunham  and 
D.  C.  Mebane. 

April  28 — Surgical  Section.  Program:  “The 

After-Treatment  Following  Abdominal  Opera- 
tions”, Dr.  G.  H.  Reams;  discussant.  Dr.  L.  F. 
Smead;  “X-ray  Diagnosis  of  Diseases  of  the 
Uterus  and  Tubes”,  Dr.  M.  E.  Goodrich;  discus- 
sant, Dr.  J.  T.  Murphy. 

The  Four  County  Medical  Society  met  at  the 
Wauseon  Hospital,  March  23.  Guest  speakers 
were  Dr.  C.  D,  Brooks  and  Dr.  Robert  Novey,  De- 
troit, and  Dr.  C.  E.  Hufford,  Toledo. — News  Clip- 
ping 

The  April  meeting  of  the  Four  County  Medical 
Society  was  held  on  April  20  at  the  Knights  of 
Pythian  Hall,  Bryan.  Guest  speakers  were  Dr.  E. 
C.  Mohr,  Dr.  Murray  Goodrich  and  Dr.  Stanley 
Giffen,  all  of  Toledo.  Dr.  Mohr  and  Dr.  Goodrich 
discussed  “The  Diagnosis  of  Small  Lesions  of  the 
Uterus  and  Tubes”  and  Dr.  Giffen  “Vomiting  in 
Infants  and  Small  Children”. — Bulletin. 

Sandusky  County  Medical  Society  met  March  30 
at  Fremont.  Dr.  J.  T.  Murphy,  Toledo,  was  the 
guest  speaker. — News  Clipping. 

Wood  County  Medical  Society  met  at  the 
Woman’s  Club,  Bowling  Green,  on  March  16.  Dr. 
A.  W.  Hemphill,  Dr.  J.  F.  Smith  and  Dr.  C S. 
Ordway,  all  of  Toledo,  presented  the  program. 
Dr.  Hemphill  and  Dr.  Smith  spoke  on  “The 
Routine  Laboratory  Tests  of  Blood  and  Urine 
Used  as  a Factor  in  Diagnosis  by  the  General 


May,  1933 


State  News 


323 


Practitioner”.  Dr.  Ordway’s  paper  was  on  “Pain 
As  a Diagnostic  Factor”. — Ralph  E.  Rasor,  M.D., 
Correspondent. 

Fifth  District 

ACADEMY  OF  MEDICINE  OF  CLEVELAND 

(C.  H.  Heyman,  M.D.,  Secretary) 

April  7 — Clinical  and  Pathological  Section. 
Program:  “A  Case  of  Malignant  Disease  of  the 
Thyroid”,  Dr.  R.  S.  Dinsmore;  “Two  Cases  of 
Dissecting  Aneurism  of  the  Aorta”,  Dr.  A.  Carl- 
ton Ernstene;  “Hereditary  Bilateral  Acoustic 
Tumors”,  Dr.  W.  J.  Gardner;  “Presentation  of  a 
Case  of  Eunuchism”,  Dr.  E.  P.  McCullagh;  “Ex- 
tra-Urinary Tract  Lesions  Producing  Urological 
Symptoms”,  Dr.  W.  E.  Lower;  “Differential 
Diagnosis  of  Mediastinal  Tumors”,  Dr.  B.  H. 
Nichols. 

April  H — Joint  meeting  of  the  Experimental 
Medicine  Section  and  the  Cleveland  Section  of 
the  Society  for  Experimental  Biology  and  Medi- 
cine. Program:  “Further  Experiments  in  Polio- 
myelitis and  Agglutinate  Changes  Against  the 
Enteric  Group  of  Organisms  Found  in  the  Blood 
Serum  of  Convalescent  Poliomyelitis  Patients”, 
Dr.  John  A.  Toomey;  “Atropin  Tolerance  in  In- 
fants and  Children”,  Dr.  James  D.  Pilcher; 
“Serum  Phosphatase  Studies  in  Infants  and  Chil- 
dren”, Dr.  G.  Richard  Russell,  Dr.  Henry  J.  Ger- 
stenberger,  Dr.  A.  J.  Horesh,  Dr.  A.  L.  Van  Horn, 
and  Edna  E.  Chapman,  M.A. ; “Chemical  Changes 
in  the  Blood  in  Experimental  Biliary  Obstruction 
and  Fistula  of  Dogs”,  Dr.  Henry  J.  Gestenberger, 
Dr.  Harry  Goldblatt,  Donalda  N.  Smith,  B.S., 
Edna  E.  Chapman,  M.A.,  and  Catharine  S.  Rose, 
A.B. ; “On  the  Motion  of  Growth:  The  Energetics 
of  Growth  and  Metabolism”,  Dr.  Norman  C. 
Wetzel. 

April  19 — Industrial  Medicine  and  Orthopedic 
Section.  Program:  “Spondylolisthesis”,  Dr.  T.  A. 
Willis;  “Crushed  Forearm”,  Dr.  J.  F.  Corrigan; 
“Pseudoarthrosis  of  the  Costal  Cartilages”,  Dr. 
Geo.  Edw.  Follansbee;  “Arteriovenous  Aneurysm”, 
Dr.  J.  N.  Wychgel;  “Ganglionectomy — Non- 

Union  of  Humerus”,  Dr.  E.  A.  Mastics. 

April  28 — Ophthalmological  and  Oto-Laryng- 
ological  Section.  Program:  “Osteomyelitis  of  the 
Skull”,  Dr.  A.  C.  Furstenberg,  University  of 
Michigan. 

Lorain  County  Medical  Society  held  its  regular 
meeting  April  18  at  the  Congregational  Church, 
commencing  with  a dinner.  Dr.  H.  C.  King, 
Lakewood,  addressed  the  society  on  “Heart  in 
Toxic  Goiter”. — Bulletin. 

Medina  County  Medical  Society  met  in  regular 
session  at  the  Evanon  on  March  16.  Motion  pic- 
tures of  “Surgery  of  Extremities  Following  In- 
juries” and  “Cancer  of  the  Skin”  were  shown. — 
News  Clipping. 

Sixth  District 

Union  Medical  Association,  comprising  the 


county  societies  of  the  Sixth  Councilor  District, 
held  its  226th  session  at  the  New  Administration 
Building,  Wooster  College,  Wooster,  on  Wednes- 
day, April  12.  The  following  program  was  pre- 
sented: “Public  Health — Some  Problems  and 

Suggestions  for  the  Future”,  Dr.  C.  B.  Meuser, 
Ashland ; “Medical  Practice  in  South  America, 
Dr.  J.  L.  Stevens,  Mansfield;  “Medical  Practice 
in  Persia”,  Dr.  R.  C.  McDowell,  Wooster;  “Re- 
cent Contributions  to  the  Etiology  and  Treatment 
of  Nephritis”,  Dr.  J.  M.  Hayman,  Cleveland; 
“Surgical  Research  and  the  Thyroid”,  Dr.  George 
M.  Curtis,  Columbus.  Previous  to  Dr.  Curtis’  ad- 
dress, dinner  was  served  with  Dr.  Charles  F. 
Wishart,  president  of  Wooster  College,  presiding. 
— Bulletin. 

Ashland  County  Medical  Society  held  its  March 
meeting  on  March  10  at  the  Samaritan  Hospital, 
Ashland.  The  guest  speaker  was  Dr.  Bernard  H. 
Nichols,  Cleveland,  who  spoke  on  “Y-ray  and 
Upper  Right  Abdominal  Pain”.  It  was  a very 
interesting  address  and  well  illustrated  with  lan- 
tern slides.  Following  the  general  discussion, 
supper  was  served  by  the  hospital  management. — 
Paul  E.  Kellogg,  M.D.,  Secretary. 

Mahoning  County  Medical  Society  held  its  Sixth 
Annual  Post-Graduate  Assembly  on  April  20  at 
Youngstown.  Those  presenting  the  program  were 
Dr.  James  Ewing,  Dr.  Burton  J.  Lee,  Dr.  Lloyd 
F.  Craver  and  Dr.  Benjamin  S.  Barringer,  all  of 
the  Memorial  Hospital,  New  York  City.  The 
papers  presented  were  on  cancer,  carcinoma,  tum- 
ors, etc. — Bulletin. 

Portage  County  Medical  Society  met  on  April 
6 at  the  home  of  Dr.  J.  H.  Krape.  An  address  on 
“The  Accessory  Sinuses”  was  delivered  by  Dr.  J. 
W.  McCall,  Cleveland. — News  Clipping. 

Stark  County  Medical  Society  met  in  regular 
session  April  11  at  the  Elks’  Club,  Canton.  Dr. 
Norman  E.  Clark  and  Dr.  Clark  Lemley,  both  of 
Detroit,  were  the  guest  speakers.  Dr.  Clark  spoke 
on  “The  Diagnosis  and  Treatment  of  the  Thyro- 
eardiac”  and  Dr.  Lemley  on  “The  End  Results  of 
Thyroid  Surgery”. — Bulletin. 

Wayne  County  Medical  Society  at  its  meeting 
on  March  14  elected  Dr.  L.  A.  Adair  vice  presi- 
dent, succeeding  Dr.  W.  A.  Morton  who  advanced 
to  the  presidency  due  to  the  death  of  Dr.  E.  H. 
McKinney,  Doylestown.  Following  a paper  by  Dr. 
W.  B.  Turner,  four  motion  pictures  on  spinal 
anesthesia  were  shown. — News  Clipping. 

Seventh  District 

Belmont  County  Medical  Society  was  addressed 
by  Dr.  E.  B.  Pierce,  superintendent  of  Molly 
Stark  Sanatorium,  Canton,  on  “The  Manifesta- 
tions of  Early  Tuberculosis”  at  its  meeting  on 
April  11  at  the  Belmont  Sanatorium. — Bulletin. 

Columbiana  County  Medical  Society  met  on 
April  18  and  was  addressed  by  Dr.  Earl  F.  Hen- 
derson, New  Castle,  Pa.,  on  “The  Surgical  As- 
pects of  Peptic  Ulcer”.  Discussions  were  pre- 


324 


The  Ohio  State  Medical  Journal 


May,  1933 


sented  by  Dr.  Crowgey,  Dr.  McGeorge  and  Dr. 
Bailey.- — Bulletin. 

Eighth  District 

Fairfield  County  Medical  Society  held  a lunch- 
eon meeting  March  16  at  the  Boys’  Industrial 
School.  The  guest  speaker  was  Dr.  C.  J.  Shepard, 
Columbus,  who  discussed  various  kinds  of  skin 
disease.— News  Clipping. 

Guernsey  County  Medical  Society  met  April  6 
at  the  Romance  Restaurant,  Cambridge,  and  was 
addressed  by  Judge  Charles  S.  Turnbaugh,  Cam- 
bridge. Judge  Turnbaugh  discussed  “Medical 
Jurisprudence”.  There  was  a good  attendance. — 
News  Clipping. 

Licking  County  Medical  Society  at  its  regular 
meeting  March  31  at  the  Warden  Hotel,  Newark, 
was  addressed  by  Dr.  C.  A.  Doan,  Columbus. — 
News  Clipping. 

Muskingum  County  Academy  of  Medicine  met 
April  5 at  the  American  Legion  Rooms,  Zanes- 
ville. Dr.  H.  M.  Austin,  superintendent  of  the 
Licking  County  Tuberculosis  Sanatorium,  was  the 
guest  speaker. — Bulletin. 

Perry  County  Medical  Society  held  its  regular 
meeting  March  20  at  the  Park  Hotel,  New  Lex- 
ington. The  principal  speaker  was  Dr.  R.  D. 
Book,  Corning,  who  discussed  the  subject,  “State 
Medicine”. — News  Clipping. 

Ninth  District 

Scioto  County — Regular  meeting  of  the  Hemp- 
stead Academy  of  Medicine  was  held  April  10  at 
the  Recreation  Hall  of  the  Nurses’  Home.  Dr. 
Samuel  L.  Meltzer  was  the  principal  speaker, 
taking  as  his  subject,  “X-ray  Studies  of  the 
Chest”. 

At  the  March  meeting  of  the  academy,  held  on 
March  13,  Dr.  C.  A.  Mills,  Cincinnati,  spoke  on 
“Hemorrhages,  Their  Cause  and  Control”. — Bul- 
letin. 

Tenth  District 

ACADEMY  OF  MEDICINE  OF  COLUMBUS 

(John  H.  Mitchell,  M.D.,  Secretary) 

April  3 — General  Session.  Program:  “Sym- 

posium on  Benign  and  Malignant  Lesions  of  the 
Stomach  and  Duodenum;  Papers:  “Treatment”, 
Dr.  W.  B.  Morrison;  “X-ray  Diagnosis”,  Dr. 
James  H.  Warren;  “Medical  Diagnosis”,  Dr.  J.  J. 
Coons;  “Surgical  Diagnosis”,  Dr.  Andre  Crotti. 

April  10 — General  Session.  Program:  “Pre- 
ventive Medicine  for  the  School  Child”,  Dr.  S.  D. 
Edelman;  discussant,  Dr.  Albert  Walton;  “The 
Columbia  Plan  of  Health  Insurance”,  Dr.  Louis 
Jentgen. 

April  17 — Clinical  demonstration  at  White 
Cross  Hospital  by  members  of  the  hospital  staff. 

April  2 if — General  Practitioners’  Section.  Pro- 
gram: “The  Value  of  Periodic  Health  Examina- 
tions”, Dr.  E.  J.  Gordon;  discussants,  Dr.  H.  M. 
Platter  and  Dr.  Jonathan  Forman. 


Crawford  County  Medical  Society  at  its  meeting 
on  April  3 at  the  Bucyrus  City  Hospital  was  ad- 
dressed by  Dr.  Homer  H.  Heath  and  Dr.  Ira  Win- 
ger, both  of  Toledo.  Dr.  Heath  spoke  on  “Tic 
Douloureux”  and  Dr.  Winger  on  “Nasal  Aspects 
of  Tic  Douloureux”.  A round-table  discussion  con- 
cluded the  meeting. — Bulletin. 

Ross  County  Medical  Society  was  addressed  by 
Dr.  A.  Henry  Dunn,  Columbus,  on  the  subject 
“State  Medicine”  at  its  regular  meeting  April  6 
at  Chillicothe. — News  Clipping. 


Undulant  Fever  Now  Listed  as  Major 
Public  Health  Problem 

Undulant  fever,  contracted  from  cattle  and 
hogs  which  are  infected  with  contagious  abortion, 
continues  to  figure  regularly,  and  in  considerable 
number,  in  reports  of  communicable  diseases  from 
the  Ohio  field.  The  fact  that  it  is  being  similarly 
reported  in  other  states,  according  to  the  records 
of  the  U.  S.  Public  Health  Service,  indicates  that 
it  constitutes  a public  health  problem  of  consider- 
able magnitude  and  also  emphasizes  the  necessity 
of  its  more  general  recognition  in  that  aspect. 

Contagious  abortion  is  quite  prevalent  among 
cattle  and  hogs  throughout  the  country.  Persons 
who  drink  raw  milk  from  infected  cattle  or  who 
handle  hogs  or  cattle  that  are  infected  are  likely 
to  contract  the  disease.  The  name,  “undulant 
fever”,  is  applied  to  the  disease  because  attacks 
of  the  fever  come  in  waves  or  undulations.  It  was 
first  recognized  on  the  island  of  Malta,  in  the 
Mediterranean,  in  1887,  and  it  was  thought  for  a 
time  that  it  was  spread  only  through  the  milk  of 
goats,  virtually  the  sole  source  of  milk  supply  in 
the  island.  Now  it  is  known  that  it  may  be  con- 
tracted from  cattle  and  hogs. 

The  disease  is  not  only  disabling,  but  exceed- 
ingly chronic  in  duration.  The  patient  may  be  ill 
for  two  or  three  years  before  any  improvement  is 
noted.  Important  studies  made  by  Miss  Alice  C. 
Evans,  bacteriologist  in  the  U.  S.  Public  Health 
Service,  have  shown  the  relation  between  this 
condition  in  human  beings  and  contagious  abor- 
tion in  cattle.  Conclusions  reached  by  bacter- 
iologists in  the  laboratories  of  the  Ohio  Depart- 
ment of  Health  through  a long  series  of  investi- 
gations are  substantially  in  line  with  those  of  the 
U.  S.  Public  Health  Service,  and  the  morbidity 
records  in  Ohio  indicate  that  it  is  even  more  of  a 
menace  in  this  state  than  in  the  United  States  as 
a whole. 

Out  of  a total  of  2365  recorded  cases  in  the 
United  States  to  the  middle  of  1931,  there  were 
officially  reported  349  cases  in  Ohio,  in  addition  to 
which  Dr.  Walter  Simpson  of  Dayton  has  per- 
sonally investigated  110  other  cases.  In  other 
words,  Ohio,  as  only  one  of  48  states,  has  re- 
ported 349  out  of  2365  officially  recognized  cases, 
or  nearly  15  per  cent  of  the  official  total.  As  the 
number  of  reported  cases  has  remained  fairly 


May,  1933 


State  News 


325 


constant,  there  is  nothing  to  indicate  that  the  re- 
lative position  of  the  state  has  been  substantially 
altered. 

In  certain  states  it  has  been  said  that  undulant 
fever  is  of  greater  importance,  as  a factor  in  the 
public  health,  than  typhoid  fever.  Many  cases  are 
contracted  from  infected  milk.  Fortunately, 
efficient  pasteurization  readily  destroys  any  of 
the  germs  of  this  disease  which  may  be  present 
in  milk.  The  chief  precautions,  therefore,  are  the 
use  of  pasteurized  milk  and  care  when  coming  in 
contact  with  animals  known  or  suspected  to  be 
infected  with  contagious  abortion.  In  a series  of 
cases  living  on  farms  recently  studied  by  the  U. 
S.  Public  Health  Service,  there  were  29  males  and 


six  females.  Of  the  males,  six  cases  are  known  to 
have  originated  through  infection  from  hogs.  In 
Ohio,  where  more  than  80  per  cent  of  the  cases 
have  originated  among  users  of  raw  or  unpas- 
teurized milk,  one  group  of  seven  occupations  in- 
volved 24  farmers,  one  farmer’s  daughter,  one 
veterinarian,  one  cattle  buyer,  one  butcher,  two 
dairymen  and  one  student  of  veterinary  medi- 
cine. All  these  persons,  with  two  exceptions,  gave 
definite  information  of  having  used  raw  milk. 

Persons  who  are  employed  on  farms  or  in  pack- 
ing houses  are  likely  to  contract  the  disease 
through  exposure  in  their  work;  others  may  con- 
tract it  through  consumption  of  raw  milk. — Ohio 
Health  News. 


Daniel  Hunter  Bowman,  M.D.,  Kenton;  Ohio 
State  University,  College  of  Medicine,  1911;  aged 
45;  member  of  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  March  19  at  the  United  States  Veter- 
ans’ Hospital,  Dayton,  of  self-inflicted  wounds. 
Dr.  Bowman  had  been  ill  with  tuberculosis  for  al- 
most a year.  He  practiced  in  Lancaster  and 
Portsmouth  before  locating  in  Kenton  in  1917. 
Dr.  Bowman  served  in  the  medical  corps  during 
the  World  War.  He  was  active  in  medical  and 
health  matters,  having  served  two  years  as  presi- 
dent of  the  Hardin  County  Medical  Society  and 
for  12  years  on  the  Kenton  Board  of  Health.  He 
also  was  a member  of  the  Methodist  Episcopal 
Church,  the  Masonic  Lodge,  the  American  Legion 
and  Phi  Delta  fraternity.  Surviving  are  his 
widow,  one  daughter,  one  sister  and  five  brothers. 

Leeland  W.  Briggs,  M.D.,  Toledo;  Toledo  Medi- 
cal College,  1892;  aged  63;  member  of  the  Ohio 
State  Medical  Association  and  the  American 
Medical  Association;  died  March  17  following  an 
extended  illness.  Dr.  Briggs  was  a native  of 
Attica,  Michigan,  and  located  in  Toledo  in  1895. 
Dr.  Briggs  was  a member  of  the  Elks  and  Pythian 
lodges.  Surviving  are  his  widow  and  two  daugh- 
ters. 

Edward  A.  Brinkerhoff,  M.D.,  Bristolville; 
Eclectic  Medical  College,  Cincinnati,  1886;  aged 
72;  died  April  1 of  pneumonia.  Dr.  Brinkerhoff 
located  in  Bristolville  46  years  ago.  He  was  a 
member  of  the  Congregational  Church  and  the 
Odd  Fellows  Lodge.  Surviving  are  his  widow  and 
two  daughters. 

William  Samuel  Bushnell,  M.D.,  Mansfield;  Co- 


lumbia LTniversity,  College  of  Physicians  and  Sur- 
geons, New  York  City,  1893;  aged  65;  former 
member  of  the  Ohio  State  Medical  Association 
and  a former  Fellow  of  the  American  Medical 
Association;  died  March  21  following  an  extended 
illness.  Dr.  Bushnell  was  a native  of  Mansfield. 
He  was  active  in  various  Masonic  bodies  and  the 
First  Congregational  Church.  Besides  his  widow, 
he  leaves  one  son,  two  daughters,  and  two 
brothers. 

Frank  C.  Curry,  M.D.,  Milford;  Medical  College 
of  Ohio,  Cincinnati,  1881;  aged  75;  member  of  the 
Ohio  State  Medical  Association  and  the  American 
Medical  Association;  died  February  27;  Dr.  Curry 
had  been  a resident  of  Milford  for  the  past  54 
years.  At  one  time  he  was  health  officer  for  Mil- 
ford. He  was  a member  of  the  Masonic,  Odd  Fel- 
lows and  Pythian  lodges.  Surviving  are  his  widow, 
two  sons,  two  daughters  and  three  sisters. 

Arthur  Bradley  Eisenbrey,  M.D.,  Shaker 
Heights;  Western  Reserve  University,  School  of 
Medicine,  1906;  aged  53;  member  of  the  Ohio 
State  Medical  Association  and  the  American 
Medical  Association;  died  March  31  of  heart  dis- 
ease. Bom  in  Germantown,  Pa.,  Dr.  Eisenbrey 
moved  to  Cleveland  at  an  early  age.  Following 
his  graduation  from  medical  school  and  research 
work  at  the  University  of  Pennsylvania,  he  opened 
an  office  in  Cleveland.  Dr.  Eisenbrey  served  22 
months  overseas  as  a major  in  the  Lakeside  Hos- 
pital Unit.  A talented  sculptor,  Dr.  Eisenbrey 
was  widely  known  as  a collector  of  art  and  an- 
tiques and  was  a member  of  the  Professional 
Men’s  Art  Club.  At  the  time  of  his  death,  Dr. 
Eisenbrey  was  a visiting  surgeon  at  City  and  St. 
Alexis  hospitals,  professor  of  oral  surgery  at  the 


326 


The  Ohio  State  Medical  Journal 


May,  1933 


Western  Reserve  University  Dental  School  and  an 
instructor  in  the  Medical  Officers’  Reserve  Corps. 
He  was  a Fellow  of  the  American  College  of 
Surgeons;  a member  of  the  American  Association 
of  Anatomists,  the  University  Club  and  the  Ma- 
sonic Lodge.  Surviving  are  his  widow,  two  sons 
and  one  sister. 

Horace  R.  Hawkins,  M.D.,  Xenia;  Cleveland 
University  of  Medicine  and  Surgery,  1892;  aged 
61 ; died  of  heart  trouble  on  March  15.  Dr.  Haw- 
kins moved  from  Dayton  to  Xenia  in  1895,  and  in 
1916  he  opened  Washington  Hospital,  Xenia.  For 
16  years  he  served  on  the  city  council.  He  was 
active  in  the  Zion  Baptist  Church  and  the  Masonic 
and  Knights  of  Pythias  Lodges.  Surviving  are 
two  sisters  and  one  brother. 

John  B.  Hiron,  M.D.,  Springfield;  Medical  Col- 
lege of  Ohio,  Cincinnati,  1885;  aged  71;  died  April 
4 following  an  extended  illness.  A native  of  High- 
land County,  Dr.  Hiron  had  lived  in  Springfield 
since  1918.  He  retired  from  practice  about  three 
years  ago.  Surviving  are  his  widow  and  one 
sister. 

John  O.  Hoffhine,  M.D.,  Columbus;  Columbus 
Medical  College,  1877;  aged  80;  died  April  1 of 
infirmities  of  age.  He  leaves  his  widow,  two  sons, 
one  of  whom  is  Dr.  Charles  H.  Hoffhine,  Colum- 
bus, two  daughters  and  one  sister. 

Carey  T.  Hull,  M.D.,  Hamilton;  Cincinnati  Col- 
lege of  Medicine  and  Surgery,  1894;  aged  66; 
former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association, 
died  April  2 from  injuries  received  in  a fall.  Dr. 
Hull  was  a member  of  the  Eagles,  Elks,  Moose 
and  Knights  oi  Pythias  lodges. 

Martin  J.  Larkin,  M.D.,  Toledo;  St.  Louis  Uni- 
versity, School  of  Medicine,  1919;  aged  40;  mem- 
ber of  the  Ohio  State  Medical  Association  and  a 
Fellow  of  the  American  Medical  Association; 
died  March  11  as  a result  of  wounds  inflicted  last 
July  by  a bandit.  Dr.  Larkin  was  a native  of 
Toledo  and  at  the  time  of  his  death  was  medical 
director  of  Mercy  Hospital,  Toledo.  He  was  a 
member  of  the  American  College  of  Physicians 
and  the  staff's  at  St.  Vincent’s  and  Lucas  County 
Hospitals.  He  leaves  his  father,  two  brothers  and 
one  sister. 

Lloyd  George  Leland,  M.D.,  Warren;  Western 
Reserve  University,  School  of  Medicine,  1883; 
aged  73;  died  April  2 of  heart  disease.  Dr.  Le- 
land was  a native  of  Trumbull  County  and  re- 
cently celebrated  the  50th  anniversary  of  his  en- 
trance into  medicine.  He  was  a member  of  the 
Masonic  Lodge.  His  widow  survives. 

Donald  H.  Linard,  M.D.,  Cleveland;  Jefferson 
Medical  College,  Philadelphia,  1926;  aged  32; 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died 
March  26  of  pneumonia.  Dr.  Linard  was  child 


psychiatrist  at  the  Cuyahoga  County  Juvenile 
Court.  He  leaves  his  widow  and  one  daughter. 

Emory  Ford  McSherry,  M.D.,  Dayton;  Uni- 
versity of  Pennsylvania,  School  of  Medicine,  1910; 
aged  50 ; former  member  of  the  Ohio  State  Medi- 
cal Association  and  former  Fellow  of  the  Ameri- 
can Medical  Association;  died  March  14  of  heart 
disease.  Dr.  McSherry  was  a native  of  Brook- 
ville  and  moved  to  Dayton  about  eight  years  ago. 
His  widow  survives. 

Edward  G.  May,  M.D.,  Toledo;  Northwestern 
Ohio  Medical  College,  Toledo,  1887;  aged  69;  died 
April  8.  Dr.  May,  former  Toledo  councilman, 
practiced  in  Toledo  for  nearly  45  years.  He  was 
a World  War  veteran.  Dr.  May  was  a member 
of  the  Masonic  Lodge,  Exchange  Club,  Scissors 
Club,  Business  and  Professional  Men’s  Club,  and 
the  American  Legion. 

Earl  L.  Overholt,  M.D.,  Fostoria;  Rush  Medical 
College,  Chicago,  1898;  aged  63;  member  of  the 
Ohio  State  Medical  Association  and  the  American 
Medical  Association ; died  March  15  of  angina 
pectoris.  Dr.  Overholt  was  bom  near  Fostoria. 
He  was  a member  of  the  United  Brethren  Church 
and  the  Masonic  Lodge.  Surviving  are  his  widow, 
one  son,  two  daughters,  his  mother  and  one  sister. 

William  Paterson,  M.D.,  Cleveland;  Cleveland 
Medical  College,  Homeopathic,  1891;  aged  70; 
died  April  7.  He  had  practiced  in  Cleveland  for 
nearly  30  years.  Surviving  are  his  widow  and 
three  daughters. 

Charles  Oliver  Probst,  M.D.,  Columbus;  Miami 
Medical  College,  Cincinnati,  1882;  aged  76;  mem- 
ber of  the  Ohio  State  Medical  Association  and  a 
Fellow  of  the  American  Medical  Association;  died 
April  2 of  pneumonia.  Dr.  Probst  was  known  as 
“the  father  of  public  health  in  Ohio”.  He  was 
instrumental  in  the  organization  of  Ohio’s  first 
state  board  of  health  and  for  25  years  served  as 
secretary  and  administrative  officer  of  that  board. 
In  1917  when  health  administration  in  Ohio  was 
reorganized,  Dr.  Probst  became  a member  of  the 
Ohio  Public  Health  Council  on  which  he  served 
until  his  death.  For  almost  40  years  he  was  a 
leading  figure  in  public  health  activity  in  Ohio. 
Born  at  Middleport,  Dr.  Probst  received  his 
early  education  in  the  Meigs  County  schools. 
After  graduating  from  medical  school,  he  prac- 
ticed for  two  years  at  West  Columbia,  West  Vir- 
ginia, and  for  a short  time  at  Athens  before 
moving  to  Columbus  to  become  secretary  of  the 
State  Board  of  Health.  For  15  years  he  was  pro- 
fessor of  hygiene  at  Starling  Medical  College 
and  for  10  years  secretary  of  the  American  Public 
Health  Association.  He  was  a former  president 
of  the  Ohio  Society  for  the  Prevention  of  Tuber- 
culosis and  former  chairman  of  the  Conference  of 
State  and  Provincial  Health  Authorities.  Dr. 
Probst  was,  in  addition  to  his  medical  affiliations, 
a member  of  the  National  Tuberculosis  Associa- 


May,  1933 


State  News 


327 


tion,  the  American  Climatological  and  Clinical 
Association,  the  Sons  of  the  American  Revolution 
and  the  Columbus  Club.  At  the  time  of  his  death 
he  was  superintendent  of  the  Franklin  County 
Tuberculosis  Sanatorium.  Surviving  are  his 
widow,  two  sons,  one  brother  and  one  sister. 

William  E.  Shackleton,  M.D.,  Cleveland;  Cleve- 
land College  of  Physicians  and  Surgeons,  1895; 
aged  63 ; member  of  the  Ohio  State  Medical  Asso- 
ciation and  a Fellow  of  the  American  Medical 
Association;  died  March  27  of  heart  disease.  Dr. 
Shackleton  was  head  of  the  department  ot 
ophthalmology  at  St,  Luke’s  Hospital,  Cleveland. 
He  had  practiced  in  Cleveland  for  39  years.  Dr. 
Shackleton  was  a member  of  the  Union  Club,  the 
Country  Club,  Pasteur  Club  and  the  American 
Ophthalmological  Society.  He  was  staff  surgeon 
at  Deaconess,  Evangelical  and  Woman’s  hospitals. 
His  widow,  three  daughters  and  two  sons  survive. 

Otto  Stephen,  M.D.,  Cincinnati;  Pulte  Medical 
College,  Cincinnati,  1802;  aged  65;  died  March 
22  following  a month’s  illness.  Dr.  Stephan  had 
practiced  in  Cincinnati  since  graduation  from 
medical  school  except  for  a short  time  at  Ports- 
mouth. He  leaves  his  widow  and  two  daughters. 

David  G.  Stewart,  M.D.,  Ironton;  Columbus 
Medical  College,  1891;  aged  76;  died  March  9 
after  a long  illness.  Dr.  Stewart  was  a native  of 
Lawrence  County  and  practiced  for  many  years 
at  Arabia,  moving  to  Ironton  in  1912  when  he 
retired.  Surviving  are  his  widow,  two  daughters, 
and  one  sister. 

Wilbur  Mason  Warner,  M.D.,  Middletown; 
Pulte  Medical  College,  Cincinnati,  1897;  aged  65; 
former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  April  11  following  an  extended  illness.  Dr. 
Warner  was  vice  chairman  of  the  Middletown 
City  Commission.  He  had  practiced  in  Middle- 
town  for  the  past  21  years.  Dr.  Warner  was  a 
member  of  the  Masonic  and  Woodmen  of  the 
World  lodges.  His  widow  and  one  son  survive. 


KNOWN  IN  OHIO 

John  J.  Atkins,  M.D.,  New  York  City,  formerly 
of  Sandusky;  Loyola  University,  School  of  Medi- 
cine, Chicago,  1926;  aged  30,  died  following  a 
brief  illness.  Dr.  Atkins  left  Sandusky  two  years 
ago  to  join  the  staff  of  Bellevue  Hospital,  New 
York  City. 

Stephen  J.  D.  Meade,  M.D.,  Fort  Thomas,  Ken- 
tucky, formerly  of  Cincinnati;  Pulte  Medical  Col- 
lege, Cincinnati,  1885;  aged  75;  died  March  15  of 
infirmities  of  age.  Dr.  Meade  was  for  many  years 
physician  at  the  Grand  Hotel,  Cincinnati.  For  18 
years  he  was  professor  of  anatomy  at  the  Pulte 
Medical  College.  He  leaves  his  widow,  one  son, 
one  sister,  and  three  brothers,  one  of  whom  is 
Dr.  Charles  C.  Meade,  Cincinnati. 

Edwin  H.  Underwood,  M.D.,  Fort  Wayne,  In- 


diana, formerly  of  Paulding  County;  Hahne- 
mann Medical  College  and  Hospital,  Chicago, 
1905;  aged  62;  member  of  the  American  Medical 
Association;  died  April  4 of  general  septicaemia. 
He  is  survived  by  his  widow,  two  daughters,  three 
sisters  and  two  brothers. 


Opinion  on  Tuberculin  Test  Is  Given  By 
Attorney  General 

It  would  be  legal  for  either  a board  of  educa- 
tion or  a board  of  health  to  give  the  tuberculin 
test  to  school  children  by  means  of  the  injection 
method  or  application  of  a salve,  if  it  is  found  to 
be  a reasonable  measure  for  the  protection  of  the 
public  health  and  safety,  according  to  an  opinion 
rendered  by  Attorney  General  John  Bricker  to 
Dr.  H.  G.  Southard,  state  director  of  health,  in 
reply  to  his  request  for  such  an  opinion. 

Mr.  Bricker  in  his  opinion  classes  the  tuberculin 
with  the  Schick  test  for  diphtheria  and  the  Dick 
test  for  scarlet  fever  as  “a  diagnosis  or  an  ex- 
amination” as  distinguished  from  a preventive  or 
a curative  measure.  On  this  point  he  said : 

“These  tests,  along  with  the  tuberculin  test, 
are  considered  as  diagnosis.  They  are  given  for 
the  purpose  of  ascertaining  whether  a person  has 
or  is  subject  to  the  disease  for  which  it  is  given. 
It  is  not  given  to  prevent  the  disease,  as  is  the 
vaccination  for  smallpox,  nor  is  it  given  to  cure 
the  disease.  When  the  school  boards  or  boards  of 
health  started  vaccinating  school  children  for 
smallpox,  there  was  a great  deal  of  litigation 
and  discussion  concerning  it.  It  was  held  in  Ohio 
that  an  order  requiring  vaccination  of  pupils,  ex- 
cept in  the  emergency  of  an  actual  impending 
epidemic,  could  only  be  sustained  by  direct  and 
specific  legislation.  As  a result  of  similar  rulings 
in  other  states,  most  of  them  passed  specific  legis- 
lation authorizing  either  the  school  boards  or  the 
boards  of  health  to  require  pupils  to  be  vac- 
cinated. 

“The  Schick  test  for  diphtheria  has  been  given 
in  the  schools  of  Ohio  for  a number  of  years;  in 
other  states  both  it  and  the  tuberculin  test  have 
been  given  without  specific  legislation.  I have 
been  unable  to  find  any  reported  cases  either  in 
this  or  any  other  state  and  no  authorities  dis- 
cussing their  legality.  Thus,  though  there  are  no 
rules  by  which  we  can  be  guided,  it  is  an  indica- 
tion that  these  boards  have  considered  themselves 
able  to  require  such  tests  under  general  grants  of 
power.  It  is  my  opinion  that  the  tuberculin  test, 
either  by  injection  or  salve,  must  be  considered 
as  being  given  for  the  purpose  of  diagnosis.  As  a 
result  of  that  conclusion,  it  would  be  legal  for 
the  school  physician  to  give  these  tests  under 
authority  of  Section  7692-1,  General  Code,  unless 
the  test  itself  be  one  of  such  nature  that  it  would 
be  prohibited  on  the  ground  of  public  policy  or 
that  the  police  power  could  not  be  extended  to 
cover  it.  * * * It  would  appear  from  the  broad 
grant  of  power  in  Section  1261-26,  providing  for 


328 


The  Ohio  State  Medical  Journal 


May,  1933 


prompt  diagnosis  and  control  of  communicable 
diseases  and  for  medical  and  dental  supervision  of 
school  children,  that  the  board  of  health  also  may 
legally  administer  the  tuberculin  test,  subject  to 
the  condition  hereinbefore  stated  with  reference 
to  the  power  of  school  physicians  to  give  such  test. 
It  also  would  derive  power  from  the  board  of  edu- 
cation to  do  such  acts  when  the  latter  has  dele- 
gated to  the  board  of  health  the  duty  of  appoint- 
ing a school  physician  as  provided  in  Section  7692, 
General  Code.” 

Attorney  General  Bricker  i-aises  the  question  as 
to  the  efficacy  of  the  tuberculin  test,  quoting 
from  “New  and  Non-Official  Remedies”  to  show 
that  “the  medical  profession  does  not  consider  the 
tuberculin  test  as  being  absolute  nor  even  as 
being  reasonably  accurate”. 

“Measures  taken  to  protect  and  preserve  the 
public  health  fall  within  the  police  power  of  the 
state,”  he  stated.  “The  test  as  to  whether  any 
particular  measure  is  valid  ordinarily  depends  on 
whether  or  not  it  is  reasonable.  The  police  power 
of  the  state  embraces  reasonable  regulations 
established  by  direct  legislation  to  protect  the 
public  health.  The  state  also  may  give  local 
boards  authority  to  take  appropriate  steps  to 
safeguard  the  public  health.  Whether  a measure 
is  reasonable  under  the  police  power  must,  in  the 
last  analysis,  be  determined  by  courts  of  com- 
petent jurisdiction.” 


jiNEWS  NQTESffDHIO 


Ashland — The  importance  of  sanitation  and 
good  medical  care  among  combat  troops  was  dis- 
cussed recently  by  Dr.  H.  M.  Gunn  before  the 
local  Lions  Club.  Dr.  Gunn  is  captain  of  the 
Ashland  hospital  unit  of  the  Ohio  National 
Guard. 

Sandusky — Dr.  E.  J.  Meckstroth  discussed  his 
experiences  in  Vienna  where  he  took  post-grad- 
uate work  in  medicine  at  a recent  meeting  of  the 
brotherhood  of  St.  Paul’s  English  Lutheran 
Church. 

New  Philadelphia — Dr.  E.  D.  Moore  spoke  on 
“Socialized  Medicine”  at  a recent  meeting  of  the 
New  Philadelphia  Rotary  Club. 

Fremont — “Preventive  Medicine”  was  the  sub- 
ject discussed  by  Dr.  0.  H.  Thomas  at  a meeting 
of  the  Otis  Parent-Teacher  Association. 

Toledo — Dr.  N.  E.  Fisher  has  returned  from 
Miami  Beach,  Florida,  where  he  was  recuperating 
from  injuries  received  in  an  automobile  accident. 

Toledo — Dr.  I.  Krishna  has  returned  from 
Perrysburg,  N.  Y.,  where  he  took  post-graduate 
work  in  pulmonary  tuberculosis  at  the  J.  N. 
Adams  Memorial  Hospital. 

Toledo — Dr.  William  M.  Shapiro  has  completed 


nine  months’  post-graduate  work  in  various  New 
York  hospitals. 

Ports-mouth — Dr.  O.  D.  Tatje  has  been  re- 
elected city  health  commissioner  and  Dr.  J.  Paul 
McAfee  city  physician  by  the  Portsmouth  Board 
of  Health. 

Bowerstown — Dr.  Edward  L.  Miller  has  re- 
sumed his  practice  after  taking  a short  post- 
graduate course  in  internal  medicine  at  the  Cook 
County  Hospital  Graduate  School,  Chicago. 

Sidney — Dr.  H.  E.  Beebe  recently  completed  60 
years  of  active  practice,  all  of  which  were  spent 
in  Sidney. 

Cleveland — Dr.  George  W.  Crile  was  elected  a 
vice  president  of  the  English  speaking  section  of 
the  Pan-American  Medical  Congress  at  its  annual 
meeting  recently  at  Dallas,  Texas. 

Cincinnati — Dr.  Louis  G.  Heyn  and  Dr.  Julien 
Benjamin  discussed  the  report  of  the  Committee 
on  the  Costs  of  Medical  Care  before  the  Women’s 
City  Club. 

Xenia — Dr.  A.  C.  Messenger,  resident  physician 
at  the  Ohio  Soldiers’  and  Sailors’  Orphans  Home, 
is  convalescing  from  an  operation  at  the  Miami 
Valley  Hospital,  Dayton. 

Doylestown — Four  physicians  recently  opened 
offices  here.  They  are:  Dr.  George  Hardgrove, 

formerly  of  Barberton;  Dr.  B.  E.  Neiswander, 
formerly  of  Columbus,  and  Drs.  R.  A.  Mathews 
and  J.  L.  Adams,  both  of  Barberton. 

Oxford — Dr.  H.  H.  Smith,  who  recently  com- 
pleted 50  years  of  active  practice,  was  honored 
with  a testimonial  dinner  given  by  Dr.  Gordon  F. 
McKim,  Cincinnati,  at  the  Hotel  Sinton,  Cincin- 
nati. Among  the  guests  was  Dr.  Parke  G.  Smith, 
Cincinnati,  son  of  Dr.  H.  H.  Smith. 

Garretsville — Dr.  E.  P.  Adams,  superintendent 
of  the  Trumbull  County  Tuberculosis  Hospital, 
was  a recent  speaker  before  the  local  Rotary  Club. 

Franklin — Announcement  has  been  made  of  the 
marriage  of  Miss  Hester  Streit,  Norwood,  to  Dr. 
William  Selden  Hamilton,  Franklin.  Dr.  Hamil- 
ton is  now  at  the  Mayo  Clinic,  Rochester,  Minn., 
taking  a fellowship  in  surgery. 

Annual  meeting  of  the  Ohio  Eclectic  Associa- 
tion will  be  held  in  Dayton,  May  16  and  17.  Dr. 
W.  L.  Layport,  Cincinnati,  president  of  the  or- 
ganization, has  announced  the  following  Dayton 
committee  on  arrangements:  Dr.  J.  K.  Bailey,  Dr. 
J.  F.  Heath,  Dr.  J.  F.  Wuist  and  Dr.  J.  D.  Smith. 
The  following  will  serve  on  the  state  committees: 
Dr.  F.  L.  Thomas,  Marion,  registration;  Dr.  B. 
H.  Nellans,  Cincinnati,  Dr.  B.  W.  Mercer,  Tiffin, 
and  Dr.  C.  S.  Smith,  Marion,  credentials;  Dr. 
Cloyce  Wilson,  Cincinnati,  and  Dr.  U.  T.  Lehr, 
Arlington,  auditing;  Dr.  C.  R.  Campbell,  New- 
town, Dr.  A.  H.  Crum,  Cincinnati,  Dr.  J.  D. 
Smith,  Dayton,  nominating;  Dr.  S.  W.  Mattox, 
Marion,  and  Dr.  G.  E.  Jones,  Lima,  exhibits,  and 
Dr.  J.  J.  Sutter,  Lima,  publications. 


May,  1933 


State  News 


329 


HOSPITAL  NOTES 


— Arrangements  have  been  completed  for  the 
annual  meeting  of  the  Ohio  State  Hospital  Asso- 
ciation in  Columbus,  May  2,  3 and  4. 

— Dr.  Merrill  F.  Steele,  Fort  Wayne,  Indiana, 
has  been  appointed  supei-intendent  of  Grant  Hos- 
pital, Columbus,  succeeding  Miss  Mary  A. 
Jamieson,  who  resigned  after  being  associated 
with  the  hospital  for  the  past  22  years.  Dr. 
Steele  was  superintendent  of  the  Fort  Wayne 
Methodist  Hospital  for  10  years  but  had  been  in 
private  practice  since  1931.  He  is  a former  presi- 
dent of  the  Indiana  State  Hospital  Association 
and  is  a graduate  of  Johns  Hopkins  and  Chicago 
universities.  Miss  Jamieson  is  president  of  the 
Ohio  State  Hospital  Association. 

— St.  Ann’s  Hospital,  Cleveland,  recently  cele- 
brated its  60th  anniversary. 

— Dr.  L.  R.  Carr  has  been  elected  chief  of  staff 
of  Flower  Hospital,  Toledo.  Other  officers  are: 
Dr.  E.  W.  Huffer,  vice  chief;  Dr.  J.  A.  Lukens, 
secretary-treasurer;  Dr.  W.  A.  Neill,  director  of 
surgery;  Dr.  H.  F.  Howe,  director  of  medicine. 

— To  conserve  resources,  the  operation  of  Ma- 
ternity Hospital  and  the  Babies’  and  Children's 
Hospital,  Cleveland,  will  be  consolidated  with 
Lakeside  Hospital  for  an  indefinite  period,  the 
trustees  of  the  University  Hospitals  Group  has 
announced. 

— The  new  20-bed  maternity  department  of  St. 
Mary’s  Hospital,  Cincinnati,  was  dedicated  re- 
cently. 

— Dr.  J.  H.  Norris  has  been  elected  chief  of 
staff  of  the  Fostoria  City  Hospital.  Dr.  Harold 
Fruth  was  elected  secretary  and  Dr.  N.  C.  Hat- 
field head  of  the  department  of  surgery;  Dr.  E. 
E.  Sheldon  head  of  the  department  of  medicine, 
and  Dr.  T.  W.  Geohegan  head  of  the  depart- 
ment of  obstetrics. 


What  to  Do  If  Unable  to  Pay  Your 
Federal  Income  Tax 

What  a person  unable  to  pay  his  Federal  In- 
come Tax  can  and  should  do  was  explained  in  a 
special  article  written  by  Special  Deputy  Com- 
missioner P.  R.  Baldridge  of  the  United  States 
Bureau  of  Internal  Revenue  and  published  in  a 
recent  issue  of  The  United  States  Daily. 

The  advice  of  Mr.  Baldridge  on  this  matter,  in 
part,  was  as  follows: 

“How  about  the  man  who  is  unable  to  pay  his 
income  tax? 

“After  the  bank  moratorium  in  early  March 
many  taxpayers  found  themselves  without  ready 


cash  to  meet  payments  on  their  taxes  when  the 
extra  period  of  grace  expired  March  31. 

“What  is  ahead — jail  or  fine? 

“It  is  assumed  that  the  majority  of  persons 
from  whom  returns  were  due  have  at  least  filed 
their  returns  with  the  collector  of  internal  rev- 
enue, even  though  no  payment  accompanied  them. 
Any  taxpayer  who  has  not  filed  a return  is  de- 
linquent in  that  respect,  unless  he  has  secured  an 
extension  of  time  or  makes  his  return  on  a fiscal 
year  basis. 

“The  Revenue  Act  of  1932  pi-ovides  that  in  case 
of  any  failure  to  make  and  file  a return  within 
the  time  specified,  25  per  cent  of  the  tax  shall  be 
added  to  the  amount  except  that  when  it  is  shown 
that  failure  to  file  was  due  to  reasonable  cause 
and  no  willful  neglect,  no  such  addition  shall  be 
made  to  the  tax. 

“Mere  inability  to  pay  the  tax,  or  at  least, 
the  first  quarterly  installment,  is  not  considered 
reasonable  cause  for  failure  to  make  and  file  a 
return. 

“Under  section  3186  of  the  Revised  Statutes, 
passed  July  13,  1866,  the  Government  is  entitled 
to  a lien  against  property  of  persons,  failing  to 
pay  taxes.  Section  3187  provides  the  procedure  to 
be  followed  in  collecting  such  taxes. 

“If  the  taxpayer  finds  he  is  unable  to  make 
payment  at  once,  he  should  discuss  the  matter 
frankly  with  his  local  collector  and  it  may  be  pos- 
sible to  work  out  some  way  by  which  the  tax- 
payer can  file  a surety  bond  or  other  agreement. 
This  will  enable  the  collector  to  exercise  leniency. 

“When  it  is  found  impossible  to  make  collec- 
tion in  full,  part  payments  may  be  accepted. 

“Collection  may  be  forced  by  warrants  of  dis- 
traint. Issuance  of  such  warrants  is  not  uncom- 
mon, the  number  in  the  hands  of  collectors’  field 
forces  for  collection  having  increased  From  15,532 
on  June  30,  1931,  to  21,056  a year  later. 

“Your  Government  is  not  heartless  in  insist- 
ing that  its  taxes  be  paid.  The  1866  law,  still  in 
effect,  protects  from  seizure  school  books,  wearing 
apparel,  arms  for  personal  use,  one  cow,  two  hogs, 
five  sheep  and  the  wool  thereof,  necessary  food  for 
such  livestock,  fuel  worth  $25,  provisions  worth 
$50,  household  furniture  up  to  $300,  and  books, 
tools  or  implements  of  a trade  or  profession  up 
to  $100.  The  act  provides  that  three  disinterested 
householders  of  the  vicinity  shall  appraise  and 
set  apart  to  the  owner  the  amount  of  property 
declared  to  be  exempt. 

“The  situation  at  this  time  in  respect  to  un- 
acceptable checks  is  not  so  bad  as  might  be  ex- 
pected. In  only  two  or  three  collection  districts 
out  of  a total  of  64  has  the  number  of  dishonored 
checks  been  extremely  large. 

“In  all  of  the  districts  the  dishonored  checks 
are  being  replaced  rapidly  by  good  remittances. 
In  many  sections  it  appears  that  taxpayers  with- 
drew large  sums  of  money  from  the  banks  before 
they  were  closed.  For  that  reason  such  taxpayers 
made  the  original  payment  in  cash  or  substituted 
cash  for  checks  that  failed  to  clear.  On  the  whole 
the  conditions  in  this  regard  are  satisfactory.” 


Annual  meeting  of  the  Central  Tri-State  Medi- 
cal Society  will  be  held  May  18  at  the  Hotel 
Prichard,  Huntington,  West  Virginia.  Physicians 
from  Ohio,  Kentucky  and  West  Virginia  are  ex- 
pected to  attend.  Among  Ohio  physicians  who  will 
take  part  in  the  program  are:  Dr.  C.  M.  Fitch, 
Portsmouth;  Dr.  C.  E.  Holzer,  Gallipolis,  and  Dr. 
G.  R.  Micklethwaite,  Portsmouth. 


330 


The  Ohio  State  Medical  Journal 


May,  1933 


POSTGRADUATE  COURSE 


LABORATORY  COURSE 


For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

A house  doctor  is  appointed  July  1st  and 
January  1st 


For  Nurses  and  Graduates  of  High  School 
CLASSES  LIMITED  TO  SIX 
X-ray,  Basal  Metabolism,  Electro-cardiography  and 
Physical  Therapy 


150  clinical  patients  daily  provide  material  for  classes. 

Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 


For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


Diabetes  Death  Rate  Increase  Attributed 
to  Better  Diagnosis 

New  aspects  of  the  diabetics  problem  are  re- 
viewed and  summarized  in  a recent  article  pub- 
lished in  the  Statistical  Bulletin  of  the  Metro- 
politan Life  Insurance  Company. 

Regarding  this  important  medical  question,  the 
article  said  in  part: 

Diabetics  today  live  longer  than  ever  before. 
Basing  his  results  on  the  experience  of  his  pa- 
tients, Dr.  Elliott  P.  Joslin  has  shown  that  the 
duration  of  life  from  the  onset  of  the  disease  to 
death  has  increased  from  five  years,  before  in- 
sulin was  discovered,  to  over  eight  years  at  the 
present  time.  The  increased  duration  of  life  of 
the  living  cases  must  be  even  more  striking. 
Thanks  to  the  use  of  insulin  and  to  the  general 
improvement  in  the  treatment  of  the  disease, 
patients  are  better  able  to  avoid  coma,  formerly 
the  chief  danger  to  them.  Indeed  when  coma  does 
develop,  the  chances  for  recovery  are  now  usually 
excellent.  As  a result,  the  deaths  of  diabetics  are 
due  more  often  to  causes  characteristic  of  their 
age  which  so  frequently  complicate  the  disease, 
namely,  arteriosclerotic  changes  in  the  heart,  kid- 
ney and  brain,  gangrene,  pneumonia  and  cancer. 

Despite  the  increasing  longevity  of  the  diabetic, 
however,  the  total  deathrate  from  the  disease  is 
still  rising.  In  1930,  it  was  the  highest  on  record 
among  the  Industrial  policyholders  of  the  Metro- 
politan Life  Insurance  Company  and  thus  far  in 
1931  there  has  been  no  marked  change  from  the 
high  level  of  mortality  of  the  corresponding 
period  in  recent  years.  On  analysis,  however,  it 
has  been  found  that  the  rate  has  declined  at  all 
ages  under  45.  It  is  only  among  older  persons, 
particularly  women,  where  the  incidence  of 
diabetes  is  highest,  that  the  deathrate  has  in- 
creased. This  rise  is  so  marked  as  to  outweigh 
th«  improvement  at  the  younger  ages. 

In  view  of  the  favorable  effects  from  the  use 
of  insulin,  it  must  be  clear  that  the  upward  trend 
in  mortality  from  diabetes  is  due  largely  to  the 
increase  in  the  reported  number  of  cases  of  the 
disease.  There  is  every  reason  to  believe  that  the 
cases  have  increased  much  faster  than  the  deaths. 
Underlying  this  phenomenon  is  a complex  of 
causes  based  on  fundamental  and  far-reaching 
changes  in  the  structure  of  the  population  which 
have  both  favored  the  development  of  the  disease 
and  have  also  facilitated  its  accurate  diagnosis. 

Chief  among  them  is  the  process  of  urbaniza- 
tion which  has  been  long  going  on  in  the  popula- 


tion of  this  country — but  at  an  accelerated  pace 
within  the  last  decade.  This  movement  from 
country  to  city  has  brought  profound  changes 
into  the  life  of  these  migrants.  Their  work  is 
generally  less  laborious  in  their  new  occupations 
and,  therefore,  requires  less  physical  energy.  But, 
although  their  food  requirements  are  less  than 
before,  the  caloric  value  of  their  new  and  more 
varied  diet  may  be  even  greater.  Similar  in  its 
effect  is  the  large  increase  in  the  immigrant  popu- 
lation of  American  cities.  To  a very  large  extent 
these  immigrants  were  recruited  from  the  peas- 
ant population  of  Europe  and  the  observations 
just  made  hold  true  for  them.  An  appreciable 
number  of  these  immigrants,  moreover,  belong  to 
racial  groups  which  are  more  than  usually  sus- 
ceptible to  the  disease.  The  peak  of  this  immigra- 
tion took  place  in  the  decade  preceding  the  Great 
War.  Because  most  immigrants  are  young  people, 
it  is  only  now  when  they  have  grown  older,  that 
they  are  largely  represented  in  those  age  periods 
in  which  diabetes  occurs  frequently  as  a cause  of 
disability  and  of  death. 

The  changes  in  the  distribution  of  the  popula- 
tion have  had  other  results  which  indirectly  aid 
in  the  detection  of  diabetes.  An  increasingly 
large  proportion  of  people  have  gained  access  to 
better  medical  and  hospital  facilities.  The  de- 
mand for  life  insurance,  too,  has  played  its  part 
in  bringing  hosts  of  persons  under  medical 
scrutiny.  It  is  of  great  significance,  in  relation 
to  diabetes,  that  the  number  of  women  examined 
for  insurance  has  increased  much  faster  than 
that  of  men  in  recent  years.  Incidentally,  the 
greater  mobility  of  the  rural  population  has 
brought  it  more  than  ever  before  within  reach  of 
hospital  facilities  which  even  in  rural  areas  have 
been  appreciably  extended. 

Important  changes  have  likewise  occurred  in 
the  field  of  medicine  that  make  for  better  diag- 
nosis. The  personnel  of  the  medical  profession 
now  contains  a large  proportion  of  young  men 
and  women  who,  unlike  the  older  generation  of 
physicians,  were  trained  from  the  beginning  in 
the  use  of  modern  laboratory  aids  to  diagnosis. 
The  methods  and  equipment  used  have  been,  in 
their  turn,  so  improved  that  the  facts  for  diag- 
nosis are  obtained  with  greater  rapidity,  ac- 
curacy and  ease.  Nor  should  one  forget  the  effect 
of  the  growing  custom  among  physicians  to  make 
urinalyses  as  a routine  matter  in  examining 
patients.  Finally,  the  dramatic  discovery  of  in- 
sulin and  its  remarkable  effectiveness  in  saving 


May,  1933 


State  News 


331 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

THE  PIONEER  POST-GRADUATE  MEDICAL 
INSTITUTION  IN  AMERICA 


TRAUMATIC  SURGERY 


Including 

General  Surgery,  Orthopedic  Surgery 
Physical  Therapy,  Anatomical  Review 
and  Operative  Surgery  on  the  Cadaver. 


For  Information  Address 

MEDICAL  EXECUTIVE  OFFICER 

345  West  50th  Street  NEW  YORK  CITY 


COOK  COUNTY  GRADUATE  SCHOOL  OF  MEDICINE 

(In  affiliation  with  Cook  County  Hospital) 

ANNOUNCES  CONTINUOUS  COURSES 

MEDICINE — General  and  Intensive  Courses,  all  branches 

PEDIATRICS — General  Course — Intensive  Course — Informal  Course 

OBSTETRICS — Extensive  Courses — Two  Weeks  Intensive  Course 

GYNECOLOGY — Three  Months  Course — Two  Weeks  Course 

ORTHOPEDICS — Three  Months  Course — Two  Weeks  Course 

UROLOGY — Two  Months  Course — Two  Weeks  Course 
CYSTOSCOPY— Intensive  Two  Weeks  Course 

SURGERY — Three  Months  General  Course — Two  Weeks  Intensive  Review  Course  Surgical  Technique  (Laboratory) 
General,  Intensive  or  Special  Courses,  Tuberculosis,  Fractures  and  Traumatic  Surgery,  Roentgenology,  Dermatology 
and  Syphilis,  Ophthalmology,  Ear,  Nose  and  Throat,  Anatomy,  Pathology,  Nervous  and  Mental  Diseases. 

Teaching  Faculty — Attending  Staff  of  Cook  County  Hospital 

Address:  Registrar,  427  South  Honore  Street,  CHICAGO,  ILLINOIS 


LANGDON  - MEYER  LABORATORIES 


ESTABLISHED  1919 


Complete  Clinical  and  Chemical  Laboratory  Service  for  Physicians 

FOURTEEN  YEARS  OF  LABORATORY  EXPERIENCE  ARE  AT 

YOUR  SERVICE 


Friedman  Pregnancy  Tests 
Toxicological  Analyses 
Expert  Legal  Testimony 
Blood  Chemistry 
Vaccines 
Etc. 


A post  card  mil  bring  you 
containers  without  charge 


Wasserman  and  Kahn  Tests 
Bacteriological  Analyses 
Pneumococcus  Typing 
Urinalyses 
Tissues 
Etc. 


519  MAIN  STREET 


CINCINNATI,  OHIO 


332 


The  Ohio  State  Medical  Journal 


May,  1933 


and  prolonging  the  lives  of  diabetics  have  re- 
ceived wide  attention  in  the  lay  and  medical 
press.  The  interest  thus  aroused  may  well  have 
caused  physicians  to  give  consideration  to  the 
possibility  of  the  existence  of  the  disease  in  cases 
which  hitherto  would  have  escaped  attention, 
either  entirely,  or  until  the  disease  was  far  ad- 
vanced and  the  patient  beset  with  its  complicat- 
ing and  terminal  conditions. 

Because  of  these  and  other  factors,  the  known 
diabetic  population  has  been  growing  rapidly. 
It  is  not  surprising,  therefore,  that  the  number 
of  deaths  from  the  disease  has  likewise  increased. 
Cases  are  being  discovered  with  greater  fre- 
quency and  at  an  earlier  stage,  and  their  number 
is  depleted  by  death  less  rapidly  than  formerly. 


PUBLIC  HEALTH  NOTES 


Extensive  waterworks  and  sewage  disposal  im- 
provements and  repairs  will  be  made  in  various 
sections  of  Ohio  and  necessary  improvements  at 
the  state’s  penal,  correctional  and  welfare  institu- 
tions will  be  undertaken  if  the  Reconstruction 
Finance  Corporation  grants  the  state’s  request 
for  approximately  $55,000,000  for  unemployment 
relief.  Application  for  the  money  has  been  made 
by  the  State  Relief  Commission.  In  the  schedule 
of  projects  is  an  estimate  of  $24,475,000  for  new 
waterworks  in  13  cities;  an  expenditure  of  $13,- 
675,000  for  repairs  and  improvements  of  sewage 
disposal  plants  in  25  cities;  $14,000,000  for  re- 
forestation and  drainage  projects,  and  several 
millions  of  dollars  for  improvements  at  state  in- 
stitutions. 

— Scientific  Session  of  the  American  Heart 
Association  will  be  held  Tuesday,  June  13,  at  the 
Knickerbocker  Hotel,  Milwaukee. 

— Ninth  Annual  Meeting  of  the  Ohio  Student 
Health  Association  was  held  at  the  Deshler-Wal- 
lick  Hotel,  Columbus,  Friday,  April  7,  with  Dr. 
A.  O.  DeWeese,  Kent  State  College,  president  of 
the  Assocsiation,  presiding.  Among  those  who 
took  part  in  the  program  were:  Drs.  Robert  N. 
Hoyt,  Western  Reserve  University;  L.  B.  Cheno- 
weth,  University  of  Cincinnati;  W.  R.  Morrison, 
Oberlin  College;  L.  W.  Childs,  Cleveland,  R.  L. 
Cummins,  Columbus;  Russell  H.  Williams,  Deni- 
son University;  J.  W.  Wilce,  Ohio  State  Uni- 
versity; George  Lowry,  Ohio  Wesleyan  Univer- 
sity; Lee  H.  Ferguson,  Western  Reserve  Univer- 
sity, and  J.  W.  Jackson,  Baldwin-Wallace  College. 

— New  postage  rates  on  specimens  mailed  to  the 
State  Laboratory  have  been  established.  Physi- 
cians should  consult  with  their  health  commis- 
sioner regarding  them. 


The  Wendt- Bristol 
Company 

Two  complete  ethical  stores  in 
Columbus 

51  E.  State  St.  721  No.  High  St. 

for  the  convenience  of  the  Physicians  and 
Surgeons — and  the  many  people  they  serve 

Two  Prescription  Departments 

maintained  in  a high  class  manner  with 
eight  registered  Pharmacists 
Other  Complete  Departments 
OFFICE  EQUIPMENT 

PHYSIO  THERAPY  APPARATUS 
HOSPITAL  SUPPLIES 

HEALTH  FOODS 

0^3 

W-B  Pharmaceutical  Supplies 
JOBBING  STOCKS  ALL  LEADING 
MANUFACTURERS 

Antitoxins  and  Vaccines  in  Special 
Refrigeration  Plants 

G^O 

Prompt  Service  on  Phone  Ordert 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES- VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 

LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Association. 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Coup,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


May,  1933 


State  News 


333 


Edward  Reinert 


Ph.G.,  M.D. 


247  East  State  Street 


Columbus,  Ohio 


Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 


FRANK  GALLEN,  M.D., 

Dermatology 

Tel.  Main  1537 


LEE  A.  HAYS,  M.D., 

Roentgenology 

University  5842 


W.  H.  MILLER,  M.  D. 


328  East  State  St. 

Office  Telephone,  MAin  3743 


Columbus,  Ohio 
Residence,  EVergreen  5644 


Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

<®^rs> 

Prompt  and  Full  Report 


334 


The  Ohio  State  Medical  Journal 


May,  1933 


Next  Medical  Exams  to  Be  Held  in 
Columubus,  June  6-9 

Examinations  for  licenses  to  practice  medicine 
and  surgery  in  Ohio  will  be  held  in  Columbus 
June  6,  7,  8 and  9,  it  was  decided  by  the  State 
Medical  Board  at  its  regular  meeting  April  3,  the 
first  in  the  new  quarters  of  the  Board  on  the 
ninth  floor  of  the  Wyandotte  Building,  21  West 
Broad  Street,  Columbus.  The  former  offices  of  the 
Board  were  at  85  East  Gay  Street. 


Must  Meet  U.  S..  Standards 

The  Federation  of  State  Medical  Boards  of  the 
United  States  at  its  last  annual  session  at  Chicago 
adopted  the  following  resolution  relative  to  admis- 
sion to  the  practice  of  medicine  in  this  country  of 
American  students  in  foreign  medical  schools: 

1.  That  no  American  student  matriculating  in  a Euro- 
pean medical  school  subsequent  to  the  academic  year  1932- 
1933  will  be  admitted  to  any  state  medical  licensing  examina- 
tion, who  does  not,  before  beginning  such  medical  study, 
secure  from  a state  board  of  medical  examiners  or  other 
competent  state  authority,  a certificate  endorsed  by  the 
Association  of  American  Medical  Colleges  or  the  Council  on 
Medical  Education  and  Hospitals  of  the  American  Medical 
Association,  showing  that  he  has  met  the  premedical  edu- 
cational requirements  prescribed  by  the  aforementioned 
associations. 

2.  That  no  student,  either  American  or  European, 
matriculating  in  a European  medical  school  subsequent  to 
the  academic  year  1932-1933  will  be  admitted  to  any  state 
medical  licensing  examination,  who  does  not  present  satis- 
factory evidence  of  premedical  education  equivalent  to  the 
requirements  of  the  Association  of  American  Medical  Col- 
leges, and  the  Council  on  Medical  Education  and  Hospitals 
on  the  American  Medical  Association  and  graduation  from  a 
European  medical  school  after  a medical  course  of  at  least 
four  academic  years,  and  submit  evidence  of  having  satis- 
factorily passed  the  examination  to  obtain  a license  to 
practice  medicine  in  the  country  in  which  the  medical 
school  from  which  he  is  graduated  is  located. 


New  Books  Received 

The  Medical  Secretary,  by  Minnie  Genevieve 
Morse,  member  of  the  Board  of  Registration,  As- 
sociation of  Record  Librarians  of  North  America. 
The  book  deals  with  the  principal  problems  con- 
fronting the  secretary  without  medical  training 
who  takes  up  the  duties  of  office  assistant  to  a 
physician.  It  also  is  valuable  for  the  trained 
nurse  without  previous  secretarial  training.  The 
chapters  cover  qualifications  for  medical  secre- 
tarial work;  medical  terminology,  medical  corre- 
spondence, bills  and  reports;  case  records;  medi- 
cal indexing  and  filing;  medical  research;  the 
preparation  of  medical  manuscripts;  office  opera- 
tion and  reception  of  patients,  and  the  personality 
of  the  medical  secretary.  The  MacMillan  Com- 
pany, 60  Fifth  Avenue,  New  York  City;  price, 
$1.50. 

Diseases  of  the  Eye,  by  Hofrat  Ernst  Fuchs, 
deceased,  former  professor  of  opththalmology, 
University  of  Vienna;  the  fifteenth  German  edi- 
tion as  revised  by  Maximilian  Saltzmann,  profes- 
sor of  ophthalmology,  University  of  Graz,  Austria, 
and  translated  by  E.  V.  L.  Brown,  M.D.,  profes- 
sor of  ophthalmology,  University  of  Chicago;  the 
tenth  English  edition  of  the  work  of  the  famous 
Vienna  specialist  and  teacher;  J.  B.  Lippincott 
Company,  Philadelphia. 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


A WELL  TRAINED  SECRETARY 

can  mean  dollars  and  cents 
to  you 

Furnish  her  with  a copy  of 

THE  MEDICAL  SECRETARY 

PARTIAL  CONTENTS 

Office  and  Patient;  Medical  Correspondence; 
Bills  and  Reports;  Case  Records;  Preparation 
of  Manuscripts;  Proofreading;  Medical  Ter- 
minology. 

Send  for  this  book  today — $1.50 
THE  MACMILLAN  CO.  Publishers 

Check  with  order 
60  FIFTH  AVENUE,  NEW  YORK 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  advertisements  under  this  heading  are  60  cents 
per  line,  payable  in  advance.  Minimum  charge  of  $1.00 
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Assistance  to  Medical  Writers — Abstracts,,  Translations, 
Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  Place,  Chicago, 
Illinois. 


May,  1933 


State  News 


335 


Pumrgito 


Borden’s  Evaporated 
Milk  was  the  first  evapo- 
rated  milk  for  infant  feed' 
ing  to  receive  the  Seal  of 
Acceptance  from  the 
American  Medical  As- 
sociation  Committee  on 
Foods. 


Wait! ...  is  she  doing  just  what 
the  doctor  ordered? 


TS  she  giving  her  baby  an  Evapo- 
rated  Milk  that  measures  up  to 
your  high  standard  of  quality,  or  is 
she  using  just  any  brand? 

When  you  prescribe  Evaporated 
Milk  for  infant  feeding,  you  have 
in  mind  a high  grade  of  milk  . . . 
pure,  fresh  and  wholesome.  You 
know  that  there  are  differences  in 
Evaporated  Milks. 

But  the  mother  may  not  know  this, 
and  she  needs  your  advice  to  guide 


her  choice  of  brand  and  quality. 

In  all  the  Evaporated  Milks 
produced  by  The  Borden  Com' 
pany,  the  physician  finds  the 
quality  he  demands  for  infant 
feeding.  Careful  selection  of  raw 

/3c?dcn/i 

EVAPORATED 

MILK 


milk  and  rigid  safeguards  through- 
out the  process  of  manufacture 
guarantee  the  quality,  purity  and 
freshness  of  every  Borden  brand . . . 
Borden's  Evaporated  Milk  . . . 
Pearl . . . Maricopa  . . . Oregon  . . . 
St.  Charles  . . . Silver  Cow. 

Write  for  free  sample  of  Borden’s 
Evaporated  Milk  and  scientific  lit- 
erature. Address  The  Borden 
Company,  Dept.  441, 350 Madison 
Avenue,  New  York,  N.  Y. 


336 


The  Ohio  State  Medical  Journal 


May,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

John  B.  Alcorn,  Chairman,  (1933) 

Columbus 

J.  H.  J.  Upham  (1934) Columbus 

C.  W.  Stone  (1935) Cleveland 

H.  M.  Platter,  (ex-officio) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

D.  C.  Houser,  (special) _Urbana 

C.  W.  Waggoner,  (special) Toledo 

A.  H.  Freiberg,  (special) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

A.  B.  Denison,  (1933) Cleveland 

Gilbert  Micklethwaite,  (1935)  ....Portsmouth 
MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

W.  H.  Snyder,  (1933) Toledo 

F.  P.  Anzinger,  (1935) Springfield 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) Toledo 

R.  H.  Birge,  (1935) Cleveland 

MEDICAL  ECONOMICS 

J.  Craig  Bowman,  Chairman,  (1933) 

Upper  Sandusky 
A.  B.  Brower,  (1934) Dayton 

E.  O.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 

V.  C.  Rowland,  Chairman Cleveland 

Jonathan  Forman Columbus 

Beatrice  T.  Hagen . —.Zanesville 

R.  R.  Hendershott Tiffin 

C.  I.  Stephen Ansonia 

MILITARY  AND  VETERANS’  AFFAIRS 

C.  W.  Stone,  Chairman Cleveland 

Fred  K.  Kislig Dayton 

A.  E.  Brant Youngstown 

COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

S.  J.  Goodman,  Chairman Columbus 

John  A.  Caldwell Cincinnati 

I.  P.  Seiler Piketon 

ARRANGEMENTS  1933  ANNUAL  MEETING 

H.  S.  Davidson,  Chairman Akron 

E.  M.  Huston . Dayton 

E.  B.  Shanley New  Philadelphia 

PROGRAM  1933  ANNUAL  MEETING 

C.  L.  Cummer,  Chairman Cleveland 

B.  J.  Hein__ Toledo 

E.  R.  Brush Zanesville 


SECTION  OFFICERS  FOR  1932-1933 


MEDICINE 

Carll  S.  Mundy Chairman 

125  15th  St.,  Toledo 

Cecil  Striker Secretary 

700  Provident  Bank  Bldg.,  Cincinnati 
SURGERY 

Carl  R.  Steinke  Chairman 

1027  Second  Natl.  Bldg.,  Akron 

Norris  Gillette Secretary 

320  Michigan  St.,  Toledo 
OBSTETRICS  AND  PEDIATRICS 

B.  H.  Carroll Chairman 

240  Michigan  St.,  Toledo 

Edward  A.  Wagner Secretary 

2560  Grandin  Rd.,  Cincinnati 


EYE,  EAR,  NOSE  AND  THROAT 


W.  V.  Mullin Chairman 

Euclid  at  93rd  St.,  Cleveland 

Ivor  G.  Clark Secretary 

188  E.  State  St.,  Columbus 

NERVOUS  AND  MENTAL  DISEASES 

J.  Fremont  Bateman Chairman 

Box  36,  Elmwood  Place 

Henry  C.  Schumacher Secretary 

2525  Euclid  Ave.,  Cleveland 

PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 
R.  H.  Markwith Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 


J.  P.  DeWitt,  (1933) Canton 

C.  E.  Kiely,  (1933) Cincinnati 

C.  W.  Waggoner,  (1933) Toledo 

Wells  Teachnor,  Sr.,  (1934) Columbus 

Ben  R.  McClellan,  (1934) Xenia 

E.  R.  Brush,  (1934) Zanesville 

C.  W.  Stone,  (1934) Cleveland 


ALTERNATES 

G.  F.  Zinninger,  (1933) Canton 

L.  H.  Schriver,  (1933) Cincinnati 

John  Sprague,  (1933) Athens 

D.  H.  Morgan,  (1934) Akron 

A.  C.  Messenger,  (1934) Xenia 

A.  Howard  Smith,  (1934) Marietta 

C.  L.  Cummer,  (1934) Cleveland 


June,  1933 


Advertisements 


337 


THE  SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 

TREATS  NERVOUS  AND  MENTAL  DISEASES 


Many  Nervous  and  Mental  patients  need  a change  in  environment,  free- 
dom from  home  cares  and  responsibilities,  proper  rest  and  encouragement,  dur- 
ing the  trying  experience  of  impaired  health.  These  needs,  combined  with  care- 
ful, individual  attention  and  thorough  treatment,  are  provided  for  at  the  Sawyer 
Sanatorium. 

Send  For  House  Book.  Address 

Sawyer  Sanatorium,  White  Oaks  Farm,  Marion,  Ohio 


The  Ohio  State  Medical  Association 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year;  single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 

Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1933) Cleveland 

Gilbert  Micklethwaite,  M.D.  (1935) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager 


Officers  1932-1933 

PRESIDENT 

H.  M.  Platter,  M.D. 

PRESIDENT-ELECT 
C.  L.  Cummer,  M.D. 

TREASURER 

James  A.  Beer,  M.D . 

EXECUTIVE  SECRETARY 

State  Council 

First  District 

Second  District 

E.  M.  Huston,  M.D.  ... ....  . ....  .. 

Dayton 

Third  District 

O.  P.  Klotz,  M.D 

Fourth  District 

Fifth  District 

H.  V.  Paryzek,  M.D.  .. 

Sixth  District 

- ..  ..Akron 

Seventh  District 

E.  B.  Shanley,  M.D.  .....  New 

Eighth  District 

Philadelphia 

Ninth  District 

I.  P.  Seiler.  M.D.  . 

Tenth  District 

Ex-Officio,  The  Ex-President 
D.  C.  Houser,  M.D.  

Urbana 

338 


The  Ohio  State  Medical  Journal 


June,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies 

First  District 

President 

Secretary 

0.  T.  Sproull,  West  Union  . 

Clinton 

Wm.  L.  Regan,  Wilmington  ..  - 

Fayette 

S.  E.  Boggs,  Washington  C.  H._ 

J.  F.  Wilson,  Washington  C.  H. . 

Hamilton 

-Parke  G.  Smith,  Cincinnati 

Geo.  B.  Topmoeller,  Cincinnati 

Highland 

Warren 

-,W.  D.  Bishop,  Greenville 

Miami 

,-F.  D.  Kiser,  Tippecanoe  City 

„G.  A.  Woodhouse,  Pleasant  Hill- 

Allen 

Auglaize 

- E.  F.  Heffner,  Wapakoneta 

C.  C.  Berlin,  Wapakoneta 

Hancock  _ 

Hardin .. 

Logan _ 

Marion 

Mercer 

Seneca 

Van  Wert 

Wyandot 

-B.  A.  Moloney,  Upper  Sandusky_ 

W.  L.  Naus,  Upper  Sandusky . 

Fourth  District 

(With  Third  District  in  Northwestern  Ohio  District) 

Defiance 

Fulton  . 

Henry  . __ 

Lucas 

L.  R.  Effler,  Toledo 

Ottawa 

R.  A.  Willett,  Elmore 

Cyrus  R.  Wood,  Port  Clinton 

Paulding 

Putnam  „ 

Sandusky 

D.  W.  Philo,  Fremont.. . 

Williams  _ 

Wood 

F.  L.  Sterling,  Bowling  Green 

R.  N.  Whitehead,  Bowling  Green- 

Fifth  District 

H.  V.  Paryzek,  Councilor 

— Chrm.  Com.  on  Arrangements 

Ashtabula 

J.  F.  Docherty,  Conneaut 

Cuyahoga 

H.  V.  Paryzek,  Cleveland 

Clarence  H.  Heyman,  Cleveland — 

Erie 

Geauga  . 

Huron ... 

Lake 

Lorain 

Herman  Campbell,  Elyria 

Medina 

Trumbull 

E.  P.  Adams.  Warren 

R.  H.  McCaughtry,  Warren 

3d  Wednesday  in  April,  Jun«,  Aug.. 
Oct. 

4th  Wednesday  in  Feb.,  May  and 
Nov. 

2d  Wednesday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Monday  evening  of  each  w««k. 

1st  Wednesday,  monthly. 

1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 


2d  Thursday,  monthly 
2d  and  4th  Wednesday  noon. 

2nd  Friday,  monthly. 

1st  Thursday,  monthly. 

1st  Friday,  monthly,  except  July 
and  August. 

1st  and  3d  Friday  each  month. 

3d  Thursday,  monthly. 

1st  Friday,  monthly 

Tiffin,  Oct.  3,  1933 
3d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 

1st  Thursday,  monthly. 

17th  of  each  month. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Thursday,  monthly. 

3rd  Thursday,  monthly 
1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


3d  Thursday,  monthly,  except 
July,  August,  December. 

2nd  Thursday  monthly. 

1st  Wednesday,  monthly. 

Friday,  each  week. 

2d  Thursday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Thursday,  monthly. 

3d  Thursday,  monthly. 

Cleveland. 

2nd  Tuesday,  monthly. 

3d  Fri.  Feb.,  March,  May,  Sept,, 
Nov.,  Dec. 

Last  Wednesday,  monthly,  except 
July,  Aug.,  Sept. 

Last  Wednesday,  Apr.  to  Oct. 

3d  Tuesday,  Feb.,  May, 

August,  Nov. 

4th  Tuesday,  monthly. 

2d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  monthly,  except 
June.  July,  August. 


June,  1933 


The  Ohio  State  Medical  Journal 


339 


Societies 

President 

Secretary 

J.  H.  Seiler,  Akron 

2d  Wed.,  Jan.,  April  & Oct. 

Ashland 

H.  M.  Gunn,  Ashland  

.Paul  E.  Kellogg,  Ashland 

2nd  Friday,  Sept,  to  May. 

,C.  T.  Bahler,  Walnut  Creek 

1st  Tuesday,  quarterly,  Jan.,  April, 

July,  October. 

-W.  M.  Skipp.  Youngstown  

3d  Tuesday,  monthly. 

..E.  J.  Widdecombe,  Kent.. 

1st  Thursday,  monthly. 

G.  H.  Bell,  Mansfield  ..  .. 

Last  Thursday,  monthly. 

F.  S.  VanDyke,  Canton 

2d  Tuesday,  monthly. 

Summit 

J.  H.  Selby,  Akron . . ..  

A.  S.  McCormick.  Akron 

1st  Tuesday,  monthly. 

Wayne W A.  Morton,  Wooster R.  C.  Paul,  Wooster 2d  Tuesday,  monthly. 


Seventh  District  _ 


Belmont G.  L.  Ramsey,  Powhatan  Point  C.  W.  Kirkland,  Bellaire 


Carroll (With  Stark  Co.  Society  I 

Columbiana J.  W.  Robinson,  Lisbon T.  T.  Church,  Salem 

Coshocton Floyd  Craig,  Coshocton J.  D.  Lower,  Coshocton 

Harrison  A.  C.  Grove,  Jewett _W.  C.  Wallace,  Hopedale 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville 

Monroe G.  W.  Steward,  Woodsfield A.  R.  Burkhart,  Woodsfield 

Tuscarawas F.  B.  Larimore,  New  Phila. G.  L.  Sackett,  New  Phila i 


1st  Thurs.,  monthly,  4 p.  m., 
except  July  and  August. 

2d  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Wednesday,  monthly. 

Last  Thursday,  monthly. 

2d  Wednesday,  monthly. 

2d  Thursday,  monthly.  ' 


eighth  District 


Athens C.  E.  Welch,  Nelsonville — T.  A.  Copeland,  Athens 

Fairfield E.  B.  Roller,  Lithopolis C.  W.  Brown.  Lancaster 

Guernsey C.  C.  Headley,  Cambridge E.  F.  Hunter,  Cambridge 

Licking Geo.  W.  Sapp,  Newark G.  A.  Gressle,  Newark — 

Morgan D.  G.  Ralston,  McConnelsville C.  E.  Northrup,  McConnelsville 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 


1st  Monday,  monthly. 

2d  Tuesday,  monthly. 

1st  and  3rd  Thursday  each  month. 
Last  Friday,  monthly. 

3d  Wednesday,  monthly. 

1st  Wednesday,  monthly. 


Noble 


Parry James  Miller,  Corning _F.  J.  Crosbie,  New  Lexington Sd  Monday,  monthly. 

Washington  W.  W.  Sauer,  Marietta G.  M.  James,  Marietta 2d  Wednesday,  monthly 


Ninth  District 


Gallia O.  A.  Vornholt.  Gallipolis Milo  Wilson,  Gallipolis 

Hocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan 

Jackson __J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 

Lawrenca Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 

Haigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy __ 

Pika L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly 

Bcioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 

Vinton O.  S.  Cox.  McArthur H.  S.  James.  McArthur __ 


1st  Wed.,  Feb.,  May,  Sept,  and  Deo. 
Qurrterly. 

2nd  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  bi-monthly. 

1st  Monday,  monthly. 

2d  Monday,  monthly. 

3d  Wednesday,  monthly 


Tenth  District 


Crawford E.  C.  Brandt,  Crestline R.  L.  Solt,  Bucyrus 

Delaware Geo.  D.  Lowry,  Delaware J.  G.  Parker,  Delaware 

Franklin Jonathan  Forman,  Columbus John  H.  Mitchell,  Columbus 

Knox S.  O.  Gantt.  Centerburg R.  L.  Eastman,  Mt.  Vernon 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  Jefferson 

Morrow F.  M.  Hartsook,  Cardington T.  Caris,  Mt.  Gilead 

Pickaway C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville 

Kobb Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 

Union E.  J.  Marsh.  Broadway Angus  Maclvor.  Marysville 


1st  Monday,  monthly. 

1st  Tuesday,  monthly. 
Every  Monday,  8 :30  p.  m. 
Last  Thursday,  monthly. 
4th  Wednesday,  monthly. 
1st  Wednesday,  monthly. 
1st  Friday,  monthly. 

1st  Thursday,  monthly. 

2d  Tuesday,  monthly. 


340 


advertisements 


June,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 


This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL,  M.D. 

Medical  Directors. 

Dayton,  Ohio 

MRS.  GEORGE  V.  SHERIDAN. 

President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

WILLIAM  LYNDON  CROOKS 
Resident  General  Manager 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


\ N approved  and  fully  equipped  Sanitarium 
for  convalescence,  diagnosis,  physical 
therapy,  and  medical  attention  under  recog- 
nized physicians. 

Created  like  a country  estate,  28  miles  south 
of  Pittsburgh.  No  mental  or  drug  cases. 
Admission  by  letter  from  physician  is  desired. 
Reports  will  be  made  to  him  on  request. 
Specially  interested  in  diabetes,  arthritis,  neu- 
ritis, anemias,  cardiovascular  diseases,  gen- 
eral orthopedic  conditions.  Isolation  for  nerv- 
ous cases.  Physical  therapy  in  all  phases. 
Address  professional  mail  to  G.  H.  McKinstry, 
M.D.,  Box  483  i;  Hills  view  Farms,  Washing- 
ton, Pa.  Phone:  Washington  2650. 


THE  OXFORD  RETREAT 

Oxford,.  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 
FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


WHITING  MINERAL  SPRINGS 

SANITARIUM  AND  BATHS 

L.  A.  WHITING,  Owner 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and  allied  diseases, 
together  with  cases  for  elimination  and  rest  cure. 

Medical  department  thoroughly  proficient  and  STRIClLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

WHITING  SANITARIUM  » » M A R T I N S VI L L E,  I N D . 

VAN  W.  WHITING,  Manager  DR.  R.  H.  RICHARDS,  Medical  Director 


THE  MERCER  SANITARIUM  - MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  hisane,  Norristown,  Pa.) 


Hilith  Editorial  Comment  by  D.K.M. 


The  87th  Annual  Meeting  of  the  Ohio  State  Medical  Association  will  be  held  in 
Akron  on  Thursday  and  Friday,  September  7 and  8,  1933. 

Determination  of  the  time  and  place  for  the  1933  meeting  of  the  State  Association 
was  made  by  The  Council  at  its  meeting  in  Columbus  on  May  7. 

As  announced  in  the  April  and  May  issues  of  The  Journal,  the  Council  of  the 
State  Association,  acting  through  a special  Executive  Committee,  postponed  the  87th 
Annual  Meeting,  scheduled  originally  to  be  held  in  Akron,  May  2 and  3,  1933. 

Improvement  recently  in  the  business  situation  generally,  together  with  a growing 
sentiment  among  the  membership  of  the  State  Association  in  favor  of  holding  an 
annual  meeting  this  year,  convinced  the  Council  that  the  meeting  should  not  be  dis- 
pensed with  but  should  be  held  at  the  earliest  suitable  time. 

Acceding  to  the  wishes  of  the  medical  profession  of  Akron,  expressed  officially  in 
a communication  from  the  Summit  County  Medical  Society,  that  the  87th  Annual 
Meeting,  if  held,  be  held  in  that  city,  the  Council  selected  September  7 and  8 as  the 
dates  for  the  meeting  and  the  Akron  profession  as  the  host  for  the  occasion. 

It  was  reported  to  the  Council  that  the  Akron  committees  are  still  fully  organized 
and  ready  to  complete  their  plans  for  making  the  Akron  gathering  one  of  the  best  in 
the  history  of  the  State  Association. 

Following  the  advice  and  recommendations  of  the  Council  Executive  Committee 
and  the  Council  Program  Committee,  the  Council  voted  that  the  full  program  which 
has  been  arranged  for  the  Annual  Meeting  should  be  carried  out  as  far  as  it  is  possible 
to  do  so. 

The  Program  Committee  has  been  instructed  to  make  every  possible  effort  to  have 
the  unusually  attractive  scientific  program  originally  planned  presented  at  the  Akron 
meeting,  with  the  possible  exception  of  some  few  changes  and  adjustments  to  meet 
conflict  in  dates  on  the  part  of  a few  essayists.  It  is  quite  probable  that  the  complete 
schedule  of  excellent  scientific  presentations  and  other  attractions  previously  arranged 
can  be  carried  out,  assuring  the  membership  of  one  of  the  best  meetings  ever  held  by 
the  State  Association. 

Detailed  information  relative  to  the  Akron  meeting  will  be  published  in  forth- 
coming issues  of  The  Journal,  including  the  complete  official  program,  reports  of  stand- 
ing and  special  committees,  hotel  information,  and  data  on  special  entertainment,  the 
golf  tournament,  etc. 

At  present,  every  member  of  the  State  Association  should  begin  making  his  plans 
to  be  in  Akron  on  September  7 and  8. 


354 


The  Ohio  State  Medical  Journal 


June,  1933 


Action  of  the  American  Hospital  Association  in 
endorsing  the  principle  of  periodic  payment  of 
the  costs  of  hospital  care  and  in  issuing  a bro- 
chure suggesting  a model 
program  for  group  hospital- 
ization has  stimulated  think- 
ing along  similar  lines  among 
many  hospital  boards  and  ex- 
ecutives throughout  the  coun- 
try. 


Insurance 


At  present,  plans  looking  toward  setting  up 
hospital  insurance  programs  are  being  studied  in 
a number  of  cities  in  Ohio.  At  the  recent  annual 
meeting  of  the  Ohio  Hospital  Association  in  Co- 
lumbus, this  subject  was  discussed  in  consider- 
able detail. 


It  is  quite  obvious  that  the  widespread  depres- 
sion has  been  a powerful  incentive  to  hospital  ad- 
ministrators to  consider  any  plan  suggested  for 
stabilizing  or  increasing  hospital  income. 

In  all  probability  during  the  ensuing  year,  in- 
creased experimentation  in  hospital  financing  will 
take  place.  Definite  trends  in  several  directions 
already  are  apparent,  with  group  hospitalization 
being  given  foremost  consideration. 

Because  of  its  intimate  relationship  with  hos- 
pitals, the  medical  profession  is  in  a position  to 
realize  the  difficulties  confronting  many  such  in- 
stitutions. Why  many  hospitals  are  being  literally 
compelled  to  take  radical  steps  to  save  them- 
selves is  obvious  to  most  physicians  who,  like- 
wise, find  themselves  faced  with  serious  economic 
problems. 

However,  the  medical  profession,  although 
sympathetically  inclined  toward  hospitals  in  their 
effort  to  meet  their  financial  emergencies,  dare 
not  disregard  the  inevitable  fact  that  serious 
medical  problems  will  arise  in  connection  with  any 
attempts  to  radically  change  the  present  re- 
lationship, financial  or  otherwise,  between  the 
hospital  and  the  public. 

The  medical  profession  in  practically  every 
community  is  faced  with  the  responsibility  of 
giving  this  question  careful  and  thorough  con- 
sideration. 


Many  medical  societies  throughout  the  country 
have  already  launched  upon  a study  of  the  prob- 
lems which  necessarily  would  be  involved  in  any 
and  all  types  of  insurance  schemes,  as  evidenced 
by  recently  published  articles  in  the  press,  both 
lay  and  medical. 

In  a recent  issue  of  the  Sedgwick  County  Medi- 
cal Bulletin  (Wichita,  Kansas),  Dr.  C.  D.  Mc- 
Keown,  president  of  the  society,  warns  the  mem- 
bership that  “in  spite  of  ethics  or  some  of  our 
whims  toward  the  problem,  the  time  is  at  hand 
when  we  should  show  our  hand  and  attack  this 
problem  in  fact,  not  in  fancy”. 

Dr.  James  C.  Sargent,  president  of  the  Mil- 
waukee Medical  Society,  writing  in  the  Milwaukee 
Medical  Times,  urges  the  membership  of  that  so- 


ciety to  study  developments  in  hospital  financing 
movements. 

“For  the  directors  of  a hospital  to  embark  on 
any  revoluntionary  economic  experiment  without 
the  full  understanding  and  hearty  approval  of 
those  doctors  who  have  been  most  loyal  supporters 
seems  unthinkable”,  he  declared. 

“When  approached  with  the  rather  tempting 
suggestion  that  the  services  of  the  hospital  be  sold 
on  an  insurance  basis,  staff  physicians  might  well 
consider  what  have  been  the  effects  of  similar  de- 
velopments elsewhere.  Under  such  a scheme  the 
patient  deals  primarily  with  the  hospital,  and  too 
often  the  choice  of  physician  comes  to  be  a mat- 
ter of  choice  by  the  hospital  rather  than  by  the 
patient. 

“Both  the  medical  profession  and  the  public 
have  as  much  to  fear  from  medical  practice  under 
hospital  control  as  under  control  of  the  insurance 
corporations  or  the  state  itself.” 

Above  all  things,  the  medical  profession  should 
not  be  deluded  into  believing  that  the  question  of 
hospital  insurance  is  not  a medical  problem,  all 
arguments  to  the  contrary  notwithstanding.  It  is. 
The  appropriate  time  to  give  it  the  consideration 
it  deserves  is  now. 

As  one  writer  has  pointed  out  with  regard  to 
hospital  insurance: 

“Once  it  is  started,  controlled  by  lay  middle- 
men, it  is  not  improbable  that  its  benefits  can  be 
extended  to  a point  where  they  will  invade  the 
field  of  the  private  practitioner.” 


Members  of  the  medical  profession  may  find 
some  solace  in  the  fact  that  several  of  the  better 
known  investigations  and  reports  during  the  past 
year  relative  to  medical 
economic  and  social  ques- 
tions have  apparently 
found  little  favor  among 
radical  individuals  and 
groups  whose  chief  ob- 
ject is  to  bring  about  among  other  things  the 
complete  socialization  of  medical  services. 

In  a recent  issue  of  the  American  Labor  Legis- 
lation Review,  edited  by  the  socially-minded  John 
B.  Andi*ews,  several  sharp  digs  are  taken  at  sev- 
eral reports  and  books  published  during  1932  on 
questions  of  medical  care,  costs  of  medical  ser- 
vices, etc. 

Mr.  Andrews  believes  Sir  Arthur  Newsholme’s 
book,  “Medicine  and  the  State”  a “well  organized 
volume”,  but  finds  fault  with  the  fact  that  “it 
carefully  tempers  its  valuable  scientific  observa- 
tions with  ‘practical  consideration  of  what  is  at- 
tainable under  existing  conditions’  ”.  He  also 
points  out  that  “this  note  also  frequently  runs 
through  the  other  reports  when  it  is  thought  the 
medical  practitioners’  group  is  to  be  placated,  or 


June,  1933 


Editorial 


355 


where  an  easy  alibi  is  sought  for  not  urging 
effective  action  ‘at  this  time’.” 

A.  M.  Simons  and  Nathan  Sinai,  authors  of 
“The  Way  of  Health  Insurance”  also  are  panned 
by  the  secretary  of  the  American  Association  for 
Labor  Legislation. 

“These  authors  understand  economic  con- 
ditions,” he  declares,  “but  while  criticizing  exist- 
ing working  plans  of  social  medical  organization 
they  display  no  inclination  to  face  criticism  in- 
volved in  any  original  proposal — except  cautious- 
ly to  suggest  that  complete  extension  of  dental 
care  of  all  school  children  at  public  expense 
would  increase  the  work  of  the  dental  profession 
and  therefore  be  acceptable,  provided  it  is  not 
called  state  medicine.  This  will  amuse  those  who 
recall  how  enthusiastically  Simons  frothed  at  the 
point  of  his  pen  twenty  years  ago  as  editor  of  the 
Chicago  Daily  Socialist.” 

Concerning  the  report  of  the  Committee  on  the 
Costs  of  Medical  Care,  Editor-Secretary  Andrews 
said : 

“On  November  29,  the  elaborate  Committee  on 
the  Costs  of  Medical  Care,  of  which  Secretary 
Wilbur  was  chairman,  finally  submitted  its  con- 
clusions in  what  is  already  dubbed  ‘the  Wilbur- 
sham  report’.  But  judgment  should  in  all  fair- 
ness be  tempered. 

“From  the  appointment  of  the  carefully  chosen 
fifty  members  until  the  qualifying  footnotes  and 
minority  reports  by  numerous  participants  were 
inserted  in  the  final  rewritten  draft,  it  must  be 
admitted,  however,  that  the  transparent  purpose 
was  to  take  into  camp  the  die-hard  representa- 
tives of  the  medical  profession  who,  of  course,  re- 
warded this  effort  by  filing  in  the  end  a vigorous 
dissenting  minority  report.  And  among  all  the 
rest  only  one — Walton  H.  Hamilton  of  Yale — had 
the  intestinal  stamina  to  break  away,  in  a well- 
reasoned  personal  statement,  from  the  complacent 
hand-picked  majority  who  find  it  more  pleasant 
to  contemplate  still  further  extended  study  in  the 
future  than  to  risk  the  arrows  of  intrenched 
prejudice  now.  Hamilton  concludes  ‘Compulsory 
health  insurance  is  the  very  minimum  which  this 
Committee  should  have  recommended’.  One  other 
member,  Edgar  Sydenstricker,  perhaps  the  fore- 
most authority  in  America,  flatly  and  tersely  re- 
fused to  sign  the  majority  report.  How  he  hap- 
pened to  be  named  on  the  Committee  originally  is 
not  known.  Already  a continuing  committee  is 
formed  with  the  timely  slogan:  “We  must  quit 
pussyfooting  and  compromising”. 

It  will  be  remembered  that  some  years  ago,  Mr. 
Andrews  and  his  organization  sponsored  a vigor- 
ous campaign  for  state-controlled  compulsory 
health  insurance.  The  campaign  failed  at  that 
time.  Mr.  Andrews’  criticism  of  recent  studies  in 
the  field  of  health  and  medicine  indicates  that 
even  many  new-era  socialists  do  not  look  with 
favor  on  his  radical  ideas. 

Mr.  Andrews’  disagreement  with  the  recom- 


mendations of  the  majority  group  of  the  Com- 
mittee on  the  Costs  of  Medical  Care  is  one  of  the 
strongest  talking  points  in  favor  of  the  relatively 
conservative  recommendations  made  by  the  minor- 
ity group  of  that  committee  which,  of  course,  are 
still  farther  removed  from  his  own  radical  views 
than  the  recommendations  he  objects  to. 

It  is  becoming  more  evident  that  the  majority 
report  of  the  Committee  on  the  Costs  of  Medical 
Care  pleased  few  individuals  except  those  who 
signed  it. 


In  a recent  issue  of  The  Survey,  Dr.  H.  Jackson 
Davis,  medical  director  of  the  New  York  State 
Temporary  Emergency  Relief  Administration,  de- 
scribed the  workings  of  the 
Participation!  emergency  relief  law  of 


Problems  sions  relating  to  the  fur- 

nishing of  medical  care  to 

the  needy. 

The  methods  used  in  New  York  to  provide  re- 
lief for  the  needy  and  unemployed  differ  as  to 
detail  from  those  in  effect  in  Ohio.  However,  in 
the  final  analysis,  the  programs  are  similar  in 
that  the  primary  responsibility  rests  with  local 
communities  for  carrying  out  the  objectives. 

Because  of  this,  Dr.  Davis  points  out,  many  of 
the  county  medical  societies  of  New  York  State 
have  formed  special  committees  to  confer  with 
local  commissioners  of  relief  for  the  purpose  of 
discussing  questions  of  local  and  mutual  interest. 

If  such  a plan  has  been  found  beneficial  in 
New  York  State — and  it  has — from  the  stand- 
point of  all  concerned,  patients,  doctors  and  tax- 
payers, it  may  well  be  copied  by  the  component 
groups  of  medical  organization  of  Ohio. 

Obviously,  most  of  the  problems  of  medical  re- 
lief to  the  poor  of  this  state  are  essentially  local. 
They  differ  according  to  the  needs  and  resources 
of  the  various  communities.  A plan  which  meets 
the  requirements  of  one  city  or  county  may  not  be 
adequate  for  those  of  an  adjoining  county.  Local 
initiative  and  local  responsibility  must  prevail  to 
a large  degree. 

Affected  as  it  is  by  the  emergency  conditions 
which  have  arisen,  the  medical  profession  of  Ohio 
has  the  right  to  a voice  in  how  medical  relief 
shall  be  administered  to  the  Tieedy.  However,  the 
question  is  one  which  must  be  met  by  the  various 
county  medical  societies  in  cooperation  with  the 
welfare  officials  and  agencies  of  their  respective 
communities.  Frequent  conferences  between  re- 
lief officials  and  representatives  of  the  medical 
profession  in  all  counties  undoubtedly  would  clear 
up  misunderstandings,  give  both  groups  a better 
insight  of  the  problems  of  each,  and  work  to  the 
advantage  of  all  mutually  interested  in  seeing 
that  the  necessary  relief  work  is  administered  on 
a basis  which  is  fair  and  equitable  to  all  con- 
cerned. 


356 


The  Ohio  State  Medical  Journal 


June,  1933 


The  workings  and  results  of  the  plan  recently 
inaugurated  by  the  Wayne  County  Medical  So- 
ciety (Detroit)  providing  for  group  medical  care 

by  members  of  the  so- 
A Unique  Flan  ciety  to  a11  persons  at  a 

c r,  charge  commensurate 

©1  OfOEp  with  their  ability  to  pay 

Medical  (Care  undoubtedly  will  be 

watched  with  consider- 
able interest  by  physicians  everywhere. 

Some  phases  of  the  project  are  unique.  Others 
have  been  in  use  to  varying  degrees  in  other 
cities.  Under  a cooperative  agreement  with  the 
Detroit  Department  of  Health,  the  organized 
medical  profession  of  Detroit  more  than  a year 
ago  developed  a method,  known  as  the  “Detroit 
Plan”,  through  which  preventive  medical  work  is 
carried  on  by  the  private  physician  in  his  own 
office.  This  project  has  been  regarded  by  many  as 
a distinct  success  and  may  have  paved  the  way 
for  similar  results  for  the  new  project  in  making 
curative  medicine  available  to  all  at  the  hands  of 
the  individual  practitioner. 

As  summarized  in  The  Bulletin  of  the  Wayne 
County  Medical  Society,  the  group  treatment  plan 
involves  the  following  essential  features: 


1.  The  members  of  the  society  become  the  active 
staff,  furnishing  all  forms  of  medical  care,  con- 
sultation, X-ray  and  laboratory  procedures  in 
their  offices,  laboratories,  or  hospitals  to  which 
they  take  their  patients. 

2.  The  headquarters  office  of  the  society  be- 
comes a central  coordinating  center  for  those  who 
are  in  need  of,  but  cannot  afford  complete  diag- 
nostic service  at  customary  rates. 


3.  Forms  are  used  for  obtaining  data  on  each 
patient  or  family  for  the  purpose  of  ascertaining 
the  percentage  ability  to  pay,  to  be  filled  out 
either  at  the  headquarters  office  or  in  a physician’s 
office. 


4.  After  the  percentage  rating  has  been  de- 
termined, an  equable  basis  is  furnished  each 
physician,  X-ray  or  clinical  laboratory  for  the 
making  of  chai'ges. 

5.  Patients  who  apply  to  the  headquarters  office 
are  directed  to  a general  practitioner  who  volun- 
teers to  participate  in  the  project. 

Explaining  the  plan  to  Detroit  physicians,  the 
Wayne  County  Bulletin  declared: 

“In  the  operation  of  this  plan,  the  majority  of 
patients  will  come  to  you  as  at  present.  Many  of 
the  middle  class  not  now  availing  themselves  of 
medical  care  will  find  it  to  their  advantage  to 
come  to  you  instead  of  going  without  that  care  or 
patronizing  the  free  clinics. 

“The  most  important  feature  of  the  plan  is  that 
it  places  complete  diagnostic  facilities  within  the 
reach  of  every  worthy  patient  at  a cost  directly 
proportionate  to  his  ability  to  pay.  It  provides  in 
addition,  the  advantages  of  a well-organized  type 
of  group  practice,  free  choice  of  physician,  and 


the  preservation  of  the  present  fundamentals  of 
medical  practice.” 

The  new  Detroit  plan  is  but  in  its  infancy. 
Weaknesses  and  flaws  may  appear  as  the  project 
develops.  It  may  or  may  not  produce  the  hoped- 
for  results. 

Nevertheless,  it  is  further  tangible  evidence  of 
the  desire  on  the  part  of  the  medical  profession  as 
a whole  to  attack  in  a constructive  manner  the 
important  problems  over  which  it  has  some  con- 
trol. 

The  new  program  launched  in  Detroit  is  an 
example  of  thinking  and  planning  on  the  part  of 
organized  medicine.  Programs  of  similar  im- 
portance have  been  put  into  effect  in  all  parts  of 
the  country,  including  some  parts  of  Ohio. 

The  medical  profession  possesses  within  its  own 
ranks  the  leadership  and  ability  to  readjust  itself 
to  new  conditions  and  to  develop  ways  and  means 
of  meeting  new  situations  without  destroying  the 
fundamentals  of  good  medical  service  about  which 
it  is  best  qualified  to  speak. 

By  putting  this  leadership  and  ability  to  work 
in  local  communities  for  the  purpose  of  meeting 
local  problems  and  conditions,  the  profession  can 
do  much  to  preserve  the  cherished  fundamentals 
of  present  medical  practice  and  at  the  same  time 
safeguard  the  interests  of  the  public  generallly. 


“I  hear  some  members  of  business  bodies  talk- 
ing these  days  about  the  possibility  of  resigning 
from  their  organizations  with  the  object  mainly 
of  supposedly  saving  money. 

Team  Work  1 can  think  of  nothing  moro 

dangerously  extravagant 
Vital  !N©W  than  that,  a wasteful  squan- 

dering of  that  invaluable 
asset  of  good  team  work  at  the  very  time  ivhen 
collaboration  is  absolutely  vital.  When  you  are 
out  in  mid-Atlantic  in  a storm,  do  you  see  any- 
body shoving  off  from  the  big  liner  in  a rowboat 
by  himself  to  save  passage  money?  Well,  hardly! 
Mass  action  is  imperative  and  mass  assaults  can 
move  mountains.” — Julius  Klein,  former  assistant 
secretary  of  commerce  of  the  United  States. 

Those  who  have  at  least  a moderate  knowledge 
of  some  of  the  critical  problems  confronting  the 
medical  profession  will  weigh  carefully  this 
sound  advice  from  one  who  has  had  much  ex- 
perience in  and  learned  many  lessons  from  or- 
ganized effort  and  activity.  Few,  if  any,  can  deny 
the  present  need  for  maintenance  by  the  medical 
profession  of  the  strongest  possible  organization 
— strong  in  numbers,  militant  in  spirit,  and  un- 
tiring in  its  concerted  efforts  to  protect  the  in- 
terests of  the  medical  profession,  and  in  so  doing, 
the  interests  of  the  public  at  large. 


Transurethral  Resection  of  the  Prostate?  A Conservative 

Procedure 

Wm.  E.  Lower,  M.D.,  and  Wm.  J.  Engel,  M.D.,  Cleveland,  Ohio 


AT  THE  present  time  there  is  a wave  of  en- 
thusiasm among  a group  of  urologists  for 
transurethral  methods  for  the  relief  of 
prostatic  obstruction.  After  two  years’  experi- 
ence, in  one  hundred  cases,  it  is  my  purpose  in 
this  paper  to  evaluate  this  procedure  in  the  light 
of  our  results.  We  have  given  the  method  im- 
partial scrutiny,  and  though  our  enthusiasm  has 
at  times  reached  high  peaks,  we  are  fully  aware 
that  final  judgment  must  await  a longer  period  of 
careful  observation  of  these  cases.  This  might, 
therefore,  be  properly  termed  a preliminary 
report. 

The  idea  of  transurethal  resection  of  the  pros- 
tate is  not  new,  but  in  recent  years  the  develop- 
ment of  the  high  frequency  current  and  its  appli- 
cation to  urologic  instruments  has  almost  com- 
pletely solved  that  one  bugbear — hemorrhage.  To 
Young,  Caulk,  and  Davis  must  go  much  credit  for 
popularizing  the  procedure,  and  to  Dr.  Joseph 
F.  McCarthy,  whose  comprehension  of  urologic 
problems  has  enabled  him  to  devise  what  is  today 
in  our  opinion  the  most  efficient  instrument  for 
carrying  out  this  procedure. 

To  secure  the  maximum  benefit  with  the  mini- 
mum danger  should  always  be  the  dictum  in  sur- 
gery. Prostatectomy  has  been,  and  always  will  be, 
a decidedly  major  operation,  attended  with  con- 
siderable risk.  Though  some  urologic  surgeons 
have  been  able  to  run  large  series  of  cases  with 
a mortality  as  low  as  1 to  5 per  cent,  the  general 
average  mortality  from  prostatectomy  the  country 
over  will  run  somewhere  between  15  and  25  per 
cent.  It  is  small  wonder  that  a man  reaching  ad- 
vanced years  with  a prostatic  obstruction  has 
shuddered  at  the  thought  of  an  operation,  and  the 
thought  of  relief  by  a conservative  procedure  has 
been  heralded  with  great  joy. 

I shall  briefly  enumerate  the  advantages  of  the 
transurethral  method,  and  discuss  them  in  order. 

1.  Minimal  risk. 

2.  Economic  advantage  of  shortened  hospital 
stay  and  shortened  convalescence. 

3.  Relief  to  bad  risk  patients  who  could  not 
stand  a prostatectomy. 

4.  Freedom  from  such  distressing  sequelae  as 
urinary  fistula  and  incontinence  of  urine. 

5.  Preservation  of  sexual  function  and  libido. 

6.  Ideal  for  conservative  management  of 
cancer. 

1.  Minimal  risk. — This  procedure  is  attended 
with  almost  no  operative  reaction  or  shock.  The 
first  postoperative  day  finds  these  patients  quite 

Read  before  the  Surgical  Section.  Ohio  State  Medical 
Association,  at  the  86th  Annual  Meeting,  Dayton,  May 
3-4,  1932. 


comfortable  and  rarely  is  morphia  required  for 
relief  of  pain.  Mortality  is  minimized.  There 
were  two  deaths  in  one  hundred  cases,  the  death 
in  one  being  in  a patient  with  carcinoma  of  the 
prostate  who  developed  pneumonia  and  died  on 
the  sixth  post-operative  day,  and  in  the  other  due 
to  angina  pectoris  on  the  seventh  day  after  opera- 
tion. This  low  mortality  appears  even  lower 
when  one  considers  that  there  have  been  patients 
in  this  group  who  were  such  bad  risks  that  a pros- 
tatectomy would  have  been  deemed  inadvisable. 

2.  Economic  advantage. — Much  expense  is 
spared  due  to  the  shortened  hospital  stay.  The 
pre-operative  preparation,  though  careful,  need 
not  be  so  prolonged.  Given  a patient  with  a 
blood  chemistry  within  normal  limits  and  a rea- 
sonably good  kidney  function,  we  have  no  hesi- 
tancy in  operating  after  one  day’s  preparation. 
Post-operatively  the  patient  normally  is  dismised 
between  the  fifth  and  the  eighth  day,  though  we 
do  not  encourage  too  early  discharge  from  the  hos- 
pital. We  have  no  sympathy  with  those  few  who 
claim  that  this  may  be  made  an  office  procedure. 
Economically  also  the  period  of  convalescence  is 
much  shortened.  These  patients  may  return  to 
their  occupations  after  two  or  three  weeks,  pro- 
vided they  can  be  under  adequate  medical  super- 
vision. This  economy  of  expense  and  time  we  feel 
is  one  of  the  method’s  chief  advantages,  at  least 
until  the  depression  is  over. 

3.  Relief  to  bad  risk  patients. — As  stated  above, 
many  patients  have  been  relieved  by  this  method 
who  would  probably  never  have  stood  a prostatec- 
tomy. In  this  group  are  those  with  advanced  ar- 
teriosclerosis, coronary  disease,  marked  renal  im- 
pairment, old  age,  etc.  One  brief  case  will  serve 
to  illustrate: 

A man,  aged  72,  came  in  with  complete  reten- 
tion of  urine.  He  gave  a definite  history  of  an- 
gina and  had  a marked  arteriosclerosis.  The  day 
after  admission  to  the  hospital  he  had  a classical 
coronary  thrombosis  with  typical  electrocardio- 
graphic findings,  and  death  seemed  inevitable. 
Under  appropriate  treatment  by  the  medical  de- 
partment, however,  he  survived  and  since  opera- 
tion of  any  kind  at  this  time  was  inadvisable,  he 
was  sent  home  for  a period  of  convalescence.  He 
returned  in  three  weeks  with  pallor,  shortness  of 
breath  and  edema  of  both  extremities,  and  insisted 
that  he  be  relieved  of  his  urinary  obstruction. 
After  preliminary  preparation,  we  carried  out  a 
transurethral  resection  of  the  prostate.  His  con- 
valescence was  uneventful,  and  upon  being  re- 
stored to  urinary  comfort,  there  was  considerable 
improvement  noted  in  his  cardiac  condition. 

It  is,  therefore,  possible  to  carry  certain  cases 
through  relief  of  urinary  obstruction  who  previ- 
ously would  have  been  denied  that  service. 

4.  Freedom  from  sequelae. — Freedom  from 


357 


358 


The  Ohio  State  Medical  Journal 


June,  1933 


urinary  fistulae  and  incontinence  of  urine,  those 
infrequent  but  very  distressing  sequelae  of  pros- 
tatectomy, is  accomplished  due  to  the  fact  that  the 
bladder  is  not  artificially  opened,  nor  is  the  ex- 
ternal sphincter  concerned  in  the  procedure. 

5.  Preservation  of  sexual  function  and  libido. 
— Preservation  of  the  sexual  function  may  be  of 
minor  importance  when  one  considers  the  age  of 
the  patients  suffering-  from  urinary  obstruction, 
and  yet  to  many  this  is  an  important  considera- 
tion. The  entire  procedure  is  carried  out  proxi- 
mal to  the  verumontanum,  which  is  thereby  spared 
any  injury. 

6.  Conservative  management  of  cancer. — In 
the  conservative  management  of  carcinoma  of  the 
prostate  this  procedure  has  been  a great  boon. 
In  those  cases  with  obstruction,  resection  is  car- 
ried out  to  give  these  patients  a channel  through 
which  to  void,  and  they  are  then  turned  over  to 
the  department  of  roentgentherapy  for  deep 
X-ray  treatment.  The  immediate  results  of  this 
management  have  been  most  gratifying,  though, 
of  course,  a longer  period  of  observation  of  these 
cases  will  be  necessary  before  the  final  evalua- 
tion. 

Transurethral  resection  is  not  suitable  for  every 
case  of  prostatic  obstruction,  and  the  degree  of 
success  will  vary  with  the  type  of  enlargement 
with  which  one  is  dealing.  On  this  account  the 
selection  of  cases  becomes  very  important.  A care- 
ful cystoscopic  visualization  of  the  bladder  neck 
and  posterior  urethra  is  necessary  in  every  case. 

At  this  point  I wish  to  emphasize  the  fact  that 
rectal  examination  alone  is  never  adequate  to  es- 
tablish the  presence  of  bladder  neck  obstruction. 
We  have  repeatedly  seen  patients  complaining  of 
difficulty,  hesitancy,  slowing  of  the  urinary 
stream,  some  increased  frequency  and  nocturia,  as 
well  as  those  with  complete  urinary  retention,  in 
whom  rectal  examination  has  revealed  a normal 
sized  prostrate,  but  with  cystoscopy,  prostatic  in- 
trusion of  marked  degree  may  be  seen.  Oblitera- 
tion of  the  median  furrow  should  always  make 
one  suspect  middle  lobe  enlargement.  However,  the 
clinical  history  of  a patient  with  bladder  neck  ob- 
struction may  be  more  reliable  than  digital  ex- 
amination of  the  prostate  which  may  give  a false 
impression  of  the  absence  of  prostatic  obstruction. 
It  is  only  in  this  way  that  we  may  make  an  early 
diagnosis  before  the  more  serious  sequelae  of  pro- 
longed urinary  obstruction  intervene  to  reduce 
the  patient’s  chances  of  recovery  from  operation. 

Ideally  suited  are  (1)  the  posterior  commis- 
sural hypertrophy  with  no  appreciable  lateral  lobe 
enlargement;  (2)  subcervical  lobe  enlargement, 
excepting  those  cases  where  the  enlargement  is  so 
great  as  almost  to  fill  the  bladder;  (3)  median 
bars,  usually  fibrotic;  and  (4)  the  great  majority 
of  malignancies.  These  cases  comprise  a large 
proportion  of  all  cases  presenting  themselves  with 
prostate  obstruction.  In  our  series  many  cases  of 
tri-lobar  hypertrophy  have  been  successfully 


handled;  however,  it  is  our  present  feeling  that 
those  cases  with  extensive,  extravesical,  bilateral 
enlargement  are  best  served  by  prostatectomy. 
This  leaves,  then,  really  but  two  groups  in  which 
prostatectomy  is  preferable,  1.  ponderous  middle 
lobe  enlargement;  2.  pronounced  extravesical  lat- 
eral lobes. 

We,  therefore,  feel  that  every  case  must  be  in- 
dividualized and  the  procedure  selected  which  best 
suits  the  particular  case.  It  is  true,  however, 
that  the  majority  of  cases  will  obtain  relief  with 
this  more  conservative  procedure. 

In  our  experience,  the  anesthetic  of  choice  for 
this  operation  is  a low  spinal,  using  1 c.c.  of 
spinocaine.  Its  administration  is  simple,  causes 
the  patient  very  little  distress,  and  it  gives  a com- 
plete and  perfect  anesthesia.  In  the  extremely 
apprehensive  patient  nitrous  oxide  is  used  for 
analgesia. 

TECHNIC 

Being  thoroughly  familiar  with  the  bladder 
neck  upon  which  one  is  working,  the  McCarthy 
electrotome  is  introduced  through  the  urethra. 
The  loop  is  connected  with  the  high  frequency 
current  and  with  the  irrigating  fluid  running,  the 
portion  to  be  resected  is  brought  into  view.  The 
loop  is  fixed  in  the  proper  position  and  then  with- 
drawn from  within  outward,  cutting  out  a piece 
of  tissue  as  it  goes.  By  repeated  sections  of  this 
type,  the  obstructing  portion  is  removed  piece  by 
piece.  It  is  usually  advisable  first  to  remove  the 
middle  lobe,  following  which  the  lateral  lobes 
may  be  resected  in  a similar  manner.  In  many 
instances,  resection  of  the  middle  lobe  alone  has 
been  sufficient  to  restore  the  patient  to  urinary 
comfort,  even  in  the  presence  of  a moderate 
lateral  lobe  enlargement.  This  fact  has  led  us  to 
believe  that  the  middle  lobe  enlargement  con- 
stitutes the  chief  factor  in  obstruction. 

Bleeding  is  controlled  by  electro-coagulation. 
After  each  cut  it  is  best  to  single  out  the  bleed- 
ing points  and  coagulate  them,  as  in  this  way  one 
has  a clear  field  to  work  in  at  all  times.  At  the 
finish  of  the  procedure  one  should  see  a smooth, 
clean  channel  extending  from  the  trigone  out  to 
the  verumontanum.  Bleeding  having  been  con- 
trolled, a soft  rubber  catheter  is  introduced 
through  the  sheath  to  remain  as  an  inlying 
catheter  from  three  to  four  days.  At  the  end  of 
this  time  the  catheter  is  removed  and  in  the  ideal 
case  the  patient  is  able  to  void  immediately.  Com- 
plete emptying  of  the  bladder  may  not  be  effected, 
but  this  follows  as  soon  as  the  edema  and  re- 
action at  the  bladder  neck  subside.  Complete 
urethral  convalescence  may  require  six  to  eight 
weeks,  but  in  most  instances  the  patient  is  quite 
comfortable  and  able  to  carry  on  his  occupation. 

COMPLICATIONS 

(1)  Bleeding.  Since  using  the  McCarthy 
electrotome  we  have  seen  no  case  of  immediate 
post-operative  hemorrhage.  In  the  series  of  100 


June,  1933 


Transurethral  Resection — Lower  and  Engel 


359 


cases  here  reported,  however,  which  include  cases 
done  with  the  Caulk  cautery  punch  and  the  Steam 
resectoscope,  there  were  two  cases,  one  of  which 
necessitated  suprapubic  cystotomy.  Late  second- 
ary bleeding,  occurring  usually  from  the  tenth  to 
the  fourteenth  day,  is  always  to  be  considered  and 
we  have  seen  three  such  cases.  In  no  instance  was 
it  alarming  and  did  not  require  cystotomy.  With 
experience  and  Improvement  of  the  instrument 
has  come  decreased  incidence  of  bleeding,  so  that 
our  last  forty  consecutive  cases  have  been  en- 
tirely free  from  this  complication. 

(2) .  Epididymitis.  This  we  have  encountered 
in  eight  cases.  In  some  cases  it  has  appeared  late 
after  the  patient’s  discharge  from  the  hospital, 
and  is  doubtless  due  to  reaction  in  the  posterior 
urethra.  We  have  not  practiced  routine  pre- 
liminary ligation  of  the  vas,  believing  that  the  low 
incidence  does  not  warrant  it. 

(3) .  There  have  been  two  cases  of  rather 
troublesome  post-operative  tenesmus  and  muscle 
spasm  which  delayed  the  result.  The  mechanism 
in  both  instances  was  very  obscure,  though  we  be- 
lieve that  the  patient’s  temperament  was  a large 
factor  in  both  instances.  This  is  only  a temporary 
thing,  and  subsides  spontaneously. 

(4) .  Pulmonary  complications,  pneumonia, 
pleurisy,  etc.,  have  been  strikingly  absent.  We 
have  had  only  a single  case  of  post-operative 
pneumonia,  which  together  with  failure  of  kidney 
function  caused  the  patient’s  demise. 

Post-operatively  one  cannot  help  being  im- 
pressed by  the  striking  absence  of  significant  com- 
plications, and  convalescence  in  most  instances  is 
short  and  uneventful. 

CONCLUSIONS 

1.  Transurethral  prostatic  resection  is  a con- 
servative procedure  for  relief  of  bladder  neck  ob- 
struction. 

2.  It  is  not  applicable  to  every  case  of  hyper- 
trophy of  the  prostate,  but  we  estimate  that  75 
to  80  per  cent  of  cases  may  be  relieved. 

3.  Careful  individualization  of  each  case  is  im- 
portant. Rectal  examination  alone  is  not  reliable 
in  determining  bladder  neck  obstruction.  Cysto- 
scopic  examination  of  the  bladder  should  be  carried 
out  in  every  case. 

4.  Mortality  and  morbidity  following  trans- 
urethral resection  are  greatly  reduced  as  com- 
pared to  prostatectomy. 

5.  We  have  been  able  to  relieve  bad  risk  pa- 
tients who  in  our  opinion  could  never  have  toler- 
ated a more  radical  surgical  procedure. 

6.  Economy  to  the  patient  is  brought  about  by 
reduced  hospitalization  and  more  prompt  return 
to  productive  occupation. 

7.  A plea  is  made  for  early  recognition  of  these 
cases  before  the  more  serious  sequelae  of  pro- 
longed urinary  obstruction  supervene.  The  earlier 
the  case,  the  more  certain  is  the  relief  following 
transurethral  resection. 


8.  One  hundred  cases  treated  by  this  method 
have  been  followed  and  reviewed  and  the  results 
tabulated. 

Cleveland  Clinic. 

DISCUSSION 

C.  J.  McDevitt,  M.D.,  F.A.C.S.,  Cincinnati: 

Almost  a year  has  elapsed  since  T.  M.  Davis 
of  Greenville,  N.  C.,  read  his  paper  on  prostatic 
resection  before  the  American  Urological  Associ- 
ation at  Memphis,  Tenn.  Comparatively,  only  a 
few  discussed  his  paper  at  that  time  and  almost 
all  jumped  on  him  with  both  feet — practically  con- 
demning the  procedure — in  spite  of  the  fact  that 
Caulk  of  St.  Louis  for  several  years  had  been  re- 
porting very  favorable  results  in  selected  cases  of 
bladder  neck  obstruction,  both  as  to  morbidity 
and  mortality,  with  his  cautery  punch.  In  less 
than  five  months  there  was  such  a wave  of  en- 
thusiasm for  this  procedure,  among  the  urologists 
of  the  country,  that  Wappler  was  almost  six  weeks 
behind,  on  orders  for  the  Sterns-Resectscope  and 
McCarthy  had  developed  his  first  cutting  loop, 
adapted  to  his  pan-endescope.  This  first  instru- 
ment of  McCarthy’s  was  crude  to  say  the  least, 
but  in  a short  time  he  installed  the  “rack  and 
pinion”  of  the  Sterns  instrument.  With  this  im- 
provement it  was  possible  to  make  a slower,  more 
steady  cut — with  the  result  that  much'  of  the 
bleeding  encountered  with  the  earlier  instrument, 
was  eliminated. 

Today  in  this  field  of  work  there  is  as  much 
difference  between  the  latest  Sterns — or  Mc- 
Carthy resectscope — and  all  of  the  old  style 
cold  or  cautery  punches,  as  there  is  between  the 
airplane  and  the  ox-cart  in  the  field  of  transpor- 
tation. Keeping  up  the  comparison,  it  takes  con- 
siderable more  time  and  study  to  prepare  one- 
self to  operate  an  airplane  than  is  necessary  to 
drive  an  ox-cart.  I feel  that  every  well  trained 
urologist  who  will  study  the  mechanism  of  this 
procedure  and  spend  a definite  amount  of  time 
with  some  skilled  resectionist  before  attempting 
the  operation  will  eventually  become  an  enthusiast. 

Recently  there  have  been  a few  sad  accidents, 
some  of  the  salesmen  sent  out  by  manufacturers 
of  the  electro-surgical  unit,  used  in  this  procedure 
are  inexperienced,  yet  daring — with  the  result 
that  the  operation  has  unjustly  received  a black 
eye  in  some  quarters. 

That  transurethral  prostatic  resection  is  here 
to  stay — is  beyond  all  question  of  a doubt. 

Any  procedure  that  will  relieve  at  least  50  per 
cent  of  all  bladder  neck  obstructions ; that  will  re- 
duce the  hospital  stay  to  days  instead  of  weeks; 
that  will  definitely  lower  both  mortality  and  mor- 
bidity rates:  and  will  not  disturb  the  sexual  func- 
tion, is,  as  Dr.  Lower  has  said,  “a  procedure  to  be 
heralded  with  great  joy”. 


The  annual  meeting  of  the  Union  Distract 
Medical  Society  was  held  April  27  at  Liberty,  In- 
diana. Among  Ohio  physicians  who  took  part  in 
the  program  were:  Dr.  H.  A.  Moore,  Oxford;  Dr, 
M.  O.  Cook,  Hamilton;  Dr.  Oscar  Berghausen, 
Cincinnati,  and  Dr.  C.  0.  Munns,  Oxford. 


The  American  College  of  Physicians  will  hold 
its  18th  annual  clinical  session  in  Chicago,  at  the 
Palmer  House,  April  16  to  20,  1934,  it  has  been 
announced  by  E.  R.  Loveland,  executive  secre- 
tary, Philadelphia,  Pa. 


Hay^Fever  Treatment  0 0 0 The  Continuous  Method 

Karl  D.  Figley,  M.D.,  Toledo,  Ohio 


VARIOUS  authorities  estimate  the  distribu- 
tion of  pollen  hay-fever  among  the  general 
population  at  from  one  to  three  per  cent. 
If  we  adopt  a conservative  estimate  of  IV2  per 
cent  as  representing  the  incidence  of  pollen  hay- 
fever  in  Ohio,  we  find  that  based  on  the  1930  cen- 
sus, there  are  approximately  one  hundred  thou- 
sand sufferers  from  pollen  disease  in  our  state. 
This  amounts  to  a number  almost  equivalent  to 
the  population  of  the  city  of  Canton.  One  needs 
but  little  imagination  to  reflect  on  the  significance 
of  these  numbers.  It  is  true  that  hay-fever,  and 
its  accompanying  seasonal  asthma  in  at  least  one- 
third  of  the  cases,  is  not  often  an  immediate  risk 
to  life.  However,  it  carries  with  it  considerable 
morbidity  in  the  form  of  the  tendency  for  second- 
ary infection  to  become  implanted  in  sinuses  and 
bronchi,  thus  leading  gradually  to  permanent 
pathological  changes. 

Overshadowing  the  risk  to  life,  is  the  economic 
loss  that  these  sufferers  must  undergo  annually. 
Persons  sensitive  to  ragweed  can  look  forward  to 
at  least  six  weeks  each  Fall,  during  which  their 
well-being  is  interfered  with  to  such  extent  that 
many  must  needs  leave  their  business  affairs  to 
seek  climatic  relief.  In  the  case  of  those  sensitive 
to  both  grasses  and  ragweeds,  the  entire  summer 
season  is  a period  of  torment  as  well  as  economic 
inefficiency. 

It  is  my  opinion  that  the  vast  majority  of  these 
hay-fever  sufferers  are  not  getting  adequate 
treatment  which  might  be  made  available  for 
them.  This  belief  on  my  part,  is  the  inspiration 
for  the  presentation  of  this  subject  before  this 
group  of  Ohio  physicians.  The  reason  for  the  un- 
satisfactory status  of  pollen  disease  therapy  in 
general  is  that  most  physicians  adhere  to  the 
preseasonal,  fifteen-dose  method  sponsored  by 
various  commercial  drug  firms.  This  method  is 
open  to  several  vital  objections.  In  the  first  place, 
no  provision  is  made  for  testing  the  patient  to 
ascertain  the  pollens  to  which  he  is  sensitized. 

In  the  second  place,  this  fifteen-dose  method  is 
inflexible  and  makes  no  allowance  for  individual 
susceptibility.  The  patient  may  be  taking  fifteen 
doses  to  reach  the  dose  he  should  have  attained  in 
four  or  five  and  then  be  only  partially  protected. 
The  last  vial  of  most  fifteen  dose  ragweed  sets 
contains  5000  units. 

In  Ohio  it  requires  a maximum  dose  of  15,000  to 
20,000  pollen  units  to  satisfactorily  protect  a case 
of  average  sensitiveness.  This  fifteen  dose  method 
makes  no  provision  for  keeping  up  during  the  sea- 
son, the  protection  gained  by  the  preseasonal 
series  of  injections.  It  is  well  known  that  toler- 

Read  before  the  Medical  Section,  Ohio  State  Medical 
Association,  at  the  86th  Annual  Meeting,  Dayton,  May  3-4, 
1932. 


ance  diminishes  rapidly  and  must  be  kept  at  a 
high  level  while  pollen  is  in  the  air.  A third,  im- 
portant, objection  is  that  one  may  encounter  a 
patient  who  is  extremely  pollen  sensitive.  He  de- 
velops violent  constitutional  reactions  from  the 
various  doses  and  there  is  no  convenient  method 
provided  for  reducing  the  dosage.  This  patient  is 
the  type  who  most  needs  help;  both  he  and  his 
physician  are  “out  of  luck”  with  this  inflexible 
system  of  dosage. 

The  task  of  building  a patient’s  resistance 
against  the  pollens  to  which  he  is  sensitive,  prior 
to  a pollen  season,  and  then  carrying  him  through 
that  season,  is  a laborious  one  for  both  patient 
and  physician.  It  is  unfortunate  if  the  tolerance 
so  dearly  gained,  be  allowed  to  lapse,  with  the 
prospect  of  going  through  the  same  procedure 
each  succeeding  summer.  With  this  idea  in  mind, 
Aaron  Brown  first  attempted  the  method  of  per- 
ennial or  continuous  hay-fever  treatment.  His 
first  paper1  on  the  subject  appeared  in  1927.  In 
the  same  year,  Vander  Veer,  Cooke  and  Spain2  re- 
ported a few  cases  treated  by  this  method.  Zella 
White  Stewart3  stated  before  the  Iowa  State  Med- 
ical Society  in  1925  that  she  was  using  the  con- 
tinuous method.  In  1926  she  read  a paper*  en- 
titled “Throughout  the  Year  Treatment  of  Hay- 
Fever”  before  the  Association  for  the  Study  of  Al- 
lergy; this  paper,  however,  was  not  published  un- 
til October,  1931.  In  November,  1930,  Figley5 
published  a paper  entitled  “The  Continuous 
Method  of  Hay-Fever  Treatment”.  Since  that 
time  other  papers  have  appeared  on  this  subject 
by  Warren  T.  Vaughan”  and  Aaron  Brown.1  It  is 
rather  surprising  that  more  has  not  been  written 
regarding  this  form  of  treatment,  for  numerous 
men  who  specialize  in  allergic  diseases,  have  used 
this  method  for  some  time. 

The  continuous  or  perennial  method  of  hay- 
fever  treatment  means  simply  the  administration 
of  the  maximal,  protective  dose  of  pollen  extract 
at  approximately  monthly  intervals  throughout 
the  entire  year.  This  maximal  dose  is  first 
reached  by  a series  of  doses  of  gradually  increas- 
ing strength.  It  is  usually  the  final  dose  attained 
in  the  first  year’s  preseasonal  treatment,  although 
with  this  method,  treatment  may  be  commenced 
at  any  time  of  the  year.  There  is  good  reason 
to  believe  that  permanent  relief  can  be  accom- 
plished in  much  shorter  time  by  the  continuous 
method,  than  by  the  interrupted  or  seasonal 
method.  If  one  will  assume  a patient  without 
previous  treatment  to  have  little  or  no  immunity, 
one  can  picture  his  resistance  or  tolerance  starting 
from  a base-line  at  Zero.  (Fig.  1). 

Through  repeated  preseasonal  injections  it  rises, 
step  by  step,  to  a certain  level.  Then,  if  the  in- 


360 


June,  1933 


Hay  Fever  Treatment — Figley 


361 


jections  are  discontinued  after  the  season,  one  pic- 
tures the  immunity  gained  as  dropping  gradually 
toward  the  base  line.  On  the  other  hand,  with 
the  continuous  method,  the  immunity  is  not  al- 
lowed to  fall,  but  is  kept  at  a high  level  indefi- 
nitely. In  this  connection,  it  should  be  pointed 
out  that  the  amount  of  pollen  antigen  the  patient 
receives  is  much  greater  with  the  continuous 


Duration  of  Immunity  from  seasonal  or  Interrupted  method. 
Duration  of  Immunity  from  continuous  method. 


Figure  1 

method  with  the  interrupted  method.  It  is 
apparently  the  frequent  administration  of  ade- 
quate amounts  of  pollen  antigen  that  exhausts  the 
patient’s  sensitiveness,  which,  in  time,  leads  to 
permanent  relief. 

Technic 

The  first  essential  in  any  form  of  hay-fever 
treatment  is  a good  case  history.  From  this  one 
can  determine  in  a general  way  whether  the  pa- 
tient’s symptoms  coincide  with  our  tree,  grass  or 
weed  pollen  seasons.  One  can  get  some  idea  of 
the  relative  sensitiveness  of  the  patient,  especially 
if  his  hay-fever  is  accompanied  by  pollen  asthma, 
for  the  asthmatics  are  always  more  susceptible  to 
reactions  from  pollen  extract  injections.  A brief 
physical  survey  should  be  made,  with  particular 
reference  to  the  nose  and  throat.  Obstructions  to 
free-breathing  such  as  deviated  septa  and  polypi 
should  be  corrected  before  the  onset  of  the  season 
— but  never  while  it  is  in  progress. 

The  next  step  consists  of  thorough  skin-testing 
by  the  scratch  method,  with  all  the  pollens  indi- 
cated by  the  patient’s  history  and  a knowledge  of 
the  hay-fever  flora  of  the  district  where  the  pa- 
tient lives.  In  addition  to  pollens,  one  should 
also  test  with  any  other  substances  indicated  by 
the  history,  such  as  orris-root,’  certain  foods  or 
certain  animal  emanations.  Many  a woman  con- 
tinues to  have  symptoms  in  spite  of  proper  pollen 
therapy  because  she  is  sensitized  to  the  orris-root 
in  her  face  powder.  Other  patients  are  peculi- 
arly affected  by  certain  foods  during  the  hay- 
fever  season, — notably  tomatoes,  cantaloupe  or 
peaches.  Still  others  may  be  affected  by  horse- 
dander  of  the  emanations  from  dogs,  cats  or 
fowls.  To  insure  a good  result  from  treatment 
means  to  take  these  other  factors  beside  pollens, 
into  consideration. 

After  the  preliminary  skin-tests  have  been 
made,  one  decides  from  the  positive  reactions  ob- 
tained and  the  patient’s  history,  just  which  pollens 


to  use  in  treatment.  Accordingly,  quantitative 
tests  are  made  with  dilutions  of  various  strengths 
of  the  pollens  selected  for  treatment.  Some  work- 
ers prefer  the  intradermal  method  for  these  quan- 
titative tests,  but  I prefer  the  scratch  method — 
the  former  being  too  delicate.  That  dilution  of 
pollen  extract  is  chosen  to  commence  the  treat- 
ment, which  just  fails  to  give  a positive  reaction 
by  scratch  test. 

In  order  to  reach  the  maximal  protective  dose, 
the  dosage  is  worked  up  at  intervals  of  four  to 
seven  days  until  the  desired  dose  is  reached.  Dur- 
ing the  season  it  is  repeated  at  intervals  of  seven 
to  ten  days.  At  the  close  of  the  season,  treatment 
is  not  discontinued.  Injections  of  the  maintenance 
dose  are  repeated  at  intervals  of  two  weeks,  then 
three  weeks  and  finally  four  weeks.  Thereafter 
they  are  repeated  at  monthly  intervals  until  the 
next  season,  with  certain  modifications  to  be  men- 
tioned shortly.  In  the  less  sensitive  cases,  the 
maintenance  dose  is  simply  a continuation  of  the 
maximum  dose  attained.  In  those  patients  classed 
as  sensitive  and  very  sensitive,  it  is  not  possible 
to  allow  an  interval  of  four  weeks  between  injec- 
tions without  risk  of  constitutional  reactions. 

Rather  than  shorten  the  intervals,  however,  the 
dose  is  decreased  somewhat  in  strength.  The 
patient  is  then  carried  along  at  monthly  inter- 
vals on  this  decreased  or  “maintenance”  dose  until 
shortly  before  the  next  season,  when  it  is  stepped 
up  to  its  protective  strength  by  a few  weekly  in- 
jections. For  example  in  a patient  quite  sensitive 
to  ragweed,  the  protective  dose  reached,  let  us 
say,  is  0.25cc  of  a 1-20  solution.  After  the  sea- 
son, the  maintenance  dose  is  dropped  to  0.5cc  of  a 
1-100  solution  on  which  the  patient  is  carried  at 
monthly  intervals  until  the  following  June  or 
July.  The  patient  is  then  retested  quantitatively, 
and  stepped  up  to  his  protective  dose  before  the 
onset  of  the  ragweed  season.  In  this  connection, 
it  should  be  pointed  out  that  retesting  to  deter- 
mine the  patient’s  sensitivity  from  year  to  year, 
is  very  important.  Most  patients  under  continu- 
ous treatment  develop  increased  immunity  as 
shown  by  reduction  in  the  size  of  skin  tests,  ab- 
sence of  symptoms  and  a tolerance  to  injections 
of  strong  doses.  Occasionally,  a patient’s  resis- 
tance apparently  diminishes  under  treatment  as 
shown  by  persistence  of  large  skin  reactions  and 
by  incomplete  freedom  from  symptoms.  In  my 
opinion  this  state  of  affairs  is  caused  by  under- 
dosage— hence  the  necessity  for  checking  up  on 
treatment  by  retesting. 

Owing  to  the  stability  of  our  present-day  pollen 
extracts,  most  patients  show  a surprising  ability 
to  tolerate  strong  maintenance  doses  at  monthly 
intervals  without  unpleasant  reactions.  Our  ex- 
tracts consist  of  50  per  cent  buffered  saline  solu- 
tion (Coca’s  fluid)  and  50  per  cent  glycerine. 
They  retain  their  potency  unchanged  for  a long 
time  if  kept  in  the  ice-box  when  not  in  use.  Suf- 
ficient stock  solution  is  made  up  to  last  for  one 


362 


The  Ohio  State  Medical  Journal 


June,  1933 


year.  When  it  is  necessary  to  change  from  an 
old  to  a new  stock  solution,  the  change  is  made 
gradually.  The  proper  dose  is  prepared  by  add- 
ing two-thirds  old  extract  to  one-third  new  ex- 
tract. A month  later,  the  dose  consists  of  two- 
thirds  new  and  one-third  old  extract.  The  next 
month,  the  dose  is  given  with  new  extract  only. 

With  the  continuous  method,  it  is  possible  to 
combine  various  mixtures  of  tree,  grass  and  weed 
pollens  in  the  same  syringe  so  that  the  dose  may 
be  given  at  one  injection.  By  manipulating  these 
mixtures  through  proper  preseasonal  increases, 
the  total  amount  of  fluid  injection  need  never  ex- 
ceed l.Occ. 

NUMBER  OF  CASES  AND  CLASSIFICATIONS 

One  hundred  and  twenty-five  cases  have  been 
treated  by  the  continuous  method  over  a period 
of  from  two  to  five  years.  (Table  1).  Twelve 
patients  were  clinically  sensitive  to  grass  alone, 
73  cases  were  sensitive  to  ragweed  alone,  while  the 
remaining  40  were  sensitive  to  both  grasses  and 
ragweeds.  On  the  basis  of  quantitative  tests, 
three  were  classed  AA  (extremely  sensitive)  ; 35 
as  A (very  sensitive)  ; 57  as  B (average) ; 30  as 
C (less  sensitive).  Seasonal  pollen  asthma  was 


a definite  symptom  in  40  cases, — approximately 
one-third  of  the  total  number. 

TABLE  I 

Grass  Sensitive  Cases 12 

Ragweed  Sensitive  Cases 73 

Grass  and  Weed  Sen.  Cases 40 — Total  125 

A A (extremely  sensitive) 3 

A (very  sensitive) 35 

B (average)  _ 57 

C (less  sensitive) 30 

No.  Cases  with  Pollen  Asthma 40 


Cases  treated  continuously  for  5 yrs.  — 5 
Cases  treated  continuously  for  4 yrs.  — 14 
Cases  treated  continuously  for  3 yrs.  — 49 
Cases  treated  continuously  for  2 yrs.  — 57 

DURATION  OF  TREATMENT 
Since  1927,  when  I first  adopted  the  continuous 
method,  five  patients  have  been  treated  continu- 
ously for  5 years,  14  for  4 years,  49  for  3 years 
and  57  for  2 years. 

CONSTITUTIONAL  REACTIONS 
One  would  naturally  expect  a large  number  of 
constitutional  reactions  where  strong  doses  of 
pollen  extracts  are  given  at  four-weekly  inter- 
vals. Such  is  not  the  case.  Reactions  are  much 
more  apt  to  occur  when  the  patient  is  being  worked 
up  to  his  protective  dose.  By  the  time  this  is 
reached,  he  has  acquired  considerable  tolerance 
so  that  reactions  are  less  likely  to  occur.  In  a 
former  report  covering  a series  of  65  cases,  the  in- 
cidence of  constitutional  reactions  for  monthly  in- 
jections was  about  one  to  every  200  injections. 
This  ratio  has  been  much  improved  in  the  past 
two  years  by  the  practice  of  combining  O.lcc  of  a 
mixture  of  ephedrin  and  epinephrin  with  each  dose 


of  pollen  extract.  This  mixture  constricts  the 
skin  blood-vessels,  thus  slowing  up  absorption  of 
the  pollen  extract.  The  usual  precautions  against 
injecting  the  extract  into  a venule,  are  of  course 
observed,  and  the  patient  is  kept  at  the  office  for 
some  time  after  the  treatment.  The  few  reactions 
that  have  occurred  after  the  patient  left  the  office, 
were  counteracted  by  the  ephedrin  tablets  with 
which  each  patient  is  provided. 

RESULTS 

The  chief  argument  in  favor  of  the  continuous 
or  perennial  method  of  treatment  is  that  the  re- 
sults are  invariably  better  than  by  the  interrupted 
method.  Except  for  100  per  cent  freedom  from 
symptoms,  percentage  figures  mean  very  little  in 
the  estimation  of  results  in  hay-fever  treatment. 
In  general,  however,  the  clinical  result  improves 
directly  in  proportion  to  the  length  of  continuous 
treatment.  Grafton  T.  Browns  has  recently  advo- 
cated the  giving  of  massive  doses  of  pollen  ex- 
tracts— as  high  as  60,000  to  100,000  units.  To 
administer  such  strong  doses  it  is  necessary  to 
give  up  lcc  of  6 to  10  per  cent  pollen  extracts. 
Brown  reports  that  by  the  use  of  such  doses,  his 
results  in  a large  series  of  cases  have  been  “almost 
monotonously  perfect”.  He  further  states  that 
“the  evidence  at  hand  would  seem  to  indicate  that 
the  administration  of  such  massive  doses  leads  to 
complete  and  permanent  desensitization,  with  a 
disappearance  of  positive  skin  reactions”.  This 
agrees  with  my  belief  that  the  more  pollen  antigen 
a patient  can  take,  the  better  the  results — also 
that  given  enough  pollen  antigen  over  a sufficient 
period,  any  patient  can  be  completely  and  perma- 
nently desensitized. 

In  my  series  of  125  cases  treated  continuously 
for  two  years  or  more,  I consider  that  12  (10  per 
cent)  have  attained  a clinical  cure  (Table  2). 
None  of  them  has  had  any  symptoms  for  the  past 
two  years  and  in  all  the  skin  tests  to  their  specific 
causative  pollens  are  negative.  Most  of  these  were 
cases  of  average  sensitivity  who  had  considerable 
acquired  immunity  before  treatment  was  begun. 
With  increased  experience  in  the  giving  of  larger 
dosage,  I am  hopeful  of  materially  increasing  my 
percentage  of  cured  cases. 

DISCUSSION 

The  advantages  of  the  continuous  method  are: 

1.  After  the  protective  dose  is  once  reached, 
the  number  of  office  visits  required  is  lessened 
appreciably. 

2.  Treatment  is  less  likely  to  be  interrupted  by 
illness  or  vacations. 

3.  Treatment  may  be  started  any  time. 

.4  After  monthly  treatments  have  been  suffi- 
ciently established,  results  are  invariably  better 
than  by  the  interrupted  method. 

5.  There  is  good  reason  to  believe  that  a clinical 
cure  can  be  accomplished  in  much  shorter  time 
than  by  the  interrupted  or  seasonal  method. 


June,  1933 


Hay  Fever  Treatment — Figley 


363 


TABLE  2 


No. 

Case 

Age  at 
Beginning- 
treatment 

Years  duration 
of  hay-fever 
before  treat- 
ment 

Type 

and 

Class 

Number 

years 

continuous 

treatment 

Maintenance 

Dose 

Constitutional 

Reaction 

Skin  Test 
to  pure 
pollen 

1. 

L.  B.  Jr. 

7 

2 

Grass  A 

Ragweed  B 

3 

Grass  .5  cc.  1-100 

Ragweed  .2  cc.  1-20 

None 

Neg. 

2. 

A.  L.  B. 

26 

12 

Ragweed  C 

3 

Ragweed  .3  cc.  1-20 

None 

Neg. 

3. 

W.  C. 

23 

2 

Grass  B 

Ragweed  B 

4 

Grass  .2  cc.  1-20 

Ragweed  .2  cc.  1-20 

None 

Neg. 

4. 

D.  H. 

13 

5 

Grass  C 

Ragweed  B 

4 

Grass  .2  cc.  1-20 

Ragweed  .5  cc.  1-20 

11-16-29 

.3  cc.  1-20  Rwd. 

Neg. 

5. 

H.  L. 

13 

3 

Grass  C 

Ragweed  B 

3 

Grass  .3  cc.  1-20 

Ragweed  .2  cc.  1-20 

None 

Neg. 

6. 

C.  L.  McK. 

34 

27 

Grass  B 

3 

Grass  .3  cc.  1-20 

None 

Neg. 

7. 

D.  S. 

15 

6 

Grass  A 

Ragweed  A 

4 

Grass  .5  cc.  1-100 

Ragweed  .5  cc.  1-100 

9-10-27 

.3  cc.  1-100  Rwd. 

Neg. 

8. 

A.  D.  V. 

28 

5 

Ragweed  B 

3 

Ragweed  .1  cc.  1-20 

None 

Neg. 

9. 

T.  R.  W. 

22 

9 

Ragweed  A 

4 

Ragweed  .2  cc.  1-20 

None 

Neg. 

10. 

C.  W. 

26 

7 

Grass  A 

4 

Grass  .3  cc.  1-20 

None 

Neg. 

11. 

M.  L.  M. 

6 

1 

Ragweed  C 

3 

Ragweed  .1  cc.  1-20 

None 

Neg. 

12. 

P.  P. 

14 

8 

Grass  B 

Ragweed  C 

3 

Grass  .2  cc.  1-20 

Ragweed  .3  cc.  1-20 

None 

Neg. 

One  other  beneficial  feature  of  this  method  is 
that  patients  are  kept  under  observation  fre- 
quently enough  and  long  enough  for  other  mani- 
festations of  allergy  to  be  recognized  and  cor- 
rected. Many  hay-fever  patients  have  other 
allergic  manifestations,  particularly  food  sen- 
sitizations, such  as  eczema,  migraine  or  colitis. 
Vaughan0  has  called  attention  to  the  fact  that 
certain  cases  treated  by  the  continuous  method 
appear  to  enjoy  better  general  health  throughout 
the  year.  I have  noticed  in  particular,  that  many 
patients  have  more  freedom  from  winter  respira- 
tory infections,  than  previously. 

From  what  has  been  said  in  this  presentation, 
the  thought  may  have  occurred  to  many  of  you, 
that  the  treatment  of  hay-fever  instead  of  becom- 
ing simpler,  is  growing  more  complex.  Quite  the 
contrary  is  true.  Very  definite  general  principles 
have  been  established.  Careful  pollen  surveys 
have  been  made  of  the  whole  country.  Potent, 
stable  extracts  are  available  for  testing  and 
treatment.  The  one  thing  that  has  fallen  down  is 
the  old  idea  that  hay-fever  can  satisfactorily  be 
treated  by  the  annual  administration  of  a set 
number  of  pollen  extract  injections.  Each  hay- 
fever  case  is  an  individual  problem,  requiring  in- 
dividual study.  The  modern  medical  man  who 
treats  a diabetic  patient  has  a working  knowledge 
of  calories,  proteins,  fats  and  starches  as  per- 
taining to  the  treatment  of  diabetes.  He  also  has 
a knowledge  of,  and  healthy  respect  for,  the 
hypodermic  administration  of  insulin.  In  the 
treatment  of  hay-fever  the  modern  physician 
should  know  his  regional  hay-fever  flora,  as  he 
does  his  food-stuffs  in  the  treatment  of  diabetes. 
By  the  same  token,  in  hay-fever  treatment  he 
should  know  his  pollen  dosage  as  he  does  his  in- 
sulin units,  for  unpleasant  inactions  occur  from 
mishandling  of  either.  My  object  in  drawing  this 
parallel  between  the  treatment  of  hay-fever  and 
diabetes  is  to  point  out  that  quite  as  much  is 
known  about  the  rational  treatment  of  the  one  as 
the  other,  and  that  both  require  a high  degree  of 
individual  care. 


SUMMARY 

1.  There  are  approximately  100,000  sufferers 
from  pollen  disease  in  the  State  of  Ohio. 

2.  One  hundred  and  twenty-five  patients  have 
been  treated  by  the  continuous  or  perennial 
method  for  from  two  to  five  years  each. 

3.  Results  by  the  continuous  method  are  in- 
variably better  than  by  the  seasonal  or  inter- 
rupted method. 

4.  Twelve  patients  have  obtained  a clinical 
cure : five  after  four  years’  continuous  treat- 
ment and  seven  after  three  years’  continuous 
treatment. 

316  Michigan  Street. 

REFERENCE 

1.  Brown,  Aaron:  J.  Immunol.,  13  : 273,  (April,  1927). 

2.  Vander  Veer,  A.  Jr.,  Cooke,  R.  A.,  and  Spain,  W.  C. : 
Am.  J.  M.  Sc.,  1U:  101,  (July)  1927. 

3.  Stewart,  Zella  White:  J.  Iowa  M.  Soe.,  16: 277  (June) 
1926. 

4.  Stewart,  Zella  White:  Med.  Women’s  Journ.  (Oct.) 

1931. 

5.  Figley,  Karl  D. : J.  Allergy  2 : 39  ( Nov. ) 1930. 

6.  Vaughan,  Warren  T. : J.A.M.A.,  97:  90,  (July  1931. 

7.  Brown,  Aaron:  J.  Allergy  3:113  (Jan.)  1932. 

8.  Brown,  Grafton  T. : J.  Allergy  3:  180  (Jan.)  1932. 

DISCUSSION 

Milton  B.  Cohen,  M.D.,  Cleveland:  It  is  a 

pleasure  to  be  asked  to  discuss  a paper  with  which 
one  can  be  in  complete  agreement.  Since  I can- 
not disagree,  I wish  to  emphasize  some  of  the 
points  made  by  Dr.  Figley. 

While  hay-fever  is  never  the  cause  of  death  di- 
rectly I would  like  to  call  your  attention  to  the 
fact  that  65  per  cent  of  the  cases  of  chronic  per- 
ennial bronchial  asthma,  began  as  a seasonal  rag- 
weed hay-fever.  Any  condition  having  this  prog- 
nostic significance  is  worthy  of  serious  study  no 
matter  how  trivial  it  may  seem  to  some. 

It  is  well  to  remember  that  it  is  the  final  dose 
given  to  the  hay-fever  patient  which  protects  him 
and  that  the  others  are  given  in  order  to  develop 
tolerance  for  the  final  dose.  No  set  series  of 
doses  will  suffice.  Doses  must  be  given  individu- 
alized care. 

A final  advantage  in  favor  of  the  year  round 
method  in  hay-fever  treatment  is  that  the  patient 
is  under  the  physician’s  care  long  enough  for 
other  complicating  allergic  manifestations  and 
other  sensitivities  to  be  corrected.  This  materially 
increases  the  number  of  seasonally  cured  patients. 


364 


The  Ohio  State  Medical  Journal 


June,  1933 


E.  L.  Sherrer,  M.D.,  Cleveland:  As  Dr.  Fig- 

ley  has  stated,  there  are  close  to  100,000  hay- 
fever  sufferers  in  the  State  of  Ohio.  This  means 
that  the  disease  must  be  diagnosed  and  treated  by 
a large  percentage  of  physicians  and  not  by  a few 
specialists.  In  order  to  treat  hay-fever  and  ob- 
tain the  excellent  results,  such  as  Dr.  Figley  has 
presented,  it  is  necessary  to  understand  the  de- 
tails of  diagnosis  and  therapy  and  to  treat  each 
case  as  an  individual  problem.  Information 
about  the  details  of  pollen  therapy  is  not  easily 
obtainable.  The  average  text-book  of  medicine 
does  not  include  it,  and  most  articles  on  the  sub- 
ject are  published  in  special  journals,  such  as  The 
Journal  of  Allergy,  or  The  Journal  of  Immun- 
ology, which  are  not  of  easy  access  to  most  phy- 
sicians. 

The  paper  just  presented  contains  a large 
amount  of  specific  information — too  much  to  be 
grasped  in  one  hearing.  When  published,  it  should 
be  read  carefully  in  order  to  fully  appreciate  all 


of  the  points  which  have  been  stressed.  As  a sug- 
gestion, I believe  that  several  additions  could 
be  made  to  make  the  published  report  a complete 
guide  to  hay-fever  treatment  in  Ohio. 

First,  a table  showing  the  common  plants  which 
cause  hay  fever  and  the  time  of  their  pollination. 

Second,  a table  showing  the  method  of  classifi- 
cation of  cases  into  groups  A,  B,  C,  etc.,  according 
to  their  sensitiveness. 

Third,  a schedule  showing  the  minimum  and 
maximum  dosages  required  for  relief  of  the  sev- 
eral degrees  of  sensitiveness. 

Fourth,  a table  giving  the  comparison  of  pollen 
extract  concentration  according  to  the  method  of 
designation,  such  as  pollen  units,  protein  units, 
dilutions  and  nitrogen  content. 

If  these  tables  are  added,  I believe  the  phy- 
sician will  have  an  accurate  and  authoritative 
plan  for  the  treatment  of  hay-fever  in  Ohio,  and 
will  not  have  to  rely  on  the  pollen  extract  sales- 
men for  his  information. 


Cervical  Lymphadenopatliy 

B.  K.  Wiseman,  M.D.,  Coumbus,  Ohio 


OF  the  vai-ious  diseases  which  attack  the 
hemapoetic  organs,  that  group  which  pri- 
marily involves  the  lymphatic  tissues  is 
the  least  understood.  There  are  many  reasons 
why  this  should  be  true.  The  cytologic  and  his- 
tologic difficulties  in  recognizing  and  interpreting 
pathologic  changes  in  the  lymphocyte,  the  funda- 
mental structural  unit  of  lymphatic  tissue,  are 
greater  than  exist  in  other  hematologic  dyscrasias. 
Furthermore,  the  extreme  confusion  relative  to 
the  nature  of  the  etiologic  agents  responsible  for 
these  changes  has  prevented  a rational  approach 
to  the  classification  and  treatment  of  the  lymph- 
adenopathies.  The  development  of  a highly  com- 
plex nomenclature  and  clinical  classification  has 
resulted,  based  largely  upon  signs  and  symptoms. 

Admitting,  then,  our  continued  need  for  more 
fundamental  data,  and  a better  basic  understand- 
ing of  the  mechanisms  involved,  it  nevertheless 
will  be  the  object  of  this  discussion  to  analyze 
critically  the  more  important  distinguishing  char- 
acteristics presented  by  this  group  of  diseases  in 
an  attempt  to  simplify  somewhat  the  immediate 
problem  of  the  clinician  faced  with  a glandular 
dystrophy;  perforce  leaving  out  much  of  the  in- 
teresting detail  and  controversy  but  without 
sacrifice  of  any  important  fact. 

CLASSIFICATION 

All  lymphadenopathies,  cervical  or  otherwise, 
can  be  divided  into  three  major  groups:  (1) 

those  in  which  the  predominate  characteristics 
are  significant  of  malignancy;  (2)  those  in  which 
the  reaction  is  like  an  infectious  process;  and  (3) 
those  which  seemingly  bear  no  relationship  to 
either  infection  or  neoplasm. 

Read  before  the  Section  on  Eye,  Ear,  Nose  and  Throat 
of  the  Ohio  State  Medical  Association,  86th  Annual  Meet- 
ing, Dayton,  May  3-4,  1932. 

From  the  Department  of  Medical  and  Surgical  Research, 
The  Ohio  State  University,  Columbus. 


These  groupings  represent  clinical  types  inas- 
much as  the  clinical  aspects  and  treatment  of 
members  within  each  group  are  similar.  Further- 
more, pathologic  differentiation  between  disease 
entities  within  each  group  is  often  difficult  and 
sometimes  impossible.  Thus  no  great  sacrifice  of 
scientific  accuracy  is  made  by  such  a grouping, 
whereas  considerable  clinical  clarification  is  ob- 
tained— and  the  only  justification  for  any  classifi- 
cation is  as  it  may  contribute  to  more  clarity  and 
understanding. 

The  first  major  group,  the  idiopathic  malignant 
non-infectious  lymphadenopathies,  may  be  said  to 
be  composed  of  three  clinical  subdivisions:  (1) 

Lymphosarcoma,  which  term  here  includes  those 
tissues  having  the  pathology  typical  of  lymphocy- 
toma,  lymphoblastoma,  reticulum  cel!  sarcoma  or 
plasma  cytoma;  (2)  the  leucemias,  comprising  the 
chloromas,  mixed-cell  leucemias,  leucosarcomas, 
pseudo-leucemias  and  the  aleucemias  as  well  as 
the  pure  myeloid,  lymphoid  or  monocytic  leuce- 
mias, and  (3)  true  tumor  metastases  in  which 
group  is  included  not  only  the  cancer  metatases 
but  also  the  primary  lymph  node  endotheliomas. 

The  second  major  group,  the  infectious,  non- 
malignant  lymphadenopathies,  comprises  five 
clinical  types:  (1)  lymphatic  tuberculosis,  (2) 

Hodgkin’s  disease,  (3)  syphilis,  (4)  simple 
lymphadenitis  (infections  of  focal  origin)  and  (5) 
infectious  mononucleosis.  Hodgkin’s  disease  is  in- 
cluded here  because  many  of  its  clinical  and  path- 
ologic aspects  coincide  with  recent  experimental 
data  and  seem  to  indicate  its  infectious  origin 
and  granulomatous  nature. 

The  third  group,  comprising  diseases  which  are 
neither  infectious  nor  malignant,  is  represented 
by  only  one  class,  lymphadenosis,  or  benign  hyper- 
trophy. This  type  is  always  a representation  of 
one  characteristic  of  some  other  underlying  con- 
dition. Thus  cervical  lymphadenosis  is  occasion- 


June,  1933 


Cervical  Lymphadenopathy — Wiseman 


365 


ally  a prominent  feature  of  thyrotoxicosis  and  of 
serum  sickness.  Status  lymphaticus  which  prob- 
ably does  not  exist  as  an  entity1  would  also  be  a 
member  of  this  group. 

Such  a scheme  of  classification  makes  possible 
a grouping  of  the  entire  field  of  cervical  adeno- 
pathies into  nine  clinical  types.  Further  dis- 
tribution of  these  into  sub-types  is  not  of  great 
practical  value  except  in  two  instances.  First, 
when  the  diagnosis  ’s  “lymphadenitis”  it  is  al- 
ways desirable  and  sometimes  necessary  to  de- 
termine the  etiologic  agent.  For  example,  the 
markedly  enlarged  cervical  nodes  sometimes  seen 
in  scarlet  fever  demand  the  recognition  of  the 
underlying  infectious  agent,  even  though  the 
diagnosis  of  the  cervical  condition  is  accurately 
made  as  “lymphadenitis”.  Second,  if  the  diagnosis 
is  syphilis,  one  wishes  to  know  in  what  stage  the 
disease  process  exists.  With  these  exceptions, 
there  does  not  seem  to  be  anything  materially 
added  of  a practical  nature  by  further  subdivision 
of  these  nine  clinical  types. 

DIFFERENTIAL  DIAGNOSIS 

A knowledge  of  the  regional  anatomy2,  3 of  the 
lymphatic  tissues  is  indispensable  in  differential 
diagnosis.  For  example,  enlargement  of  the  pre- 
auricular  node  may  be  due  to  a focus  of  chronic 
conjunctivitis.  With  information  of  this  char- 
acter in  hand,  one  is  then  properly  equipped  to 
apply  the  various  differential  criteria  which 
characterize  the  different  types  of  disease. 

In  every  case  of  cervical  adenopathy  which 
presents  difficulties  in  diagnosis  there  are  five 
points  to  be  determined.  These  are  characteristics 
which  offer  clinical  and  laboratory  contrast  and 
represent  basic  objective  phenomena  important  to 
all  lymphatic  disease.  Many  signs  peculiar  to  in- 
dividual diseases  will  not  be  mentioned  as  such 
detail  is  obviously  beyond  the  scope  of  this 
paper.  The  following  characteristics,  however, 
must  be  searched  for  when  any  particular  dis- 
ease syndrome  is  suspected. 

1.  Temperature.  With  the  exception  of  leuce- 
mia  in  an  acute  stage,  serum  sickness  and  the 
moribund  states  of  any  adenopathy,  fever  is 
found  only  among  the  diseases  of  the  infectious 
group.  The  form  of  the  temperature  curve  is 
often  important;  thus  a Pel-Ebstein  type  of  curve 
is  very  suggestive  of  Hodgkin’s  disease,  and  a 
septic  curve  of  suppurating  lymphadenitis.  It 
must  be  recognized  however,  that  absence  of  tem- 
perature does  not  deny  the  existence  of  an  in- 
fectious process ; it  is  rather  the  presence  than  the 
absence  of  the  critei’ion  that  is  significant. 

2.  Characteristics  of  the  Nodes.  Important 

points  to  be  determined  here  are:  (a)  the  pres- 

ence or  absence  of  pain  (and  other  evidences  of 
inflammation)  upon  palpation  of  the  nodes;  (b) 
the  distribution  of  the  swellings,  whether  local  or 
generalized,  and  (c)  the  physical  characteristics 
(“feel”)  imparted  to  the  palpating  fingers  by  the 
diseased  nodes.  Presence  of  painful  glands  always 


immediately  classifies  the  adenopathy  as  infec- 
tious. This  is  the  most  important  single  objective 
physical  criterion  in  a differential  diagnosis,  and 
if  tuberculosis  can  be  ruled  out  an  immediate 
diagnosis  of  simple  lymphadenitis  of  focal  origin 
can  be  made  with  considerable  assurance.  Painful 
glands  practically  always  mean  inflammation  and 
therefore  infection.  Care  must  be  exercised,, 
however,  to  distinguish  between  the  pain  induced 
in  surrounding  structures  by  pressure  and  that 
which  is  resident  in  the  node  capsule  itself.  The 
former  may  or  may  not  be  inflammatory  in  origin 
while  the  latter  nearly  always  is. 

The  distribution  of  the  gland  swellings,  taken 
with  other  data,  is  of  importance  in  differential 
diagnosis.  Thus,  generalized  adenopathy  without 
temperature  is  characteristic  of  the  chronic- 
leucemias,  the  afebrile  stage  of  Hodgkin’s  disease 
and  the  benign  hypertrophies;  if  an  elevated  tem- 
perature is  present,  a generalized  swelling  of 
lymphatic  tissue  usually  means  syphilis,  Hodg- 
kin’s disease,  infectious  mononucleosis,  general- 
ized lymphatic  tuberculosis  (which  is  uncommon), 
serum  sickness  or  an  acute  phase  of  leucemia.  On 
the  other  hand,  local  adenopathy  without  tem- 
perature or  evidence  of  inflammation  suggests 
lymphosarcoma,  tumor  metatasis,  lymphadenosis, 
tertiary  syphilis,  or  Hodgkin’s  disease.  Local 
swelling  combined  with  pain  and  inflammation  is 
nearly  always  indicative  of  local  infection,  either 
lymphatic  tuberculosis  or  pyogenic  lymphadenitis,, 
but  never  of  Hodgkin’s  disease. 

The  physical  characteristics,  as  obtained  by  pal- 
pation of  an  enlarged  node  is  usually  said  to  give 
important  data.  With  the  exception  of  lymphatic 
tuberculosis,  fluctuant  lymphadenitis,  and  leuce- 
mia, I do  not  wish  to  emphasize  the  importance  of 
this  criterion  as  a reliable  aid  in  differential 
diagnosis.  It  is  true  that  some  cases  of  metastatic 
carcinoma  and  some  very  chronic  (sclerosing) 
types  of  Hodgkin’s  disease  present  very  hard  and 
unyielding  glands.  But  many  do  not.  It  is  also 
true  that  many  malignant  adenopathies  and  cases 
of  Hodgkin’s  disease  exhibit  discrete,  not  fused, 
glands.  Nevertheless,  I have  not  infrequently 
seen  these  conditions  reversed.  In  leucemia,  how- 
ever, the  glands  are  always  discrete  and  elastic 
to  the  touch.  Similarly  a chronic  fluctuant  or 
soft  node,  if  painful,  adherent  to  the  skin,  or 
showing  evidence  of  previous  sinus  formation, 
usually  means  localized  lymphatic  tuberculosis. 
With  these  exceptions,  it  cannot  be  said  that  the 
physical  characteristics  of  the  enlarged  nodes 
offer  a great  deal  of  help  in  differential  diagnosis. 

3.  Splenomegaly.  The  presence  and  degree  of 
splenic  enlargement  is  important  from  a clinical 
standpoint.  Thus  a hard  spleen  extending  nearly 
to  the  umbilicus  with  concomitant  generalized 
adenopathy  nearly  always  means  leucemia— and 
the  larger  the  spleen  the  more  likely  is  the  leuce- 
mia to  be  myelogenous  in  type.  Some  cases  of 
leucemia,  however,  have  only  slightly  enlarged 


366 


The  Ohio  State  Medical  Journal 


June,  1933 


.spleens.  In  Hodgkin’s  disease  the  spleen  does  not 
usually  extend  much  below  the  costal  border  and 
is  not  palpable  at  all  in  approximately  one-half 
the  cases.  A slightly  enlarged  spleen  is  not  un- 
commonly a feature  of  infectious  mononucleosis. 
Lymphosarcoma  only  occasionally  present  a pal- 
pable spleen.  In  general,  the  presence  of  a pal- 
pable spleen  in  conjunction  with  a chronic  cervical 
adenopathy  strongly  suggests  the  presence  of 
leucemia  or  Hodgkin’s  disease. 

4.  Blood  Picture.  This  is  one  of  the  most  im- 
portant single  determinations  that  should  be  ob- 
tained in  every  obscure  cervical  adenopathy. 
■Curiously  enough,  this  fact  does  not  seem  gen- 
erally to  be  appreciated.  It  should  further  be 
emphasized  that  the  amount  of  information  de- 
rived will  be  in  direct  proportion  to  the  care 
with  which  the  blood  study  is  made. 

In  the  group  comprising  the  malignant  cervical 
adenopathies,  the  blood  picture  is  normal  except 
in  those  patients  in  an  advanced  stage  of  the  dis- 
ease or  with  leucemia.  In  the  latter  instance,  of 
course,  the  blood  count  is  pathognomonic.  Leuco- 
cytosis  with  neutrophilia  is  strong  evidence  that 
the  adenopathy  in  question  is  of  infectious  origin. 
With  lymphocytosis,  monocytosis  and  mild  anemia 
of  the  hemoglobin  type  one  suspects  lymphatic 
tuberculosis;  with  lymphopenia,  eosinophilia  and 
monocytosis  (and  usually  leucopenia,  with 
mai’ked  anemia  of  the  R.B.C.  type),  the  blood  re- 
flects Hodgkin’s  disease;  with  eosinophilia  and 
lymphocytosis  but  normal  total  reds  and  whites, 
the  findings  suggest  lues;  with  marked  lymphocy- 
tosis, Reider  nuclei  and  normal  red  cells  the  sug- 
gestion of  infectious  mononucleosis  is  given.  With 
simple  pyogenic  lymphadenitis,  only  a neutro- 
philia is  observed,  the  other  cell  types  being  re- 
latively undisturbed. 

The  non-infectious,  non-malignant  group  of 
lymph  gland  dyscrasias  is  characterized  by  nor- 
mal total  counts  but  relative  increases  in  the 
lymphocytes.  Care  must  be  exercised  here  not  to 
confuse  this  group  with  aleucemic  phases  of 
chronic  lymphatic  leucemia.  This  can  be  avoided 
by  demonstrating  a concurrent  disease  other  than 
leucemia  that  is  responsible  for  the  lymphatic  re- 
action. 

5.  Biopsy.  With  all  the  information  attainable 
by  the  above  procedures,  there  will  still  be  a con- 
siderable residue  of  cases  in  which  the  diagnosis 
remains  uncertain.  These  cases  should  be  sub- 
mitted unhesitatingly  to  biopsy.  The  gland  se- 
lected should  in  all  cases  be  that  which  is  likely 
to  contain  the  most  pathology,  i.e.,  usually  the 
largest  gland.  This  tissue  should  be  removed 
without  cutting  across  or  rupturing  of  the  gland, 
and,  if  feasible,  it  is  well  to  remove  all  the  dis- 
eased tissue.  A recent  case  in  our  clinic  in  which 
the  diagnosis  was  uncertain  before  operation,  was 
completely  cured  by  a biopsy  in  which  all  the 
visible  affected  lymphatic  tissue  was  removed. 
Examination  of  the  removed  tissue  showed  a re- 
latively early  and  well-localized  actinomycosis. 


In  a differential  diagnosis  between  various 
types  of  cervical  swellings,  one  must  constantly 
keep  in  mind  the  possibility  that  the  disease  may 
be  extra-lymphatic.  Chief  among  these  latter  are 
thyroid  carcinoma,  branchiogenic  carcinoma, 
angioneurotic  oedema  and  various  cysts  such  as 
dermoids,  ranula,  etc.  Confusion  of  this  group  of 
diseases  with  lymphatic  dyscrasias  is  not  uncom- 
mon but  usually  can  be  avoided  simply  by  keeping 
them  in  mind. 

TREATMENT 

Treatment  of  the  idiopathic  types  of  cervical 
adenopathy  is  best  accomplished  by  means  of 
irradiation.  Treatment  of  the  other  types  re- 
solves itself  essentially  into  caring  for  the  under- 
lying etiologic  factors.  Of  this  latter  group,  some 
special  mention  should  be  made  of  tuberculous 
and  pyogenic  lymphadenitis  as  these  are  most 
often  seen  in  the  nose  and  throat  clinics. 

Soper1  and  others  have  said  that  cervical  tuber- 
culosis is  rarely  antecedent  to  the  pulmonary  type 
of  disease.  There  is  good  reason,  however,  to  be- 
lieve that  a certain  percentage  of  cases  will  later 
develop  pulmonary  tuberculosis5  probably  through 
a bacillemia6.  The  chief  concern  in  treating  cer- 
vical tuberculosis  is  therefore  one  of  attacking 
the  nodes  before  metastasis  results.  This  has 
been  emphasized  by  Miller  and  Shedden7.  The 
plan  of  treatment  should  therefore  first  of  all  be 
general  with  rest  and  liberal  vitamin  intake. 
Heliotherapy  is  advisable  unless  the  usual  con- 
traindications are  present.  These  adjuncts  com- 
bined with  X-ray  locally  constitute  the  method  of 
treatment  favored  by  most  therapists. 

Although  the  recent  trend  has  been  away  from 
radical  surgery,  there  a re  still  many  advocates  of 
this  procedure7* s.  With  the  potential  dangers  of 
pulmonary  metastasis  to  be  reckoned  with  :t 
would  seem  that  careful  dissection  and  removal 
of  the  diseased  tissue  without  rupture  into  the 
wound  is  the  most  certain  method  of  eliminating 
this  focus  of  organisms.  In  any  case  if  a sup- 
purating node  does  not  yield  to  other  forms  of 
treatment,  or  if  fibrosed  tissues  cause  permanent 
deformity,  removal  is  indicated.  Since  the  ma- 
jority of  cases  have  their  origin  in  tonsils  or 
adenoids,  these  tissues  should  be  removed  in  all 
cases  of  cervical  tuberculosis  providing  absence 
of  pulmonary  tuberculosis  of  the  adult  type  can 
be  demonstrated.  One  should  not  forget  to  inquire 
into  the  primary  source  of  the  organisms.  An 
improper  milk  supply  or  poor  hygienic  habits  may 
require  correction. 

The  choice  of  treatment  for  pyogenic  lympha- 
denitis resolves  itself  into  whether  the  process  is 
acute  or  chronic.  Tonsillectomy  for  the  chronic 
process  has  long  been  accepted  and  practiced.  In 
acute  infections  there  is  considerable  controversy, 
some  regarding  this  procedure  as  desirable70.  It 
would  seem,  however,  that  the  potential  risks  out- 
weigh the  possible  advantages11’  A 

A more  conservative  plan  is  to  treat  the  focus 


June,  1933 


Determination  of  Visual  Acuity — Moore 


367 


medically  or  surgically  as  indicated,  and  the 
secondarily  involved  nodes  either  with  rest  in  bed 
using  cold  compresses  or  with  X-ray,  which  latter 
has  been  extensively  advocated  recently1 0 17.  If 
fluctuation  occurs,  incision  with  drainage  is,  of 
course,  necessary.  Ar-ray  is  said  usually  to  pre- 
vent suppuration  if  given  by  the  third  to  fourth 
day  of  the  disease17. 

SUMMARY 

Although  there  are  a great  variety  underlying 
pathologic  changes  found  in  diseases  of  the  lymph 
nodes,  for  practical  purposes  these  can  all  be 
grouped  into  a relatively  small  number  of  clinical 
types.  Many  of  the  latter  can  be  accurately 
identified  by  clinical  examination,  but  recourse  to 
biopsy  is  often  necessary.  The  chief  differential 
diagnostic  criteria,  a clinical  classification,  and 
the  therapeutic  rationale  for  the  more  important 
types  have  been  emphasized. 


BIBLIOGRAPHY 

1.  Young,  M.,  and  Turnbull,  H.  M.,  J.  Path,  and  Bad., 
1931,  3Jf,  213. 

2.  Lester,  C.  W.,  Internat.  Clinics,  1930,  3,  7. 

3.  Trotter,  H.  A.,  Ann  Otol.,  Rliin.  and  Laryngol.,  1930, 
39,  384. 

4.  Soper,  W.  B.,  in  Textbook  of  Medicine,  Edited  by  R. 
L.  Cecil,  W.  B.  Saunders  Co.,  Phila.,  1929. 

5.  Myers,  J.  A.  Tuberculosis  Among  Children,  Charles 
Thomas,  Baltimore,  1930. 

6.  Connerth,  O.,  Deutsch.  med.  Wochnschr.,  1926,  52, 
533. 

7.  Miller,  R.  H.,  and  Shedden,  W.  M.,  Am.  Rev.  Tuberc, 
1929,  19,  511. 

8.  Hanford,  J.  M.,  Ann.  Surg.,  1924,  80,  885. 

9.  Clute,  H.  M.,  Ann.  Surg.,  1927,  86,  666. 

10.  Baum,  H.  L.,  J.A.M.A.,  1930,  95,  1829. 

11.  Lucas,  W.  P.,  Modern  Practice  of  Pediatrics,  Mac- 
Millan Co.,  N.  Y.,  1927. 

12.  Waynes,  C.  E.,  Del.  State  Med.  J.,  1929,  1,  39. 

13.  Heidenhain,  L.,  and  Fried,  C.,  Arch.  f.  klin.  Chir., 
1924,  6U,  133. 

14.  Schuler,  R.,  Munch,  med.  Wochnschr.,  1926,  73,  1580. 

15.  Fried,  C.,  Strahlentherapie,  1926,  21f,  37. 

16.  Kohler,  A.,  Deutsche  Ztschr.  f.  Chir.,  1927,  203,  539. 

17.  Rosenberg,  L.  C.,  Am.  J.  Dis.  Child.,  1929,  37,  529, 


Detemniinataoii  of  tine  Visual  Acuity 

Paul  G.  Moore,  M.D.,  F.A.C.S.,  Cleveland,  Ohio 


A MAN’S  efficiency  is  dependent  on  his  vision. 
Three  factors  make  up  a man’s  ability  to 
see,  the  central  vision  both  distant  and 
near,  spoken  of  hereafter  as  the  visual  acuity,  the 
field  of  vision  and  the  muscle  function. 

This  paper  is  particularly  concerned  with  the 
determination  of  the  visual  acuity — 

First,  how  it  is  to  be  done;  second,  when  it  is  to 
be  done;  and  third,  why  it  is  to  be  done. 

The  following  points  are  to  be  discussed: 
Standards  used;  method  of  using;  errors  made; 
value  of  records;  visual  acuity;  and  visual  effi- 
ciency. 

The  first  factor  to  be  determined  is  the  acuity 
of  vision  for  distance.  This  process  is  familiar  to 
all  of  us,  but  in  order  to  be  explicit  it  will  be  re- 
viewed. A Snellen  vision  chart  is  hung  on  a wall 
or  support,  with  proper  illumination,  in  a room 
at  a distance  of  20  feet  from  the  chair  in  which 
the  person  to  be  examined  is  seated.  If  at  all  pos- 
sible a distance  of  20  feet  or  six  meters  should  be 
used.  A shorter  distance  can  be  used  if  the  proper 
corrections  are  made  in  the  expression  of  the  re- 
sults, or  if  a statement  is  made  to  the  effect  that 
such  a distance  less  than  twenty  feet  is  used. 

Where  a number  of  applicants  are  to  be  ex- 
amined time  might  be  saved  by  having  them 
stand  in  line,  but  where  speed  is  not  imperative  it 
is  better  to  seat  the  applicant  previous  to  ex- 
anrning  him.  Seating  the  patient  comfortably 
secures  more  accuracy  and  cooperation.  Time  can 
be  saved  by  omitting  the  reading  of  the  larger 
types. 

The  left  eye  is  now  covered  with  a card  and  the 

Read  before  the  Section  on  Public  Health  and  Industrial 
Medicine,  Ohio  State  Medical  Association,  86th  Annual  Meet- 
ing, Dayton,  May  3-4,  1932. 


individual  to  be  examined  reads  the  chart  with 
the  right  eye  as  far  down  as  he  can.  Using  a card 
over  the  eye  prevents  the  patient  holding  his  eye 
shut  with  his  fingers  and  blurring  the  vision  from 
pressure  on  the  eyeball.  Much  time  is  lost  waiting 
for  the  examined  to  recover  his  eyesight  after 
pressure  on  the  left  eyeball  with  the  fingers. 

The  examined  reads  the  card  with  the  right  eye 
as  far  as  he  can  and  the  notation  in  feet  at  the 
end  of  the  last  line  read  gives  the  denominator 
of  the  formula  which  expresses  his  vision,  20  feet 
being  the  numerator.  The  expression  of  vision  in 
the  right  eye  being  20/40  or  20  feet,  the  distance 
at  which  the  eyes  are  tested  over  40  feet  the 
lowest  line  of  letters  the  examined  is  able  to  read. 

The  right  eye  is  then  covered  with  the  card  and 
the  vision  in  the  left  eye  determined  in  the  same 
way.  No  difficulty  is  experienced  in  getting  the 
individual  to  read  unless  he  is  dull  or  ignorant  of 
the  letters  for  he  wishes  to  make  his  best  appear- 
ance, consequently  reads  as  far  as  he  can.  Never 
stop  a man  who  is  reading  the  test  chart  in  the 
middle  of  a line  and  ask  him  to  correct  a mis- 
take, let  him  finish  the  line  first.  He  will  do  far 
better  and  will  not  become  confused. 

The  near  vision  is  the  next  determined,  first  in 
the  right  eye  then  in  the  left  eye  using  a card 
whose  letters  are  drawn  in  proportion  to  the 
ones  for  the  distance  chart,  only  this  card  is 
meant  to  be  held  at  a distance  of  14  inches. 

The  numerator  in  the  expression  of  near  vision 
will  be  14  and  the  denominator  the  number  op- 
posite the  smallest  line  of  letters  the  examined 
can  read.  These  values  should  be  immediately  re- 
corded before  they  are  forgotten.  The  examiner 
should  be  particular  in  setting  these  expressions 
of  vision  down  on  paper  that  the  expression  for 


368 


The  Ohio  State  Medical  Journal 


June,  1933 


the  right  eye  comes  first  and  the  left  right  be- 
low it. 

If  the  examined  wears  glasses  determine  and 
record  the  vision,  both  distant  and  near  as  stated 
above  with  the  benefit  of  his  glasses. 

The  Industrial  Commission  of  Ohio  uses  three 
factors  in  the  determination  of  the  visual  acuity 
— the  distant  vision,  the  near  vision  and  the  field 
of  vision. 

The  field  of  vision  is  now  determined.  It  is  true 
that  it  is  impossible  to  accurately  plot  the  visual 
field  on  a perimeter  in  a short  time  but  the  ex- 
amining physician  or  a well  trained  assistant  can 
obtain  valuable  information  concerning  the  field 
of  vision  by  a simple  method  taking  very  little 
time.  The  normal  cases  can  be  passed  and  the 
abnormal  ones  with  tubular  vision  and  hemi- 
onopsias  can  be  held  for  further  examination  if 
their  services  are  otherwise  desirable. 

A simple  form  of  history  record  sheets  is  here 
shown  which  aims  to  give  all  the  details  which 
might  be  asked  for  in  an  examination  by  the  In- 
dustrial Commission  of  Ohio. 

Briefly  I have  reviewed  the  method  of  taking 
the  vision.  If  it  is  desired  to  determine  the  visual 
acuity  of  an  eye  the  above  data  is  now  substituted 
in  a formula  devised  by  the  Eye  Section  of  the 
American  Medical  Association  and  adopted  in 
1926  by  the  Industrial  Commission  of  Ohio. 

FORMULA  FOR  COMPUTING  VISUAL  ACUITY  OF  ONE 
EYE 

Visual  Acuity  = A -)-  2 B 
3 

A = Distant  Vision  A = 20/40  = 83.6% 

B = Near  Vision  B = 14/49  = 64% 

Visual  Acuity 

= A + 2 B = 83.6  x 1 + 64  x 2 =70.53% 

3 3 

The  Snellen  vision  chart  used  above  was  de- 
vised by  Dr.  Herman  Snellen,  a Dutch  ophthalmo- 
logist who  lived  during  the  last  century.  Although 
numerous  charts  have  been  devised  since  they  are 
all  based  on  the  same  principle  which  so  far  is 
scientifically  sound.  Several  theories  as  to  the 
measurement  of  vision  have  been  proposed  since, 
but  have  not  been  accepted. 

I bring  up  this  elementary  explanation  of  tak- 
ing vision  in  order  to  introduce  the  subject  of 
errors  made  in  recording  the  visual  acuity. 

First,  if  the  examined  is  unable  to  read  the 
largest  letter  on  the  chart  it  is  permissible  to  ad- 
vance his  position  toward  the  chart  until  he  can 
see  to  read  the  first  letter  and  then  use  the  dis- 
tance from  him  to  the  chart  as  the  numerator,  for 
instance  10  feet,  but  if  at  10  feet  he  reads  more 
than  the  first  letter,  the  distance  between  him  and 
the  chart  must  be  increased  again  until  he  only 
sees  the  first  letter,  otherwise  there  is  confusion 
in  estimating  the  true  value  of  the  reading. 

Second,  on  a great  many  of  the  vision  charts 
used  are  printed  various  expressions  in  common 


and  compound  fractions  generally  along  the  left 
side  of  the  chart.  This  has  given  rise  to  a great 
deal  of  confusion,  leading  physicians  to  the  belief 
that  these  fractions  were  valuations  of  the  visual 
acuity  and,  up  to  1926  they  were  so  used.  For  a 
number  of  years  ophthalmologists  had  recognized 
that  these  figures  were  inadequate  to  express 
visual  acuity.  Occasionally  some  one  still  uses 
these  fractions  or  is  misled  by  them.  Because  the 
fraction  5/10  occurs  opposite  the  20/40  line  and 
because  20/40  in  common  fractions  can  be  re- 
duced to  5/10  or  % it  is  thought  that  it  must  ex- 
press % of  the  visual  acuity  and  formerly  it  was 
so  taken. 

One  of  the  errors  most  commonly  made  in  the 
recording  of  vision  is  the  reduction  of  the  ex- 
pression of  the  vision  to  its  lowest  terms  as  a 
common  fraction — 20/40  is  reduced  to  % and 
20/200  to  1/5.  If  the  examiner  would  also  express 
the  distance  he  had  used  for  examination  as  10 
feet  or  20  feet  the  reader  could  multiply  both 
terms  of  the  supposed  fraction  by  the  proper 
factor  to  make  the  records  correspond  to  the 
standard. 

If  you  will  excuse  a homely  illustration  I may 
be  able  to  make  my  point  clear: — Twenty  apples 
over  forty  apples  is  not  a common  fraction  and 
cannot  be  reduced  to  % apple  without  destroying 
or  removing  several  apples.  20  feet  over  40  feet 
cannot  be  reduced  to  an  expression  of  % visual 
acuity. 

Occasionally  the  vision  is  taken  at  a distance  of 
10  feet  or  3 meters  or  at  15  feet.  If  so,  it  should 
be  so  stated  to  avoid  confusion.  When  the  figure 
20  is  used  in  the  numerator  the  distance  20  feet 
is  understood. 

THE  VALUE  OF  RECORDS 

If  an  employe  suffers  an  eye  injury  it  is  as- 
sumed that  he  had  100  per  cent  vision  in  the  in- 
jured eye  previous  to  the  accident  unless  there  is 
a reliable  record  to  the  contrary. 

A year  or  so  ago  a company  of  opticians  used 
the  statement  “The  Value  of  Records”  as  a selling 
point  to  several  industrial  concerns  in  Cleveland. 
They  were  to  be  permitted  to  examine  the  em- 
ployes and  make  a record  of  their  vision  which 
records  were  to  be  retained  by  the  company.  A 
certain  percentage  of  vision  is  shown  by  these 
records,  but  the  standard  by  which  it  was  de- 
termined is  not  stated. 

In  a number  of  cases  following  a slight  ac- 
cident, such  as  emery  on  the  cornea  or  oil  and 
steel  chips  splashing  in  the  eye,  a loss  of  a greater 
part  or  all  of  the  vision  is  discovered.  On  ex- 
amination of  the  interior  of  the  eye,  a lesion  is 
discovered,  sufficient  to  have  caused  the  loss  of 
vision,  which  probably  existed  previous  to  the 
accident.  There  may  be  a detachment  of  the 
retina,  an  iritis  or  uveitis,  or  even  evidences  of  a 
former  penetrating  injury  to  the  eye  ball.  If 
several  days  have  elapsed  since  the  time  of  oc- 


June,  1933 


Determination  of  Visual  Acuity — Moore 


369 


currence  of  the  reported  accident  and  the  time  of 
examination,  it  is  extremely  difficult  to  state 
whether  the  disability  followed  the  accident  or 
not.  If  an  optic  atrophy  or  an  old  choroditis  is 
found  we  know  the  accident  did  not  cause  the  dis- 
ability because  sufficient  time  has  not  elapsed  for 
the  development  of  such  a lesion. 

If  a record  of  the  man’s  vision  in  the  disabled 
eye  previous  to  the  accident  exists  then  the  de- 
cision as  to  the  causative  factor  is  greatly  simpli- 
fied. In  case  no  record  exists,  if  the  vision  can  be 
taken  immediately  after  the  accident,  that  is,  on 
the  same  or  next  day  much  trouble  can  be  avoided 
for  the  injured  is  not  then  looking  for  compensa- 
tion nor  has  he  consulted  with  his  friends  as  to 
the  collection  of  damages. 

For  example. — Mr.  H.  W.  was  struck  in  the 
right  eye  on  August  5,  1931,  by  oil  and  steel 
chips.  The  accident  happened  at  quitting  time 
and  the  shop  shut  down  for  a week.  On  August 
19,  1931,  the  claimant  reported  to  the  physician 
complaining  of  blurred  vision.  On  September  4, 
1931,  examination  showed  vitreous  opacities  and 
detachment  of  the  retina.  The  vitreous  opacities 
could  not  have  developed  in  the  four  weeks  which 
had  elapsed,  but  the  character  of  the  accident  did 
not  warrant  us  in  believing  the  detachment  of  the 
retina  was  caused  by  the  oil  splashing  in  the  eye. 
If  the  vision  had  been  taken  a day  or  two  after 
the  accident  and  found  defective  it  would  have  in- 
dicated the  detachment  and  inflammatory  con- 
dition had  already  existed  and  that  the  accident 
was  not  the  cause  of  the  disability.  This  path- 
ological condition  might  also  have  been  discovered 
if  the  vision  had  been  taken  at  the  time  of  em- 
ployment. Since  the  accident,  the  employer  has 
had  this  case  examined  by  several  oculists  in  an 
effort  to  protect  himself. 

At  the  beginning  of  this  paper  the  statement 
was  made  that  a man’s  efficiency  is  dependent 
on  his  vision.  Certain  types  of  work  demand 
more  acuteness  of  vision  than  others.  Conse- 
quently, other  factors  being  equal,  it  would  be 
rational  to  select  men  with  suitable  visual  acuity 
for  this  work. 

Production  would  be  increased,  the  waste  of 
defective  articles  produced  would  be  decreased  or 
eliminated,  and  safety  would  be  increased.  In 
order  to  secure  the  employe  who  is  better  fitted  as 
to  his  vision,  for  the  work  assigned,  a classifica- 
tion as  to  vision  becomes  necessary. 

For  example,  in  one  of  the  large  automotive 
industries  in  Cleveland  a number  of  men  were 
employed  as  testers  driving  trucks  on  the  road. 
Several  of  these  men  were  discovered  with  de- 
fective vision.  It  was  decided  to  make  an  exami- 
nation of  the  vision  of  the  testers  and  the  inspec- 
tors and  then  all  of  the  employes. 

The  following  plan  of  classification  was  then 
adopted : 

Class  “A” — all  individuals  having  vision  of 
20/20  or  better  in  each  eye  without  glasses.  All 


drivers  and  testers  were  required  to  have  class 
“A”  vision. 

Class  “B” — -vision  of  20/20  or  better  in  each 
eye  with  glasses.  All  mechanics,  tool  makers  and 
inspectors  were  required  to  have  class  “A”  or 
class  “B”  vision. 

Class  “C” — vision  of  20/20  in  one  eye  and  as 
low  as  20/200  in  the  other  eye  with  or  without 
correction.  This  class  included  truckers,  sweepers 
and  day  laborers. 

A classification  which  is  fairer  to  the  employe 
is  the  following: 

Individuals  doing  constant  and  fine  work  as 
draftsman,  seamstresses,  inspectors,  comptometer 
operators,  stenographers  and  accountants  are 
grouped  as  class  “A”  and  require  100  per  cent 
visual  efficiency. 

Three  factors  constitute  100  per  cent  visual 
efficiency  in  this  class:  1 — normal  distant  vision; 
2 — absence  of  eye  strain ; 3 — -good  near  vision. 

In  class  “B”  are  grouped  common  laborers, 
janitors  and  elevator  operators  with  a require- 
ment that  there  be  an  arbitrary  vision  sufficient 
for  safety,  not  less  than  20/70. 

There  is  one  job  to  which  are  retired  the  old 
and  disabled  employes,  the  job  of  elevator  opera- 
tors, which  in  my  opinion  demands  a fairly  high 
degree  of  vision. 

Class  “D”  includes  those  who  are  very  much 
limited  in  their  useful  vision  and  even  blind. 
These  people  can  do  certain  selected  types  of 
work. 

The  visual  efficiency  is  greatly  improved  by  the 
wearing  of  proper  fitting  glasses.  It  has  been  ob- 
served that  operators  who  did  not  know  that  they 
were  being  observed,  were  checked  before  and 
after  being  fitted  with  glasses  and  showed  an  in- 
crease in  production,  in  aggravated  cases  of  from 
50  per  cent  to  100  per  cent,  and  increases  of  20 
per  cent  in  production  in  cases  having  had  20/20 
or  100  per  cent  vision  previous  to  refraction. 
Properly  fitted  glasses  not  only  improve  the  dis- 
tant vision  in  those  having  defective  eyes,  but  the 
near  vision  also  and  the  employe’s  efficiency  is 
improved  by  the  elimination  of  eye  strain  and  his 
production  is  speeded  up. 

The  large  number  of  employes  with  defective 
vision  is  not  appreciated.  Men  delay  putting  on 
glasses  or  refuse  to  wear  them.  1,  because  of  the 
expense;  2,  because  they  are  afraid  to  admit  the 
need  of  glasses  fearing  it  will  give  away  their 
age  to  wear  them;  3,  because  of  their  experience 
with  cheap  glasses  or  inexperienced  fitters,  they 
believe  that  all  glasses  have  too  long  or  too  short 
a focus  and  that  it  is  impossible  to  work  with 
them;  4,  because  their  experience  with  bi-focal 
glasses  has  been  uncomfortable  due  to  poor  ad- 
justment of  frames  ^nd  reading  segments. 

A very  impoi'tant  factor  in  the  improvement  of 
near  work  is  the  correction  of  presbyopia,  or  de- 
fective near  vision  coming  on  with  age.  Employes 
are  very  prone  to  neglect  seeking  correction  for 


370 


The  Ohio  State  Medical  Journal 


June,  1933 


this  condition  on  account  of  the  greater  expense 
of  bi-focal  glasses,  and  because  they  have  heard 
that  bi-focal  glasses  are  hard  to  wear,  and  that 
bi-focal  lenses  tell  a man’s  age.  Again  presbyopia 
creeps  on  us  so  insidiously  that  we  do  not  realize 
how  dim  our  vision  grows  with  years. 

Near  vision  is  the  most  important  factor  in 
visual  efficiency.  The  Committee  of  the  American 
Medical  Asosciation  considered  it  of  such  im- 
portance that  they  gave  near  vision  a weighted 
value  of  twice  the  distant  vision  in  their  formula 
for  computing  visual  acuity. 

An  employe,  the  quality  of  whose  work  has  been 
failing  and  who  is  a valued  asset  to  his  company 
can  be  rendered  as  efficient  as  before  and  kept  so 
for  years  if  proper  presbyopic  glasses  are  fitted. 

CONCLUSIONS 

1.  It  is  a good  policy  economically  to  make  a 
record  of  employes’  vision. 

2.  Visual  acuity  should  be  computed  by  a cer- 
tain standard,  that  used  by  the  Industrial  Com- 
mission of  Ohio  as  recommended  by  the  Commit- 
tee on  Appraisal  of  Visual  Efficiency  of  the 
American  Medical  Association. 

3.  Records  should  be  made  at  the  time  of  em- 
ployment. 

4.  Certain  forms  of  employment  demand  cer- 
tain standards  of  visual  efficiency. 

1701  Medical  Arts  Building. 

DISCUSSION 

G.  F.  Sykes,  M.D.,  Cleveland:  Dr.  Moore’s 

paper  has  so  thoroughly  covered  the  technique  in- 
volved in  the  determination  of  visual  acuity  that 
there  is  nothing  for  me  to  add  to  the  matter  pre- 
sented in  his  paper.  However,  there  are  certain 
practical  considerations  of  particular  interest  to 
the  industrial  physician  rather  than  the  oculist 
that  I believe  would  bear  some  emphasis. 

About  fifteen  years  ago  the  company  with 
which  I am  associated  decided  to  expand  and  in- 
crease the  service  rendered  by  their  medical  de- 
partment. The  question  of  the  visual  efficiency  of 
the  employes  and  the  care  of  eyes  injured  in  the 
course  of  employment  received  considerable  study 
at  this  time.  It  was  then  decided  to  call  in  an 
oculist  as  a consultant  member  of  the  medical 
staff  of  our  industrial  dispensary.  The  oculist 
proceeded  to  organize  an  eye  department  for  our 
plant  that  has  functioned  to  the  entire  satisfac- 
tion of  the  plant  management  ever  since. 

Since  that  time  each  new  employe  has  been 
given  a general  physical  examination,  in  the 
course  of  which  an  examination  to  determine  the 
visual  efficiency  is  made  and  recorded.  Certain 
standards  as  outlined  in  Dr.  Moore’s  paper  have 
been  used  in  the  placement  of  new  employes  in 
their  jobs.  Where  an  employe  was  found  to  have 
a low  visual  efficiency  he  was  not  rejected  im- 
mediately for  employment  but  was  sent  to  the 
oculist’s  office  where  a refraction  was  done,  and 
if  his  efficiency  could  be  brought  up  with  glasses 
he  was  passed  for  the  job.  It  has  been  an  in- 
variable rule  that  we  insist  that  the  new  employe 
procure  the  necessary  glasses  before  he  actually 
starts  work. 

Originally  this  program  started  with  the  ex- 
amination of  new  employes  but  as  time  went  on 
selected  groups  of  employes  were  brought  in  and 
a record  made  of  their  visual  efficiency,  and  where 


glasses  seemed  to  be  necessary  they  also  were  re- 
ferred to  the  oculist  for  refraction.  In  addition, 
as  the  program  developed  many  employes  volun- 
tarily came  to  the  medical  department  to  have 
their  vision  checked  and  if  their  visual  efficiency 
was  found  to  be  low  or  there  seemed  to  be  symp- 
toms of  eye  strain  they  were  referred  to  the 
oculist. 

In  making  the  test  for  visual  efficiency  we  use 
the  method  outlined  by  Dr.  Moore  in  his  paper. 
The  actual  tests  are  made  by  a nurse  assistant. 
However,  the  nurse  assistant  has  been  trained  in 
this  work  by  an  oculist  and  thoroughly  under- 
stands the  proper  method  of  making  the  tests. 

Over  a period  of  time  we  have  developed  a 
large  collection  of  records  of  the  visual  efficiency 
of  our  employes,  which  are  now  very  valuable 
both  for  the  protection  of  the  employe  and  the 
employer  in  case  of  injury.  There  is  no  question 
in  my  mind  but  that  the  improvement  in  visual 
efficiency  of  our  employes  over  the  past  few  years 
has  resulted  in  increased  efficiency  on  the  job,  less 
scrapped  work  and  increased  earning  power  of 
the  individual  employe. 

I see  no  reason  why  an  established  industrial 
medical  department  cannot  institute  a program 
such  as  has  been  outlined  in  my  remarks  with 
their  present  staff,  but  before  embarking  on  such 
a program  it  would  be  wise  to  have  the  advice  of 
a consulting  oculist  to  assist  in  developing  the 
organization. 

A.  D.  Frost,  M.D.,  Columbus:  Dr.  Moore  has 
certainly  given  us  a very  clear  and  concise  under- 
standing of  the  methods  of  determining  visual 
acuity  and  of  the  importance  of  the  employer 
having  a record  of  every  worker.  The  scope  of 
such  an  examination  naturally  varies  in  different 
industries  and  may  be  limited  to  the  distant 
Snellen  chart  in  ordinary  laborers  to  a very  com- 
plete examination  such  as  is  made  in  the  Bausch 
and  Lomb  Instrument  Company  by  an  oculist. 

For  the  employer’s  protection  it  is  especially 
desirable  if  there  is  any  hazard  for  eye  injuries. 
What  standards  are  to  be  accepted  depends  of 
course  on  the  nature  of  the  employment.  If  such 
were  not  the  case  it  would  be  hard  for  those  with 
defective  vision  to  earn  a livelihood. 

Since  this  program  of  examination  is  not  the 
rule  and  perhaps  cannot  be  made  compulsory,  we 
should  adopt  some  substitute  which  will  insure 
fairness  to  both  employer  and  employe.  Great 
laxity  has  prevailed  in  our  own  profession  in  not 
recording  the  visual  acuity  in  both  eyes  of  every 
eye  injury  that  we  treat.  This  may  seem  unim- 
portant in  simple  foreign  body  cases  but  very 
often  these  cases  later  cause  much  trouble  to  the 
Industrial  Commission  or  other  insurance  agencies 
from  patients  claiming  loss  of  vision  from  trivial 
injuries.  The  report  should  require  the  testing  of 
visual  acuity  in  both  eyes  at  the  time  of  the  first 
visit.  This  should  also  be  done  in  every  case  of 
any  head  injury  as  soon  as  possible.  It  is  only  by 
this  co-operation  that  the  physician  can  carry  out 
his  duty  to  the  patient  and  society.  Strange  to 
say  the  report  may  even  fail  to  disclose  which  eye 
Was  injured,  nor  any  real  description  of  the  in- 
jury. Unless  this  information  is  at  hand  it.  is 
very  difficult  for  an  examiner  later  to  determine 
in  justice  the  proper  compensation.  I have  in 
mind  the  case  of  a man  who  was  struck  in  the  eye 
by  a stone,  panophthalmitis  developed  and  the  eye 
was  enucleated.  Some  time  later  the  claimant 
reported  that  the  other  eye  was  affected.  Ex- 
amination disclosed  a nearly  blind  eve  from  con- 
genital aniridia,  nystagmus  and  with  the  usual 
secondary  glaucoma  and  corneal  degeneration.  I 
am  quite  satisfied  that  the  injury  had  nothing  to 


June,  1933 


Discourse  on  the  Debunkment  of  Healing 


371 


do  with  this  change  in  the  other  eye,  but  no  ex- 
amination or  report  of  it  had  been  made. 

Occasionally  we  see  cases  in  which  we  feel  there 
is  something  lacking  in  the  method  of  estimating 
visual  efficiency  by  which  awards  are  made.  In 
many  cases  there  may  be  less  than  25  per  cent  loss 
of  visual  acuity  in  one  eye  which  is  not  com- 
pensable but  so  much  binocular  confusion  is  ex- 
perienced that  the  claimant  is  woi'se  off  than  if 
he  had  a greater  or  a complete  loss  of  an  eye. 

Many  of  these  patients  develop  a definite  neu- 
rosis with  spiral  or  tubular  fields  of  vision  and 


are  really  made  unfit  to  efficiently  return  to  their 
employment.  I find  quite  as  many  of  this  type 
as  actual  malingerers.  These  cases  should  not  be 
settled  on  the  standards  set  forth  by  the  ap- 
praisal committee  alone. 

Still  other  factors  exist  that  cannot  be 
evaluated  by  this  formula:  namely  accommoda- 
tion disturbances,  muscle  imbalances  without 
diplopia,  metamorphopsia,  plastic  defects,  etc. 
The  examining  oculist  is  perhaps  best  able  to 
judge  these  difficulties. 


IV, 


By  Socrates  Asklepian 


— Master,  we  bring  Lithios  with  us  this  morn- 
ing, whom  you  know  as  the  pupil  of  Xanthinos, 
the  most  talked-of  among  the  newer  priests  in  the 
Temple  of  Health. 

— He  is  very  welcome,  for  he  comes  clothed  in 
the  robes  of  Xanthinos  himself.  What  would  you 
Lithios? 

— To  speak  truly,  great  Teacher,  praise — praise 
Tor  my  master.  He  has  gained  for  himself  many 
followers  of  whom  I am  but  one;  and  his  brother 
priests  regard  him  highly. 

— Fairly  the  greatest  tribute  that  may  be  paid 
to  any  man — to  have  his  own  class  praise  him. 
It  distinguishes  not  only  the  one  priest  from  the 
many  but  the  one  pedlar  from  the  marketful  and 
the  collector  of  night  soil  from  the  other  scav- 
engers. 

— That  does  not  sound  like  praise,  Socrates. 

— It  is,  nevertheless ; for  fame  rests  upon  praise 
Trom  the  mediocre.  And  do  the  pilgrims  to  the 
Temple  of  Health,  those  who  seek  out  Xanthinos, 
also  praise  him? 

— Great  crowds  seek  him  out,  Socrates. 

— I ask,  do  they  praise  him? 

— Of  that  I do  not  know. 

— They  show  praise  of  him  if  they  return  to 
him. 

— Their  faces  seem  constantly  new,  Socrates. 

— Let  us  speak  no  further  on  this  matter  at  the 
moment  but  rather  of  the  new  virtues  that  your 
master  has  brought  our  priestly  calling.  What  said 
you,  Lithios,  was  the  purpose  of  his  labors? 

— To  debunk  the  healing  practice. 

— A new  word  in  our  Greek  language,  Lithios. 
Will  you  explain  its  meaning  to  these  pupils  of 
mine? 

— It  means  the  uprooting  of  nonsense  out  of 
our  Temple  methods.  It  means  the  substitution  of 
numbers  and  facts  for  those  impressions  regard- 
ing the  sick  that  most  of  the  Temple  priests  seem 
to  work  with. 

— The  substitution  of  science,  in  othei-  words, 
for  vagueness.  I understand  you,  Lithios,  and  it 
is  excellent. 

Then  you,  too,  Socrates,  must  praise  my  mas- 

• ter? 


— Every  priest  must  praise  what  brings  to  our 
calling  the  larger  measure  of  truth. 

— My  master  does  so;  and  he  teaches  the 
greater  truth  even  to  the  pilgrims.  He  debunks 
not  only  the  healing  science  but  the  healing  prac- 
tice. He  shows  the  pilgrims  in  the  Temple  that 
prayer  does  not  reduce  fever,  that  the  laying  on 
of  hands  leaves  the  paralytics  paralyzed  and  that 
the  tonic  draughts  which  other  priests  have  pre- 
scribed and  which  have  failed  to  cure  in  twenty 
years  will  never  cure. 

— Does  Xanthinos  cure  these  illnesses,  Lithios? 

— He  does  not,  Socrates,  and  declares  so,  hon- 
estly. 

— What  else  does  your  master  debunk? 

— He  debunks  carriage  in  the  physicians  and 
their  dress.  He  deems  the  clinic  manner  a 
fraud  designed  to  deceive  the  bedridden  and  he 
has  cast  off  his  own  priestly  habit.  When  in  the 
halls  and  cubicles  of  the  sick  he  dresses  as  do  the 
men  at  the  games.  He  declares  everywhere  that 
the  priests  of  healing  are  merely  men  and  that, 
stripped  of  their  robes,  their  intelligence,  even,  is 
not  above  that  of  other  men. 

— He  has  courage,  Lithios;  but  I question  his 
wisdom. 

— Why  withhold  praise  of  that,  Socrates? 

- — What  deem  you,  Lithios,  to  be  the  physician’s 
purpose  in  life? 

— To  heal  the  sick,  of  course. 

— And  what  if  the  sick  cannot  be  healed? 

— In  your  school,  to  give  comfort. 

— In  your  school,  too,  Lithios,  only  you  have 
been  so  busy  doing  things  that  you  have  had  no 
time  for  meditation.  You  have  not  thought  long 
enough  nor  far  enough  into  this  subject.  Every 
pilgrim  to  a Temple  of  Asklepios  seeks  comfort 
first,  and  cure  afterwards.  Cure  is  only  the 
greater  comfort.  Do  you  follow  me,  Lithios? 

— I only  see  that  you  are  arguing  against  my 
master,  Socrates.  You  are  decrying  Xanthinos’ 
truth  bearing. 

— Interpret  that  as  you  will,  Lithios,  the  pil- 
grim goes  to  the  Temple  to  get  something. 
Xanthinos  would  have  a visit  to  the  Temple  just 
another  walk  into  the  market  place.  I hold  that 


372 


The  Ohio  State  Medical  Journal 


June,  1933 


both  in  the  wares  offered  and  in  the  criers,  things 
should  be  different.  Where  be  those  pilgrims  that 
Xanthinos  could  not  cure  of  imagined  ills;  or  of 
their  melancholies;  or  of  their  dolors  of  long 
standing? 

— I know  not,  Socrates,  for  they  return  not  to 
our  Temple. 

— Then  I will  tell  you,  Lithios.  They  are  lying 
about  the  roadways  in  distress  of  mind;  they  are 
hearkening  to  salve  doctors  in  the  square  of  the 
city;  they  are  following  the  magicians  and  pseudo- 
sciencers  and  praying  to  gods  other  than  Askle- 
pios. 

— You  would  not  have  us  take  up  their  tricks, 
would  you,  Socrates? 

— In  spirit,  no;  in  fact,  yes.  The  pilgrims  come 
first  to  you  because  you  offer  the  better  comfort. 
When  you  fail  them,  they  seek  it  elsewhere.  I say 
that  you  must  know  all  their  tricks,  even  more, 
and  practice  them;  only  they  do  it  for  their  own 
sakes  and  you  must,  for  the  pilgrims’. 

— You  counsel  against  truth  speaking. 

— I counsel  silence  where  speech  brings  naught 
but  greater  pain. 

— You  counsel  false  hope. 

— I counsel  hope  and  pray  that  it  may  not  be 
false. 

— You  counsel  an  elevation  of  the  healing 
priesthood  above  the  level  of  the  common  man. 

— It  stands  for  Asklepios  in  our  living  present 
and  therefore  should  be. 

— You  counsel  that  robes  and  soft  light  and 
quiet  should  be  used  to  impress  the  pilgrim. 

— Exactly,  Lithios.  I insist  that  the  physician 
can  better  follow  his  calling  in  a temple  than  in 
a shop. 

— You  counsel  not  less  bunk  but  more,  Socrates. 

— Put  it  in  your  own  words,  Lithios.  I speak 
only  of  the  need  of  the  pilgrim  and  the  need  of 
the  priest. 


Writing  on  “The  Doctor’s  Practical  Relation  to 
the  Cancer  Problem’’  in  the  Bulletin  of  the  Ameri- 
can Society  for  the  Control  of  Cancer,  Dr.  Wil- 
liam C.  MacCarty,  Rochester,  Minn.,  declared: 
“In  conclusion,  may  it  be  said  that  progress  in 
handling  the  cancer  problem  rests  for  the  present 
at  least  on  more  complete  examinations  (espe- 
cially with  roentgen  rays  and  biopsy),  the  recog- 
nition of  the  fact  that  early  cancers  do  not  give 
symptoms  of  cancer  as  described  in  text  books, 
the  general  acceptance  of  the  relationship  of 
chronic  inflammation  to  cancer,  and  the  elimina- 
tion of  much  if  not  all  of  our  confused  and  not 
universally  accepted  terminology.  If  these  sim- 
ple and  established  facts  form  an  intimate  part 
of  the  practitioner’s  system  of  dealing  with  all 
patients,  then  he  will  surely  discover  many  early 
cancers  and  properly  care  for  the  2,000,000  or 


3,000,000  which  are  now  waiting  to  be  recognized. 
There  is  no  use  talking  about  ‘early  diagnosis’ 
and  then  expecting  to  make  diagnosis  in  this 
stage  by  signs  and  symptoms  of  cancer.  The 
various  organizations  for  the  dissemination  of 
knowledge  to  laymen  have  done  their  work  well.” 


New  Books  Received 

New  and  Nonofficial  Remedies,  1933,  contain- 
ing descriptions  of  articles  which  stand  accepted 
by  the  Council  on  Pharmacy  and  Chemistry  of 
the  American  Medical  Association  on  January  1, 
1933;  publisher,  American  Medical  Association; 
price,  $1.50,  postpaid.  The  annual  editions  of 
this  volume  contain  all  that  the  busy  physician 
needs  to  know  concerning  the  newer  preparations 
which  he  is  daily  importuned  by  the  detail  men 
of  the  pharmaceutical  manufacturers  to  use.  The 
remedies  listed  and  described  here  have  been  ex- 
amined and  found  acceptable  by  the  Council  on 
Pharmacy  and  Chemistry,  the  deliberative  body 
charged  by  the  American  Medical  Association 
with  the  performance  of  this  service  for  the  prac- 
titioner, who  has  not  the  time  or  means  to  make 
the  determinations  for  himself.  The  book  con- 
tains general  articles,  descriptive  of  the  classifi- 
cation under  which  the  various  drugs  are  listed. 
According  to  the  preface,  more  or  less  thorough- 
going revisions  have  been  made  of  the  articles: 
Arsenic  Compounds;  Dyes,  Iodin  Compounds; 
Liver  and  Stomach  Preparations;  Radium  and 
Radium  Salts  and  Silver  Preparations. 

Annual  Reprint  of  the  Reports  of  the  Council 
on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association  for  1932;  publisher,  Amer- 
ican Medical  Association;  price  $1.00. 

The  Council  in  Pharmacy  and  Chemistry  still 
carries  on  its  work  of  informing  the  medical  pro- 
fession concerning  the  new  medicinal  products 
brought  out  by  the  various  manufacturers  of 
pharmaceuticals.  This  volume  contains  the  re- 
port on  products  considered  and  rejected  by  the 
Council  during  the  past  year.  Besides  the  re- 
ports on  rejected  articles,  the  volume  contains 
“Preliminary”  and  “Special”  reports  of  excep- 
tional timeliness  and  value. 

Diseases  of  Tradesmen,  by  -Bernardino  Ramaz- 
zini  (1633-1714),  compiled  by  Herman  Goodman, 
M.  D.,  New  York  City,  together  with  Silk  Hand- 
lers’ Disease  of  the  Skin,  by  Dr.  Goodman;  Medi- 
cal Lay  Press,  New  York  City. 


— Dr.  F.  F.  Kramer  has  been  appointed  head  of 
the  new  maternity  department  at  St.  Mary  Hos- 
pital, Cincinnati.  Others  named  on  the  staff  of 
the  department  are:  Dr.  James  T.  Clear  and  Dr. 
Frank  G.  Wellman,  attending  obstetricians;  Drs. 
Leonard  J.  Wuest,  J.  H.  Kattus,  Thomas  J.  Ball 
and  John  F.  Lyons,  assistant  obstetricians. 


The  President’s  Poqe 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


Attendance  at  medical  meetings  develops  a spirit  of  fraternity  between  the  young 
and  the  old  practitioner.  Each  needs  to  be  associated  with  the  other  and  each  must 
make  his  contribution  to  the  medical  meeting  to  make  it  a success.  The  experience  of 
the  older  practitioner  is  as  valuable  to  the  younger  one  as  the  knowledge  of  recent 
medical  procedure  is  of  value  to  the  elder.  The  closer  the  practitioners  of  all  ages  are 
drawn  together  the  better  will  be  the  quality  of  service. 

When  we  consider  the  reports  of  the  Committee  on  the  Costs  of  Medical  Care  cer- 
tain discrepancies  in  conclusion  appear.  To  most  who  will  take  the  time  to  read  them 
the  conclusion  will  be  drawn  that  the  expense  of  modem  medical  service  is  prohibitive. 
Very  few  will  take  the  time  to  subtract  nursing  and  hospital  care,  medicine,  and  cult 
practice  from  the  one  thing  which  the  doctor  renders — namely,  service.  Very  few  will 
analyze  what  modern  medical  service  is  compared  with  medical  service  twenty  years 
ago.  This  is  very  vital  if  we  are. to  arrive  at  an  understanding  of  the  whole  mattef. 

After  serious  indictment  of  mistakes  of  omission  and  commission  the  majority  re- 
port signers  admit  that  modern  medical  service  with  hospital,  nursing,  and  laboratory 
procedures  is  expensive,  and  will  continue  to  be  so  under  any  plan  which  'may  be  de- 
vised. But  waiving  aside  the  real  reason,  cost,  for  which  the  Committee  was  appointed, 
the  signers  of  the  majority  report  are  inclined  to  believe  that  if  we  surrender  our  tra- 
ditions and  our  Code  of  Ethics  to  hospital  groups  or  political  organizations  all  of  the 
complaints  against  present  day  medical  practice  such  as  fee  splitting,  profiteering,  and 
other  moral  and  professional  lapses  will  be  corrected.  There  is  nothing  in  the  record 
of  accomplishments  of  those  groups  to  maintain  that  position. 

Modern  business  methods  are  under  serious  indictment  at  the  present  time.  Ap- 
parently a complete  re-organization  will  be  necessary.  Many  glaring  examples  of  poor 
economics  and  extravagances  appear  in  the  record,  and  modern  hospital  management, 
too,  suffers  the  same  way.  A complete  over-hauling  will  be  necessary  for  it. 

Before  we  surrender  our  birth-right  to  these  groups  it  is  well  to  study  their  record 
of  performance.  The  practice  of  medicine  is  a profession.  Its  members  must  adhere 
to  the  highest  ideals  and  comport  themselves  in  conformity  with  a high  standard  of 
professional  ethics.  No  student  of  medical  history  will  deny  the  tremendous  advance- 
ment that  has  been  made  under  present  day  conditions.  This  advancement  will  be 
more  rapid  and  more  evenly  distributed  when  we  induce  all  eligible  members  of  the 
profession  to  attend  and  to  participate  in  the  deliberations  of  the  county  medical 
societies.  From  an  organization  standpoint  young  men  as  well  as  old  should  assume  a 
part  of  the  burden  and  obligation  of  the  county  society  and  we  will  then  approximate 
the  duties  imposed  upon  us. 

Medical  organization  should  represent  all  classes  of  the  profession  and  should  be 
interested  in  each  individual  so  long  as  his  practices  are  ethical.  It  should  not  and  is 
.not  expected  to  champion  the  cause  of  an  individual  who  is  guilty  of  a serious  trans- 
gression. We  have  in  our  profession  a percentage  of  undesirables  for  which  we 
apologize.  So  has  every  other  profession  or  group,  generally  speaking.  I am  of  the 
opinion  that  this  percentage  in  our  organization  is  less  than  in  any  other  profession. 
Our  rate  of  progress  is  as  rapid  as  we  can  reasonably  expect,  though  far  short  of 
what  we  wish.  At  any  rate,  so  long  as  progress  is  assured  and  interest  is  maintained 
there  is  no  reason  for  radical  change  and  certainly  every  reason  why  we  as  individuals 
should  seriously  oppose  being  swallowed  up  in  a political  machine. 


373 


Amoiaal  Meeting  Dates,,  Workmen's  Compensation  Problems^ 
Legislation^,  and  Other  Important  Matters  Considered 
at  May  Council  Meeting 


The  Council  of  the  Ohio  State  Medical  Associa- 
tion met  in  the  headquarters  office,  Columbus,  at 
1:00  P.  M.  on  Sunday,  May  7,  1933. 

The  Officers  and  Councilors  present  were: 
President,  Dr.  Platter;  President-Elect,  Dr.  Cum- 
mer; Ex-President,  Dr.  Houser;  Treasurer,  Dr. 
Beer;  Councilors,  Drs.  Caldwell,  Huston,  Klotz, 
Davidson,  Shanley,  Brush,  Seiler  and  Goodman; 
Dr.  Alcorn,  chairman,  and  Dr.  Upham,  member 
of  the  Policy  Committee;  Dr.  Southard,  State 
Director  of  Health;  Executive  Secretary  Martin 
and  Assistant  Executive  Secretary  Nelson.  (Dr. 
Paryzek  and  Dr.  Hein,  the  only  two  absentees, 
were  unable  to  be  present,  the  former  on  account 
of  illness,  and  the  latter  being  in  attendance  at  a 
medical  meeting  in  Washington,  D.  C.). 

The  minutes  of  the  Council  meeting  held  on 
March  5,  1933  (published  on  pages  248  to  250, 
inclusive,  of  the  April,  1933,  issue  of  The  Jour- 
nal) , were  read,  and  on  motion  by  Dr.  Huston, 
seconded  by  Dr.  Seiler  and  earned,  were  ap- 
proved. 

PROBLEMS  OF  THE  1933  ANNUAL  MEETING 

The  Council  considered  in  detail  information 
and  a report  submitted  by  the  Council  Executive 
Committee  in  relation  to  the  problem  of  setting 
dates  for  the  annual  meeting  (following  the  post- 
ponement of  the  meeting  from  May  2 and  3)  and 
not  in  conflict  with  other  meetings  already 
scheduled. 

Upon  invitation  from  the  Council,  a delegation 
from  the  Erie  County  Medical  Society  (consisting 
of  Dr.  J.  C.  Kramer,  Dr.  H.  W.  Lehrer,  Dr.  F.  M. 
Houghtaling  and  Mr.  Fred  Long  of  the  G.  A. 
Boeckling  Company),  presented  an  invitation  to 
hold  the  1933  meeting  at  Cedar  Point.  This  in- 
vitation supplemented  a written  communication 
including  a detailed  analysis  of  facilities. 

Following  the  departure  of  the  delegation  from 
the  Erie  County  Medical  Society,  the  Council 
further  discussed  the  problem  of  the  annual  meet- 
ing, and  it  was  the  consensus  of  opinion  that  if 
the  membership  in  Akron  still  desired  the  1933 
annual  meeting  that  it  should  be  held  there,  the 
House  of  Delegates  at  the  last  annual  meeting 
having  selected  that  city. 

Dr.  Davidson  reported  on  a meeting  of  the  local 
committees  on  arrangements  and  a meeting  of  the 
Summit  County  Medical  Society,  which  had  offi- 
cially renewed  its  invitation  for  the  meeting  to 
be  held  in  that  city.  He  reported  that  the  com- 
mittees had  all  details  well  in  hand  following  the 
postponement  and  that  Akron  still  desired  the 
meeting. 


On  motion  by  Dr.  Huston,  seconded  by  Dr. 
Shanley  and  carried,  the  Council  decided  to  hold 
the  87th  annual  meeting  of  the  State  Association 
in  Akron  on  Thursday  and  Friday,  September  7 
and  8,  1933.  Dr.  Davidson  reported  that  these 
dates  would  be  satisfactory  from  the  standpoint 
of  the  Akron  profession,  the  hotel  situation,  etc. 

Dr.  Cummer  reported  in  detail  consideration 
given  by  the  Council  Program  Committee  and  the 
Council  Executive  Committee  to  the  character  of 
the  program  for  the  meeting.  Upon  his  motion, 
seconded  by  Dr.  Houser  and  carried,  the  Council 
decided  to  schedule  a full  annual  meeting  with 
the  complete  scientific  program  as  originally 
planned,  in  as  far  as  it  possibly  could  be  carried 
out.  By  this  motion,  the  Council  Program  Com- 
mittee was  authorized  to  make  such  changes  and 
adjustment  in  the  program  as  might  be  found 
necessary. 

workmen’s  compensation  developments 

On  behalf  of  the  Special  Workmen’s  Compensa- 
tion Committee,  consisting  of  Dr.  Follansbee, 
chairman,  Dr.  Caldwell  and  Dr.  Hein,  Dr.  Cald- 
well submitted  a detailed  report  on  a number  of 
conferences  held  with  officials  of  the  State  Indus- 
trial Commission  and  the  Department  of  Indus- 
trial Relations,  including  problems  and  procedure 
in  administration,  and  especially  matters  pertain- 
ing to  medical  and  hospital  service  and  medical 
fees,  prior  to  a formal  conference  held  on  Wednes- 
day, April  19,  which  was  followed  by  a meeting  of 
the  committee  on  April  26,  at  which  time  an  offi- 
cial communication  and  report  to  the  Industrial 
Commission  was  formulated  for  submission  to  the 
Council  for  its  approval. 

In  the  informal  report  to  the  Council,  reference 
was  made  to  the  detailed  minutes  of  the  con- 
ference of  April  19,  which  had  been  previously 
mailed  to  the  members  of  the  Council  for  their 
consideration,  and  in  which  an  analysis  of  the 
financial  problems  of  workmen’s  compensation 
was  set  forth  in  some  detail  showing  a decrease 
in  the  reserve  fund  and  a relative  increase  .in  the 
cost  per  case  in  medical,  surgical,  hospital  and 
nursing  fees. 

This  report  by  Dr.  Caldwell  showed  that  offi- 
cials of  the  Industrial  Commission  had  felt  that 
something  must  be  done  to  reduce  medical,  surgi- 
cal and  hospital  costs,  and  that  the  Medical  De- 
partment of  the  Commission  had  drafted  a sug- 
gested, revised  and  reduced  fee  schedule  to  which 
the  Special  Workmen’s  Compensation  Committee 
of  the  State  Medical  Association  had  objected. 

Dr.  Caldwell  then  submitted  a proposed  report 


374 


June,  1933 


State  News 


375 


to  the  Industrial  Commission,  which,  on  motion 
by  Dr.  Davidson,  seconded  by  Dr.  Shanley  and 
canned,  was  officially  approved  by  the  Council  of 
the  State  Association.  (This  report  and  com- 
munication, a part  of  these  minutes,  is  published 
on  pages  377  to  380  of  this  issue  of  The  Journal). 

ECONOMIC  AND  SOCIAL  DEVELOPMENTS  AFFECTING 
MEDICINE 

There  was  submitted  for  the  information  of  the 
Council  a report  on  the  progress  of  the  “social 
program”  in  Ohio  and  other  states,  including  the 
status  of  social  and  welfare  legislation.  A report 
was  also  submitted  on  the  “program”  of  the  Ohio 
Pastors’  Convention  (referred  to  on  pages  225 
and  226  of  the  April  issue  of  The  Journal). 

The  newspaper  reports  on  the  social  program 
of  the  Ohio  Branch  of  the  League  for  Independent 
Political  Action,  a meeting  of  which  was  held  in 
Columbus,  Ohio,  April  24,  were  also  submitted 
for  the  information  of  the  Council. 

A report  was  submitted  on  the  annual  meeting 
of  the  Ohio  Hospital  Association  held  in  Colum- 
bus, May  2,  3 and  4,  with  special  reference  to  the 
discussion  on  group  payment  on  an  insurance 
basis  or  otherwise  for  hospital  service,  and  on 
discussion  by  officials  of  the  Hospital  Association 
of  pending  legislation. 

A discussion  was  also  had  regaining  actions 
and  developments  locally  on  propaganda  based  on 
the  report  of  the  national  Committee  on  the  Costs 
of  Medical  Care. 

LEGISLATION  AND  POLICY 

A summary  of  developments  and  activities  by 
the  committees  of  the  State  Legislature,  which 
had  been  in  session  during  the  present  recess,  was 
reported  to  the  Council.  Dr.  Alcorn,  chairman  of 
the  Policy  Committee,  analyzed  the  prospects  at 
the  resumption  of  the  legislative  session  on  May 
15.  He  explained  that  all  measures  affecting 
health-welfare  and  medical  practice  which  have 
been  introduced  during  the  present  session,  are 
still  pending,  and  the  legislative  problems  of  the 
medical  profession  are  still  “wide  open”.  He  dis- 
cussed and  made  recommendations  for  continued 
activity  by  the  Councilors  and  the  legislative  com- 
mitteemen, and  presented  for  the  consideration  of 
the  Council  a proposed  analysis  of  the  taxation 
program  for  inclusion  in  a legislative  bulletin, 
together  with  a reference  to  and  analysis  of  de- 
velopments on  other  pending  measures. 

FINANCIAL  MATTERS 

Dr.  Platter,  the  President,  on  behalf  of  the 
Council  Executive  Committee,  reported  on  budget 
and  financial  details,  including  detailed  expendi- 
tures and  prospects  for  a “balanced  budget”.  He 
explained  economies  that  had  been  made  effective 
in  operation,  maintenance,  and  publication  costs. 
He  reported  that  Dr.  Paryzek  (unavoidably  ab- 
sent on  account  of  illness)  had  desired  to  present 


to  the  Council  recommendations  from  the  Cleve- 
land Academy  of  Medicine  for  a reduction  in  the 
annual  dues  of  the  State  Association  and  perhaps 
a refund  from  this  year’s  dues.  Members  of 
Council  discussed  this  problem  at  some  length, 
and  it  was  the  consensus  of  opinion  that  the 
present  $5.00  per  capita  annual  dues  for  members 
of  the  State  Association  were  sufficiently  nominal 
and  that  at  least  at  this  time  it  would  be  unwise 
and  impractical  to  consider  either  a decrease  in 
dues  or  a refund.  (In  connection  with  this  dis- 
cussion, reference  was  made  to  the  same  question 
in  the  minutes  of  the  meeting  of  the  Council  on 
October  2,  1932 — page  794,  November,  1932,  issue 
of  The  Journal).  Members  of  Council  expressed 
regret  at  Dr.  Paryzek’s  inability  to  be  present  at 
this  meeting,  and  recommended  that  Dr.  Paryzek 
be  permitted  to  submit  his  proposals  and  ideas  at 
a subsequent  meeting. 

Upon  motion  by  Dr.  Seiler,  seconded  by  Dr. 
Klotz  and  earned,  further  consideration  of  this 
entire  matter  was  tabled. 

REGULATIONS  OF  MEDICINAL  LIQUOR 

Special  reference  was  made  to  the  article  pub- 
lished on  page  319  to  321,  inclusive,  of  the  May, 
1933,  Journal,  relative  to  recent  changes  in  fed- 
ei’al  and  state  laws  and  proposed  regulations  per- 
taining to  medical  liquor.  Dr.  Upham  analyzed 
some  of  the  features  of  the  pending  regulations 
now  under  consideration  by  the  Treasury  De- 
partment and  U.  S.  Attorney  General  on  this 
matter.  Reference  was  also  made  to  a possible 
conflict  in  the  federal  and  state  laws  on  this  sub- 
ject. Announcement  was  made  that  the  Ohio  At- 
torney General  now  has  under  consideration  an 
opinion  on  the  effect  of  House  Bill  9 (the  Smolka- 
McNamee  Act),  signed  by  the  Governor  on  March 
15,  which  becomes  effective  on  June  14. 

POLICY  ON  BENEFITS  TO  U.  S.  VETERANS 

The  changes  in  policy  and  benefits  to  U.  S. 
veterans,  especially  for  non-service-conected 
disabilities,  was  considered  at  some  length,  and 
reference  made  to  the  article  on  this  subject  on 
pages  316  to  318  of  the  May,  1933,  Journal,  sup- 
plementing previous  articles  on  this  subject. 

MISCELLANEOUS 

Consideration  was  given  to  several  suggestions 
and  recommendations  to  the  delegates  from  Ohio 
to  the  House  of  Delegates  of  the  American  Medi- 
cal Association  for  the  forthcoming  meeting  to  be 
held  in  Milwaukee,  June  12  to  16.  While  no 
definite  instructions  were  issued  to  the  delegates, 
several  Councilors  called  attention  to  the  federal 
ruling  whereby  funds  from  the  Reconstruction 
Finance  Corporation  for  “relief”  could  not  be 
used  for  medical  service.  Discrepancies  and  dis- 
criminations against  the  medical  profession  were 
cited,  and  references  made  to  the  analysis  of  the 


376 


The  Ohio  State  Medical  Journal 


June,  1933 


state  and  federal  “relief”  program,  published  on 
pages  257  to  258  of  the  April,  1933,  Journal. 

On  behalf  of  the  Publication  Committee  a rec- 
ommendation was  submitted  to  the  Council  that 
when  space  permits  and  suitable  and  valuable 
material  is  available,  that  articles  be  published 
in  The  Journal  on  historical  medicine  in  Ohio. 
Reference  was  made  to  the  possible  sources  for 
some  of  this  material.  On  motion  by  Dr.  Good- 
man, seconded  by  Dr.  Seiler  and  earned,  the 
Council  authorized  the  Publication  Committee  to 
use  its  judgment  in  this  matter. 

Upon  recommendation  of  the  Publication  Com- 
mittee, the  Council  also  took  action  officially  on 
the  previous  vote  by  mail  on  the  question  of  the 
acceptance  of  cigarette  advertising.  On  motion 
by  Dr.  Huston,  seconded  by  Dr.  Brush  and  car- 
ried, the  Council  authorized  the  Publication  Com- 
mittee to  accept  cigarette  advertising  for  The 
Journal,  provided  the  advertising  copy  is  properly 
edited  and  does  not  contain  any  material  which 
might  be  construed  as  “health  claims”. 

A report  on  membership  showed  a tabulation  of 
a total  in  the  State  Association  on  May  6 of 
4,657  for  1933,  as  compared  with  5,061  on  the 
same  date  last  year,  and  as  compared  with  a total 
of  5,352  for  the  year  of  1932.  The  Council  dis- 
cussed several  means  of  interesting  delinquent 
members  in  paying  their  dues  and  promptly  re- 
newing their  membership. 

There  was  a discussion  on  the  medical  defense 
situation  and  suggestions  for  the  prevention  of 
suits.  It  was  also  suggested  that  county  medical 
societies  arrange  to  discuss  this  question  with 
special  reference  to  “prevention”,  as  recommended 
by  the  Medical  Defense  Committee. 

The  Council  adjourned  to  meet  at  the  call  of 
the  President. 

S.  J.  Goodman,  M.D., 
Secretary  of  Council. 


Medical  Systems  in  Austria  Are  Described 
by  American  Physician 

Inasmuch  as  the  question  of  developing  various 
kinds  of  insurance  schemes  for  financing  medical 
and  hospital  bills  is  at  the  present  time  being  dis- 
cussed far  and  wide  as  offering  a solution  to  some 
of  the  economic  aspects  of  sickness,  the  following 
excerpts  from  a letter  written  by  a former  Mil- 
waukee physician,  now  in  Vienna,  to  the  editor  of 
the  Wisconsin  Medical  Journal  raise  some  sig- 
nificant points  concerning  socialized  medicine. 

Prefacing  his  report  with  the  explanation  that 
it  is  a cross-section  of  opinions  of  a half  a dozen 
more  or  less  prominent  Viennese  physicians,  the 
former  Milwaukee  physician  writes: 

“Vienna  at  present  has  approximately  two  mil- 
lion inhabitants  of  which  180,000  are  out  of  work. 
These  and  their  families  are  being  cared  for  in 
the  free  municipal  hospitals  and  clinics.  Of  the 


remainder,  approximately  80  per  cent  are  mem- 
bers of  various  health  insurance  companies 
(Krankenkassen) . The  insurance  companies  are 
both  municipal  and  semi-private  corporations  but 
in  any  case  closely  controlled  by  municipal  regu- 
lations. 

“About  20  per  cent  of  the  money  collected  by 
the  insurance  companies  is  paid  out  to  physicians. 
The  remaining  80  per  cent  is  consumed  in  the 
overhead  of  the  company  upkeep  of  offices,  state 
and  municipal  taxes  and  assessments,  and  the 
building  of  dwelling  houses  for  the  unemployed. 

“The  average  general  practitioner  receives  3 
shillings  for  an  office  call  and  5 for  a house  call. 
The  specialist  receives  4 shillings  for  an  office  call 
and  7 for  a house  call.  The  shilling  is  worth  ap- 
proximately 12  cents.  Operative  fees  are  of  cor- 
responding size.  It  was  stated  by  one  surgeon 
that  he  prefers  to  take  his  insurance  patients  to 
his  own  municipal  operative  clinic,  where  all 
wox’k  is  done  free  of  charge,  rather  than  be  in- 
convenienced by  operating  at  another  hospital  in 
order  to  collect  the  small  fee.” 

Another  bit  of  illuminating  evidence  relative  to 
the  injustices  of  socialized  medicine,  both  from 
the  standpoint  of  the  patient  and  the  physician! 


Plan  for  Control  Over  Medical  and  Dis- 
pensary Service  Adopted  in 
Cincinnati 

A plan  “providing  for  some  measure  of  control 
by  the  medical  profession  over  the  granting  of 
medical  care  to  individuals  applying  for  medical 
sei-vice  at  free  dispensaries  either  directly  or 
through  social  agencies”  has  been  approved  by  the 
Cincinnati  Academy  of  Medicine  and  recommended 
to  the  board  of  trustees  of  the  Cincinnati  General 
Hospital  for  a trial  in  connection  with  the  opera- 
tion of  the  Out-Patient  Department. 

The  plan  proposes  that  an  applicant  for  service 
at  free  dispensaries  or  clinics  receive  a card  which 
he  must  take  to  his  family  physician.  If  the 
physician  wishes  to  care  for  the  applicant,  he 
must  mail  back  the  card  to  the  clinic.  If  the  phy- 
sician wishes  the  applicant  cared  for  at  the  clinic, 
the  physician  signs  the  card  and  the  applicant 
presents  it  at  the  clinic.  If  the  applicant  has  no 
family  physician,  he  would  be  referred  to  a phy- 
sician in  his  neighborhood  who  has  certified  a 
willingness  to  cooperate  in  the  plan.  The  finances 
of  applicants  referred  to  the  clinic  either  by  phy- 
sicians or  social  agencies  would  be  carefullly  in- 
vestigated and  only  applicants  certified  as  to 
their  inability  to  pay  for  medical  services  ac- 
cepted. 

The  Council  of  the  Academy  in  endorsing  the 
plan  pointed  out  that  steps  must  be  taken  to  meet 
the  present  conditions  since  many  persons  “are  in 
danger  of  becoming  free-clinic  minded”. 


Acmte  and  Serious  Problems  in  W orkmen's  Compensation.  t $ 


Confronted  with  acute  financial  problems  re- 
sulting from  the  prolonged  business  slump,  un- 
employment, reduction  of  premium  income,  in- 
crease in  the  average  cost  per  claim,  deprecia- 
tion in  the  value  of  securities,  and  other  factors 
arising  from  the  general  economic  situation,  the 
State  Industrial  Commission  has  been  seriously 
considering  reductions  in  the  medical  and  sur- 
gical fee  schedule  governing  medical  services  to 
beneficiaries  of  the  Ohio  Workmen’s  Compensa- 
tion Fund. 

The  serious  financial  and  administrative  prob- 
lems confronting  the  Industrial  Commission  were 
analyzed  at  a recent  series  of  conferences  at- 
tended by  officials  of  the  Commission,  officers  of 
the  Ohio  State  Medical  Association,  and  mem- 
bers of  the  Special  Woi'kmen’s  Compensation 
Committee  of  the  State  Association,  at  which 
time  the  Commission  submitted  for  consideration 
a suggested  revised  and  reduced  schedule  of  fees 
to  be  paid  to  physicians  for  treating  disabled 
workmen  entitled  to  benefits  of  the  compensation 
fund. 

Information  presented  by  the  Commission  at 
these  conferences  revealed  that  the  conditions 
which  led  it  to  feel  that  something  must  be  done 
to  curtail  medical,  surgical  and  hospital  costs  in 
connection  with  workmen’s  compensation  cases 
have  been  developing  over  a period  of  time  and 
had  reached  an  acute  stage  within  the  past  few 
months. 

It  was  the  opinion  of  representatives  of  the 
Ohio  State  Medical  Association  present  at  these 
conferences  that  the  financial  and  administrative 
problems  of  the  Commission  would  not  be  solved 
through  reductions  in  the  medical  and  surgical 
fee  schedule  which,  it  was  contended,  is  reason- 
able and  fair  for  the  honest,  competent  phy- 
sicians and  for  the  Industrial  Commission. 

Realizing,  at  the  same  time,  that  the  prob- 
lems confronting  the  Commission  are  serious  and 
that  there  have  been  a number  of  abuses  on  the 
part  of  some  physicians,  hospitals,  claimants,  etc., 
the  Special  Workmen’s  Compensation  of  the  State 
Medical  Association  has  submitted  to  the  State 
Industrial  Commission  a report,  officially  approved 
by  The  Council  of  the  State  Association,  embody- 
ing a number  of  suggestions  for  correcting  these 
abuses  and  for  solving  the  financial  problems  of 
the  Commission,  but  strongly  recommending  that 
no  reductions  be  made  now  in  the  medical  and 
surgical  fee  schedule. 

PROBLEMS  OF  COMMISSION  SUMMARIZED 

Information  presented  at  the  previously  men- 
tioned conferences  by  the  Commission  revealed 


that  for  some  time  the  disbursements  from  the 
Ohio  Workmen’s  Compensation  Fund  have  ex- 
ceeded the  income  obtained  from  premiums  paid 
by  insured  employers. 

This,  members  of  the  Commission  declare,  has 
been  the  result  of  two  factors.  First,  due  to  the 
falling  off  of  industrial  payrolls  on  which  premi- 
ums are  based.  Second,  because  of  the  average 
increase  in  the  amount  paid  out  per  claim  filed 
with  the  Commission. 

It  has  been  estimated  by  the  Commission  that 
whereas  the  average  yearly  expenditures  during 
the  past  few  years  for  compensation  to  disabled 
workmen  and  for  medical,  nursing  and  hospital 
bills  have  been  almost  $15,000,000,  the  income  from 
premiums  has  averaged  approximately  $7,500,000. 
In  1931,  for  example,  expenditures  from  the 
fund  were  $12,230,782.35  for  compensation  to  dis- 
abled employes,  $3,208,673.12  for  medical  fees, 
and  $1,524,598.67  to  hospitals  and  nurses,  total- 
ing almost  $17,000,000,  or  approximately  $4,500,- 
000  in  excess  of  the  premium  income  for  that 
year. 

The  Commission  states  that  its  records  reveal 
two  main  reasons  for  the  relative  increase  in  the 
average  cost  per  claim,  although  the  number  of 
claims  filed  has  been  practically  cut  in  half. 

One  reason  cited' is  the  marked  tendency  toward 
the  extension  of  periods  of  disability  and  the 
filing  of  border-line  or  questionable  claims  during 
the  period  of  unemployment  and  when  wages 
have  been  materially  reduced.  In  other  words, 
in  some  instances  an  effort  has  been  made  to  per- 
vert the  purpose  of  the  workmen’s  compensation 
fund  to  unemployment  relief. 

Another  factor,  it  is  said,  is  the  increase  in  the 
average  cost  per  claim  for  medical,  hospital  and 
nursing  services.  Figures  compiled  by  the  Com- 
mision  show  a gradual  increase  in  the  average 
amount  paid  out  per  case  for  such  services  during 
the  years  1924  to  1932,  inclusive,  as  contrasted 
with  a decrease  in  the  amount  per  case  paid  out 
to  disabled  employes. 

Faced  with  this  situation,  the  Commission  for 
some  time,  in  order  to  meet  compensation  claims 
and  all  medical,  hospital  and  nursing  bills,  has 
been  compelled  to  draw  from  funds  accumulated 
in  previous  years  and  segregated  on  an  actuarial 
basis  to  take  care  of  prolonged  or  permanent 
cases  of  disability  and  other  obligations  already 
incurred.  This  has  resulted  in  a reduction  of 
the  so-called  “reserve  fund”  of  the  Commission 
and  has  disturbed  the  actuarial  basis  of  the  fund. 

At  the  same  time,  the  action  of  the  Commission 
in  drawing  upon  its  “reserve”  when  necessary  to 


377 


378 


The  Ohio  State  Medical  Journal 


meet  current  obligations  has  met  with  unforseen 
and  unexpected  complications,  intensifying  the 
problems  of  the  Commission. 

Much  of  the  “reserve  fund”  of  the  Commission 
is  invested  in  various  types  of  securities,  includ- 
ing municipal  bonds.  These  securities  have  in 
most  instances  depreciated  in  value;  in  some 
cases  the  interest  from  which  has  defaulted.  In- 
asmuch as  the  sale  of  some  of  these  securities 
would  force  the  Commission  to  take  a loss,  the 
Commission  has  been  reluctant  to  convert  them 
into  cash. 

The  nation-wide  banking  holiday  and  subse- 
quent results  also  added  to  the  Commission’s  dif- 
ficulties. For  a time  all  the  cash  assets  of  the 
Commission  were  frozen.  Likewise,  this  applied 
to  the  funds  of  employers  who  had  not  paid  their 
premiums.  Some  funds  which  ordinarily  by  now 
would  have  been  paid  into  the  compensation  fund 
by  employers  still  is  tied  up  in  banks  which  have 
not  been  permitted  to  resume  operations. 

In  addition,  many  political  subdivisions,  hard- 
pressed  for  funds,  have  been  unable  or  have 
failed  to  contribute  to  the  public  employes’  sec- 
tion of  the  workmen’s  compensation  fund. 

Under  emergency  legislation  enacted  by  the 
present  Legislature,  the  Commission  was  author- 
ized to  borrow  up  to  $10,000,000  on  its  securities. 

However,  the  Commission  found  to  do  so  it 
would  be  compelled  to  pay  interest  of  4%  to  5%, 
whereas  the  Commission  gets  from  banks  on  its 
inactive  accounts  but  1%  interest.  For  obvious 
reasons,  the  Commission  has  been  hoping  to  avoid 
this  contingency. 

Almost  one  year  ago,  the  Commission,  realizing 
the  seriousness  of  the  financial  situation  con- 
fronting it,  took  positive  steps  to  meet  this  sit- 
uation, but  postponed  drastic  action,  hoping  that 
employment  and  industrial  conditions  would  im- 
prove. 

At  that  time,  as  reviewed  in  the  September, 
1932,  issue  of  the  Ohio  State  Medical  Journal,  the 
Commission  increased  by  approximately  17%  the 
average  basic  rate  assessed  Ohio  employers  and 
drafted  a new  set  of  rules  and  regulations  gov- 
erning the  filing  and  handling  of  claims  and 
medical,  nursing  and  hospital  fee  bills. 

The  Commission  felt  that  by  making  possible  a 
closer  and  more  constant  check  on  all  claims  and 
fee  bills  it  would  be  able  to  minimize  malingering, 
overtreatment  of  claimants,  and  excessive  charg- 
ing on  the  part  of  some  physicians  and  hospitals. 
Revision  of  the  rules  and  regulations,  in  effect 
since  last  September  15,  has  in  the  opinion  of 
the  Commission,  eliminated  some  abuses  and 
aided  materially  in  conserving  the  workmen’s 
compensation  fund. 

However,  recent  financial  developments,  to- 
gether with  the  continued  gradual  increase  in 
medical  and  hospital  costs,  have  convinced  the 
Commission  that  more  stringent  action  must  be 


June,  1933 

taken  to  solve  the  acute  problems  which  con- 
front it. 

As  one  factor  in  the  situation,  the  Commission 
cites  the  fact  that  since  the  first  of  the  year  it 
has  been  hard-pressed  to  meet  current  obliga- 
tions and  that  for  a period  of  almost  two  months 
it  had  to  suspend  entirely  the  payment  of  medical 
and  hospital  fees. 

CHANGES  SUGGESTED  BY  COMMISSION 
Confronted  with  an  unprecedented  emergency, 
officials  of  the  Industrial  Commission  sought  the 
cooperation  and  counsel  of  the  Ohio  State  Medical 
Association  in  a study  and  solution  of  the  present 
problems,  realizing  that  medical  organization  is 
deeply  interested  in  proper  administration  of  the 
workmen’s  compensation  fund  and  over  a long 
period  of  years  has  cooperated  to  the  fullest  in 
constructive  methods  for  minimizing  costs  and 
preventing  abuses  in  compensation  cases. 

As  stated  previously,  a series  of  conferences 
was  held.  Among  contingencies  suggested  by 
officials  of  the  Commission  as  temporary  measures 
to  solve  existing  financial  problems  were  the  fol- 
lowing: 

“1.  More  close  adherence  to  the  legal  limitation 
of  $200  per  case  for  medical,  surgical  and 
hospital  service. 

“2.  A possible  revision  (temporary  or  otherwise) 
downward  of  the  present  medical  and  surgi- 
cal fee  schedule. 

”3.  A possible  flat  percentage  reduction  in  medi- 
cal fees  after  adjustment  on  the  basis  of  the 
present  fee  schedule. 

“4.  A graduated  reduction  in  the  fee  schedule 
in  classification  of  injuries  under  the  present 
schedule.” 

Numerous  angles  in  connection  with  the  admin- 
istration of  the  workmen’s  compensation  law,  in- 
cluding medical  and  hospital  costs,  were  thor- 
oughly discussed  at  these  conferences.  It  was 
agreed  that  the  Special  Workmen’s  Compensation 
Committee  of  the  State  Association,  representing 
the  medical  profession,  should  analyze  the  data 
presented  by  the  Commission  and  the  opinions  ex- 
pressed by  those  attending  the  conferences,  and 
prepare  a report  setting  forth  the  views  of  the 
State  Association  on  the  questions. 

This  committee,  consisting  of  Dr.  Geo.  Edw. 
Follansbee,  Cleveland,  chairman,  Dr.  John  A. 
Caldwell,  Cincinnati,  and  Dr.  B.  J.  Hein,  Toledo, 
made  a careful  study  of  the  situation  and  pre- 
pared a report  which  on  May  7 was  approved  by 
the  Council  of  the  State  Association  and  subse- 
quently submitted  to  the  State  Industrial  Com- 
mission. 

REPORT  OF  SPECIAL  COMMITTEE 
The  report  objecting  to  a reduction  in  the  med- 
ical fee  schedule  and  making  a number  of  alter- 
native suggestions  for  solving  the  problems  con- 
fronting the  Commission  follows: 

On  behalf  of  medical  organization,  the  Special 
Workmen’s  Compensation  Committee  of  the  Ohio 
State  Medical  Association  expresses  appreciation 


June,  1933 


State  News 


379 


to  the  State  Industrial  Commission  and  the  De- 
partment of  Industrial  Relations  for  mutual  un- 
derstanding and  cordial  cooperation  over  a period 
of  years.  We  realize  the  acute  and  serious  prob- 
lems confronting  the  Commission  at  the  present 
time,  and  we  wish  to  support  and  cooperate  with 
you  to  the  fullest,  and  with  other  groups  sincei'ely 
concerned  with  problems  and  principles  of  work- 
men’s compensation. 

We  realize  that  there  has  been  a number  of 
abuses  by  some  physicians  and  some  hospitals. 
We  do  not  condone,  and  instead  we  condemn, 
those  persons  who  have  unfairly  and  dishonestly 
sought  to  take  advantage  of  the  workmen’s  com- 
pensation fund;  and  we  desire  to  assist  you  in  the 
elimination  of  such  abuses. 

Undoubtedly,  there  has  been  a number  of  cases 
which  were  unreasonably  prolonged  or  over- 
treated, which  have  added  to  the  costs  of  adminis- 
tration— not  only  in  medical  and  hospital  fees,  but 
in  compensation  to  the  claimants.  We  believe 
that  a correction  of  these  abuses  will  go  far  to- 
ward solving  the  problems  now  confronting  the 
Commission,  and  that  such  a solution  is  practical. 

We  respectfully  submit  for  your  consideration 
the  following  suggestions : 

A.  That  more  authority  be  vested  in  the  local 
regional  offices  of  the  Commission  in  those  large 
industrial  centers  where  such  offices  are  main- 
tained, to  the  end  that  in  all  prolonged,  chronic 
or  revived  cases  definite  and  frequent  check-ups 
be  made  of  physicians’  and  hospitals’  services. 
That  in  such  cases  the  employer  be  informed  of 
any  unusual  factors  in  the  case,  whether  sus- 
pected overtreatment,  excessive  hospitalization, 
undue  prolongation  of  the  period  of  disability,  or 
malingering,  so  that  he  may  assist  toward  prompt 
rehabilitation. 

B.  That  the  Commission  and  its  Medical  De- 
partment adhere  more  strictly  to  the  Rules  and 
Regulations  which  became  effective  on  September 
15,  1932;  especially  in  regard  to  the  requirements 
for  reports  by  physicians  and  hospitals.  And 
that  in  those  types  of  treatment  for  which  permis- 
sion must  be  granted  in  advance,  such  permission 
be  granted  or  refused  promptly.  That  the  Medi- 
cal Department  formulate  (with  the  assistance  of 
this  committee  if  desired)  a tabulation  of  the 
average  length  of  treatment,  number  of  dress- 
ings, period  of  hospitalization,  convalesence, 
length  of  disability,  and  other  major  factors  in 
average  types  of  injuries  and  disabilities,  to  aid 
them  in  determining  usual  medical  costs  and  com- 
pensation. 

C.  That  regional  medical  boards  of  review  be 
selected  to  review  and  pass  upon  chronic,  pro- 
longed, unusual  or  revived  cases.  It  is  our  belief 
that  such  a medical  board  of  review  would  save 
many  times  its  cost  by  eliminating  malingering, 
fraudulent  or  exorbitant  medical  and  hospital 
costs,  and  avoiding  a perversion  of  the  fund  to- 
ward unemployment  benefits.  Such  boards  of  re- 
view would  also  act  as  special  examiners  for  the 
Commission.  (It  is  suggested  that  such  regional 
boards  be  appointed  by  the  Commission  from  a list 
of  nominations  made  by  the  Ohio  State  Medical 
Association. 

D.  That  in  flagrant  cases  of  abuse  or  fraud, 
prosecutions  be  undertaken  promptly  as  provided 
under  Sections  1465-109  and  1465-110.  That  if 
local  prosecuting  attorneys  and  other  enforcement 
officials  appear  reluctant  to  prosecute  as  requested 
when  information  and  files  are  furnished  to  them, 
that  the  Industrial  Commission  and  the  Depart- 
ment of  Industrial  Relations  ask  the  Attorney 
General  to  designate  a staff  member  to  assist  and 
support  the  prosecuting  attorney  in  such  cases. 


E.  That  a plan  be  devised  whereby  medical 
organization  can  furnish  CONFIDENTIALLY 
information  to  the  Medical  Department,  not  only 
on  cases  of  suspected  malingering  or  on  cases  of 
disability  not  compensable  because  not  traceable  to 
employment,  but  on  the  character  and  professional 
standing  of  physicians  who  may  be  suspected  of 
promoting  abuses.  Undoubtedly,  the  Commission 
knows  from  its  records  over  a period  of  years 
those  physicians  and  hospitals  which  are  sus- 
pected of  unnecessary  or  unduly  prolonged  treat- 
ment, padding  fee  bills,  or  collusion  with  claim- 
ants. In  this  conection  we  recommend  that  if 
the  evidence  warrants  (even  though  evidence  may 
not  be  sufficient  to  prosecute) , that  the  Commis- 
sion rule  that  such  physicians  and  hospitals  shall 
not  be  permitted  to  treat  workmen’s  compensa- 
tion cases  in  the  future,  and  that  payments  be 
withheld  or  properly  reduced  on  cases  now  pend- 
ing or  recently  terminated. 

F.  That  the  present  medical  and  surgical  fee 
schedule  adopted  in  1920,  an  average  year,  not  be 
reduced  at  this  time,  thus  penalizing  the  honest 
physician  and  discriminating  in  favor  of  the  dis- 
honest members  of  the  profession.  (Obvoiusly, 
those  relatively  few  dishonest  physicians  who,  in 
the  total  number  of  cases  handled  by  them,  add 
excessively  to  medical,  hospital,  nursing  and  com- 
pensation costs,  would  not  abate  their  illegitimate 
practices  merely  because  of  a fee  schedule  re- 
vision imposed  upon  all  physicians  generally). 
It  is  our  belief  that  the  pi'esent  fee  schedule  is 
reasonable  and  fair  for  the  honest,  competent  phy- 
sician and  for  the  Industrial  Commission.  We  re- 
spectfully call  attention  to  the  rapid  changes  in 
our  entire  governmental  and  monetary  situation, 
with  the  possibility  of  “cheapened  money”  through 
currency  inflation,  thus  reducing  the  value  of  the 
present  dollar.  If  after  a trial  of  the  sugges- 
tions contained  herein,  necessary  economies  are 
not  affected,  we  will  be  glad  to  submit  suggestions 
for  a plan  of  temporary  reduction  in  medical 
costs  other  than  that  proposed  recently  by  your 
Medical  Department. 

G.  That  concerted  effort  be  made  by  those 
earnestly  interested  in  safeguarding  the  principle 
of  workmen’s  compensation  and  the  workmen’s 
compensation  fund,  to  secure  from  the  Legislature 
adequate  appropriations  for  administration,  be- 
lieving that  sufficient  qualified  personnel  to  handle 
the  recommendations  herein  contained  would  safe- 
guard and  preserve  the  workmen’s  compensation 
fund,  reduce  the  relative  amount  now  being  paid 
in  compensation,  medical  and  hospital  fees,  and 
save  in  undue  compensation  and  payment  for 
services  an  amount  many  times  the  added  expense. 

H.  We  pledge  medical  organization  to  thorough 
cooperation  on  the  suggestions  made  herein,  as 
well  as  our  earnest  effort  in  the  eliminating  of  all 
abuses  chargeable  to  members  of  the  medical  pro- 
fession, through  disciplinary  action  and  otherwise. 

This  communication,  report,  and  recommenda- 
tions were  officially  approved  for  transmission  to 
you  by  the  Council  (the  governing  board)  of  the 
Ohio  State  Medical  Association  at  its  meeting  on 
May  7,  1933. 

* * * 

As  pointed  out  in  the  foregoing  report,  medical 
organization  is  fully  aware  of  the  serious  and 
acute  problems  confronting  the  Industrial  Com- 
mission and  pledges  itself  to  support  and  cooper- 
ate with  the  Commission  and  others1  sincerely  con- 
cerned in  the  principles  of  workmen’s  compensa- 
tion and  in  the  administration  of  the  workmen’s 
compensation  law.  At  the  same  time,  the  medical 


380 


The  Ohio  State  Medical  Journal 


June,  1933 


profession  is  of  the  opinion  that  the  proper 
method  of  solving  the  problems  of  the  Commis- 
sion is  by  eliminating  obvious  abuses,  initiation 
of  drastic  action  against  repeated  offenders,  and 
improving  the  machinery  set-up  to  administer  the 
law  and  handle  the  compensation  fund. 

The  suggestions  made  by  the  Special  Work- 
men’s Compensation  Committee  to  the  Industrial 
Commission  undoubtedly  could  be  supplemented 
by  numerous  other  constructive  recommendations 
for  solving  the  Commission’s  problems.  The  com- 
mittee, acting  for  the  State  Association,  would 
welcome,  in  fact  solicits,  suggestions  and  advice 
from  all  members  of  the  State  Association  on  this 
important  question.  Moreover,  it  is  of  the  opin- 
ion that  it  speaks  for  the  great  majority  of  the 
physicians  of  the  state  when  it  pledges  medical 
organization  “to  thorough  cooperation  on  the  sug- 
gestions made  herein,  as  well  as  our  honest  effort 
in  eliminating  abuses  chargeable  to  members  of 
the  medical  profession”. 


Medicinal  Liquor  Prescription  Ques- 
tion Subject  to  Court  Interpreta- 
tion Between  Ohio  and 
Federal  Statutes 


By  the  time  this  issue  of  The  Journal  reaches 
the  membership,  steps  may  have  been  taken  to 
clear  up  the  confusion  which  exists  relative  to 
the  medicinal  liquor  question  in  Ohio. 

At  the  time  The  Journal  went  to  press.  Senator 
John  F.  Smolka,  Cleveland,  was  considering  ask- 
ing the  General  Assembly  (if  the  time  and  op- 
portunity permitted  in  the  haste  and  confusion 
over  the  tax  muddle)  to  amend  the  Smolka-Mc- 
Namee  Act,  signed  by  the  Governor  March  15 
and  effective  June  14,  in  such  a way  that  there 
will  be  no  misunderstanding  or  misinterpretation 
of  its  provisions  which  are  intended  to  make  the 
Ohio  restrictions  on  the  prescribing  of  medicinal 
liquor  conform  to  the  new  Federal  rules  and  regu- 
lations which  place  no  quantitative  restriction  on 
the  amount  which  may  be  prescribed  by  a phy- 
sician. 

As  pointed  out  in  the  May  issue  of  The  Jour- 
nal, pages  319  and  320,  the  Smolka-McNamee 
Act  provides  that  an  Ohio  physician  may  pre- 
scribe medicinal  liquor  in  an  amount  “now  per- 
mitted by  federal  statutes  and  regulations”.  At 
the  time  the  bill  was  signed  by  the  Governor 
(March  15),  the  Federal  statutes  provided  that 
the  quantitative  limitation  was  one  pint  in  any 
period  of  10  days.  However,  on  March  31,  Con- 
gress eliminated  from  the  Federal  law  any  ref- 
erence to  quantitative  limitation  and  on  May  15 
the  new  Federal  rules  and  regulations  governing 
medicinal  liquor  became  effective.  These  rules 
and  regulations  leave  to  the  judgment  of  the 
physician  the  amount  of  medicinal  liquor  which 


should  be  prescribed  to  meet  the  medicinal  needs 
of  the  individual  patient,  subject  to  definite  pro- 
visions set  up  by  the  U.  S.  Attorney  General  and 
Secretary  of  the  Treasury. 

Since  the  Federal  limitation  was  one  pint  at  the 
time  the  Smolka-McNamee  Act  was  signed  by 
the  Governor,  there  is  divided  opinion  as  to 
whether  after  June  14  when  the  law  becomes 
effective,  Ohio  physicians  will  be  limited  to  one 
pint  prescriptions  or  whether  they  will  be  per- 
mitted to  prescribe  any  amount  deemed  neces- 
sary for  their  patients  as  authorized  under  the 
new  Federal  regulations. 

To  clear  up  this  controversial  point,  Senator 
Smolka  may  ask  the  Legislature  to  change  the 
phrasing  of  the  Smolka-McNamee  Act  in  such  a 
way  that  Ohio  physicians  will  be  permitted  to 
take  advantage  of  the  unlimited  pi’escribing 
privileges  given  under  the  Federal  regulations. 

At  any  rate,  Ohio  physicians  should  remember 
that  until  June  14,  the  legal  limitation  in  Ohio  on 
prescribing  of  medicinal  liquor  is  one-half  pint. 
Whether  there  will  be  a one-pint  limitation  or  no 
limitation  after  June  14  depends  on  what,  if  any, 
action  the  Legislature  takes  or  on  court  decisions 
to  determine  the  point  in  question. 

Additional  information  on  the  question  will  be 
published  in  the  next  issue  of  The  Journal. 


Medical  Golfers  to  Contest  in  Akron  On 
September  6,  the  Day  Preceding 
Annual  Meeting  of  O.S.M.A. 

Annual  tournament  of  the  Ohio  State  Medical 
Golfers’  Association  will  be  held  at  the  Portage 
Country  Club,  Akron,  on  Wednesday,  Septem- 
ber 6,  the  day  preceding  the  opening  of  the 
Eighty-Seventh  Annual  Meeting  of  the  Ohio  State 
Medical  Association,  to  be  held  in  Akron,  Thurs- 
day and  Friday,  September  7 and  8,  according  to 
an  announcement  made  by  Dr.  J.  B.  Morgan, 
Cleveland,  secretary  of  the  Golfing  Association. 

When  the  time  for  holding  the  annual  meeting 
of  the  State  Association,  scheduled  for  last  May 
2 and  3,  was  postponed  indefinitely,  with  the 
possibility  that  no  meeting  would  be  held  this 
year,  the  Golfers’  Association  was  invited  by  its 
president,  Dr.  J.  P.  DeWitt,  Canton,  to  hold  its 
annual  tournament  in  that  city  some  time  dur- 
ing the  summer. 

Plans  for  the  Canton  get-to-gether  were  be- 
ing formulated  when  the  September  dates  for  the 
annual  meeting  of  the  State  Association  were  set. 

Immediately,  the  Golfers’  Association  aban- 
doned plans  for  a tournament  at  Canton  and  se- 
lected September  6 as  the  date  and  the  Portage 
Country  Club  course  as  the  site  for  this  year’s 
tournament. 

Arrangements  for  the  golfers’  outing  in  Akron 
are  being  made  by  Dr.  J.  L.  McEvitt,  vice-presi- 
dent of  the  Golfing  Association  and  a committee 
of  Akron  golfing  physicians. 


Ohio  to  Have  Prominent  Part  in  A,  M.  A,  Annual  Meeting 

in  Milwaukee 


Many  Ohio  physicians  undoubtedly  are  plan- 
ning' to  attend  the  Eighty-Fourth  Annual  Session 
of  the  American  Medical  Association  in  Mil- 
waukee, June  12  to  16,  inclusive. 

The  session  will  open  at  10  a.  m.,  Monday,  June 
12,  when  the  House  of  Delegates  convenes  at  the 
Hotel  Schroeder,  the  headquarters  hotel.  The 
Scientific  Assembly  will  open  with  a general 
meeting  at  8 p.  m.  Tuesday,  June  13,  and  the 
scientific  sections  will  meet  Wednesday,  Thurs- 
day and  Friday,  June  14,  15  and  16.  All  the 
scientific  meetings  and  the  Scientific  Exhibit  will 
be  held  in  the  Milwaukee  Auditorium  which  also 
will  house  the  registration  headquarters. 

Special  rates  have  been  granted  for  the  benefit 
of  Fellows  of  the  A.M.A.  and  dependent  members 
of  their  families  by  all  railroads  on  the  “cer- 
tificate” plan  and  some  roads  have  arranged  for 
special  “stop-over”  privileges  in  Chicago  for 
members  who  desire  to  attend  the  Century  of 
Progress. 

The  complete  program  of  the  A.M.A.  session, 
data  concerning  railroad  rates  and  information 
relative  to  hotel  accommodations  and  rates  were 
published  in  the  May  13  issue  of  The  Journal  of 
the  American  Medical  Association. 

The  Ohio  medical  profession  will  be  represented 
in  the  A.M.A.  House  of  Delegates  by  Drs.  Wells 
Teachnor,  Columbus,  Ben  R.  McClellan,  Xenia, 
E.  R.  Brush,  Zanesville,  C.  W.  Stone,  Cleveland, 
J.  P.  DeWitt,  Canton,  C.  E.  Kiely,  Cincinnati, 
and  C.  W.  Waggoner,  Toledo. 

Dr.  J.  H.  J.  Upham,  Columbus,  vice-chairman  of 
the  Board  of  Trustees  of  the  A.M.A.,  and  Dr. 
Geo.  Edw.  Follansbee,  Cleveland,  chairman  of  the 
Judicial  Council,  as  usual,  will  take  a prominent 
part  in  the  meetings  of  the  House  of  Delegates 
and  other  business  sessions  held  during  the  Mil- 
waukee session. 

Other  A.M.A.  officials  from  Ohio  who  will  take 
an  active  part  in  the  meeting  are : Dr.  Roger  S. 
Morris,  Cincinnati,  member  of  the  Council  on 
Scientific  Assembly;  Dr.  H.  N.  Cole  and  Dr. 
Torald  Sollmann,  both  of  Cleveland,  members  of 
the  Council  on  Pharmacy  and  Chemistry,  and  Dr. 
Howard  T.  Karsner,  Cleveland,  member  of  the 
Council  on  Physical  Therapy. 

Dr.  Cole  and  Dr.  Russell  L.  Haden,  also  of 
Cleveland,  will  present  demonstrations  in  the 
Clinical  Lectures  feature  of  the  meeting. 

Dr.  Elmore  B.  Tauber,  Cincinnati,  is  a member 
of  the  executive  committee  of  the  Section  on 
Dermatology  and  Syphilology  and  assisted  in  ar- 
ranging the  program  to  be  presented  before  that 
section. 

Dr.  John  T.  Murphy,  Toledo,  is  secretary  of 
the  Section  on  Radiology,  and  took  a prominent 


part  in  arranging  that  section’s  program. 

Others  from  Ohio  who  will  take  part  in  the 
Milwaukee  meeting  as  essayists,  discussants,  or 
scientific  exhibitors  are: 

Drs.  Alfred  Friedlander,  Cincinnati;  John  P. 
Anderson,  Cleveland;  Henry  J.  John,  Cleveland; 
T.  D.  Spies,  Cleveland;  Robert  S.  Dinsmore, 
Cleveland;  George  W.  Crile,  Cleveland;  W.  James 
Gardner,  Cleveland;  John  P.  Gardiner,  Toledo; 
W.  W.  Brand,  Toledo;  Derrick  T.  Vail,  Jr.,  Cin- 
cinnati; A.  D.  Ruedemann,  Cleveland;  William  V. 
Mullin,  Cleveland;  H.  M.  Goodyear,  Cincinnati; 
Samuel  Iglauer,  Cincinnati;  Edward  D.  King, 
Cincinnati;  Harris  H.  Vail,  Cincinnati;  Henry  J. 
Gerstenberger,  Cleveland;  Arthur  J.  Horesh, 
Cleveland;  G.  Richard  Russell,  Cleveland;  Edna 
E.  Chapman,  Cleveland;  R.  A.  Kehoe,  Cincinnati; 
J.  Victor  Greenebaum,  Cincinnati;  A.  Graeme 
Mitchell,  Cincinnati;  Lee  Foshay,  Cincinnati; 
George  M.  Curtis,  Columbus;  Francis  J.  Phillips. 
Columbus;  Louis  J.  Karnosh,  Cleveland;  Howard 
D.  McIntyre,  Cincinnati;  J.  R.  Driver,  Cleveland; 
Henry  C.  Shaw,  Cleveland;  Emery  R.  Hayhurst, 
Columbus;  P.  A.  Davis,  Akron;  D.  M.  McDonald, 
Akron;  W.  E.  Lower,  Cleveland;  W.  J.  Engel, 
Cleveland;  Burt  G.  Chollett,  Toledo;  Robert  Ca- 
rothers,  Cincinnati;  James  A.  Dickson,  Cleveland; 
Marion  N.  Gibbons,  Cleveland;  Joseph  A.  Frei- 
berg, Cincinnati;  E.  H.  Wilson,  Columbus;  Wal- 
lace S.  Duncan,  Cleveland;  H.  K.  Dunham,  Cin- 
cinnati; David  Steel,  Cleveland;  Samuel  Brown, 
Cincinnati;  U.  V.  Portmann,  Cleveland;  Herbert 
A.  Wildman,  Wooster;  Carl  R.  Steinke,  Akron;  C. 
L.  Hyde,  Akron;  H.  F.  DeWolf,  Cleveland;  J.  V. 
VanCleve,  Cleveland. 

The  annual  tournament  of  the  American  Medi- 
cal Golfing  Association  will  be  held  over  the  Blue 
Mound  Country  Club  course,  Milwaukee,  on  Mon- 
day, June  12.  Communications  concerning  the 
tournament  or  matters  of  enrollment  should  be 
addressed  to  the  secretary  of  the  golfing  associa- 
tion, William  J.  Burns,  4421  Woodward  Avenue, 
Detroit. 


Physicians  are  needed  to  conduct  suitable  medi- 
cal service  for  the  reforestation  camps  for  the  un- 
employed, according  to  an  announcement  made  by 
the  Federal  Government.  Applications  may  be 
sent  to  commanders  in  the  various  army  corps 
ar-eas.  The  headquarters  of  the  Fifth  Corps  Area, 
of  which  Ohio  is  a part,  is  at  Fort  Hayes,  Co- 
lumbus. Civilian  hospitals  in  the  areas  adjacent 
to  the  different  camps  are  being  used  when  hos- 
pitalization is  found  necessary  and  civilian  phy- 
sicians are  being  used  when  available. 


381 


382 


The  Ohio  State  Medical  Journal 


June,  1933 


Northern  Tri-State  Meeting  Featured  by 
Attractive  and  Instructive  Program 

The  60th  annual  meeting  of  the  Northern  Tri- 
State  Medical  Association  at  LaPorte,  Indiana, 
April  11,  was  attended  by  about  300  physicians 
representing  Ohio,  Indiana  and  Michigan, 
which  comprise  the  organization. 

A scientific  program  of  unusual  merit  was 
presented.  At  the  business  session,  the  following 
officers  for  the  ensuing  year  were  elected:  Presi- 
dent, Dr.  G.  0.  Larson,  LaPorte,  Indiana;  vice 
president,  Dr.  Edward  P.  Gillette,  Toledo;  secre- 
tary, Dr.  G.  E.  Jones,  Lima;  treasurer,  Dr.  H.  E. 
Randall,  Flint,  Michigan;  councilors,  Dr.  Charles 
Lukens,  Toledo;  Dr.  P.  N.  Sutherland,  Angola, 
Indiana,  and  Dr.  William  M.  Donald,  Detroit. 

The  program  was  opened  with  a symposium 
on  fractures  presented  by  Dr.  Paul  B.  Magnuson 
and  Dr.  R.  W.  McNealy,  Northwestern  Univer- 
sity. Dr.  Magnuson  condemned  the  use  of  metal 
plates  in  fracture  work,  advocating  early  reduc- 
tion with  sufficient  traction  to  overcome  muscle 
tension.  He  demonstrated  by  the  use  of  slides  a 
new  method  for  the  repair  of  a fractured  hip  by 
hollowing  out  the  head  of  the  femur  and  fitting 
the  shaft  into  it.  Dr.  McNealy  gave  a detailed 
demonstration  of  the  various  conditions  and  com- 
plications in  fractures  of  the  pelvis,  such  as  in- 
juries to  the  bladder,  urethra  and  rectum.  He 
stated,  spinal  anesthesia  should  not  be  used  in 
such  cases. 

Dr.  Russell  M.  Wilder,  Rochester,  Minnesota, 
spoke  on  “Diseases  of  Parathyroid  with  Special 
Reference  to  Parathyroid  Overfunction”.  He  dis- 
cussed- the  syndromes  of  hypoparathyroidism, 
stressing  the  changes  in  the  calcium  and  phos- 
phorous ratio.  Dr.  Wilder  advised  the  use  in 
treatment  of  sun-light,  calcium  chloride  and  vio- 
sterol.  In  discussing  hyperparathyroidism,  he 
stressed  bone  conditions,  especially  osteo-fibrosis- 
cystica.  This  condition,  he  stated,  is  due  to  an 
overgrowth  or  tumor  of  the  parathyroid  for 
which  he  advised  removal  if  it  could  be  found. 
The  differential  points  between  hyperparathyroid 
conditions  of  the  bone  and  osteo-malacia  and 
osteo-pyprosis  were  discussed. 

“Some  Diagnostic  Points  Differentiating  Ab- 
dominal and  Genito-Urinary  Diseases”  was  the 
subject  of  a paper  by  Dr.  E.  Benjamin  Gillette, 
Toledo.  Dr.  Gillette  illustrated  by  cases  and 
diagnostic  procedure  the  differential  findings  be- 
tween genito-urinary  conditions  and  abdominal 
diseases,  stressing  especially  appendicitis  and 
gallbladder  conditions. 

Dr.  George  L.  Waldbott,  Detroit,  addressed  the 
gathering  on  “The  Control  of  Chronic  Intractable 
Asthma  with  Pollen”.  He  spoke  of  pollen  as  an 
etiological  factor  in  asthma  and  reported  cases. 
Dr.  Waldbott  left  the  impression  that  many  pa- 
tients in  their  later  years  had  asthma  which  is 
not  seasonal  but  had  had  its  origin  in  seasonal 


pollenization.  He  recommended  skin  tests  and 
desensitization. 

Some  of  the  phases  of  appendicitis  were  dis- 
cussed by  Dr.  Arthur  E.  Hertzler,  professor  of 
surgery,  University  of  Kansas.  He  recommended 
early  operation  upon  appendicitis. 

Dr.  Frederick  A.  Collar,  University  of  Michi- 
gan, spoke  on  “The  Delayed  Treatment  of  Ad- 
vanced Cases  of  Appendicitis”.  He  reported 
cases  and  expressed  the  belief  that  operation 
should  be  deferred  until  an  abscess  formed  or 
the  cases  became  improved. 

Dr.  Charles  A.  Elliott,  Northwestern  Univer- 
sity, discussed  the  subject,  “Management  of 
Hepatic  Diseases”.  He  advocated  increasing  the 
glyocen  reserve  in  the  liver  before  operation, 
especially  the  gallbladder,  by  giving  glucose  by 
all  methods  except  the  rectum  which  he  holds  to 
be  of  little  value  because  of  its  irritating  effects. 

“Special  Sense  Organs  as  a Factor  in  Head- 
ache” was  the  subject  of  a paper  by  Dr.  Charles 
Lukens,  Toledo.  Dr.  Lukens  presented  an  outline 
on  general  classifications  of  headache,  suggesting 
an  appropriate  treatment  for  each  class. 

Dr.  Charles  P.  Emerson,  University  of  Indiana, 
spoke  on  “Oriental  Observation  of  Neuropsychoses 
from  the  Viewpoints  of  the  Internist”.  He  pre- 
sented an  interesting  description  regarding  vari- 
ous diseases  common  to  India,  Africa,  China  and 
Japan. 

Arrangements  for  the  LaPorte  meeting  were 
made  by  Dr.  Edward  B.  Pedlow,  Lima,  the  retiring 
president;  Dr.  Larson,  the  incoming  president; 
Dr.  Edward  P.  Gillette,  Toledo,  the  secretary; 
Dr.  Randall,  the  treasurer;  and  Dr.  Charles 
Lukens,  Toledo;  Dr.  Sutherland,  and  Dr.  Joseph 
H.  Andries,  Detroit,  councilors. 


Legal  Opinion  on  Membership  on  District 
Board  of  Health 

In  answer  to  a request  concerning  the  validity 
of  the  appointment  of  two  members  to  a district 
board  of  health,  both  of  whom  reside  in  the  same 
municipality  which  is  a part  of  the  district, 
Attorney  General  John  Bricker  recently  handed 
down  an  opinion  (No.  817),  holding  that: 

1.  Under  Section  1261-18,  General  Code,  the 
district  advisory  council  is  authorized  to  appoint 
only  one  member  of  the  district  board  of  health 
from  a municipality  forming  part  of  the  health 
district,  the  population  of  which  municipality 
comprises  less  than  one-fifth  of  the  total  popula- 
tion of  the  district. 

2.  Where  two  members  of  a district  board  of 
health  are  appointed  from  a municipality  entitled 
to  only  one  member,  only  the  one  first  appointed 
is  a de  jure  officer  entitled  to  continue  in  office. 

Mr.  Bricker  pointed  out  in  his  opinion  that  be- 
fore a municipality  would  be  entitled  to  two  mem- 
bers on  the  board  of  health  it  would  have  to  have 
a population  equal  to  at  least  two-fifths  of  the 
total  population  of  the  district. 


June,  1933 


State  News 


383 


Specimens  to  State  Laboratory  Can  Be 
Sent  at  Lower  Postage  Rates  If 
Rules  are  Observed 

Following  a series  of  correspondence  between 
Dr.  H.  G.  Southard,  State  Director  of  Health,  and 
the  United  States  Post  Office  Department,  a new 
set  of  regulations  relative  to  the  mailing  of  speci- 
mens by  physicians  and  health  commissioners  to 
the  State  Department  of  Health  Laboratories  has 
been  drafted. 

The  principal  benefit  to  be  derived  by  physi- 
cians from  the  new  regulations  is  that  in  ordi- 
nary cases,  providing  the  provisions  of  the  regu- 
lations are  complied  with,  specimens  may  be  sent 
to  the  State  Laboratory,  Columbus,  at  third  and 
fourth  class  postage  rates  instead  of  at  first  class 
rates,  thus  saving  themselves  a considerable  sum 
annually. 

Specimens  may  be  sent  to  the  State  Laboratory 
at  fourth  class  postage  rates  if  the  following  in- 
structions are  followed: 

1.  The  name  and  address  of  the  sender  must 
appear  on  the  outside  wrapper. 

2.  The  words,  “First  Class  Postage”  or  any 
other  reference  to  first  class  mail,  must  be  marked 
out  on  the  outside  wrapper  on  old  containers. 

3.  There  must  be  no  writing  on  the  informa- 

tion blank  sent  with  the  specimen  except  matter 
descriptive  of  the  specimen.  This  prohibits  an 
answer  to  such  a question  as:  “Do  you  wish  tele- 

gram at  your  expense”?  If  this  question  is  an- 
swered on  the  information  blank,  the  container 
must  be  sent  at  first  class  rates. 

4.  If  it  is  found  necessary  to  write  matter 
other  than  descriptive  of  the  specimen  the  con- 
tainer must  be  sent  first  class. 

5.  To  insure  immediate  delivery,  the  postage 
must  be  fully  prepaid. 

To  comply  with  the  instructions  of  the  Post 
Office  Department,  the  State  Department  of 
Health  has  revised  the  wrappers  for  containers 
and  the  information  blanks  to  be  filled  out  by 
physicians  sending  in  specimens. 

The  new  wrapper  provides  a space  where  the 
sender  of  the  specimen  must  place  his  name  and 
address.  In  event  that  insufficient  postage  is 
placed  on  the  container,  it  will  be  returned  to  the 
sender  by  the  postmaster  for  additional  postage. 

All  questions  not  relevant  to  a description  of 
the  specimen  have  been  taken  from  the  informa- 
tion blanks.  For  example,  the  words:  “Purpose 
for  which  specimen  was  taken”  have  been  substi- 
tuted on  the  feces  and  syphilis  forms  for  the  old 
wordings:  “To  be  examined  for”  and  “Indicate 

whether  specimen  is  for:”  followed  by  items  to 
be  checked-marked  for  the  purpose  of  indicating 
the  nature  of  the  examination  requested. 

There  are  many  old  containers  in  the  hands  of 
physicians.  These  may  be  used  but  the  sender 
to  take  advantage  of  the  third  and  fourth  class 
rates  must  cross  off  all  reference  to  first  class 


postage  and  place  on  the  wrapper  his  name  and 
address.  Likewise,  the  old  information  cards 
may  be  used  but  questions  not  descriptive  of  the 
specimen  should  be  marked  off  or  not  answered. 
If  this  is  not  done  the  sender  will  be  required  to 
send  the  container  at  first  class  rates.  Of  course,, 
if  it  is  deemed  advisable  to  send  additional  in- 
formation in  unusual  cases,  such  information 
should  accompany  the  container,  but  the  con- 
tainer must  be  mailed  in  such  cases  at  the  first 
class  rates. 

The  State  Department  of  Health  has  sug- 
gested that  should  any  question  arise  with  a 
postmaster  or  postal  clerk  concerning  the  mailing 
of  specimens  under  the  new  regulations,  his  at- 
tention should  be  called  to  Section  589,  Postal 
Laws  and  Regulations,  and  if  this  is  not  sufficient 
to  settle  any  misunderstanding,  he  should  be  re- 
quested to  take  up  the  matter  with  the  Post  Office 
Department  at  Washington. 

A special  form  summarizing  the  new  regula- 
tions has  been  prepared  by  the  State  Depart- 
ment of  Health  and  is  being  sent  out  with  all 
containers.  All  physicians  who  use  the  State 
Laboratory  should  read  these  instructions  care- 
fully. Physicians  failing  to  receive  the  instruc- 
tion form,  may  obtain  detailed  information  from 
their  health  commissioner  who  has  been  fur- 
nished with  information  on  the  new  regulations. 


Qualifications  for  Hospital  Superintendent 

The  qualifications  for  a hospital  superintend- 
ency were  summarized  as  follows  by  Dr.  R.  A. 
Seymour,  formerly  superintendent  of  the  City 
Hospital,  Saskatoon,  Sask.,  Canada,  in  an  address 
at  a recent  provincial  meeting: 

“Whether  he  is  a physician,  a layman  or  a 
nurse,  the  chief  executive  of  a hospital  requires 
certain  attributes  necessary  to  his  office.  The 
much  spoken  of  quality  called  ‘personality’  is 
essential.  He  must  possess  dignity  and  honesty 
of  purpose,  courtesy  and  tact.  He  must  be  loyal 
to  those  whom  he  serves — the  governing  body,  the 
medical  staff,  the  institution  and  the  patients. 
Sympathy  must  mark  his  dealings  with  the  pa- 
tients and  the  public  and  all  who  come  to  him  for 
counsel.  With  all  these  abstract  qualities  he 
must  possess  sound  mental  and  physical  health 
and  be  able  to  cast  aside  the  worries  of  his  office 
and  play  when  it  is  time  to  play.  A sense  of 
humor  will  do  much  to  relieve  the  tension  on  try- 
ing days  and  fortunate  is  he  who  can  laugh  out- 
right and  with  much  merriment”. 


Metabolic  Disorders  will  be  the  theme  of  the 
1933  Graduate  Fortnight  of  the  New  York  Acad- 
emy of  Medicine,  to  be  held  October  23  to  Novem- 
ber 3,  inclusive,  according  to  an  announcement, 
made  by  Dr.  Frederick  P.  Reynolds,  2 East  103rd 
Street,  New  York  City,  in  charge  of  arrangements 
for  the  assembly. 


[7VEWLS  NOTWOHIO 


Greenville — Dr.  Robert  T.  Poling  recentlly  un- 
derwent an  appendicitis  operation  at  the  Green- 
ville hospital. 

Mansfield — Dr.  R.  V.  Myers  addressed  the 
Hermit  Club  on  “The  History  of  Medicine”. 

Orrville — Dr.  A.  A.  Brooks  was  honored  on  the 
51st  anniversary  of  his  entrance  into  medicine  by 
a dinner  at  the  home  of  M.  J.  Leickheim,  attended 
by  members  of  the  medical  profession  and  others 
of  Orrville  and  vicinity. 

Sidney — Dr.  H.  E.  Beebe  recently  celebrated 
his  60th  anniversary  as  a physician. 

Lisbon — Dr.  Seward  Harris  has  been  appointed 
physician  at  the  Columbiana  County  Jail. 

Toledo — Dr.  0.  W.  Burkholder  has  been  ap- 
pointed local  physician  for  the  Pere  Marquette 
Railroad,  succeeding  the  late  Dr.  L.  W.  Briggs. 

Columbus — The  principal  speaker  at  the  annual 
banquet  of  Alpha  Mu  Pi  Omega  Fraternity,  Ohio 
State  University,  was  Dr.  Joseph  C.  Bloodgood, 
Baltimore,  Md.  While  in  Columbus,  Dr.  Blood- 
good  delivered  two  lectures  on  cancer,  one  to 
medical  students  at  the  University  and  one  to 
local  members  of  the  medical  profession. 

Sandusky — Drs.  Hugo  Sarchet,  John  A.  Yochem 
and  George  A.  Stimson  have  been  appointed  city 
poor  physicians  by  the  City  Commission. 

Toledo — Dr.  J.  P.  Spooner  was  a recent  speaker 
before  the  Toledo  Exchange  Club. 

Dayton — Dr.  H.  C.  Schumacher,  Cleveland,  was 
among  the  speakers  at  a two-day  institute  held 
here  by  the  Dayton  Mental  Hygiene  Clinic. 

Columbus — Dr.  George  M.  Curtis,  director  of 
the  department  of  surgical  research,  Ohio  State 
University,  College  of  Medicine,  has  returned 
from  Washington  where  he  addressed  the  Amer- 
ican Society  for  Clinical  Investigation  on  “The 
Use  and  Effects  of  Iodine  in  the  Treatment  of 
Goiter”.  Other  members  of  the  faculty  who  at- 
tended the  meeting  were  Dr.  Charles  A.  Doan,  Dr. 
Bruce  K.  Wiseman,  and  Dr.  George  I.  Nelson. 

College  Comer — Dr.  W.  H.  Hawley  recently 
completed  48  years  in  the  practice  of  medicine. 

Pomeroy — Dr.  W.  S.  Ellis,  Meigs  County  health 
commissioner,  will  serve  on  the  staff  of  the 
emergency  hospital  at  the  Century  of  Progress, 
Chicago,  during  the  week  of  August  28. 

Columbus — The  principal  speaker  at  a two-day 
institute  on  mental  hygiene  sponsored  by  the 
Columbus  Council  of  Social  Agencies  was  Dr. 


George  K.  Pratt,  medical  director  of  the  New 
York  City  Committee  on  Mental  Hygiene. 

Sandusky — The  local  Kiwanis  Club  was  ad- 
dressed by  Dr.  E.  J.  Meckstroth  on  social  and 
economic  conditions  in  Vienna. 

Niles — Dr.  John  D.  Knox,  formerly  of  Niles  but 
now  practicing  in  Warren,  has  moved  back  to 
Niles  and  has  opened  offices  here. 

Ashland — Hospital  Company,  No.  135,  Ohio 
National  Guard,  received  a high  rating  in  the  re- 
cent federal  inspection,  according  to  word  re- 
ceived from  Washington  by  Dr.  H.  M.  Gunn, 
commander  of  the  company. 

Zanesville — Dr.  and  Mrs.  W.  A.  Melick  have 
returned  from  a cruise  to  Cuba  and  Panama  dur- 
ing which  Dr.  Melick  recuperated  from  his  recent 
serious  illness. 

Lorain — Dr.  John  W.  Adrain  has  completed; 
postgraduate  work  in  eye,  ear,  nose  and  throat  at 
the  Indiana  University  Medical  School. 

Portsmouth — Announcement  has  been  made  of 
the  approaching  marriage  of  Miss  Judith  Quasser 
of  this  city  and  Dr.  I.  L.  Levin,  Lorain. 

Cleveland — Dr.  Victor  F.  Woldman,  who  in 
March,  1934,  will  become  resident  physician  at 
the  Lying-In  Hospital,  Chicago,  is  taking  post- 
graduate work  in  gynecology  and  obstetrics  at 
European  medical  centers. 

Zanesville — Dr.  W.  L.  Cruise  who  has  been 
taking  postgraduate  work  at  the  Verebely  Clinic, 
Budapest,  will  return  to  Zanesville  the  latter  part 
of  June  to  resume  his  practice. 

Columbus — Dr.  Donald  E.  Yochem,  formerly  a 
member  of  the  faculty  at  the  College  of  Medicine. 
Ohio  State  University,  has  been  appointed  di- 
rector of  the  Licking  County  Tuberculosis  Hos- 
pital, Newark. 

Columbus— At  a meeting  of  the  Women’s  Med- 
ical Club  of  Columbus,  Dr.  Shirley  Armstrong 
discussed  “The  More  Common  Aspects  of 
Dermatology”. 

Portsmouth — Dr.  W.  A.  Quinn,  member  of  the 
local  board  of  health,  addressed  the  Civitan  Club 
on  “The  Health  Board  and  Its  Functions”. 

Norwood — Dr.  S.  H.  Portnoy  has  completed 
nine  months’  study  in  Vienna  and  has  opened 
offices  here  for  practice  in  eye,  ear,  nose  and 
throat  work. 

Lancaster — Dr.  L.  E.  Stenger  and  Mrs.  Stenger 
have  been  in  New  York  City  where  Dr.  Stenger 


384 


June,  1933 


State  News 


385 


took  postgraduate  work  at  the  New  York  Poly- 
clinic Postgraduate  School. 

Gahanna — Dr.  Alex  Doran,  formerly  of  Byes- 
ville,  has  opened  offices  here. 

Marion — Dr.  E.  L.  Brady,  president  of  the 
Marion  Academy  of  Medicine,  has  been  elected 
president  of  the  local  Rotary  Club. 

Toledo — The  following  Toledo  physicians  at- 
tended the  annual  Congress  of  Physicians  and 
Surgeons  of  North  America  at  Washington:  Drs. 
B.  J.  Hein,  F.  C.  Clifford,  L.  A.  Levison,  S.  H. 
Patterson,  L.  E.  Payne,  B.  Steinberg,  W.  W. 
Stone,  H.  F.  Howe,  A.  L.  Bei’shon,  Philip  Katz 
and  E.  J.  McCormick. 

Chillicothe — A discussion  of  the  recent  report 
of  the  Committee  on  the  Costs  of  Medical  Care 
was  presented  before  the  local  Sunset  Club  by  Dr. 
L.  E.  Hoyt,  after  which  the  club  condemned  the 
report  for  its  theories  and  recommendations. 

Shadyside — Dr.  C.  W.  Kirkland,  Bellaire,  as- 
sailed attempts  to  place  medical  practice  under 
the  control  of  the  state  in  an  address  before  the 
Shadyside  Americus  Club. 

Columbus — Dr.  and  Mrs.  Joseph  Price  have  re- 
turned from  a three  months’  trip  abroad. 

Cincinnati — Dr.  Richard  E.  Scammon,  Uni- 
versity of  Minnesota  Medical  School,  delivered  the 
third  annual  series  of  addresses  under  the  Ben- 
jamin K.  Rachford  Lectureship  at  the  University 
of  Cincinnati,  College  of  Medicine. 

Ashtabula — The  local  Rotary  Club  was  ad- 
dressed by  Dr.  L.  G.  Moore,  Kinsman,  on  his 
experiences  while  serving  with  the  British  and 
American  expeditionary  forces  during  the  World 
War. 

Cincinriati — Dr.  William  Muhlberg  has  been 
appointed  a member  of  the  board  of  trustees  of 
the  National  Health  Foundation. 

Cincinnati — About  200  attended  the  three-day 
meeting  of  the  American  Association  of  Ana- 
tomists held  at  the  University  of  Cincinnati. 

Akron — Announcement  has  been  made  of  the 
marriage  of  Miss  Jane  E.  Lynch,  Cuyahoga  Falls, 
and  Dr.  Robert  F.  Etienne,  Akron. 

Marion — Dr.  J.  E.  Baker  on  his  50th  anniver- 
sary as  a practicing  physician  was  honored  with 
a special  program  presented  by  the  Smart  Sun- 
day School  Class  of  the  Epworth  M.  E.  Church, 
of  which  Dr.  Baker  is  a member.  About  160  men 
attended  the  special  services  at  which  Dr.  Baker 
was  eulogized  and  he  responded  with  a brief  re- 
view of  his  experiences  as  a medical  practitioner. 
Among  those  who  attended  were  the  following 
physicians:  Drs.  H.  K.  Mouser,  R.  S.  Dombaugh, 
A.  A.  Starner,  J.  H.  Jackson,  F J.  Hunter,  C.  L. 
Baker,  John  Bull,  Bret  Hurd,  F.  L.  Thomas,  F. 
E.  Mahla  and  E.  L.  Brady. 


B.  W.  Stewart,  superintendent  of  the  Youngs- 
town City  Hospital,  was  elevated  to  the  presi- 
dency of  the  Ohio  Hospital  Association  at  the 
annual  meeting  of  the  association  in  Columbus, 
May  2-4.  He  succeeds  Miss  Mary  A.  Jamieson, 
former  superintendent  of  Grant  Hospital,  Co- 
lumbus. 

John  R.  Mannix,  University  Hospitals,  Cleve- 
land, former  executive  secretary  of  the  associa- 
tion, was  named  president-elect,  and  A.  E.  Hard- 
grove,  Akron  City  Hospital,  was  elected  executive 
secretary.  Other  officers  chosen  were:  Carroll  H. 
Lewis,  Christ  Hospital,  Cincinnati,  first  vice  pres- 
ident; Sister  M.  Anastasia,  Mercy  Hospital,  To- 
ledo, second  vice  president;  Dr.  E.  R.  Crew,  Miami 
Valley  Hospital,  Dayton,  and  Miss  Jamieson, 
trustees. 

Financing  programs  and  hospital  economics 
were  the  principal  subjects  discussed  at  the  meet- 
ing, the  discussions  being  led  by  Mannix,  Rev.  Fr. 
M.  F.  Griffin,  Cleveland,  and  Dr.  E.  L.  Harmon, 
Cleveland. 

Mannix  proposed  a reorganization  of  the  state 
association  and  the  division  of  the  organization 
into  sections  to  be  units  of  the  state  organization. 
Rev.  Fr.  Griffin  spoke  on  the  need  for  practical 
means  of  aiding  hospitals  to  carry  their  charity 
load,  and  Dr.  Harmon  analyzed  plans  now  under 
way  in  Cleveland  for  the  formation  of  a hospital 
finance  corporation  to  provide  a monthly  payment 
plan  for  persons  unable  to  meet  their  hospital 
bills  promptly. 

The  recent  report  of  the  Committee  on  the  Costs 
of  Medical  Care  was  discussed  at  the  banquet  of 
the  association  by  Dr.  J.  H.  J.  Upham,  dean  of 
the  College  of  Medicine,  Ohio  State  University, 
and  a member  of  the  board  of  trustees  of  the 
American  Medical  Association. 

— Dr.  Edward  Alberts,  for  the  past  two  years 
receiving  ward  physician  at  the  Cincinnati  Gen- 
eral Hospital,  has  joined  the  staff  of  the  Lying- 
In  Hospital,  Chicago. 

— H.  M.  Gee,  former  executive  secretary  of  the 
Van  Wert  Independent  Retail  Merchants  Asso- 
ciation, has  been  named  superintendent  and  busi- 
ness manager  of  the  Van  Wert  County  Hospital. 

— R.  A.  Bates,  superintendent  of  the  Piqua 
Memorial  Hospital  since  last  summer,  has  re- 
signed to  return  to  Iowa  City  his  former  home. 
His  successor  has  not  been  named. 

—The  staff  of  the  Union  Hospital,  Dover,  has 
elected  Dr.  G.  I.  Goodrich  president;  Dr.  R.  J. 
Foster,  vice  president  and  Dr.  Burrell  Russell, 
secretary-treasurer. 


PUBLIC  HEALTH  NOTES 


— There  have  been  reported  in  Ohio,  during  the 
past  five  years,  144,486  cases  of  measles;  37,969 
of  these  occurred  last  year.  Deaths  from  this 
disease  have  averaged  258  per  annum  for  the 
past  10  years;  last  year  163  deaths  were  recorded 
— a rate  of  2.38  per  100,000  population.  Concern- 
ing these  figures,  the  Ohio  Health  News  says: 

“This  doesn’t  seem  a very  high  death  rate,  but 
when  consideration  is  given  to  the  fact  that  a 
vast  majority  of  the  deaths  from  measles  is 
among  infants  under  two  years  of  age,  the  serious- 
ness of  an  epidemic  may  be  realized.  Most  of  the 
cases  in  these  neighborhood  epidemics  are  among 
school  children  and,  proportionately,  few  of  them 
die;  the  preschool  children  are  those  in  peril,  and 
the  younger  the  child  when  he  contracts  the  dis- 
ease, the  more  readily  he  succumbs. 

“Records  show  that  measles  is  25  times  as  fatai 
for  babies  under  one  year  as  it  is  for  those  of 
four  years,  and  that  it  is  almost  50  times  as  fatal 
for  children  under  one  year  as  for  those  of  5 to 
9 years  of  age. 

“Danger  to  life  of  the  individual  child  depends 
on  many  things — age,  the  state  of  health  at  the 
time  of  exposure,  the  virulence  of  infection,  the 
care  of  the  patient  and  whether  complications 
arise — broncho-pneumonia  being  the  most  fre- 
quent complication  and  also  the  most  frequent 
cause  of  death. 

“Suppression  of  measles  is  one  of  the  unsolved 
problems,  and  prevalence  of  the  disease  is  un- 
likely to  decrease  until  recognition  is  possible  be- 
fore the  transmissable  stage  is  reached,  or,  not 
until  physicians  have  the  cooperation  of  a public 
educated  to  the  knowledge  that  exposure  of  young 
children  to  measles  is  playing  with  death ; that 
measles  is  a ‘visitor’s  disease’  and  if  a susceptible 
person  enters  a room  wherein  there  is  a case,  al- 
most invariably  that  person  contracts  the  disease. 

“Parents  should  know  that  a child  with  the 
common  cold  signs,  reddened  eyes  and  a tempera- 
ture above  99  degrees  F.,  especially  when  there 
are  cases  of  measles  in  the  neighborhood,  should 
be  regarded  as  a possible  victim,  should  be  iso- 
lated for  the  good  of  others,  should  be  in  bed  for 
his  own  safety  and  remain  there  until  his  physi- 
cian says  he  may  safely  arise.” 

— Dr.  J.  D.  Stires,  Malvern,  was  elected  to  a 
five-year  term  on  the  Carroll  County  Board  of 
Health  at  a recent  meeting  of  the  advisory  coun- 
cil. 

— The  Crawford  County  advisory  council  has 
elected  Dr.  J.  A.  Agnew,  Crestline,  a member  of 
the  county  board  of  health  for  a five-year  term. 

— Dr.  C.  K.  Schloss,  Osborn,  has  been  named  a 
member  of  the  Greene  County  Board  of  Health. 


— Dr.  B.  H.  Biddle,  Sugar  Grove,  has  been 
elected  health  commissioner  of  Fairfield  County, 
succeeding  Dr.  W.  R.  Coleman,  Bremen. 

— The  advisory  council  of  Ottawa  has  elected 
Dr.  R.  A.  Willet,  Elmore,  a member  of  the  county 
board  of  health  for  a period  of  five  years. 

— Dr.  A.  E.  King,  Mt.  Cory,  has  been  elected  to 
a five-year  term  on  the  Hancock  County  Board  of 
Health. 

— Dr.  H.  A.  Moore,  Oxford,  was  re-elected  a 
member  of  the  Butler  County  Board  of  Health 
for  a five-year  term. 

— Dr.  R.  A.  Rulmann,  Minster,  was  elected  to 
the  Auglaize  County  Board  of  Health  at  a recent 
meeting  of  the  county  advisory  council. 

- — Dr.  E.  H.  Knowlton,  Mantua,  a member  of 
the  Portage  County  Board  of  Health  for  the  past 
12  years,  has  been  re-elected  for  a five-year  term. 

— The  advisory  council  of  Fulton  County  has 
re-elected  Dr.  C.  E.  Patterson,  Fayette,  a mem- 
ber of  the  county  board  of  health. 

— Dr.  Paul  E.  Gilmor  was  elected  by  the  Stark 
County  advisory  council  to  serve  as  a member  of 
the  county  board  of  health  for  a five-year  term. 

— With  the  coming  of  seasonable  weather,  the 
state  enters  on  a new  building  era,  in  which  re- 
creational features  and  facilities  occupy  an  im- 
portant position.  One  class  of  improvement  that 
will  receive  much  attention,  among  many  wherein 
the  health  of  individuals  and  the  public  is  con- 
cerned, is  that  of  swimming  pools,  to  which 
Ohioans  have  been  turning  in  increasing  numbers 
as  natural  facilities  for  swimming  have  become 
fewer  in  number  and  also  sources  of  considerable 
danger. 

The  State  Department  of  Health  has  prepared 
a set  of  “Regulations  Governing  Public  Swimming 
Pools”,  in  accord  with  the  latest  development  in 
swimming  pool  construction,  equipment  and 
operation,  and  recommends  their  adoption  and  en- 
forcement by  the  health  departments  of  city  and 
general  health  districts  in  Ohio.  These  regula- 
tions contain  what,  in  the  opinion  of  the  Depart- 
ment, are  the  minimum  requirements  for  the 
proper  design,  equipment  and  operation  of  a safe 
pool.  Reg.  No.  1 defines  public  swimming  pools; 
No.  2 requires  plans  to  be  submitted  to  and  ap- 
proved by  the  board  of  health  before  a pool  for  the 
use  of  the  public  can  be  constructed;  No.  3 per- 
tains to  the  issue  of  permits  for  the  operation  of 
pools;  No.  4 is  “Detail  Requirements  of  Design 
and  Equipment”,  and  No.  5 covers  “Detail  Re- 
quirements of  Operation.” 


386 


June,  1933 


The  Ohio  State  Medical  Journal 


387 


Housing  Conditions  at  Many  State  In- 
stitutions “Shocking”  Report  By 
Legislators  Declares 

Regardless  of  what,  if  any,  action  is  taken  by 
the  90th  General  Assembly  to  remedy  the  housing 
situation  at  many  of  the  22  state  welfare  insti- 
tutions and  eliminate  fire  hazards  at  some  of 
them,  a report  recently  submitted  by  a sub-com- 
mittee to  the  Finance  Committee  of  the  House 
of  Represenatives  presents  some  interesting  in- 
formation on  conditions  at  these  institutions  and 
evidences  the  necessity  for  proper  steps  in  the 
near  future  to  improve  them. 

“This  inspection  has  revealed,”  the  report  de- 
clared, “conditions  that  are  shocking  to  the  minds 
of  normal  persons.” 

The  report  points  out  that  while  the  penal  in- 
stitutions are  greatly  overcrowded,  they  do  not 
constitute  a fire  hazard.  The  chief  criticism  of 
the  sub-committee  was  leveled  at  the  correctional 
and  mental  hygiene  institutions. 

Regarding  these  institutions  the  report  stated: 

“The  committee  has  nothing  of  praise  to  offer 
for  our  industrial  schools  and  institutions  for 
feeble  minded  and  epileptics,  except  that  the  heads 
of  these  institutons  are  all  quite  capable,  honest, 
interested  in  their  work  and  have  considered  the 
well  being  of  inmates  as  more  important  than 
their  own  personal  desires. 

“As  to  the  department  of  welfare  they  are  cer- 
tainly to  be  commended  upon  their  accomplish- 
ments with  the  limited  funds  provided  by  the 
legislature. 

“At  the  present,  Ohio  has  in  the  above  men- 
tioned institutions  approximately  36,000  guests 
and  inmates.  The  department  of  welfare  has 
registered  upon  its  waiting  list  approximately 
1,500  prospective  patients. 

“An  untold  number  are  now  impounded  in  our 
county  homes  and  jails  for  safe  keeping  and  a 
still  greater  number  are  being  cared  for  by  their 
families,  and  if  space  was  available  within  our 
institutions  they  would  be  immediately  committed 
there  by  the  probate  court. 

“These  are  all  proper  wards  of  the  state  and 
adequate  facilities  should  be  immediately  pro- 
vided. 

“In  making  these  charges  the  committee  feels 
that  it  is  their  duty  to  be  specific  so  they  set  forth 
a few  instances  in  which  the  state  has  failed  to 
assume  its  entire  obligation. 

“Cuyahoga  County  is  spending  approximately 
$100  per  hour  for  the  care  of  insane  and  feeble 
minded  patients,  all  of  whom  should  be  in  state 
institutions.  Other  counties  have  similar  prob- 
lems based  upon  their  proportionate  population. 

“In  the  Columbus  State  Hospital  for  Insane 
over  100  patients  are  compelled  to  sleep  on  the 
floor  and  the  mattresses  stored  during  the  day. 
This  institution  has  facilities  to  properly  house 
2,200  patients  but  they  are  aftef  a fashion  ac- 
commodating 2,800.  For  example,  in  one  room 
10x15%  feet — eight  patients  are  compelled  to 
sleep. 

“The  Massillon  State  Hospital  has  a normal 
capacity  of  1,900  patients  but  is  trying  its  best  to 
care  for  its  present  population  of  2,800. 

“The  Girls’  Industrial  Home  in  Delaware  is  also 
so  crowded  that  in  some  of  its  dormitories  beds 


must  be  placed  so  close  together  that  the  girls  in 
retiring  must  climb  over  the  foot  of  the  bed. 

“At  Gallipolis  State  Hospital  for  Epileptics,  we 
were  told  that  if  every  patient  in  the  hospital 
(approximately  2,200)  were  discharged  today 
they  have  a sufficient  waiting  list  in  the  state  to 
completely  refill  the  institution  tomorrow. 

“In  one  ward  of  approximately  40  women  pa- 
tients, all  of  whom  are  untidy,  and  many  of  them 
without  sufficient  mentality  to  recognize  hunger, 
a young  girl  is  employed  as  caretaker  working 
from  the  hours  of  5:30  in  the  mornig  until  8 in 
the  evening  for  the  paltry  sum  of  $37.40  per 
month  and  maintenance,  with  one  day  off  per 
month. 

“In  several  of  the  institutions  in  Ohio  the  pa- 
tients are  kept  in  buildings  which  have  been  con- 
demned by  the  state  authorities  and  would  under 
no  circumstances  be  allowed  to  stand  in  their 
present  state  were  they  owned  by  private  corpor- 
ations or  individuals. 

“Many  of  these  buildings  constitute  a real  fire 
hazard,  being  two  and  three  stories  high,  wooden 
floors,  and  without  adequate  fire  escapes. 

“The  floors  in  some  of  the  wards  in  Athens  are 
in  such  a bad  state  of  repair  that  patients  are 
liable  to  break  through  and  receive  permanent 
injuries. 

At  Delaware  the  same  conditions  exist,  but  in 
addition  parts  of  the  basement  have  no  floor  and 
is  a breeding  place  for  rats  and  skunks.  But  in 
no  instance  can  this  be  charged  to  mismanage- 
ment on  the  part  of  superintendents  or  the  head 
of  the  division  of  welfare,  but  rather  to  negli- 
gence on  the  part  of  the  State  of  Ohio. 

“The  committee  feels  that  inasmuch  as  this  is 
an  obligation  on  the  part  of  the  state,  that  the 
citizens  should  be  fully  informed.  It  is  quite  evi- 
dent that  the  correction  of  this  condition  is  no 
easy  task,  owing  to  the  present  financial  situation. 

“However,  a possible  avenue  of  relief  lies  in  the 
abandonment  of  one  of  our  four  state  normal 
schools  which  may  be  used  for  additional  housing 
facilities. 

“The  committee  intends  to  make  an  immediate 
survey  of  these  institutions  with  that  thought  in 
mind.  This  action  is  being  taken  in  view  of  the 
fact  that  the  saturation  point  in  the  teaching 
profession  was  reached  six  years  ago,  and  that 
from  that  time  on  a surplus  has  gradually  ac- 
cumulated until  today  4,000  well  trained  teachers 
are  unemployed.” 


At  a recent  meeting  of  the  Ohio  Mental  Hygiene 
Association  in  Columbus,  the  following  officers 
were  elected:  President,  Bleecker  Marquette,  ex- 
ecutive secretary  of  the  Cincinnati  Public  Health 
Federation;  first  vice  president,  Dudley  Blossom, 
welfai’e  director  of  Cleveland ; second  vice  presi- 
dent, Mrs.  Simon  Ross,  Cincinnati;  secretary, 
Charles  Sherwood,  Columbus,  former  assistant 
state  welfare  director;  treasurer,  R.  E.  Miles, 
Columbus,  director  of  the  Ohio  Institute;  trustees, 
Miss  Bertha  Luckey,  Cleveland;  Miss  M.  Edith 
Campbell,  Cincinnati;  Dr.  John  D.  O’Brien,  Can- 
ton. 


Dr.  C.  C.  Taylor  was  elected  by  the  advisory 

council  as  a member  of  the  Columbiana  County 
Board  of  Health. 


W.  B.  Andrews,  M.D.,  Kent,  Ohio 


I propose  to  devote  a short  discussion  to  the 
business  side  of  running-  a doctor’s  office,  the  chief 
end  of  which  is  getting  fees  for  services  per- 
formed. We  will  set  aside  the  matter  of  charity 
work,  a duty  which  we  all  perform,  willingly  or 
not.  My  chief  aim  will  be  to  discuss  various  ways 
of  getting  fees. 

To  be  a collector  one  has  to  be  patient  and  per- 
sistent. I believe  there  must  be  a proper  set-up 
in  an  office  if  one  expects  to  get  paid  for  his  work. 
We  take  it  for  granted  that  you  will  keep  a reli- 
able set  of  account  books.  I favor  no  particular 
kind ; any  should  be  good  if  it  will  tell  you  quickly 
how  much  a debtor  owes  you. 

Primarily,  I think  a doctor  should  employ  a 
secretary,  office  girl,  nurse,  bookkeeper  or  at- 
tendant, to  take  care  of  his  books.  Do  this  just 
as  soon  as  you  can  after  you  begin  practice.  This 
secretary  may  be  your  wife  if  you  can  afford  no 
other  at  first. 

One  can  do  little  in  the  collecting  of  bills,  if  he 
is  busy,  unless  he  has  a bookkeeper  or  secretary. 
I think  any  good  secretary  will  more  than  pay  for 
herself  annually,  by  the  amount  of  money  she 
personally  accounts  for,  as  well  as  for  the  added 
time  it  allows  you  for  practice,  without  being  an- 
noyed by  petty  details.  I think  I have  not  been 
without  one  since  the  first  year  of  my  practice 
and  no  money  I have  paid  out  has  given  me  more 
satisfactory  returns. 

Having  established  these  essentials  now  for  the 
collecting : 

CASH,  IF  POSSIBLE 

First,  get  all  of  the  fee  you  can  at  the  time  the 
service  is  rendered.  Do  not  turn  down  any  offer 
to  pay  in  part  or  whole  on  the  plea  that  the  job 
is  not  finished.  Take  all  you  can  get  at  the  time. 
Remember  the  old  saw  about  the  bird  in  hand. 

In  our  office  we  send  out  statements  at  the  end 
of  the  month  to  new  accounts,  and  repeat  every 
one  or  two  months.  We  have  several  different 
kinds  of  statements  and  envelopes  which  we  use 
in  mailing  bills,  using  one  for  one  type  of  patient 
and  another  for  a different  type.  Many  kinds  of 
bill-forms  with  various  appeals  printed  thereon 
may  be  purchased,  none  of  which  will  get  all  the 
debtors,  but  any  one  of  which  will  get  some  of 
them. 

We  employ  collecting  agencies  very  little  and 
when  we  do  we  prefer  a local  agency.  They 
usually  charge  less,  will  report  more  often  and 
can  reach  the  out-of-town  debtors  as  well  as  any- 
one else. 


Read  before  a meeting  of  the  Portage  County  Medical 
Society. 


Our  most  successful  experience  with  collectors 
has  been  to  employ  a local  individual,  usually  a 
persistent  man  of  mature  years  who  will  probably 
stick  to  the  job  if  you  give  him  enough  accounts. 

I have  sued  very  few  accounts.  My  experience 
has  not  been  encouraging.  I have  felt  that  the 
same  results  might  be  obtained  in  other  ways, 
with  less  notoriety,  and  with  less  of  the  patient’s 
money  wasted  in  court  costs,  which  sometimes 
consumes  most  of  it. 

PERSONAL  APPEAL  BEST  METHOD 

The  thing  that  has  probably  given  me  the  most 
satisfaction,  not  only  in  its  return  but  in  mutual 
understanding,  has  been  the  personal  appeal. 
There  are  many  reasons  why  people  do  not  pay 
bills  aside  from  the  so-called  deadbeat  stuff. 
Nothing  will  adjust  these  misunderstandings  like 
a personal  visit.  Among  the  various  reasons  given 
are:  Inability  to  pay,  dissatisfaction  with  the 

fee,  dissatisfaction  with  the  service  rendered, 
misunderstanding  as  to  who  is  responsible  for  the 
bill,  a desire  to  make  a large  payment  when  only 
a small  one  can  be  made,  and  others,  most  of 
which  may  be  classified  under  one  of  those  already 
mentioned.  You  may  be  surprised,  if  you  call  on 
these  people  personally,  how  many  misunder- 
standings may  be  ironed  out  and  how  many 
really  good  friends  you  may  salvage  from  a group 
of  disgruntled  former  patients.  If  it  is  at  all  pos- 
sible I have  a personal  interview  with  every  per- 
son who  owes  me  an  amount  large  enough  and 
long  enough  1 to  make  it  worth  while. 

We  have  some  spare  time  on  our  hands  during 
certain  seasons  of  the  year,  which  many  doctors 
use  to  play  golf,  attend  baseball  and  football 
games,  fishing,  etc.  In  these  days  of  good  roads 
and  automobiles  you  can  do  two  or  three  times  as 
much  work  as  you  could  twenty  years  ago  in  the 
same  length  of  time.  Some  of  this  spare  time  can 
be  used  to  good  advantage  in  collecting  your  bills. 

It  is  my  practice  to  have  my  secretai'y  place  on 
my  desk  at  intervals  a short  list  of  debtors  with 
all  the  information  at  her  command  about  the  ac- 
count. I pick  out  such  of  these  as  will  fit  in  with 
my  calls  for  the  day  or  week  and  write  these 
names  in  my  visiting  list  in  a conspicuous  place. 
It  is  then  a very  simple  matter  as  I make  my 
rounds  (if  I have  any  to  make)  to  stop  at  these 
places  as  I pass  by  and  have  a personal  interview 
with  some  one  in  authority,  more  frequently  the 
wife. 

It  is  right  here  that  we  get  down  to  a truthful 
and  mutual  understanding  about' the  bill.  Not  in- 
frequently I have  gone  back  to  my  office  and  can- 
celled the  account,  but  much  more  often  I have 


388 


June,  1933 


State  News 


389 


completed  some  satisfactory  arrangement  for 
payment. 

This  personal  contact  arouses  very  little  an- 
tagonism and  if  developed  along  the  lines  I have 
mentioned  will  bring  many  dollars  into  your  cof- 
fers, all  of  which  is  yours,  including  the  commis- 
sion. It  has  brought  back  patients  to  me  and 
made  friends  of  potential  enemies. 

One  need  feel  no  embarrassment  about  it. 
Neighbors  may  wonder  why  you  call,  but  how 
often  you  also  call  to  make  life  insurance  exami- 
nations and  for  other  reasons  which  may  also  at- 
tract neighborly  attention ! 

And  here  comes  in  the  moral  effect  of  this  type 
of  dunning.  If  the  debtor  does  not  want  you  to 
call  he  is  likely  to  call  on  you  himself  to  avoid 
this  so-called  publicity.  It  has  never  been  beneath 
my  dignity  to  ask  any  man  or  woman  for  what  I 
thought  was  coming  to  me. 

Keep  your  eyes  and  ears  open  for  clues  as  to 
the  whereabouts  of  debtors  who  have  disappeared. 
Don’t  trust  your  memory.  Write  the  information 
down  at  once  on  anything  at  your  command. 

We  keep  in  touch  with  the  local  papers,  watch 
reports  of  sales,  appointment  of  administrators, 
guardianships,  get  information  through  relatives 
and  friends,  through  business  associates,  reports 
of  accidents,  lawsuits,  news  items,  through  lodges, 
etc.  No  clue  is  unimportant  enough  to  be  over- 
looked. 

Few  days  pass  in  our  office  that  we  do  not  do 
something  about  our  accounts.  The  man  who  is 
too  busy  to  properly  supervise  his  accounts  is 
probably  wasting  a lot  of  his  time  on  people  who 
never  will  pay  him.  The  moral  effect  of  this  is 
bad;  bad  for  his  own  business  and  bad  for  his 
colleagues.  The  physician  who  gets  the  money  is 
not  bothered  much  by  deadbeats.  His  reputation  as 
a money-getter  keeps  them  away  from  him. 

I might  have  cited  many  instances  where  ac- 
counts, outlawed  for  years,  have  been  paid  or  col- 
lected. These  occur  in  every  one’s  practice  if  he 
has  been  in  business  long  enough.  They  simply 
go  to  show  that  no  account  is  so  old  as  to  make  it 
improbable  to  get  some  kind  of  a settlement. 

DOCTOR  CAN  BE  BUSINESS-LIKE 

Too  well  we  know  that  physicians  as  a whole 
have  questionable  reputations  as  business  men ; 
reputations  largely  deserved  and  built  up  chiefly 
on  our  gullibility  and  lack  of  business  training 
and  acumen.  For  the  life  of  me  I cannot  see  why 
any  professional  man,  be  he  a physician  or  what- 
not, should  be  an  easy  mark  for  professional  dead- 
beats and  come-on  salesmen. 

Develop  the  business  side  of  your  profession. 
Take  an  interest  in  local  affairs,  and  in  this  and 
other  ways,  make  contacts  with  business  men  of 
reputation  whose  advice  and  example  may  develop 
within  you  that  instinct  to  make  good  on  the 
material  side  of  the  ledger. 

If  one  chooses  to  take  only  what  comes  his  way 


he  may,  and  probably  will,  remain  a good  doctor, 
but  if  he  cares  to  share  some  of  the  bigger  things 
of  life  it  behooves  him  to  not  only  better  himself 
professionally  and,  as  a means  to  this  same  end, 
better  himself  financially  by  looking  after  his 
accounts. 

I had  rather  do  a moderate  business  for  which 
I was  fairly  well  paid  than  a large  practice  for 
which  I was  poorly  paid.  Personally,  I think  I 
would  much  prefer  to  die  with  a reputation  as  a 
good  collector  and  something  to  show  for  it,  than 
to  die  with  a reputation  as  a good  old  doctor, 
with  little  or  nothing  as  my  family’s  reward. 


Postgraduate  and  Alumni  Day  in  Cin- 
cinnati, June  9 

Notices  have  been  sent  to  3,000  graduates  of 
the  College  of  Medicine,  University  of  Cincin- 
nati, announcing  the  Annual  Reunion  to  be  held 
Friday,  June  9. 

As  part  of  the  program  for  the  entertainment 
of  the  returning  alumni,  a postgraduate  demon- 
stration of  the  work  of  the  Cancer  Clinic  has 
been  arranged  as  well  as  demonstration ' of  the 
work  of  the  Vascular  Clinic. 

The  golf  tournament  will  be  played  at  the 
Maketewah  Country  Club  and  is  in  charge  of  Dr. 
Louis  Feid,  Jr. 

On  Friday  evening,  the  annual  banquet  will  be 
held  at  the  Gibson  Hotel.  Speakers  on  this  occa- 
sion will  be:  Dr.  Raymond  Walters,  president 

of  the  university;  Dr.  Richard  S.  Austin,  pro- 
fessor and  director  of  the  department  of  pathol- 
ogy, and  Dr.  Mont  Reid,  professor  and  director 
of  the  department  of  surgery.  Dr.  A.  C.  Bach- 
meyer,  dean  of  the  college  of  medicine,  will  in- 
duct the  graduating  class  into  the  Alumni  Asso- 
ciation. 

Those  assisting  Dr.  Alfred  Friedlander,  presi- 
dent of  the  Alumni  Association,  in  arranging  for 
the  homecoming  celebration,  are:  Dr.  William 

Doughty,  vice  president;  Dr.  Stanley  E.  Dorst, 
secretary;  Dr.  Carl  A.  Wilzbach,  Dr.  William 
Abbott,  Dr.  Mary  K.  Asbury,  Dr.  Richard  S. 
Austin,  Dr.  A.  C.  Bachmeyer,  Dr.  Frank  Cross, 
Dr.  Louis  Feid,  Jr.,  Dr.  Martin  H.  Fischer,  Dr. 
Fred  Heinold,  Dr.  Robert  H.  Kotte,  Dr.  Donald 
J.  Lyle,  Dr.  Dudley  Palmer,  Dr.  Helena  Ratter- 
man,  Dr.  Mont  R.  Reid,  Dr.  Robert  Rothenberg. 


New  officers  of  the  Western  Reserve  University 
Chapter  of  Sigma  Xi,  elected  recently  are:  Presi- 
dent, Dr.  Harold  S.  Booth,  associate  professor  of 
chemistry;  vice  president,  Dr.  James  A.  Doull, 
professor  of  public  health;  secretary,  Dr.  Wilton 
M.  Krogman,  associate  professor  of  physical 
anthropology;  treasurer,  Dr.  A.  H.  Hersh,  as- 
sistant professor  of  biology. 


— Dr.  Beatrice  T.  Hagen  has  been  re-elected 
health  commissioner  of  Muskingum  County. 


Njgs  Rrom 

ties  Academies 


First  District 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(George  B.  Topmoeller,  M.D.,  Secretary) 

May  1 — General  session.  Report  of  nominat- 
ing committee  with  slates  of  nominees  as  follows: 
President,  Dr.  John  A.  Caldwell,  both  tickets; 
treasurer,  Dr.  E.  0.  Swartz,  both  tickets;  secre- 
tary, Dr.  Harold  F.  Downing-  and  Dr.  Jerry 
Lavender;  trustees,  Dr.  Edward  King  and  Dr. 
T.  A.  Ratliff;  delegates  to  state  meeting,  Dr. 
Charles  Kiely,  both  tickets,  and  Dr.  Howard 
Schriver  and  Dr.  Louis  Feid,  Jr.,  contesting;  al- 
ternate delegates,  Dr.  L.  B.  Johnston  and  Dr. 
Joseph  Freiberg  on  one  ticket;  Dr.  E.  0.  Swartz 
and  Dr.  Samuel  Zielonka,  on  the  other.  Program : 
“The  Use  of  Free  Transplant  of  Fascie  in  the 
Treatment  of  Hernia”,  Dr.  J.  Louis  Ransohoff; 
discussants,  Dr.  J.  D.  Heiman  and  Dr.  John 
Goode;  “Functional  Disorders  of  the  Colon”,  Dr. 
H.  H.  Shook;  discussants,  Dr.  Henry  Wald  Bett- 
mann  and  Dr.  Walter  Stix. 

May  8 — General  session.  Program:  “Human 
Biology  in  the  Orient  and  its  Bearing  on  the  Man- 
churian Question”,  Dr.  Thomas  J.  LeBlanc;  “The 
Nasopharyngoscope”,  Dr.  Harry  H.  Haggart;  dis- 
cussants, Dr.  Henry  M.  Goodyear  and  Dr.  Arthur 
Beyer. 

May  1 5 — General  Session.  Program:  “The 
Doctor  in  Court”,  Judge  Benton  S.  Oppenheimer; 
“A  Biochemical  Concept  of  Gastric  Ulcer,”  Dr. 
Symmes  Oliver;  discussants,  Dr.  Shiro  Tashiro 
and  Dr.  C.  C.  Fihe. 

May  22 — General  session.  Program:  “Epi- 
lepsy”, Dr.  Foster  Kennedy,  professor  of  neu- 
rology, Cornell  University  Medical  School. 

Adams  County  Medical  Society  met  in  regu- 
lar session  April  26  at  the  court  house  at  West 
Union.  The  following  program  was  presented: 
“Food  Poisoning”,  Dr.  Robert  B.  Ellison,  Peebles; 
“Common  Colds  and  Catarrhal  Ailments”,  Dr. 
Victor  Fishback,  Cincinnati,  and  “The  Four  Chil- 
dren”, Dr.  George  P.  Tyler,  Manchester.  Dinner 
was  served  at  the  Northshore  Hotel. — News 
Clipping. 

Butler  County  Medical  Society  was  addressed 
by  Dr.  J.  A.  Judy,  Dayton,  at  its  meeting  April 
20  at  the  Middletown  City  Hospital. — New^ 
Clipping. 

Clermont  County  Medical  Society  has  as  its 
guest  of  honor  at  its  regular  meeting  May  17  at 
the  Owensville  School  Auditorium,  Dr.  William  E. 
Thompson,  of  Bethel,  98-year-old  physician,  who 
reviewed  the  changes  in  medicine  and  medical 


practice  during  his  70  years  of  practice.  Brief 
talks  were  made  by  Drs.  F.  H.  Leever,  G.  S.  Van 
Horn,  J.  M.  Coleman,  Thomas  Longworth,  Ken- 
neth Hanson,  A.  V.  Smith  and  S.  W.  Scorce. — 
Bulletin. 

Clinton  County  Medical  Society  was  addressed 
by  Dr.  Elmoz’e  B.  Tauber,  Cincinnati,  at  its  meet- 
ing May  9 at  the  General  Denver  Hotel,  Wilming- 
ton. Dr.  Tauber  discussed  “Dermatology  for  the 
General  Practitioner”. 

At  its  April  meeting  on  April  4 at  the  Shreve 
Hotel,  the  society  was  addressed  by  Dr.  Louis  J. 
Feid,  Jr.,  Cincinnati,  on  “The  Modern  Treatment 
of  Cancer”. — News  Clipping. 

Fayette  County  Medical  Society  heard  an  in- 
teresting talk  on  “Foot  Strain”  by  Dr.  H.  P.  Wor- 
sted, Columbus,  at  its  regular  meeting  May  4 
at  the  Washing-ton  C.  H.  Y.  M.  C.  A. — James  F. 
Wilson,  M.  D.,  Secretary. 

Highland  County  Medical  Society  was  addressed 
by  Dr  Robert  E.  Howard,  Cincinnati,  at  its  meet- 
ing May  3 at  Hotel  Parker,  Hillsboro.  Dr.  How- 
ard discussed  throat  ulcers  and  illustrated  his 
talk  with  motion  pictures. — News  Clipping. 

Second  District 

Clark  County  Medical  Society  on  April  12  was 
addressed  by  Dr.  H.  H.  McClellan,  former  super- 
intendent of  the  Dayton  State  Hospital,  on  “Are 
the  Psychoses  Due  to  Meningisms?” 

At  its  May  10  meeting  the  society  was  ad- 
dressed by  Dr.  Ralph  G.  Carothers,  Cincinnati, 
on  “Modern  Treatment  of  Fractures”. — News 
Clipping. 

Darke  County  Medical  Society  was  entertained 
at  a dinner  meeting  on  April  28  by  the  Greenville 
members  of  the  society.  Following  the  dinner 
at  the  Service  Restaurant,  the  society  was  ad- 
dressed by  Dr.  R.  E.  Baker,  Columbus,  on 
“Anatomy  of  the  Accessory  Nasal  Sinuses”.  The 
talk  was  illustrated  with  slides  and  specimens. — 
News  Clipping. 

Greene  County  Medical  Society  had  as  its  guest 
speaker  on  May  4,  Dr.  T.  C.  Sheridan,  Dayton, 
who  spoke  on  “Arsenical  Dermatitis”.  Follow- 
ing a general  discussion,  luncheon  was  served  at 
Geyer’s  Restaurant. — News  Clipping. 

Miami  County  Medical  Society  held  a dinner 
meeting  May  5 at  the  West  Milton  Inn.  Before 
the  program  was  presented,  the  society  toasted 
Dr.  Gainor  Jennings,  West  Milton,  in  recogni- 
tion of  his  50  years  of  medical  practice,  presented 
him  with  a floral  tribute,  and  adopted  a resolu- 


390 


June,  1933 


State  News 


391 


tion  eulogizing  him.  The  guest  speaker  was  Dr. 

J.  K.  Hoerner,  Dayton,  who  presented  a paper 
on  “Occiput  Posterior  Position”. — News  Clipping. 

Montgomery  County  Medical  Society  was  ad- 
dressed by  Dr.  J.  K.  Hoerner  and  Dr.  V.  L.  Hart 
at  its  meeting  April  21.  Dr.  Hoerner  spoke  on 
“Occiput  Posterior  Position”  and  Dr.  Hart  on 
“Fractures  and  Dislocations  of  the  Elbow”.  Dr. 
F.  C.  Rounds  and  Dr.  J.  A.  Judy  led  the  discus- 
sions of  the  papers. 

The  May  5 meeting  of  the  society  was  held  at 
the  National  Military  Home.  Following  a din- 
ner, case  reports  were  presented  by  the  follow- 
ing members  of  the  medical  and  surgical  staff  of 
the  home:  Drs.  John  P.  Jones,  Walter  F.  Coak- 
ley,  Henry  A.  Monat,  James  M.  Graham  and 
John  A.  Baird. 

The  society  met  in  regular  session  May  19  and 
the  following  symposium  on  “Meningitis  and  En- 
cephalitis” was  presented:  “Types  of  Mening- 
gitis  (etiology  and  pathology)”,  Dr.  C.  C.  Payne; 
“Symptoms  and  Differential  Diagnosis”,  Dr.  R. 
D.  Hostetter;  “Encephalitis”,  Dr.  W.  B.  Taggart; 
“Treatment  of  Meningitis  and  Encephalitis”,  Dr. 
S.  Winter.  The  discussion  of  the  papers  was 
led  by  Drs.  Dickinson,  Ashmun,  Fischbein  and 
Simpson. — Bulletin. 

Preble  County  Medical  Society  had  as  its  guest 
speaker  on  April  20,  Dr.  Malcolm  Cook,  Hamil- 
ton. Dr.  Cook  spoke  on  “Diagnosis  and  Man- 
agement of  Skull  Fractures”. — Bulletin. 

Third  District 

Allen  County  Academy  of  Medicine  on  April  18 
met  at  the  State  Hospital  for  the  Criminal  In- 
sane, Lima,  with  a large  attendance.  Dr.  R.  E. 
Bushong,  superintendent  of  the  institution,  ad- 
dressed the  meeting  on  “Responsibility  of  a Hos- 
pital for  Criminal  Insane”.  Case  reports  were 
presented  by  Dr.  H.  M.  Turk  and  Dr.  Earl  Crafts, 
members  of  the  hospital  staff. — News  Clipping. 

Hancock  County  Medical  Society  was  addressed 
on  May  4 at  the  Elks’  Club,  Findlay,  by  Dr.  J. 
L.  Reycraft,  Cleveland,  son  of  Dr.  A.  J.  Rey- 
craft,  Fostoria. — News  Clipping. 

Hardin  County  Medical  Society  and  the  Hardin 
County  Dental  Society  held  a joint  dinner  meet- 
ing April  20  at  the  Kenton  Cafe.  The  guest 
speakers  were  Dr.  C.  C.  Sherburne  and  D.  P.  Sny- 
der, D.D.S.,  both  of  Columbus.  Dr.  Sherburne 
spoke  on  “The  Relation  of  Oral  Sepsis  to  Sys- 
temic Disease”  and  Dr.  Snyder  on  “Surgery  of 
the  Mouth  and  Jaws”. — New  Clipping. 

Logan  County  Medical  Society  met  in  regular 
session  May  5 at  the  Hotel  Ingalls,  Bellefontaine. 
Program:  A round-table  discussion  of  blood  de- 
ficiency diseases.  Films  of  local  cases  were 
shown  and  discussions  were  presented  by  Drs. 
0.  C.  Amstutz,  John  P.  Harbert,  M.  L.  Pratt,  C. 

K.  Startzman,  Hobart  Mikesell,  Frank  B.  Kay- 
lor  and  A.  J.  McCracken. — News  Clipping. 


Marion  Academy  of  Medicine  was  addressed 
on  May  2 by  Dr.  Wells  Teachnor  and  Dr.  Wells 
Teachnor,  Jr.,  Columbus.  Both  discussed  phases 
of  the  cancer  problem  and  suggested  ways  for 
treating  cancer.  Members  of  the  Seventh  District 
Association  of  Nurses  were  guests  of  the  acad- 
emy.— J.  W.  Jolley,  M.D.,  Secretary. 

Van  Wert  County  Medical  Society  was  ad- 
dressed by  Dr.  J.  H.  J.  Upham,  Columbus,  dean 
of  the  College  of  Medicine,  Ohio  State  University, 
on  “Preventive  Medicine”  at  its  regular  meeting 
May  1 at  the  Y.  M.  C.  A.,  Van  Wert. — News 
Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO 
AND  LUCAS  COUNTY 

(A.  P.  Hancuff,  M.D.,  Secretary) 

May  .5 — General  session.  Program : “Occupa- 
tion and  Respiratory  Diseases”,  Dr.  Albert  E. 
Russell,  chief  surgeon,  U.  S.  Bureau  of  Mines, 
and  surgeon,  U.  S.  Health  Service,  Washing- 
ton, D.  C. 

May  12 — Section  of  Pathology,  Experimental 
Medicine,  and  Bacteriology.  Program:  “Rabies 
from  a Public  Health  Standpoint”,  W.  P.  S.  Hall, 
D.V.M.;  “Rules  and  Regulations  for  the  Quaran- 
tine of  Infectious  Diseases”,  Dr.  W.  S.  Holley,  To- 
ledo health  commissioner. 

May  19 — Medical  Section.  Program:  “Silk 

Sensitization  with  Special  Reference  to  Allergic 
Eczema”,  Dr.  K.  D.  Figley  and  Dr.  H.  J.  Park- 
hurst;  discussants,  Dr.  A.  P.  R.  James  and  Dr. 

L.  A.  Levison. 

May  26 — Surgical  Section.  Program  : Sympo- 
sium on  Abdominal  Pain  as  follows:  “To  the  In- 
ternist”, Dr.  Frank  C.  Clifford;  “To  the  Pedia- 
trician”, Dr.  Berman  S.  Dunham;  “To  the  Sur- 
geon”, Dr.  A.  P.  Hancuff;  discussants,  Dr.  J.  L. 
Stifel,  Dr.  L.  I.  Clark  and  Dr.  Will  Fisher. 

Putnam  County  Medical  Society  held  a dinner 
meeting  May  2 with  Dr.  C.  W.  Waggoner  and 
Dr.  W.  W.  Stone,  both  of  Toledo,  as  guest  speak- 
ers. Dr.  Waggoner  discussed  septic  sore  throat, 
acute  rheumatic  fever,  typhoid  fever  and  scarlet 
fever.  He  reviewed  the  symptoms,  diagnosis  and 
treatment  of  each  from  the  modern  point  of  view 
and  cited  cases  to  prove  the  efficiency  of  modern 
treatment  and  management  of  these  ailments. 
Dr.  Stone  read  a paper,  illustrated  with  slides, 
on  “Surgery  of  the  Chest”.  He  described  the 
various  operations  in  pulmonary  tuberculosis, 
stressing  the  importance  of  early  intervention 
after  careful  investigation  and  X-ray  diagnosis 
confirming  the  necessity  for  surgery.  There  was 
a large  attendance  and  a lively  round-table  dis- 
cussion held  following  the  papers.  Dr.  Wag- 
goner also  discussed  the  necessity  for  coopera- 
tion between  medical  organization  and  various 
township  and  county  officials  on  questions  of  poor 


392 


The  Ohio  State  Medical  Journal 


June,  1933 


relief. — J.  R.  Echelbarger,  M.D.,  Corresponding 
Secretary. 

Sandusky  County  Medical  Society  met  in  regu- 
lar session  on  April  27  at  the  Fremont  City  Hall. 
Dr.  R.  A.  Eyestone,  Gibsonburg,  was  the  prin- 
cipal speaker,  discussing  “Artificial  Feeding  of 
Infants”.  The  following  committee  was  ap- 
pointed to  arrange  for  a picnic:  Dr.  Charles 

Wehr,  Bellevue,  chairman,  Dr.  W.  H.  Booth  and 
Dr.  C.  R.  Pontius,  Fremont. 

Wood  County  Medical  Society  met  at  the  Wo- 
man’s Club,  Bowling  Green,  on  April  20.  Dr.  D. 
R.  Barr,  Grand  Rapids,  Ohio,  gave  an  interesting 
talk  on  “A  New  Method  for  the  Clinical  Study 
of  the  Circulation”.  He  illustrated  his  talk  with 
lantern  slides  and  demonstrated  the  sphygmotono- 
graph. 

On  April  28  members  of  the  society  attended 
in  a body  an  anesthesia  clinic  conducted  at  the 
East  Side  Hospital,  Toledo,  by  Dr.  C.  S.  Ordway 
and  the  hospital  staff. — Ralph  E.  Rasor,  M.D., 
Correspondent. 

Fifth  District 

ACADEMY  OF  MEDICINE  OF  CLEVELAND 

(C.  H.  Heyman,  M.D.,  Secretary) 

May  5 — Clinical  and  Pathological  Section.  Pro- 
gram by  Staff  of  Marine  Hospital:  “Case  of 

Aortic  Aneurism”,  Dr.  E.  J.  Mulholland;  “Case 
of  Aortic  Aneurism”,  Dr.  R.  S.  Baylor,  Jr.;  “Case 
of  Pituitary  Dyscrasis”,  Dr.  R.  E.  Butler;  “Case 
of  Mandibular  Fracture”,  Edgar  Pendlebury, 
D.D.S.;  “Case  of  Acne  Conglobata”,  Dr.  R.  H. 
Flinn;  “Case  of  Extreme  Hyperthyroidism”,  Dr. 
L.  E.  Burney;  “Case  of  Tuberculosis  Chorio-Reti- 
nitis”.  Dr.  Donald  McIntyre. 

May  12 — Experimental  Medicine  Section  and 
the  Cleveland  Section  of  the  Society  for  Experi- 
mental Biology  and  Medicine.  Program:  “Clin- 
ical Electrocardiographic  and  Pathological  Ob- 
servations on  Patients  with  Coronary  Sclerosis”, 
Dr.  C.  S.  Higley  and  Dr.  H.  Feil;  “Further  Ob- 
servations on  Arterioles  of  Skeletal  Muscles”,  Dr. 
David  Seecof,  Dr.  R.  W.  Scott  and  Dr.  A,  A.  Hill; 
“Experimental  Observations  on  the  Effect  of  Alu- 
minum Hydroxid  of  Gastric  Acidity”,  J.  P.  Quig- 
ley, Ph.D.,  and  Dr.  I.  H.  Einsel. 

May  19 — General  Session.  Program:  “The 

Fracture  Problem”,  Dr.  Willis  Campbell,  Mem- 
phis, Tenn.,  professor  of  orthopedic  surgery,  Uni- 
versity of  Tennessee  Medical  School. 

May  2b — Pediatric  Section.  Program:  “Or- 
thopedic Problems  of  Interest  to  Pediatricians”, 
Dr.  C.  H.  Heyman;  “Clinical  Remarks  on  the 
Surgery  of  Childhood”,  Dr.  Carl  F.  Lenhart. 

Ashtabula  County  Medical  Society  held  a din- 
ner meeting  April  11  at  the  Hotel  Cleveland,  Con- 
neaut.  The  guest  speaker  was  Dr.  Steinburg, 
Erie,  Pa.,  who  gave  an  illustrated  lecture  on  “The 
Common  Skin  Diseases  as  Met  With  in  a General 
Practitioner’s  Office”.  At  the  business  session, 


Dr.  E.  H.  Merrell  and  Dr.  P.  J.  Collander  were 
appointed  to  the  executive  committee  of  the  Ash- 
tabula County  Health  League. 

The  May  meeting  of  the  society  was  held  May 
9 at  Maple  Manor,  Geneva-on-the-Lake.  Follow- 
ing the  dinner,  Dr.  J.  E.  Tuckerman,  Cleveland, 
spoke  to  the  society  on  “Chronic  Malaria”.  A 
paper  on  “The  Disabilities  at  the  Knee  Joint” 
was  presented  by  Dr.  C.  H.  Heyman,  Cleveland. 
Dr.  Ellis  W.  List,  Andover,  was  elected  to  mem- 
bership.— A.  M.  Mills,  M.D.,  Secretary. 

Lorain  County  Medical  Society  held  a well-at- 
tended meeting  April  18  at  the  Congregational 
Church,  Lorain.  Following  the  dinner,  Dr.  H.  C. 
King,  Lakewood,  addressed  the  gathering  on 
“Heart  in  Toxic  Goiter”. 

No  regular  meeting  of  the  society  was  held  in 
May,  but  members  of  the  society  attended  the  im- 
munization clinic  conducted  at  St.  John’s  Hos- 
pital, Cleveland. — News  Clipping. 

Sixth  District 

Ashland  County  Medical  Society  met  in  regu- 
lar session  April  14  at  the  Good  Samaritan  Hos- 
pital, Ashland.  The  guest  speaker  was  Dr. 
Walter  Hoyt,  Akron,  who  spoke  on  “The  Hip 
Joint”.  His  lecture  was  illustrated  with  slides 
and  during  the  discussion  which  followed  he  re- 
lated many  interesting  experiences  during  his  trip 
last  summer  through  the  Mediterranean,  Egypt, 
Italy  and  Greece.  Dr.  Hoyt  presented  a case  re- 
port showing  the  complete  recovery  of  a case  of 
infantile  paralysis  in  a period  of  two  years,  the 
patient  having  been  completely  paralyzed.  Dr. 
Weir,  Mansfield,  was  a guest  of  the  society. — 
Paul  E.  Kellogg,  M.D.,  Secretary. 

Mahoning  County  Medical  Society  on  May  16 
had  as  its  guest  speaker,  Dr.  George  J.  Heuer, 
professor  of  surgery,  Cornell  University.  Dr. 
Heuer  spoke  on  “Surgery  of  the  Thorax”.  The 
June  meeting  of  the  society,  scheduled  for  June 
27,  will  be  a joint  gathering  with  the  Mahoning 
County  Bar  Association,  at  which  the  speakers 
will  be  Hon.  F.  R.  Hahn,  Youngstown  attorney, 
who  will  talk  on  “Medico-Legal  Considerations 
From  the  Standpoint  of  the  Lawyer”  and  Dr. 
Edwin  A.  Hamilton,  Columbus,  whose  subject  will 
be  “Medico-Legal  Considerations  From  the  Stand- 
point of  the  Doctor”.  Arrangements  have  been 
made  for  a course  of  eight  lectures  by  Dr.  L.  J. 
Karnosh,  Cleveland,  to  members  of  the  society, 
starting  about  the  middle  of  June.  The  talks 
will  be  on  “Anatomy  and  Physiology  of  the  Cen- 
tral Nervous  System  and  Clinical  Aspects  of  Neu- 
rology and  Psychiatry”. — Bulletin. 

Portage  County  Medical  Society  in  meeting 
May  4 at  the  Portage  County  Hospital  was  ad- 
dressed by  Dr.  Paul  M.  Spurney,  Cleveland,  on 
“Calcium  Metabolism”.  He  stressed  the  impor- 
tance of  calcium  to  develop  bone  structure  and  to 


June,  1933 


State  News 


393 


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CINCINNATI,  OHIO 


394 


The  Ohio  State  Medical  Journal 


June,  1933 


prevent  decay  of  the  teeth.  Dr.  Ivor  Campbell 
was  elected  to  membership. — News  Clipping. 

Stark  County  Medical  Society  met  at  the  Can- 
ton Elks’  Club  on  May  9 and  listened  to  an  ad- 
dress by  Dr.  Joseph  H.  Barach,  Pittsburgh,  on 
“Hypertension  and  Cardiovascular  Disease”. — 
Bulletin. 

Summit  County  Medical  Society  held  its  regu- 
lar meeting  May  2 at  the  Mayflower  Hotel.  A 
paper  on  “Lung  Pathology  in  Relation  to  In- 
dustrial Compensation”  was  presented  by  Dr.  P. 

C.  Langan,  accompanied  by  a lantern  demonstra- 
tion. The  talk  was  discussed  by  Dr.  C.  L.  Hyde 
and  Dr.  A.  C.  Robinson. 

The  April  meeting  of  the  society  was  held  on 
April  4 at  which  time  Dr.  F.  C.  Potter  addressed 
the  society  on  “Cerebral  Vascular  Accidents”. 
Dr.  H.  I.  Cozad  led  the  discussion. 

On  May  17,  many  members  of  the  society  were 
guests  of  the  Summit  County  Dental  Society  at 
a dinner  meeting  addressed  by  Boyd  Gardner, 

D. D.S.,  of  the  Mayo  Clinic. — Bulletin. 

Seventh  District 

Columbiana  County  Medical  Society  met  on 
May  9 at  Harris’  office,  Lisbon.  Dr.  John  A. 
Fraser  was  the  essayist  and  the  round-table  dis- 
cussion was  led  by  Drs.  Larkins,  Bookwalter  and 
Derfus. — Bulletin. 

Coshocton  County  Medical  Society  met  in  regu- 
lar session  April  27  at  the  Nurses’  Home,  Coshoc- 
ton. Dr.  S.  D.  Kistler  read  a paper  on  “Ear  Dis- 
eases and  Their  Complications”.  The  members 
voted  to  close  their  offices  on  Thursday  afternoon 
and  evening  during  June,  July  and  August. — 
News  Clipping. 

Eighth  District 

Athens  County  Medical  Society  was  addressed 
by  Dr.  R.  C.  Baker,  Columbus,  at  its  meeting 
April  3 on  “Nasal  Accessory  Sinuses”.  The  pro- 
gram followed  a luncheon  by  the  women  of  the 
First  M.  E.  Chui’ch. — News  Clipping. 

Fairfield  County  Medical  Society  met  May  9 at 
the  Music  Box  at  Lancaster.  The  guest  speakers 
were  Dr.  John  W.  Means  and  Dr.  H.  L.  Rein- 
hart, Columbus,  who  discussed  the  subject,  “Can- 
cer”. 

Licking  County  Medical  Society  was  addressed 
by  Dr.  J.  H.  J.  Upham,  Columbus,  member  of  the 
Board  of  Trustees  of  the  American  Medical  Asso- 
ciation and  dean  of  the  College  of  Medicine,  Ohio 
State  University,  at  its  meeting  on  April  28  at  the 
Hotel  Warden.  Dr.  Upham  discussed  the  report 
of  the  Committee  on  the  Costs  of  Medical  Care. — 
News  Clipping. 

Muskingum  County  Academy  of  Medicine  held 
a dinner  meeting  May  3 at  the  Zane  Hotel  with 
75  members  and  guests  in  attendance.  The  guest 
speaker  was  Dr.  George  W.  Crile,  Cleveland.  Dr. 


Crile  presented  two  papers,  one  on  “Peptic  Ulcer” 
and  one  on  “Neurocirculatory  Asthenia.” — Bul- 
letin. 

Perry  County  Medical  Society  was  addressed 
by  Dr.  J.  H.  Clouse,  Somerset,  on  “Hemolitic 
Jaundice”  at  its  meeting  April  17  at  the  Park 
Hotel,  New  Lexington. — News  Clipping. 

Washington  County  Medical  Society  had  as  its 
guest  speaker  on  May  10,  Dr.  H.  E.  LeFever, 
Columbus,  who  addressed  the  society  on  “A  Con- 
sideration of  the  Late  Effects  of  Head  Injuries”. 

The  March  meeting  of  the  society  on  March  S 
was  addressed  by  Dr.  William  C.  D.  McCusky, 
Wheeling,  W.  Va.,  who  spoke  on  “Prostatism”. — 
G.  M.  James,  M.D.,  Secretary. 

Ninth  District 

Hocking  Comity  Medical  Society  and  the  Hock- 
ing County  Dental  Society  held  a joint  dinner 
meeting  May  1 at  Nelsonville.  Dr.  D.  M.  Johnson 
and  Frederick  R.  Aldrich,  D.D.S.,  both  of  Colum- 
bus, were  the  guest  speakers.  Dr.  Johnson  spoke 
on  “Some  Results  of  Infection  in  Upper  Respira- 
tory Tract  in  Children”.  Dr.  Aldrich  discussed 
the  subject  “Orthodontia  As  Related  to  Medicine 
and  Dentistry”. — M.  H.  Cherrington,  M.D.,  Secre- 
tary. 

Pike  County  Medical  Society  met  May  1 at  the 
office  of  Dr.  R.  M.  Andre,  Waverfly.  Dr.  W.  B. 
Morrison,  Columbus,  was  the  guest  speaker.  He 
discussed  “Benign  and  Malignant  Conditions  of 
the  Stomach”. — News  Clipping. 

Scioto  County — The  Hempstead  Academy  of 
Medicine  met  in  regular  session  on  May  8 at  the 
Recreational  Hall  of  the  Nurses’  Home.  Dr.  W. 
B.  Morrison,  Columbus,  spoke  on  “Treatment  of 
Benign  and  Malignant  Lesions  of  the  Stomach 
and  Duodenum”.  A buffet  supper  was  served 
following  the  meeting. — Bulletin. 

Tenth  District 

ACADEMY  OF  MEDICINE  OF  COLUMBUS 

(John  H.  Mitchell,  M.D.,  Secretary) 

May  1 — General  Session.  Prog-ram:  “Endocrine 
Disturbances  of  Adolescence”,  Dr.  R.  A.  Ramsey; 
discussant,  Dr.  Andre  Crotti;  “State  Medicine  As 
Related  to  General  Economics”,  Dr.  A.  H.  Dunn. 
Report  of  the  committee  appointed  to  investigate 
the  Franklin  County  Tuberculosis  Sanitarium  re- 
ceived. 

May  8 — General  Session.  Program:  “Diagnosis 
and  Treatment  of  Seasonal  Hay  Fever”,  Dr.  Karl 
D.  Figley,  Toledo. 

May  15 — Clinic  at  Mercy  Hospital  by  the  hos- 
pital staff. 

May  22 — General  Session.  Program:  “The  Re- 
sponsibility of  the  Dentist  in  Phases  of  Surgery 
in  the  Oral  Cavity”,  D.  T.  Snyder,  D.D.S. 

May  29 — General  Practitioners’  Section.  Pro- 
gram: “The  Diagnostic  Significance  of  Fatigue,” 
Dr.  H.  D.  Piercy,  Cleveland;  discussants,  Dr. 


June,  1933 


State  News 


395 


Edward  Reinert 

Ph.G.,  M.D. 

247  East  State  Street  Columbus,  Ohio 

Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 

FRANK  GALLEN,  M.D.,  LEE  A.  HAYS,  M.D., 

Dermatology  Roentgenology 

Tel.  Main  1537  University  5842 


■I 


W.  H.  MILLER,  M.  D. 

328  East  State  St.  Columbus,  Ohio 

Office  Telephone,  MAin  3743  Residence,  EVergreen  5644 

QLsf o) 

Specializes  in 


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Superficial  Malignancy  Electro-Coagulation 

i 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

<Lrs> 


Prompt  and  Full  Report 


396 


The  Ohio  State  Medical  Journal 


June,  1933 


POSTGRADUATE  COURSE 


LABORATORY  COURSE 


For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

A house  doctor  is  appointed  July  1st  and 
January  1st 


For  Nurses  and  Graduates  of  High  School 
CLASSES  LIMITED  TO  SIX 
X-ray,  Basal  Metabolism,  Electro-cardiography  and 
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Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 


For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


Janies  H.  Warren,  Dr.  Bruce  Lindsey  and  Dr. 
C.  C.  Ross. 

Crawford  County  Medical  Society  held  its  regu- 
lar meeting  on  May  1 at  the  Bucyrus  City  Hos- 
pital Dr.  W.  James  Gardner  of  Cleveland,  ad- 
dressed the  society  on  “Surgical  Treatment  of 
Brain  Tumor”. — Bulletin. 

Ross  County  Medical  Society  was  entertained 
on  May  4 at  the  United  States  Veterans’  Hos- 
pital. A clinic  was  presented  by  Dr.  Frederick 
R.  Simms,  superintendent,  and  his  staff. — News 
Clipping. 

Union  County  Medical  Society  entertained  the 
members  of  the  Delaware  County  Medical  Society 
at  a dinner  April  11  at  the  Incur  Hotel,  Magnetic 
Springs.  Dr.  Frank  W.  Harrah,  Columbus,  was 
the  principal  speaker. — News  Clipping. 


Henry  J.  Arnold,  M.D.,  Fairview;  Ohio  Medical 
University,  Columbus,  1898;  aged  63;  former 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association ; died  April 
26  following  a stroke  of  paralysis.  Dr.  Arnold 
was  a native  of  Tuscarawas  County.  He  settled 
in  Guernsey  County  after  graduating  from  medi- 
cal school,  practicing  at  Middlebourne  and  Fair- 
view.  He  moved  to  Barnesville  15  years  ago  and 
practiced  there  until  he  was  forced  to  retire  be- 
cause of  his  health.  Dr.  Arnold  was  a member  of 
the  Methodist  Episcopal  Church,  Knights  of 
Pythias  and  Modern  Woodmen  lodges.  Surviving 
are  his  widow  and  one  son. 

Edgar  T.  Behymer,  M.D.,  Batavia;  Eclectic 
Medical  College,  Cincinnati,  1881;  aged  78;  died 
April  19  following  a prolonged  illness.  Dr. 
Behymer  practiced  in  Cincinnati  from  1892  until 
1915  when  he  retired.  His  widow  and  one  brother 
survive. 

Ivan  Lester  Biggs,  M.D.,  Fostoria;  Ohio  State 
University,  College  of  Medicine,  1910;  aged  46; 
died  April  29  following  an  operation  for  removal 
of  his  spleen.  Dr.  Biggs  was  bom  at  Bowling 
Green  and  practiced  at  Custer  until  his  discharge 


from  the  army  following  the  World  War  when  he 
located  in  Fostoria.  Dr.  Biggs  leaves  his  widow, 
one  son  and  his  mother. 

Thomas  A.  Bickerstaph,  M.D.,  LaGrange; 
Hahnemann  Medical  College  and  Hospital,  Chi- 
cago, 1895;  aged  75;  died  May  1 following  an  ex- 
tended illness.  Dr.  Bickerstaph  moved  to  La- 
Grange  from  New  London  15  years  ago.  He  was 
a member  of  the  Methodist  Episcopal  Church  and 
the  Masonic  Lodge.  Surviving  are  his  widow,  one 
brother  and  two  sisters. 

Leander  F.  Cain,  M.D.,  Caldwell;  Kentucky 
School  of  Medicine,  Louisville,  1887 ; aged  77 ; 
died  April  27  following  a stroke  of  paralysis;  Dr. 
Cain  had  practiced  in  Noble  County  since  his 
graduation  from  medical  school.  He  served  at  one 
time  in  the  General  Assemblly  as  state  represen- 
tative from  Noble  County.  Surviving  are  his 
widow,  two  sons,  one  daughter,  and  three  brothers. 

Edwin  R.  Kreider,  M.D.,  Monroeville;  Jefferson 
Medical  College,  Philadelphia,  1890;  aged  65; 
died  April  5.  Dr.  Kreider  had  practiced  in  Mon- 
roeville for  42  years.  He  was  a member  of  the 
Congregational  Church  and  the  Masonic  Lodge. 
Surviving  are  his  widow,  one  daughter,  one  sister 
and  one  brother. 

Charles  H.  McFarland,  M.D.,  Cleveland;  Cleve- 
land College  of  Physicians  and  Surgeons,  1905; 
aged  56 ; former  member  of  the  Ohio  State  Medi- 
cal Association  and  the  American  Medical  Asso- 
ciation; died  March  31  of  heart  trouble.  Dr.  Mc- 
Farland was  former  superintendent  of  Cleveland 
City  Hospital  and  former  physician  at  the  county 
jail.  During  the  World  War  he  was  a lieutenant 
colonel  in  the  medical  corps  and  served  nine 
months  overseas.  Dr.  McFarland  also  was  a 
veteran  of  the  Spanish-American  War.  He  was  a 
member  of  the  Masonic  Lodge  and  the  Associa- 
tion of  Military  Surgeons.  Surviving  are  two 
sons. 

George  Milton  Marshall,  M.D.,  Wheelersburg; 
Columbus  Medical  College,  1880;  aged  83;  mem- 
ber of  the  Ohio  State  Medical  Association  and 
the  American  Medical  Association;  died  April  11. 
Dr.  Marshall  retired  from  active  practice  15  years 
ago  and  resided  on  his  farm  near  Wheelersburg. 
He  was  a member  of  the  Masonic  Lodge.  His 
widow,  the  former  Dr.  Margaret  Fulton,  and  one 
son,  survive. 

John  E.  Moore,  M.D.,  Shiloh;  College  of  Phy- 
sicians and  Surgeons,  Baltimore,  1890;  aged  75; 


June,  1933 


State  News 


397 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


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COLUMBUS,  OHIO 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 

LABORATORY 

Clinical  and  Pathological 


Th  E MENACE  OF 

VITAMIN  D DEFICIENCY 

during  pregnancy 

No  physician  needs  to  be  told  how  critical  the  pre- 
natal period  is  to  both  mother  and  child.  Even  a 
slight  Vitamin  D deficiency  at  this  time  may  manifest 
itself  in  softening  of  the  mother’s  bones  and  teeth — or 
may  seriously  affect  the  developing  foetus. 

For  Vitamin  D,  as  you  know,  controls  the  absorp- 
tion and  utilization  of  calcium  and  phosphorus;  and 
the  demand  for  these  two  essential  minerals  is  at  least 
twice  as  great  during  pregnancy  as  under  normal 
conditions. 

Many  physicians  safeguard  the  developing  child — 
and  protect  the  mother’s  bones  and  teeth — by  pre- 
scribing Cocoinalt.  It  contains  not  less  than  30  Steen- 
bock  (300  ADMA)  units  of  Vitamin  D per  ounce. 
Prepared  as  directed,  each  glass  is  equivalent  in  Vita- 
min D content  to  not  less  than  two-thirds  of  a tea- 
spoonful of  standard  cod  liver  oil.  Laboratory  analyses 
show  that  Cocomalt  increases  the  protein  content  of 
milk  45%  — the  carbohydrate  content  184%  — the 
mineral  content  (calcium  and  phos- 
phorus) 48%. 

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Cocomalt,  free. 


Cocomalt  is  ac- 
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Foods  of  the 
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Established  1904 

Approved  by  the  American  Medical  Association. 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Coup,  A.B. 

Flora  Moone 

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Please  send  me  a trial-size  can  of  Cocomalt,  free. 

Address 


City... 


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398 


The  Ohio  State  Medical  Journal 


June,  1933 


former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  April  13.  Dr.  Moore  retired  from  active 
practice  several  years  ago.  He  was  a member  of 
the  Baptist  Church  and  the  Elks’  Lodge. 

Granville  C.  McCreight,  M.D.,  Willard;  Miami 
Medical  College,  Cincinnati,  1901;  aged  60;  for- 
mer member  of  the  Ohio  State  Medical  Associa- 
tion and  the  American  Medical  Association;  died 
April  22  following  a prolonged  illness.  Dr.  Mc- 
Creight retired  from  practice  several  years  ago 
after  practicing  for  almost  30  years  in  Willard. 
He  was  at  one  time  a member  of  the  city  council 
and  the  board  of  education.  He  was  a lieutenant 
in  the  medical  corps  during  the  World  War  and 
was  the  first  commander  of  the  Willard  American 
Legion  Post.  Dr.  McCreight  was  affiliated  with 
the  Masonic  Lodge.  Surviving  are  his  widow,  two 
sons,  one  daughter,  one  brother  and  one  sister. 

William  C.  Pontius,  M.D.,  Warren;  Temple 
University  School  of  Medicine,  Philadelphia, 
1917;  aged  45;  former  member  of  the  Ohio  State 
Medical  Association  and  the  American  Medical 
Association;  died  May  3 of  pneumonia.  Dr.  Pon- 
tius served  as  a captain  in  the  medical  corps  with 
the  A.E.F.  He  was  a member  of  the  Methodist 
Episcopal  Church,  Veterans  of  Foreign  Wars. 
Masonic  Lodge,  Elks  Lodge  and  the  Alpha  Kappa 
Kappa  and  Phil  Delta  Theta  fraternities.  Dr. 
Pontius  leaves  his  widow,  two  sons,  his  parents, 
one  sister  and  three  brothers. 

Arthur  Curtis  Richards,  M.D.,  Mt.  Gilead;  Ohio 
State  University,  College  of  Medicine,  1917 ; aged 
44;  member  of  the  Ohio  State  Medical  Associa- 
tion and  a Fellow  of  the  American  Medical  Asso- 
ciation; died  April  15  following  a cerebral  hemor- 
rhage. Dr.  Richards  was  a native  of  Franklin 
County,  locating  in  Mt.  Gilead  14  years  ago.  Dr. 
Richards  was  a World  War  veteran,  having 
served  as  a first  lieutenant  in  the  medical  corps. 
He  organized  the  Mt.  Gilead  American  Legion 
Post  and  was  its  first  commander.  Dr.  Richards 
also  belonged  to  the  Methodist  Episcopal  Church, 
the  Masonic  and  Eagles  lodges,  the  Kiwanis  Club 
and  Galion  Country  Club.  Surviving  are  his 
widow,  three  daughters  and  four  brothers. 

Esther  A.  Ryerson,  M.D.,  Dayton;  University 
of  Illinois,  College  of  Medicine,  Chicago,  1903; 
aged  69;  former  member  of  the  Ohio  State  Medi- 
cal Association  and  the  American  Medical  Asso- 
ciation ; died  April  19.  Dr.  Ryerson  practiced 
medicine  in  Cincinnati  before  moving  to  Dayton 
19  years  ago  to  become  a staff  physician  at  the 
Dayton  State  Hospital.  She  retired  from  that 
position  five  years  ago. 

Joseph  Dallas  Smith,  M.D.,  Columbus;  Uni- 
versity of  Wooster  Medical  Department,  Cleve- 
land, 1880;  aged  87;  died  April  26  of  heart  dis- 
ease. Dr.  Smith  jDracticed  in  Danville,  Ohio,  be- 
fore moving  to  Columbus  where  he  practiced  for 
36  years.  He  leaves  his  widow,  one  son  and  two 
daughters. 


Ralph  L.  Waters,  M.D.,  Lakeside;  Western  Re- 
serve University  School  of  Medicine,  1883;  aged 
74;  former  member  of  the  Ohio  State  Medical 
Association  and  the  American  Medical  Associa- 
tion; died  May  5.  Dr.  Waters  retired  a year  ago. 
His  widow  and  two  daughters  survive. 

Leslie  A.  Woolf,  M.D.,  Ravenna;  Medical  Col- 
lege of  Ohio,  Cincinnati,  1905;  aged  54;  member 
of  the  Ohio  State  Medical  Association  and  a Fel- 
low of  the  American  Medical  Association;  died 
April  30  of  apoplexy.  Dr.  Woolf  practiced  two 
years  in  Kent  before  opening  an  office  in  Ravenna 
in  1908.  He  was  a member  of  the  Masonic  Lodge 
and  the  Rotary  Club.  Surviving  are  his  widow, 
one  son,  one  daughter  and  one  sister. 


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Rates  for  advertisements  under  this  heading  are  60  cents 
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For  Sale  or  Trade — Location  for  doctor  or  surgeon,  South- 
ern Ohio  town,  10,000  population.  Bargain.  Address  W.  S. 
J.,  care  Ohio  State  Medical  Journal. 


June,  1933 


State  News 


399 


The  spirit  of  investigation  and 
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progressive  chemists  everywhere 
has  been  an  important  factor  in 
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of  physicians  as  an  alkalizer. 
For  over  half  a century  it  has 
successfuly  served  physicians  in 
prescribing  for  patients  at  home 
and  in  the  hospital. 


A BALANCED  ALKALIZER 

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the  alkaline  buffer  salts  in  soluble 
form  to  quickly  replenish  the  de- 
pleted alkali  reserve  or  to  maintain 
the  supply  where  necessary. 


UNIFORM  DOSAGE 

No  mixing  to  be  done  by  the  patient, 
which,  obviously  is  an  advantage  in 
standardizing  the  alkalizing  expect- 
ancy. 


EXTREME  PALATABILITY 

Obtained  largely  by  proper  carbona- 
tion;  patient  does  not  object  to  tak- 
ing it  in  sufficient  quantities  to  assure 
rapid  alkalization. 


(artificial) 

Wagner  Medicinal  Laboratories — The  W.  T.  Wagner’s  Sons  Co. 
In  Cincinnati  Since  1868 


400 


The  Ohio  State  Medical  Journal 


June,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

John  B.  Alcorn,  Chairman,  (1933) 


Columbus 

J.  H.  J.  Upham  (1934) Columbus 

C.  W.  Stone  (1935) Cleveland 

H.  M.  Platter,  (ex-officio) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

D.  C.  Houser,  (special) Urbana 

C.  W.  Wag-goner,  (special) Toledo 

A.  H.  Freiberg,  (special) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

A.  B.  Denison,  (1933) -...Cleveland 


Gilbert  Micklethwaite,  (1935)  ....Portsmouth 

MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

W.  H.  Snyder,  (1933) Toledo 

F.  P.  Anzinger,  (1935) Springfield 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) _Toledo 

R.  H.  Birge,  (1935) Cleveland 

MEDICAL  ECONOMICS 
J.  Craig  Bowman,  Chairman,  (1933) 

Upper  Sandusky 

A.  B.  Brower,  (1934) Dayton 

E.  O.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 


V.  C.  Rowland,  Chairman Cleveland 

Jonathan  Forman . Columbus 

Beatrice  T.  Hagen Zanesville 

R.  R.  Hendershott Tiffin 

C.  I.  Stephen Ansonia 

MILITARY  AND  VETERANS'  AFFAIRS 

C.  W.  Stone,  Chairman Cleveland 

Fred  K.  Kislig  (deceased) Dayton 

A.  E.  Brant Youngstown 


COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

S.  J.  Goodman,  Chairman Columbus 

John  A.  Caldwell Cincinnati 

I.  P.  Seiler Piketon 

ARRANGEMENTS  1933  ANNUAL  MEETING 

H.  S.  Davidson,  Chairman Akron 

E.  M.  Huston Dayton 

E.  B.  Shanley . New  Philadelphia 

PROGRAM  1933  ANNUAL  MEETING 

C.  L.  Cummer,  Chairman Cleveland 

B.  J.  Hein Toledo 

E.  R.  Brush Zanesville 


SECTION  OFFICERS  FOR  1932-1933 


MEDICINE 

Carll  S.  Mundy Chairman 

126  16th  St.,  Toledo 

Cecil  Striker Secretary 

700  Provident  Bank  Bldg.,  Cincinnati 
SURGERY 

Carl  R.  Steinke  Chairman 

1027  Second  Natl.  Bldg.,  Akron 

Norris  Gillette Secretary 

320  Michigan  St.,  Toledo 

OBSTETRICS  AND  PEDIATRICS 

B.  H.  Carroll Chairman 

240  Michigan  St.,  Toledo 

Edward  A.  Wagner Secretary 

2560  Grandin  Rd.,  Cincinnati 


EYE,  EAR,  NOSE  AND  THROAT 


W.  V.  Mullin Chairman 

Euclid  at  93rd  St.,  Cleveland 

Ivor  G.  Clark Secretary 

188  E.  State  St.,  Columbus 

NERVOUS  AND  MENTAL  DISEASES 

J.  Fremont  Bateman Chairman 

Box  36,  Elmwood  Place 

Henry  C.  Schumacher Secretary 

2625  Euclid  Ave.,  Cleveland 

PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 
R.  H.  Markwuth Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 


ALTERNATES 


J.  P.  DeWitt,  (1933) Canton 

C.  E.  Kiely,  (1933) Cincinnati 

C.  W.  Waggoner,  (1933) ’ Toledo 

Wells  Teachnor,  Sr.,  (1934) Columbus 

Ben  R.  McClellan,  (1934) Xenia 

E.  R.  Brush,  (1934) Zanesville 

C.  W.  Stone,  (1934) Cleveland 


G.  F.  Zinninger,  (1933) Canton 

L.  H.  Schriver,  (1933) Cincinnati 

John  Sprague,  (1933) Athens 

D.  H.  Morgan,  (1934) Akron 

A.  C.  Messenger,  (1934) Xenia 

A.  Howard  Smith,  (1934) Marietta 

C.  L.  Cummer,  (1934) Cleveland 


EIGHTY- SEVENTH  ANNUAL  MEETING, 
AKRON,  SEPTEMBER  7th  and  8th,  193  3 


July,  1933 


Advertisements 


401 


THE  SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 


TREATS  NERVOUS  AND  MENTAL  DISEASES 


NERVOUS  CASES  who  are  normal,  but  whose  personal  efficiency,  both 
physical  and  psychical,  can  be  increased  by  treatment  and  a better  understand- 
ing and  wise  guidance  by  experienced  persons,  find  the  Sawyer  Sanatorium 
especially  adapted  to  their  needs. 

Send  For  House  Book.  Address 

Sawyer  Sanatorium,  White  Oaks  Farm,  Marion,  Ohio 


The  Ohio  State  Medical  Association 

Ohio  State  Medical  Journal 


Entered  as  second  class  matter  July  B,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

Subscription  $3.00  per  year ; single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 

Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1933)  Cleveland 

Gilbert  Micklethwaite,  M.D.  (1935) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney  Advertising  Manager 


Officers  1932-1933 

PRESIDENT 

H.  M.  Platter,  M.D. 

PRESIDENT-ELECT 
C.  L.  Cummer,  M.D.  .... 

TREASURER 
James  A.  Reer,  M.D. 

EXECUTIVE  SECRETARY 
Don  K.  Martin 

State  Council 

First  District 

Second  District 

Third  District 

O.  P.  Klotz,  M.D.  ..... 

Fourth  District 

B.  J.  Hein,  M.D. 

Fifth  District 

H.  V.  Paryzek,  M.D.  ...  .... 

Sixth  District 

Seventh  District 

E.  B.  Shanley,  M.D.  New  Philadelphia 

Eighth  District 

Ninth  District 

I.  P.  Seiler,  M.D 

Tenth  District 

Ex-Officio,  The  Ex-President 
D.  C.  Houser.  M.D.  

Urbana 

402 


The  Ohio  State  Medical  Journal 


July,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies 


President 


Secretary 


First  District 


Adams L.  H.  Leonard,  Manchester O.  T.  Sproull,  West  Union 

Brown R.  B.  Hannah,  Georgetown Geo.  P.  Tyler,  Jr.,  Ripley 

Butler H.  O.  Lund,  Middletown Walter  Roehl,  Middletown 

Clermont J.  K.  Ashburn,  Batavia Allan  B.  Rapp,  Owensville 

Clinton F.  A.  Peele,  Wilmington. Wm.  L.  Regan,  Wilmington 

Fayette S.  E.  Boggs,  Washington  C.  H J.  F.  Wilson,  Washington  C.  H.  . 

Hamilton Parke  G.  Smith,  Cincinnati Geo.  B.  Topmoeller,  Cincinnati — 

Highland C.  C.  Cropper,  Lynchburg W.  B.  Roads,  Hillsboro 

Warren J.  E.  Witham,  Waynesville James  Arnold,  Lebanon 


3d  Wednesday  in  April,  June,  An*.. 
Oct. 

4th  Wednesday  in  Feb.,  May  and 
Nov. 

2d  Wednesday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Monday  evening  of  each  week 
1st  Wednesday,  monthly. 

1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 


Second  District  Cyril  Hussey,  Sidney 

Champaign N.  M.  Rhodes,  Urbana 

Clark C.  W.  Evans,  Springfield 

Darke W.  T.  Fitzgerald,  Greenville 

Greene L.  L.  Taylor,  Yellow  Springs 

M iami F.  D.  Kiser,  Tippecanoe  City 

Montgomery A.  F.  Kuhl,  Dayton 

Preble C.  M.  Treffinger,  Eaton 

Shelby R.  E.  Paul,  Botkins 


. .H.  R.  Huston,  Dayton_ 


L.  A.  Woodburn,  Urbana 

Roger  Marquart,  Springfield 

W.  D.  Bishop,  Greenville 

H.  C.  Schick,  Xenia 


G.  A.  Woodhouse,  Pleasant  Hill- 

Miss  M.  E.  Jeffrey,  Dayton 

C.  J.  Brian,  Eaton 

A.  B.  Lippert,  Sidney 


Third  District  _ 

Allen 

Auglaize 

Hancock 

Hardin 

Logan  

Marion 

Mercer 

Seneca 

Van  Wert 

Wyandot 

Fourth  District 
Defiance 

Fulton 

Henry 

Lucas  

Ottawa 

Paulding 

Putnam 

Sandusky  

Williams 

Wood 

Fifth  District 

Ashtabula 

Cuyahoga  


Erie  . 


Geauga  

Huron 


Lake 


Lorain 

Medina 

Trumbull 


V . H.  Hay,  Lima C.  E.  Hufford,  Toledo 

E.  C.  Yingling,  Lima H.  L.  Stelzer,  Lima 

E.  F.  Heffner,  Wapakoneta C.  C.  Berlin,  Wapakoneta 

A.  E.  King,  Mt.  Cory H.  O.  Crosby,  Findlay 

. F.  M.  Elliott,  Ada W.  N.  Mundy,  Forest 

O.  C.  Amstutz,  Bellefontaine W.  H.  Carey,  B.'llefontaine 

E.  L.  Brady,  Marion J.  W.  Jolley,  Marion 

- M.  B.  Vishbaugh,  Celina F.  E.  Ayers,  Celina 

Paul  Leahy,  Tiffin R.  E.  Hershberger,  Tiffin 

A.  T.  Rank,  Van  Wert R.  H.  Good,  Van  Wert 

_B.  A.  Moloney,  Upper  Sandusky W.  L.  Naus,  Upper  Sandusky 

(With  Third  District  in  Northwestern  Ohio  District) 

S.  E.  DeMuth,  Hicksville D.  J.  Slosser,  Defiance 

. P.  S.  Bishop,  Delta Geo.  McGuffin,  Pettisville 

_T.  P.  Delventhal,  Napoleon F.  M.  Harrison,  Napoleon 

L.  R.  Effler,  Toledo.. A.  P.  Hancuff,  Toledo 

- R.  A.  Willett,  Elmore Cyrus  R.  Wood,  Port  Clinton 

C.  E.  Houston,  Paulding Gaile  L.  Doster,  Paulding 

E.  Blackburn,  Kalida W.  B.  Light,  Ottawa 

D.  W.  Philo,  Fremont J.  C.  Boyce,  Fremont 

B.  C.  Bly,  Bryan H.  R.  Mayberry,  Bryan 

F.  L.  Sterling,  Bowling  Green R.  N.  Whitehead,  Bowling  Green- 

H.  V.  Paryzek,  Councilor Chrm.  Com.  on  Arrangements 

J.  F.  Docherty,  Conneaut A.  M.  Mills,  Ashtabula 

H.  V.  Paryzek,  Cleveland Clarence  H.  Heyman,  Cleveland — 

_J.  C.  Kramer,  Sandusky G.  A.  Stimson,  Sandusky 

H.  E.  Shafer,  Middlefield Isa  Teed-Cramton,  Burton 

-W.  W.  Lawrence,  Norwalk Geo.  F.  Linn,  Norwalk 

G.  O.  Hedlund,  Painesville B.  T.  Church,  Painesville 

-Herman  Campbell,  Elyria W.  E.  Hart,  Elyria 

Harry  Streett,  Litchfield J.  K.  Durling,  Wadsworth 

E.  P.  Adams,  Warren R.  H.  McCaughtry,  Warren 


2d  Thursday,  monthly. 

2d  and  4th  Wednesday  noon. 

2nd  Friday,  monthly. 

1st  Thursday,  monthly. 

1st  Friday,  monthly,  except  July 
and  August. 

1st  and  3d  Friday  each  month. 

3d  Thursday,  monthly. 

1st  Friday,  monthly. 

Tiffin,  Oct.  3,  1933 
3d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 

1st  Thursday,  monthly. 

17th  of  each  month. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Thursday,  monthly. 

3rd  Thursday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


3d  Thursday,  monthly,  except 
July,  August,  December. 

2nd  Thursday  monthly. 

1st  Wednesday,  monthly. 

Friday,  each  week. 

2d  Thursday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Thursday,  monthly. 

3d  Thursday,  monthly. 

Cleveland. 

2nd  Tuesday,  monthly. 

3d  Fri.  Feb.,  March,  May,  Sept., 
Nov.,  Dec. 

Last  Wednesday,  monthly,  except 
July,  Aug.,  Sept. 

Last  Wednesday,  Apr.  to  Oct. 

3d  Tuesday,  Feb.,  May, 

August,  Nov. 

4th  Tuesday,  monthly. 

2d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  monthly,  except 
June,  July,  August. 


July,  1933 


The  Ohio  State  Medical  Journal 


403 


Societies  President  Secretary 

Sixth  District  A.  E.  Brant,  Youngstown J.  H.  Seiler,  Akron 2d  Wed.,  Jan.,  April  & Oct 

Ashland H.  M.  Gunn,  Ashland  Paul  E.  Kellogg,  Ashland 2nd  Friday,  Sept,  to  May. 

Holmes L.  E.  Anderson,  Mt.  Hope C.  T.  Bahier,  Walnut  Creek 1st  Tuesday,  quarterly,  Jan..  April 

July,  October. 

Mahoning J.  P.  Harvey,  Youngstown W.  M.  Skipp,  Youngstown 3d  Tuesday,  monthly. 

Portage S.  U.  Sivon,  Ravenna E.  J.  Widdecombe,  Kent 1st  Thursday,  monthly. 

Richland C.  H.  Bell,  Mansfield Mabel  Emery,  Mansfield Last  Thursday,  monthly. 

Stark H.  Welland,  Canton F.  S.  VanDyke,  Canton 2d  Tuesday,  monthly. 

Summit J.  H.  Selby,  Akron A.  S.  McCormick.  Akron 1st  Tuesday,  monthly. 

Wayne W.  A.  Morton,  Wooster R.  C.  Paul,  Wooster 2d  Tuesday,  monthly. 


Seventh  District  _ 


Belmont 

Carroll 

Columbiana 

Cor  hoc  ton  

Harrison 

Jefferson  

Monroe 

Tuacarn  wrm 


„G.  L.  Ramsey,  Powhatan  Point  ... 

_(With  Stark  Co.  Society) 

_.J.  W.  Robinson,  Lisbon 

Floyd  Craig,  Coshocton 

A.  C.  Grove,  Jewett 

. S.  A.  Harris,  Steubenville 


G.  W.  Steward,  Woodsfield- 

F.  B.  Larimore,  New  Phila— 


_C.  W.  Kirkland,  Bellaire 


_T.  T.  Church,  Salem 


_J.  D.  Lower,  Coshocton 

_W.  C.  Wallace,  Hopedale . 

-John  Y.  Bevan,  Steubenville 

_A.  R.  Burkhart,  Woodsfield 

_G.  L.  Sackett,  New  Phila 


1st  Thurs.,  monthly,  4 p.  m.7 
except  July  and  August. 

2d  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Wednesday,  monthly. 

Last  Thursday,  monthly. 

2d  Wednesday,  monthly. 

2d  Thursday,  monthly. 


eighth  DlMtrict 


Athens  C.  E.  Welch,  Nelsonville T.  A.  Copeland,  Athens 

Fairfield E.  B.  Roller,  Lithopolis C.  W.  Brown,  Lancaster 

Guernsey C.  C.  Headley,  Cambridge E.  F.  Hunter,  Cambridge 

Licking Geo.  W.  Sapp,  Newark G.  A.  Gressle,  Newark 

Morgan D.  G.  Ralston,  McConnelsville C.  E.  Northrup,  McConnelsville 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 


1st  Monday,  monthly. 

2d  Tuesday,  monthly. 

1st  and  3rd  Thursday  each  month. 
Last  Friday,  monthly. 

3d  Wednesday,  monthly. 

1st  Wednesday,  monthly. 


Noble 


Parry James  Miller,  Corning F.  J.  Crosbie,  New  Lexington 3d  Monday,  monthly. 

Washington  W.  W.  Sauer,  Marietta G.  M.  James,  Marietta 2d  Wednesday,  monthly 


Ninth  Dlntrict 


Gallia O.  A.  Vornholt.  Gallipolie Milo  Wilson.  Gallipolis 

flocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 

Lawrence Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 

Pike L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 

Vinton O.  S.  Cox.  McArthur H.  S.  James.  McArthur 


1st  Wed.,  Feb.,  May,  Sept,  and  Dec 
Quarterly. 

2nd  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  bi-monthly 
1st  Monday,  monthly. 

2d  Monday,  monthly. 

3d  Wednesday,  monthly 


lenth  District 

Crawford E.  C.  Brandt,  Crestline R.  L.  Solt,  Bucyrus 1st  Monday,  monthly. 

Delaware Geo.  D.  Lowry,  Delaware J.  G.  Parker,  Delaware 1st  Tuesday,  monthly. 

Franklin Jonathan  Forman,  Columbus John  H.  Mitchell,  Columbus Every  Monday,  8:30  p m. 

Knox S.  O.  Gantt,  Centerburg R.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  Jefferson 4th  Wednesday,  monthly. 

Morrow F.  M.  Hartsook,  Cardington T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly 

Pickaway  C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville 1st  Friday,  monthly 

Kobb Glen  Nisley,  Chillicothe W.  C.  Breth.  Chillicothe 1st  Thursday,  monthly 

Union E.  J.  Marsh.  Broadway Angus  Maclvor.  Marysville 2d  Tuesday,  monthly 


404 


Advertisements 


July,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 


This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL.  M.D. 

Medical  Directors. 

Dayton,  Ohio 

MRS.  GEORGE  V.  SHERIDAN, 
President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

NAOMI  VOGE,  R.  N. 

Resident  Superintendent 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


A MODERN  ETHICAL  HOSPITAL 

Rates:  S25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alcohol,  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  Not  limited  as  to  the  quantity 
used  but  can  give  the  patient  as  much  whiskey  as  his  condition  requires. 

NERVOUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoscine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  that  their  own 
home  affords. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 

tal. Female  attendants  only ; absolute  privacy ; com- 
fortable, well-appointed  ladies’  lounge. 

Cherokee  Road  (Long  Distance  Phone  East  1488) 

THE  STOKES  SANATORIUM 

Louisville,  &y.  27  Years  Treating  Nervous  Patients. 


THE  OXFORD  RETREAT 
Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 


FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


WHITING  MINERAL  SPRINGS 

SANITARIUM  AND  BATHS 

L.  A.  WHITING,  Owner 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and  allied  diseases, 
together  with  cases  for  elimination  and  rest  cure. 

Medical  department  thoroughly  proficient  and  STRICTLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

WHITING  SANITARIUM  » » M A RTI  N S VI L L E,  I N D . 

VAN  W.  WHITING,  Manager  DR.  R.  H.  RICHARDS,  Medical  Director 


THE  MEECEE  SANITARIUM  - MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristown,  Pa.) 


PUBL1©  HEALTH  <=•  SOCIAL  W.ELFARI 
MEDIGAL  ECONOMICS 
"mnd  OlECANIZATION  PftOBLi 

Htfith  Editorial  Comment  by  D.K.M. ^===:5^( 


Plans  are  rapidly  being  completed  for  the  87th 
Annual  Meeting  of  the  Ohio  State  Medical  As- 
sociation in  Akron,  Thursday  and  Friday,  Sep- 
tember 7 and  8. 


Aamiial  Meetimj 
Interest  (Gains 


Elsewhere  in  this  is- 
sue of  The  Journal  will 
be  found  articles  con- 
cerning some  of  the 
features  which  promise 
to  make  the  Akron  meeting  one  of  the  best  in 
the  history  of  the  State  Association.  In  the 
August  issue  of  The  Journal  the  official  program 
for  the  1933  gathering  will  be  published. 

The  Council  Program  Committee  and  the  offi- 
cers of  the  various  scientific  sections  have  worked 
long  and  faithfully  in  an  effort  to  provide  this 
year’s  meeting  with  a program  of  exceptional 
merit  and  attractiveness.  Fortunately,  few 
changes  in  the  tentative  program  were  found  nec- 
essary following  the  change  in  dates  of  the  An- 
nual Meeting.  In  general,  the  program  will  be 
presented  as  the  Program  Committee  had  drafted 
it,  assuring  the  medical  profession  of  Ohio  of  an 
unusual  opportunity  to  review  progress  being- 
made  in  scientific  medicine. 

The  1933  meeting  of  the  State  Association 
should  be  regarded  as  one  of  extreme  importance 
to  the  medical  profession  of  the  state.  The  past 
year  has  been  one  of  the  most  critical  periods  in 
the  history  of  medicine.  Changing  economic  and 
social  conditions  have  created  many  serious  prob- 
lems for  members  of  the  profession.  Many  of 
these  are  awaiting  a solution.  They  must  be  met 
with  courage  and  with  unity  on  the  part  of  or- 
ganized medicine. 

The  Akron  gathering  will  offer  an  opportunity 
to  discuss  these  questions;  crystallize  activity  and 
thought  among  the  profession  generally;  and  map 
out  in  some  instances  ways  and  means  of  meeting 
some  of  the  more  important  problems  confronting 
us.  Organized  medicine  during  the  next  few 
years  will  be  confronted  with  even  more  serious 
questions  arising  from  the  backwash  of  the  pres- 
ent era  of  change  and  unrest.  Now  is  the  time 
to  prepare  to  meet  the  new  conditions  and  situ- 
ations which  are  inevitable.  However,  we  can- 
not meet  them  as  individuals  or  as  small  groups. 
We  must  face  the  issues  with  an  unanimity  of 
interest  and  activity  and  with  our  ranks  un- 
divided. 

In  spite  of  the  deplorable  economic  conditions 
of  the  past  year  in  which  the  medical  profession 


has  suffered  extensively,  similar  meetings  which 
have  been  held  so  far  this  year  by  other  state 
medical  associations  have  been  largely  attended. 
All,  according  to  the  official  reports  appearing  in 
the  various  medical  journals,  have  been  excep- 
tional . from  the  standpoint  of  interest  and 
activity. 

The  activities  of  medical  organization  now  are 
having  a greater  appeal  to  the  profession  gener- 
ally than  ever  before.  More  and  more  physicians' 
are  beginning  to  realize  that  the  profession  can- 
not successfully  meet  the  challenges  which  have 
been  hurled  at  it  unless  they  make  even  a greater 
effort  than  they  have  made  in  the  past,  to  im- 
prove their  knowledge  and  usefulness,  and  unless 
they  are  united  on  the  vital  social  and  economic- 
issues  which  vitally  affect  them. 

The  Akron  meeting  will  furnish  an  opportunity 
to  make  a fresh  start  and  to  prepare  for  future 
contingencies.  All  who  can  do  so  should  be  will- 
ing to  join  with  their  colleagues  for  two  days  de- 
voted to  professional  advancement  and  serious- 
consideration  of  vital  issues  in  which  every  phy- 
sician is,  or  should  be,  interested.  Whatever 
sacrifice  of  time  and  money  may  be  necessary  to 
be  in  Akron  on  September  7 and  8 should  be  re- 
garded by  all  as  an  investment,  the  dividends 
from  which  are  large.  One  effective  way  to 
grapple  with  these  questions  is  for  us  to  resolve 
ourselves  into  a committee  of  the  whole  for  the 
purpose  of  speaking  frankly  and  fearlessly,  ap- 
praising our  strength  and  our  weaknesses,  and 
laying  our  plans  carefully  for  the  future.  The 
87th  Annual  Meeting  of  the  State  Association 
presents  that  opportunity. 


Selection  by  the  House  of  Delegates  of  the 
American  Medical  Association  of  Cleveland  as 
the  place  for  the  1934  annual  session  of  the 

A.  M.  A. 
has  the 
approval 


The  1934  A.M.A. 
Meeting  To  Be 
Held  in  Cleveland 


medical 
of  Ohio. 
It  has 


naturally 
unanimous 
of  the 
profession 


been 


than  50  years  since  the  last  A.M.A.  meeting  was 
held  in  Cleveland.  Since  that  time,  Cleveland 
has  become  one  of  the  greatest  medical  centers 
in  the  world  as  well  as  one  of  the  world’s  leaders 
from  a business  and  civic  standpoint. 

The  Ohio  medical  profession  joins  with  col- 
leagues in  Cleveland  in  appreciating  the  honor 


417 


418 


The  Ohio  State  Medical  Journal 


July,  1933 


which  has  been  accorded  it  in  being  granted  an 
■opportunity  to  be  host  to  the  profession  of  this 
country.  Because  of  its  convenient  location  and 
because  of  its  splendid  facilities,  Cleveland  has  an 
opportunity  to  become  the  scene  of  one  of  the 
largest  and  best  annual  sessions  ever  held  by  the 
A.M.A.  The  medical  profession  in  Cleveland 
should  have  the  support  of  the  entire  profession 
of  the  state  in  its  efforts  to  make  such  a meeting 
possible. 

Cleveland  richly  deserves  the  honor  which  has 
been  conferred  upon  it,  for  members  of  the  Ohio 
medical  profession  always  have  taken  a promi- 
nent part  in  both  the  scientific  and  business  acti- 
vities of  the  Americal  Medical  Association.  Now 
the  Ohio  profession  through  active  interest  in  and 
support  of  the  plans  of  the  Cleveland  Academy 
of  Medicine  for  entertaining  the  A.M.A.  in  1934 
has  an  opportunity  not  only  to  demonstrate  its 
hospitality  but  to  prove  conclusively  that  this 
state  bows  to  none  in  medical  progress  and  medi- 
cal activities. 


“Science  is  glorious,  but  it  is  not  medicine”, 
is  the  answer  of  Dr.  Howard  W.  Haggard,  pro- 
fessor of  physiology,  Yale  University,  and  medical 

historian  extraor- 
Medlciine — Science^  dinary,  to  those  who 
A would  make  auto- 

Art  Or  matons  out  of  phy- 

Kelagion  sicians  and  factories 

out  of  hospitals. 

Addressing  the  New  York  State  Medical  So- 
ciety recently,  Dr.  Haggard  pointed  out  “if  the 
art  and  science  and  practice  of  medicine  are  to 
continue  to  be  their  full  and  enormous  benefit, 
then  the  public  must  come  to  a realization  of  their 
responsibility  for  the  continuance  of  medicine, 
must  acknowledge  its  prestige  and  give  co- 
operation”. 


Dr.  Haggard  believes  if  the  modem  physician 
is  held  in  a regard  less  warm  than  that  accorded 
to  the  old  family  doctor  and  is  less  revered  as  a 
leading  citizen,  then  either  the  physician  has 
changed,  or  the  public,  or  both.  He  is  of  the 
opinion  that  it  is  both. 


The  reasons  why  the  attitude  of  the  public  has 
changed  and  for  the  change  in  the  physician  him- 
self are  closely  interwoven  and  that  the  principal 
reason  underlying  all  others  is  “the  decline  of 
medicine  as  an  art”,  he  holds. 

“Let  me  say,  that  before  the  ancients  en- 
deavored to  make  it  a science,  medicine  was  a 
religion;  always  it  has  been  an  art”,  Dr.  Hag- 
gard declared. 


“Religion,  trade,  science,  art,  all  of  these  things 
have  had  their  influence  in  shaping  medical  prac- 
tice. Elements  of  each  one  of  them  are  found  in 
the  profession  today.  But  throughout  the  span 
of  history  one  has  predominated,  then  another, 
and  another,  each  in  turn  coloring  the  practice  of 
a period  and  each  in  turn  arising  as  a product  of 
the  public  of  the  time. 


“The  average  level  of  medical  practice  never 
gets  far  from  the  level  of  its  public.  We  talk  of 
the  public’s  regard  of  medicine,  but  in  doing  so 
we  forget  that  the  physician  himself  in  any  period 
is  a pi'oduct,  is  a part,  of  that  same  public.  He 
has  grown  from  it,  his  ideas  and  his  ideals  are 
colored  by  it.  The  state  of  the  practice  of  medi- 
cine at  any  period  reflects  the  state  of  the  public; 
the  public’s  attitude  toward  medicine  reflects  in 
turn  precisely  the  regard  in  which  the  physician 
himself  holds  his  own  calling.  When  he  regards  it 
as  an  art  or  a religion  he  is  venerated.  When  he 
holds  it  has  a trade,  he  is  treated  as  a tradesman. 
When  he  holds  it  as  a science  he  is  treated  as  a 
scientist.  * * * The  regard  in  which  medicine  is 
held  is  an  emotional  state.  Religion  and  art  ap- 
peal to  the  emotions,  trade  and  science  do  not. 
Modern  scientific  medicine  appeals  to  reason;  the 
public  while  admitting  that  medicine  should  be 
furthered,  disease  eliminated,  life  prolonged,  re- 
main aloof  in  the  matter,  for  in  the  more  or  less 
sapient  human  beings  that  make  up  our  public 
and  our  medical  profession  emotions  are  not  yet 
dictated  by  reason.” 

Delving  into  history  to  prove  his  contentions, 
Dr.  Haggard  presented  an  interesting  sidelight  on 
the  social  and  economic  aspects  of  medicine  as 
found  in  the  history  of  ancient  Greece.  The  medi- 
cine of  the  ancient  Greeks  was  subsidized  medi- 
cine, strictly  institutional  and  supported  by  the 
public,  a variety  that  has  been  strongly  advocated 
in  recent  years  by  socially-minded  individuals,  he 
pointed  out. 

“It  is  peculiar  how  by  the  whirligig  of  time  the 
old  continually  comes  back  as  the  new — we  are 
now  offered  subsidized  medicine  with  the  will  of 
the  Gods  replaced  by  the  dictates  of  a board  of  lay 
executives”,  he  said. 

“Subsidized,  institutionalized  medicine  is  based 
upon  the  conception  that  medicine  is  either  an 
omnipotent  religion  or  an  exact  science.  Among 
the  Greeks  it  was  such  a religion;  among  the 
moderns  it  is  neither  an  omnipotent  religion  nor 
an  exact  science.  It  is  unlikely  that  medicine  will 
again  become  such  a religion;  when  and  if  it  does 
become  an  exact  science  then  the  highly  trained 
and  skillful  physician  will  no  longer  be  needed, 
but  merely  medical  technicians  such  as  now  can 
carry  out  those  aspects  of  medicine  which  have 
been  reduced  to  a nearly  exact  science  and  are 
hence  wholly  impersonal  as  are  some  phases  of 
sanitation.” 

Dr.  Haggard  blames  the  medical  profession  to  a 
large  extent  because  the  public  does  not  feel  the 
thrill  of  emotion  and  pay  fitting  tribute  to  the 
profession  which  has  been  the  greatest  civilizing 
fox-ce  in  all  history. 

“The  emotion  felt  by  the  public  is  pi’ecisely  the 
emotion  felt  by  the  physician”,  he  declared. 
“When  he  loves  his  profession,  gives  his  life  and 
soul  to  it  in  faith,  then  and  then  only  do  the 
public  feel  the  warmth  of  sympathy  that  makes 
for  veneration  of  the  profession.  Only  when  medi- 
cine is  a l-eligion  or  an  art  is  this  feeling  en- 
gendered. It  is  not  called  for  when  medical  prac- 
tice is  a mercenary  trade  or  a cold  science. 

“Sick  people  often  care  less  for  science  than  for 
sympathy  and  human  understanding.  They  want 
the  physician  to  do  something  for  them,  something 
kindly.  So  long  as  the  human  mind  in  its  full 
ramifications  remains  beyond  an  evaluation  by 
scientific  pi’ecision  then  medicine  must  remain  an 
art.  So  long  as  medical  practice  involves  the  per- 


July,  1933 


Editorial 


419 


sonal  contact  of  physician  and  patient  then  it  is 
the  art  of  the  physician  that  must  establish  the 
necessary  bond  of  sympathy.  And  if  in  the  in- 
terest of  science  rather  than  humanity  this  identi- 
fication, this  contact  between  patient  and  phy- 
sician is  lost  then  the  public  will  in  revolt  turn  to 
the  charlatans  who  while  doing  nothing  of  phy- 
sical benefit  for  their  patients  give  them  mental 
comfort. 

“The  physician  must  be  an  artist;  an  artist  is  a 
man  whose  talent,  whose  personality  is  suited  to 
his  calling.  Few  great  scientists  have  been  great 
physicians.  Yet  the  physician,  realizing  the  in- 
estimable value  of  these  discoveries  of  science  to 
the  physical  welfare  of  his  patient,  has  too  often 
tried  to  make  the  sick  room  a laboratory.  * * * 
The  physician  today  is  too  often  wedded  to  science. 
An  artist  is  appreciated  by  the  public;  he  is 
revered;  the  scientist  is  not.  Science  to  the  Amer- 
ican people  for  all  that  has  been  said  of  it  is  not 
a God;  it  is  a servant;  in  becoming  a scientist  the 
physician  has  taken  his  stand  with  the  chemist, 
the  physicist,  the  engineer.  And  the  chemist  and 
the  physicist,  and  the  engineer  for  all  of  the  great 
good  they  have  done  and  are  doing  to  our  civiliza- 
tion are  not  revered;  they  do  not  have  the  prestige 
which  is  so  essential  in  medicine.” 


As  reported  by  the  Health  News,  publication  of 
the  New  York  State  Department  of  Health,  a 
local  health  commissioner  of  that  state  at  the  re- 
quest of  the  state  de- 
partment, made  a de- 
tailed study  and  report 
of  an  outbreak  of  in- 
fluenza in  his  district  and 
appended  to  his  report 

“In  making  this  little  study  of  the  flu  ‘on  my 
own’,  I became  more  convinced  than  ever  that 
private  physician  and  health  officer  are  two  dis- 
tinct jobs.  If  I took  pains  to  get  the  record  ac- 
curate I had  to  watch  that  I did  not  overlook 
something  about  the  patient.  If  I gave  my  best 
to  the  patient  I always  forgot  something  about 
the  record.  The  physician  is  an  individualist  in- 
terested in  his  patient  above  all  else.  He  looks  in 
mild  contempt  on  the  statistics  and  graphs  of  the 
health  officer.  Trained  to  minute  detail  he  does 
not  find  it  easy  to  think  in  terms  of  mass  trends 
and  mass  prevention.  The  health  officer  trained 
to  broad  vision  finds  it  hard  to  focus  his  attention 
on  a single  unit.” 

Applying  the  foregoing  observation  to  the  field 
of  public  health,  it  may  be  argued  logically  that 
the  health  officer  has  plenty  on  his  hands  if  he 
sticks  to  the  fundamental  activities  of  public 
health  administration  and  leaves  the  care  of  in- 
dividual cases  to  the  private  medical  practitioner. 

Likewise,  it  may  be  contended  that  the  diffi- 
culties encountered  by  the  health  officer  figuring 
in  the  episode  described,  illustrate  the  inherent 
evils  in  any  system  of  medical  practice  which 
would  not  permit  the  physician  to  devote  his  en- 
tire attention  to  the  welfare  of  his  patients. 

It  is  perfectly  obvious  that  no  physician  can 
render  effective  medical  care  if  shackled  with  too 
much  red-tape  or  fox-ced  against  his  wishes  to 
follow  mechanized,  stereotyped  methods  which 


Health  Work 
And  Private 
ictice 


t.Vip  fnllnwincr  pnrmnprif.  • 


may  not  meet  the  requirements  of  individual 
cases. 

In  this  pertinent  analysis  of  the  difference  in 
viewpoint  and  responsibility  of  the  physician 
treating  his  patient  as  an  individual  and  the 
health  officer  serving  the  public  generallly,  there 
is  found  a most  convincing  argument  in  favor  of 
the  practice  of  medicine  on  an  individualistic 
basis  and  against  the  organization  of  medical 
practice  in  accord  with  the  principles  of  mass 
treatment  and  mechanization. 


It  is  not  uncommon  for  some  writers  and  dis- 
cussants of  the  serious  questions  confronting  the 
world  today  to  use  the  word  “fear”  to  describe 
their  attitude  regarding 
the  future  of  our  social, 
economic  and  govern- 
mental structures. 

As  one  writer  has 
pointed  out  the  fear 
no  less  than  a phobia” 
among  many  groups  of  society,  having  anything 
but  a wholesome  effect. 

The  medical  profession  is  no  exception. 

“Medical  men,  being  human  beings,  are  not  free 
from  this  fear  complex”,  the  editor  of  the  Mil- 
waukee Medical  Times  declared  recently  in  ex- 
pressing regret  at  the  extreme  pessimistic  at- 
titude which  has  been  taken  by  a portion  of  the 
profession  regarding  the  outcome  of  the  present 
unsettled  state  of  affairs. 

“Many  physicians”,  he  added,  “are  much  per- 
turbed by  the  pressure  of  the  present  economic 
situation,  and  seriously  disturbed  by  the  changes 
which  seem  to  be  impending  in  the  practice  of 
medicine.  Particularly  at  this  time  is  this  true 
among  men  who  have  established  themselves. 
These  men,  and  we  believe  they  are  in  the  ma- 
jority, are  apprehensive  because  they  are  far  from 
being  assured  that  the  changes  which  seem  im- 
minent will  be  for  the  better.  They  do  not  enjoy 
the  prospect  of  being  parties  to  an  experiment, 
the  outcome  of  which  is  problematical.  * * * 

“The  danger  that  we  see  in  the  situation  is  not 
so  much  that  some  new  system  may  be  injected 
into  medical  practice  in  this  country,  but  that 
through  indifference  or  fear  the  medical  profes- 
sion may  not  grasp  the  opportunity  which  pre- 
sents itself  for  leadership. 

“The  fear  complex  has  no  place  within  our  pro- 
fession now.  We  must  bend  our  efforts  to  ascer- 
tain the  facts  and,  being  guided  by  faith  in  our- 
selves, step  forward  to  meet  the  problems  of 
health  and  disease  with  the  honesty  and  courage 
that  may  be  expected  of  us.” 

There  is  much  to  be  said  in  favor  of  this  way 
of  looking  at  the  present  situation  confronting  the 
medical  profession. 

It  is  obvious,  however,  that  nothing  which  will 
affect  the  ultimate  outcome  can  be  attained  if 


Redoubled 
Interest  and 
Effort  Necessary 

complex  “has  become 


420 


The  Ohio  State  Medical  Journal 


July,  1933 


physicians  permit  themselves  to  become  blinded 
to  realities  and  opportunities.  Naturally,  all  phy- 
sicians are  agitated  and  disturbed  over  various 
changes  and  developments  which  are  taking  place 
and  the  rumblings  of  even  more  radical  readjust- 
ments. They  shoqld  be.  A critical  situation  is 
facing  them. 

However,  little  can  be  accomplished  toward 
meeting  the  present  and  impending  problems  if 
the  profession  permits  itself  to  become  static  or 
paralyzed  by  this  fearful  attitude.  The  present 
emergency  calls  for  greater  activity,  interest,  co- 
operation,  unity  and  wisdom  on  the  part  of  all 
physicians.  Facts  should  be  assembled  and 
studied.  Plans  formulated  and  tested.  These 
things  should  be  done  by  the  profession  itself  and 
not  left  to  those  whose  interests  in  the  question 
are  secondary. 

Medical  organization  possesses  the  facilities, 
the  leadership  and  the  intelligence  to  analyze  the 
new  developments  in  medicine  and  to  formulate 
ways  and  means  of  combatting  those  which  are 
likely  to  prove  detrimental  to  the  profession  and 
the  public.  Backed  by  concerted  effort  and  active 
cooperation  on  the  part  of  its  membership,  medi- 
cal organization  can  achieve  much  in  the  right 
direction  in  these  critical  times. 

How  the  medical  profession  must  react  to  the 
present  situation  and  as  it  faces  the  future  was 
well  expressed  by  a writer  in  The  Bulletin  of  the 
San  Diego  County  Medical  Society  recently,  when 
he  declared: 

“The  call  to  the  medical  profession  throughout 
it  all  is  a challenge  to  close  cooperation  one  with 
the  other.  Our  difficulties  in  the  past  have  been  the 
result  of  our  lack  of  cohesion.  As  we  are  feeling 
our  way  through  the  fog  each  man’s  hand  must 
be  on  the  other  man’s  shoulder  to  keep  the  ranks 
from  breaking  apart  and  the  individuals  from  be- 
coming the  prey  of  the  selfish  and  ignorant  out- 
sider. It  is  no  t;me  for  personal  feelings  and 
group  antagonisms  to  roughen  if  not  make  im- 
passable the  path  to  economic  security.  This  may 
sound  selfish,  but  economic  security  underlies  the 
whole  scheme  of  scientific  medical  service  to  so- 
ciety at  large.” 


Standard 


Promiscuous  use  of  statistics,  be  they  ever  so 
accurate  or  the  user  ever  so  competent,  has  in 
many  instances  proved  unreliable  and  dangerous. 

This  is  illustrated  by  recent 
efforts  to  measure  the  quality 
of  maternity  care  in  the 
United  States  by  analyzing 
vital  statistics  gathered  by 
public  health  authorities  in 
different  parts  of  the  nation. 

Can  vital  statistics  be  used  to  measure  the 
quality  of  maternity  care? 

Many  who  have  devoted  considerable  study  to 
this  question  are  of  the  opinion  that  they  cannot 


— at  least  in  their  present  form. 

In  his  thesis  for  membership  in  the  American 
Association  of  Obstetricians,  Gynecologists  and 
Abdominal  Surgeons,  published  in  a recent  issue 
of  the  New  England  Medical  Journal,  Dr.  James 
Raglan  Miller,  assistant  obstetrician  and  gynec- 
ologist of  the  Hartford  (Conn.)  Hospital,  makes 
this  significant  statement: 

“Vital  statistics  of  puerperal  and  neonatal 
mortality  and  of  stillbirths  now  available  are  not 
in  a form  nor  of  a quality  to  be  of  much  use  as 
a measure  of  the  quality  of  obstetric  and  pre- 
natal care.” 

Dr.  Miller  points  out  that  able  statisticians  in 
reporting  a study  of  records  of  the  Maternity 
Center  Association  of  New  York  made  the  mis- 
take of  comparing  the  maternity  mortality  rate 
of  live  births  among  women  served  by  the  Ma- 
ternity Center  Association  with  the  rate  among 
white  women  in  the  whole  of  New  York  City  and 
that  the  Visiting  Nurse  Association  of  Detroit 
has  compared  its  low  maternal  mortality  rate 
with  the  higher  rate  for  the  city  of  Detroit 

Dr.  Miller  states  that  he  does  not  wish  in  any 
way  to  minimize  the  work  done  by  these  and 
similar  organizations  but  he  does  believe  that 
“comparisons  cannot  be  made  in  such  an  easy 
going  manner  for  two  reasons,  namely: 

First,  the  average  city  mortality  rate  includes 
deaths  from  abortions  and  recent  work  has  shown 
that  in  large  cities  abortions  cause  nearly  20  per 
cent  of  all  puerperal  deaths. 

Second,  the  patients  who  are  in  the  care  of 
such  associations  are  to  some  extent  a selected 
group,  for  women  who  expect  to  have  difficult 
delivery  will  seek  out  specialists  and  be  delivered 
in  hospitals  rather  than  remain  at  home. 

Dr.  Miller  points  out  that  for  these  same  rea- 
sons “we  cannot  compare  urban  and  rural  death 
rates,  nor  rates  for  physicians  with  those  for 
midwives,  if  one  uses  the  statistics  which  are 
available  at  present. 

To  eliminate  this  confusion  against  frequent 
mis-statements,  Dr.  Miller  suggests  a more  re- 
stricted classification  in  this  field  which,  he  be- 
lieves, would  produce  vital  statistics  which  can 
more  accurately  be  used  as  a gauge  of  the  ma- 
ternity program.  He  suggests: 

Vital  statistics  covering  deaths  of  mothers 
should  include  all  women  dying  from  ‘puerperal 
causes’  as  defined  by  the  Census  Bureau,  whose 
terms  of  pregnancy  have  reached  at  least  the 
twenty-eighth  week,  with  no  time  limit  after  de- 
livery. 

Stillbirths  should  be  enumerated  in  which  the 
fetus  has  developed  at  least  to  the  twenty-eighth 
week. 

Neonatal  mortality  should  be  reckoned  on  the 
babies  which  die  during  the  first  week  of  life  in 
whom  development  has  proceeded  to  at  least  the 
twenty-eighth  week. 


Therapeutic  Values  of  Scarlet  lever  Antitoxin 

F.  E.  Stevenson,  M.D.,  M.  V.  Veldee,  M.D.,  and  A.  Graeme  Mitchell,  M.D.,  Cincinnati,  Ohio. 


A CAREFULLY  controlled  clinical  study  was 
made  in  the  contagious  department  of  the 
Cincinnati  General  Hospital  to  determine 
the  therapeutic  effects  of  scarlet  fever  antitoxin 
when  administered  intramuscularly  to  scarlet 
fever  patients  during'  the  acute  stage  of  the  ill- 
ness. Case  selection  of  the  patients  was  avoided 
in  order  that  a series  of  control  and  serum-treated 
patients  might  be  obtained  who  would  comprise 
individual  groups  as  nearly  identical  as  possible. 
Negroes  were  omitted  from  the  study  because  they 
constituted  a group  too  small  for  separate  con- 
sideration. Patients  admitted  during  or  after  the 
period  of  decline  of  the  disease  were  also  excluded. 
At  the  beginning  of  the  study  every  alternate  pa- 
tient coming  into  the  reeciving  ward  of  the  con- 
tagious division  of  the  Cincinnati  General  Hospital 
was  placed  automatically  into  the  control  series, 
the  other  into  the  antitoxin-treated  gi'oup.  This 
antitoxin  will  be  identified  as  antitoxin  A.  Later, 
a second  brand  was  also  employed,  which  will  be 
referred  to  as  antitoxin  B.  With  the  addition  of 
antitoxin  B to  the  study,  scarlet  fever  patients 
were  allocated  on  admission  so  that  of  each  three 
cases  admitted,  one  received  antitoxin  A,  one  anti- 
toxin B,  and  one  became  the  control.  Of  the  total 
196  patients  observed,  84  constituted  the  control 
group,  74  the  antitoxin  A group,  and  38  the  anti- 
toxin B group. 

Antitoxin  A was  purchased  in  the  open  market. 
It  was  a concentrated  serum  prepared  with  4 
strains  of  hemolytic  streptococci,  originally  iso- 
lated from  scarlet  fever  patients.  The  thera- 
peutic package  was  labeled  to  contain  6,000  units 
of  antitoxin  in  a volume  of  15  cc.  However,  be- 
cause of  an  allowance  for  deterioration,  each 
therapeutic  dose  given  contained  approximately 
20  cc.  and  possessed  an  antitoxin  value  of  about 
7,200  units. 

Antitoxin  B was  not  for  sale  in  the  open 
market.  It  was  an  unconcentrated  serum  pre- 
pared from  a single  strain  of  hemolytic  strep- 
tococcus which  had  previously  been  isolated  from 
a case  of  scarlet  fever.  Tests  made  at  the  Na- 
tional Institute  of  Health  determined  that  this 
antitoxin,  although  unconcentrated,  contained  in 
the  therapeutic  dose  of  8 cc.  approximately  6,400 
units  of  antitoxin. 

The  patients  were  classified  as  medium,  moder- 
ate, and  severe,  as  determined  by  the  apparent 
seriousness  of  their  illness.  The  method  of  dis- 
tribution actually  resulted  in  producing  thi-ee 
groups  which  contained  at  the  time  of  admission 

Read  before  the  Third  General  Session,  Ohio  State 
Medical  Association,  at  the  86th  Annual  Meeting,  Dayton, 
May  3 and  4,  1932. 

From  the  B.  K.  Rachford  Department  of  Pediatrics, 
University  of  Cincinnati,  the  Children’s  Hospital  Research 
Foundation,  and  The  National  Institute  of  Health. 


patients  with  very  similar  clinical  manifestations. 
Actually,  however,  further  observation  showed 
that  75  per  cent  of  the  patients  in  the  control 
group  were  moderately  ill,  as  compared  to  85  per- 
cent of  the  antitoxin  A group  and  90  per  cent  of 
the  antitoxin  B group.  Entirely  by  chance  the 
control  group  had  received  a few  more  patients 
of  a milder  type  than  did  either  of  the  antitoxin 
A or  B group.  Except  for  the  moderately  severe 
groups,  to  which  our  analysis  was  largely  con- 
fined, the  number  of  patients  was  too  small  to 
permit  individual  study. 

Treatment. — Each  patient  in  the  serum-treated 
groups  was  injected  intramuscularly  with  one  so- 
called  therapeutic  dose  of  scarlet  fever  antitoxin. 
Aside  from  the  use  of  antitoxin,  the  form  of  iou- 
tine  treatment  during  the  acute  stage  of  the 
disease  was  similar  for  all  patients. 

The  Eruption. — The  eruption  was  interpreted 
to  include  both  the  diffuse  erythema  and  the 
papillae  or  elevated  element  of  the  exanthem. 
The  skin  manifestations  were  not  recorded  as 
completely  subsided  until  the  papillae  as  well  as 
the  erythema  had  disappeared.  In  a minority  of 
instances,  however,  and  especially  in  those  where 
the  erythema  had  been  the  predominant  element 
of  the  eruption,  the  disappearance  of  the  ery- 
thema terminated  the  period  of  eruption. 

In  patients  moderately  ill  and  treated  with  anti- 
toxin A or  B,  the  average  time  of  the  appear- 
ance of  the  eruption  was  on  the  second  day  of  the 
illness,  or  almost  24  hours  after  the  onset  of  the 
disease.  These  same  patients  received  their  anti- 
toxin on  the  third  day  of  the  illness  or  almost  48 
hours  after  the  appearance  of  the  first  symptoms. 
Thus  the  patients  had  had  their  skin  manifesta- 
tions on  an  average  for  one  day  before  receiving 
antitoxin.  It  was  found  that  irrespective  of  the 
apparent  severity  of  the  disease,  the  duration  of 
the  eruption  in  the  control  group  was  6.8  days; 

4.3  days  in  those  treated  with  antitoxin  A;  and 

4.4  in  those  treated  with  antitoxin  B.  It  is  evi- 
dent that  the  rash  continued  for  a mean  of  3 days 
after  the  injection  of  antitoxin.  The  influence 
of  the  antitoxin  on  the  erythema  is  even  more 
marked  than  these  figures  indicate  and  in  the  ma- 
jority of  patients  the  erythema  had  faded  in  the 
first  12  hours  following  antitoxin  so  as  to  repre- 
sent only  one-half  its  original  intensity. 

The  Post-eruption — Pre-desquamation  Interval. 
— The  interval  between  the  first  appearance  of  the 
eruption  and  the  beginning  of  desquamation 
showed  no  significant  variation  in  the  three 
groups.  The  mean  number  of  days  intervening 
in  the  control  group  was  5.4,  in  antitoxin  A group 

6.4  and  in  antitoxin  B group  5.4  days. 

Desquamation  Pernod. — Of  significance  were 

the  changes  observed  in  the  duration  of  the  des- 


421 


422 


The  Ohio  State  Medical  Journal 


July,  1933 


quamation  period.  In  the  control  group  the  period 
of  desquamation  (from  onset  to  disappearance) 
averaged  26.2  days  as  contrasted  to  21.6  days  for 
patients  treated  with  antitoxin  A,  and  20  days  for 
those  receiving  antitoxin  B.  One  and  three- 
tenths  per  cent  of  the  control  cases  completed 
their  desquamation  within  14  days  from  its  onset, 
whereas  in  the  antitoxin  A group  21.1  per  cent 
were  desquamation-free  within  the  two-week 
period,  and  in  the  antitoxin  B group  27.8  per  cent. 
Furthermore,  while  all  patients  in  the  control 
group  went  on  to  desquamation,  5.6  per  cent  of 
the  serum-treated  patients  (2  patients  receiving 
antitoxin  A and  4 receiving  antitoxin  B)  failed  to 
show  definite  signs  of  peeling. 

Character  of  Desquamation. — Differences  in  the 
character  and  extent  of  the  desquamation  between 
the  three  groups  were  even  more  striking  than  its 
duration.  In  the  control  group,  desquamation  was 
marked  in  41.8  per  cent  of  the  patients,  whereas 
this  was  true  in  only  9.6  per  cent  of  those  of  anti- 


in this  study  no  antipyretic  measures  were  used. 
Throughout  the  febrile  period  the  temperature 
was  taken  every  4 hours  during  the  day  and 
thereafter,  twice  a day.  For  purposes  of  tabula- 
tion and  comparison,  the  temperature  readings 
shown  in  the  following  table  represent  the  mean 
morning  and  afternoon  temperatures.  Further- 
more, these  readings  were  tabulated  according  to 
the  day  of  the  illness  in  each  individual  case  and 
not  according  to  the  day  of  admission  in  the  hos- 
pital. As  will  be  seen,  differences  between  control 
and  antitoxin-treated  groups  are  not  sticking. 
Twenty-seven  per  cent  of  the  patients  treated 
with  antitoxin  A showed  a mean  temperature  for 
the  first  half-day  following  administration  of 
antitoxin  which  was  higher  than  their  admission 
temperature.  These  initial  elevations,  however, 
may  have  been  due  to  the  considerable  volume  of 
horse  serum  injected,  since  similar  elevations  did 
not  develop  in  the  antitoxin  B group. 

Complications. — -Before  scarlet  fever  antitoxin 


TABLE  I. 

The  mean  morning  and  afternoon  temperatures  of  all  cases  included  within  the  groups  desig- 
nated, irrespective  of  age,  severity  of  disease,  or  the  development  of  complications. 


Day  of  Disease 

Control  group, 
mean  of  82 
eases 

A.M.  P.M. 

Combined  A and  B 
groups,  mean  of 
104  cases 
A.M.  P.M. 

GROUP  TREATED  WITH — 

Antitoxin  A 
A.M.  P.M. 

Antitoxin  B 
A.M.  P.M. 

First  

Second 

101.3 

101.7 

101.5 

102.0 

101.7 

Third  ...  ... 

100.7 

101.3 

100.5 

100.7 

101.0 

100.9 

99.5 

100.2 

Foux-th  

100.4 

100.7 

99.9 

100.2 

100.1 

100.4 

99.5 

99.8 

Fifth  . 

99.8 

100.1 

99.4 

99.7 

99.7 

99.8 

99.1 

99.6 

Sixth  .... 

99.4 

99.8 

99.0 

99.5 

99.1 

99.6 

99.0 

99.4 

Seventh  

99.2 

99.6 

98.9 

99.6 

99.1 

99.7 

98.9 

99.7 

Eighth  

98.9 

99.2 

99.0 

99.5 

99.1 

99.5 

99.0 

99.6 

Ninth  

98.6 

99.2 

98.8 

99.2 

98.9 

99.3 

98.7 

99.2 

Tenth  

98.5 

99.1 

98.7 

99.0 

98.7 

99.0 

98.8 

99.3 

Eleventh  

98.4 

98.9 

98.5 

98.9 

- 98.5 

99.0 

98.5 

98.9 

Twelfth  

98.2 

98.8 

98.4 

98.8 

98.4 

98.8 

98.4 

98.9 

Thirteenth  __  

98.2 

98.7 

99.2 

98.2 

98.3 

98.7 

98.2 

99.0 

Fourteenth  

98.1 

98.7 

98.2 

98.9 

98.1 

98.7 

98.6 

98.9 

toxin  A group  and  19.4  per  cent  of  antitoxin  B 
group.  In  the  antitoxin-treated  groups  the  tend- 
ency was  for  desquamation  to  be  moderate  or  mild 
in  character  as  contrasted  to  moderate  or  marked 
in  the  control  group. 

Distribution  of  Desquamation. — It  was  found, 
too,  that  desquamation  showed  a definite  tendency 
to  remain  much  more  circumscribed  or  localized  in 
the  antitoxin-treated  patients.  Of  the  control  pa- 
tients, 91.1  per  cent  desquamated  generally  over 
practically  the  entire  body.  Similar  desquama- 
tion occurred  in  37  per  cent  of  those  of  the  anti- 
toxin A and  58.3  per  cent  of  the  antitoxin  B 
group.  Localized  desquamation  occurred  in  8.9 
per  cent  of  the  control  patients  in  contrast  to  50.5 
per  cent  of  the  antitoxin-treated  group.  As  pre- 
viously pointed  out,  5.5  per  cent  of  the  antitoxin- 
treated  patients  failed  to  desquamate. 

Temperature. — Many  conflicting  observations 
are  found  in  the  medical  literature  concerning  the 
influence  of  antitoxin  upon  the  course  of  the  fever 
in  scarlet  fever.  It  should  be  pointed  out  that 


can  be  adopted  for  general  therapeutic  use  it  must 
be  shown  to  accomplish  something  more  than 
merely  a shortening  of  the  period  of  eruption  and 
a modification  of  the  character  and  extent  of  des- 
quamation. At  least  in  the  United  States  the  se- 
verity of  scarlet  fever  has  diminished  to  such  an 
extent  that  the  probability  of  a fatal  outcome  has 
become  greatly  minimized.  Complications,  how- 
ever, continue  to  develop  in  a fairly  large  percent- 
age of  patients  and  a study  of  the  effect  of  anti- 
toxin in  the  prevention  and  in  the  tx-eatment  of 
these  would  appear  to  furnish  an  estimation  of 
its  therapeutic  value.  In  our  study,  no  attempt 
was  made  to  determine  the  effect  of  antitoxin  in 
the  treatment  of  complications  ali'eady  developed. 
While  a variety  of  minor  complications  occurred 
in  all  gi-oups,  the  discussion  is  limited  to  the  effect 
of  antitoxin  therapy  upon  the  incidence  of  major 
complications. 

The  percentage  distribution  of  the  major  com- 
plications was  as  follows: 

Cervical  Adenitis  developed  in  19.5  per  cent  of 


July,  1933  Scarlet  Fever  Antitoxin — Stevenson,  Veldee  and  Mitchell 


423 


the  control  group  and  in  6.4  per  cent  of  the  com- 
bined antitoxin-treated  group. 

Otitis  media,  including  all  types,  occurred  in 
17.1  per  cent  of  the  control  group  and  in  7.3  per 
cent  of  the  antitoxin-treated  group.  Suppurative 
otitis  media  developed  in  7.3  per  cent  of  control 
group  and  in  3.6  per  cent  of  antitoxin-treated 
group. 

One  and  two-tenths  per  cent  of  the  control 
group  developed  mastoiditis.  This  complication 
did  not  occur  in  the  antitoxin-treated  group. 

Acute  glomerular  nephritis  was  observed  in  12.2 
per  cent  of  the  control  group  and  in  0.9  per  cent 
of  the  antitoxin-treated  group. 

Toxic  arthritis  occurred  in  6.1  per  cent  of  the 
control  group  but  in  none  of  the  antitoxin-treated 
group. 

To  summarize  this  there  were,  in  other  words, 
75  per  cent  fewer  major  complications  among  the 
antitoxin-treated  patients  than  among  the  con- 
trol patients. 

Serum  sickness  occurred  in  varying  degrees  in 
66.3  per  cent  of  antitoxin-treated  patients — -an  in- 
cidence too  great  to  be  lightly  dismissed.  Before 
serum  therapy  can  be  employed  routinely  in  scar- 
let fever  its  therapeutic  effects  must  definitely 
outweigh  any  deleterious  results. 

It  is  quite  commonly  stated  that  scarlet  fever 
antitoxin,  in  contrast  to  diphtheria  antitoxin,  is 
particularly  liable  to  give  rise  to  serum  sickness. 
Without  discussing  the  various  causes  which  are 
said  to  predispose  to  serum  sickness,  two  factors 
should  be  mentioned  which  appeared  to  influence 
the  incidence  of  serum  sickness  in  the  antitoxin- 
treated  patients  in  this  study. 

It  was  found  that  of  patients  who  had  received 
a previous  injection  of  horse  serum  in  any  form 
(diphtheria  antitoxin,  tetanus  antitoxin,  toxin-an- 
titoxin and  the  like) , the  incidence  of  serum  sick- 
ness following  the  injection  of  scarlet  fever  anti- 
toxin was  87.2  per  cent  (antitoxin  A,  88.6  per 
cent;  antitoxin  B 83.3  per  cent).  Furthermore, 
the  character  of  the  reaction  could  be  classified  as 
severe  in  38.3  per  cent  of  these  patients. 

Of  patients  who  had  not  received  a previous  in- 
jection of  horse  serum  in  any  form,  40.8  per  cent 
developed  serum  sickness  (antitoxin  A,  66.7  per 
cent;  antitoxin  B,  16.0  per  cent).  In  this  group, 
however,  the  reaction  was  severe  in  only  8.2  per 
cent  of  the  patients. 

It  is  interesting  to  note  that  of  the  34  persons 
who  previously  had  received  horse  serum  only  in 
the  form  of  diphtheria  toxin-antitoxin,  85.3  per 
cent  developed  serum  sickness,  an  incidence  prac- 
tically the  same  as  in  the  miscellaneous  group  of 
persons  who  had  previously  received  horse  serum 
in  one  or  more  of  a variety  of  forms.  Gordon 
and  Creswell1  observed  that  if  patients  had  pre- 
viously received  toxin-antitoxin  mixtures,  75.3  per 

iGordon,  J.  E.,  and  Creswell,  S.  M.,  J.  Prevent.  Med. 
3;  21,  1929. 


cent  developed  serum  sickness  following  the  in- 
jection of  scarlet  fever  antitoxin,  and  73.5  per 
cent  following  diphtheria  antitoxin.  These 
authors  also  noticed  that  those  patients  who  had 
received  toxin-antioxin  injections  constituted  37.6 
per  cent  of  all  scarlet  fever  patients  and  only  18.1 
per  cent  of  the  diphtheria  patients.  In  this  entire 
group  of  patients  treated,  55.3  per  cent  of  the 
scarlet  fever  patients  and  76  per  cent  of  the  diph- 
theria patients  were  presumably  non-sensitive  to 
horse  serum  on  admission.  According  to  Gordon 
and  Creswell,  if  allowances  are  made  for  these 
sensitization  differences,  the  frequency  of  serum 
sickness  following  the  injection  of  either  diph- 
theria or  scarlet  fever  antitoxin  is  nearly  the 
same.  These  observations  offer  further  evidence 
in  favor  of  the  use  of  diphtheria  toxoid  in  pref- 
erence to  diphtheria  toxin-antitoxin  in  the  active 
immunization  against  diphtheria. 

While  40.8  per  cent  of  our  patients  who  had  re- 
ceived no  previous  injection  of  horse  serum  devel- 
oped serum  sickness,  it  seemed  that  in  this  group 
the  volume  of  serum  directly  influenced  the  fre- 
quency of  serum  disease.  For  example,  66.7  per 
cent  of  these  patients  who  received  20  cc.  fin  the 
form  of  antitoxin  A developed  serum  sickness; 
while  only  16.0  per  cent  of  those  injected  with 
8 cc.  of  serum  in  the  form  of  antitoxin  B devel- 
oped serum  reactions. 

Summary. — Of  the  total  196  patients  observed 
in  the  study  of  the  therapeutic  effects  of  scarlet 
fever  antitoxin,  84  patients  constituted  the 
conti’ol,  74  the  antitoxin  A group,  and  38  com- 
prised the  antitoxin  B series. 

The  duration  of  the  period  of  eruption  in  the 
combined  antitoxin-treated  groups  was  4.4  days, 
as  against  6.8  days  in  the  control  group. 

Apparently,  the  antitoxin  had  no  influence  on 
the  duration  of  the  interval  before  desquamation 
began,  nor  did  it  have  a pronounced  influence  on 
the  desquamation  period. 

There  was  a definite  tendency  for  the  desqua- 
mation to  be  localized  and  mild  in  character  in 
the  serum-treated  cases  but  to  be  generalized  and 
marked  in  the  control  patients. 

An  analysis  of  the  temperature  records  failed 
to  reveal  any  definite  febrile  reduction  following 
an  administration  of  antitoxin. 

Excluding  serum  sickness,  there  were  75 
per  cent  fewer  major  complications  (cervical 
adenitis,  otitis  media,  mastoiditis,  nephritis  and 
toxic  arthritis)  in  the  serum-treated  than  in  the 
control  group. 

Sixty-six  and  three-tenths  per  cent  of  the 
serum-treated  patients  developed  serum  sickness 
of  varying  degrees  of  severity. 

A previous  injection  of  serum  seemed  to  be  the 
most  important  predisposing  cause  of  serum  sick- 
ness. Eighty-seven  and  two-tenths  per  cent  of 
those  patients  who  had  received  a previous  injec- 
tion of  horse  serum  in  any  form  and  85.3  per  cent 


424 


The  Ohio  State  Medical  Journal 


July,  1933 


of  those  who  had  previously  received  serum  only 
in  the  form  of  diphtheria  toxin-antitoxin  devel- 
oped serum  sickness. 

In  the  group  of  patients  who  had  received  no 
previous  injection  of  serum  the  total  percentage 
of  serum  sickness  was  40.8.  In  this  group  the  in- 


cidence of  serum  sickness  seemed  to  be  directly 
influenced  by  the  volume  of  serum  injected,  since 
66.7  per  cent  of  the  patients  receiving  20  cc.  of 
serum  (antitoxin  A)  and  16.0  per  cent  of  those 
receiving  8 cc.  of  serum  (antitoxin  B)  developed 
serum  complications. 


A Radiological  Study  of  Abdominal  Tumors  and  Their 

Differentiation 

Samuel  Brown,  M.D.,  Cincinnati,  Ohio 


THE  abdomen,  because  of  the  many  organs 
contained  within  its  cavity,  is  the  most 
fruitful  source  of  tumor  formation.  The 
diagnosis  of  these  tumors  is  at  times  easy  and  at 
times  exceedingly  difficult.  The  diagnosis  is 
especially  difficult  in  the  early  development  of  the 
tumors  when  the  clinical  and  physical  signs  are 
either  entirely  absent  or  if  present  are  not  of  a 
sufficient  degree  to  suggest  the  presence  of  a 
tumor.  It  is,  therefore,  quite  evident  that  the  in- 
troduction of  the  A-ray  method  of  investigation 
of  abdominal  lesions  should  receive  immediate  ac- 
ceptance on  the  part  of  the  medical  profession. 
However,  its  usefulness  in  elucidating  correct 
A'-ray  findings  will  depend  upon  the  experience 
of  the  radiologist  and  the  particular  technic  he  is 
applying  in  his  investigations.  The  technic  which 
was  found  most  useful  in  my  experience  is  the 
following: 

I proceed  to  answer  the  following  questions  in 
the  order  they  are  placed. 

1.  Is  there  present  a tumor  within  the  abdomen 
or  not? 

2.  If  present,  where  is  the  tumor  located? 

3.  Where  does  the  tumor  originate? 

4.  Is  the  tumor  of  an  inflammatory  or  neo- 
plastic origin? 

5.  If  neoplastic,  is  the  tumor  benign  or  malig- 
nant? 

6.  If  malignant,  is  it  primary  or  secondary? 

7.  What  is  the  exact  pathological  nature  of  the 
tumor? 

If  I succeed  in  answering  the  above  questions 
the  diagnosis  is  made.  However,  this  ideal  is  not 
always  possible  to  achieve  by  the  A'-ray  method 
alone.  One  must  often  take  into  full  consideration 
the  clinical,  physical,  chemical,  and  pathological 
findings  before  he  is  enabled  to  arrive  at  a cor- 
rect diganosis.  It  is  only  by  full  cooperation  be- 
tween the  clinician  and  radiologist  that  the  best 
results  may  be  obtained. 

The  technical  procedure  consists  in  the  exami- 
nation of  the  chest  in  order  to  determine  the 
presence  of  metastatic  deposits  in  the  lungs.  The 

Read  before  the  Surgical  Section,  Ohio  State  Medical 
Association,  at  the  86th  Annual  Meeting,  Dayton,  May  3-4, 
1932. 


position  of  the  diaphragm  and  it’s  excursions 
should  be  noticed.  Elevation  of  the  diaphragm  on 
both  sides  may  indicate  increased  intra-abdominal 
pressure  as  a result  of  a tumor,  fluid,  or  gas 
within  the  peritoneal  cavity  or  gastro-intestinal 
tract.  Elevation  of  the  right  diaphragm  may  in- 
dicate enlargement  of  the  liver  as  a result  of  a 
tumor.  Elevation  of  the  left  diaphragm  may  in- 
dicate a splenic  enlargement.  The  chest  examina- 
tion is  followed  by  a plain  view  of  the  abdomen 
in  the  antero-posterior  position  and  at  times  one 
in  the  lateral  position.  Such  views  may  often 
clinch  the  diagnosis  without  any  further  study. 
At  other  times  they  may  direct  one’s  attention  to 
a particular  organ  requiring  a more  detailed 
study.  A plain  view  of  the  abdomen  will  enable 
the  examiner  to  obtain  a fair  idea  as  to  the  size, 
shape,  and  position  of  the  liver,  spleen,  and  kid- 
neys. At  times  it  is  possible  to  outline  masses 
outside  of  the  known  organs.  The  presence  of  gall 
stones  or  renal  stones  may  often  be  demonstrated. 
Calcified  masses  in  the  abdomen  or  pelvis  may  be 
recognized.  Gaseous  distension  of  the  stomach  or 
bowels  as  a result  of  obstruction  is  readily  shown. 
After  a careful  study  of  the  plain  views  of  the 
abdomen  the  gastro-intestinal  tract  is  examined 
by  barium  mixtures.  A knowledge  of  the  position 
of  the  stomach  and  bowels  under  normal  and  ab- 
normal conditions  is  absolutely  essential  to  the 
radiologist. 

The  radiological  study  of  the  position  of  the 
stomach  and  bowels : 

The  position  of  the  stomach  varies  within  wide 
limits  under  normal  conditions.  Thus  one  may 
find  the  stomach  occupying  a transverse  position 
in  the  sthenic,  or  a vertical  position  in  the  as- 
thenic, or  any  position  between  these  two  extremes 
according  to  one’s  build.  The  position  of  the 
stomach  also  depends  upon  the  position  of  the 
body  as  a whole  and  the  position  of  the  dia- 
phragm. Thus  the  stomach  occupies  a higher  level 
in  the  recumbent  posture  and  a lower  level  in  the 
erect  posture.  It  is  evident,  therefore,  that  no 
study  of  the  position  of  the  stomach  is  complete 
unless  all  the  various  factors  are  taken  in  con- 
sideration. 

The  stomach  possesses  several  anatomical 


July,  1933 


Radiological  Study  of  Tumor — Brown 


425 


•characteristics.  Those  which  concern  the  present 
study  are  its  capacity  of  great  mobility  and  its 
constant  relation  with  the  neighboring  organs. 
The  stomach  is,  relatively  speaking,  a freely 
movable  organ.  Its  position  will  therefore  depend 
upon  the  position  of  the  body  as  a whole.  Being 
in  intimate  relation  with  the  neighboring  organs 
its  position  will  depend  upon  the  size  and  position 
of  its  neighboring  structures.  The  mobility  of  the 
neighboring  organs  of  the  stomach  as  a result  of 
a change  in  the  position  of  the  body  may  be  dis- 
regarded. Their  mobility  does  not  influence  the 
position  of  the  stomach  to  any  great  extent. 

An  alteration  in  the  position  of  the  stomach  as 
a result  of  a change  in  the  position  of  the  body  or 
a change  in  the  size  of  its  neighboring  organs  does 
not  take  place  in  a haphazard  manner,  but  follows 
a definite  order  both  under  normal  and  abnormal 
conditions.  A knowledge  of  this  order  is  essential 
for  the  proper  elucidation  of  the  causes  responsi- 
ble for  the  abnormal  position  of  the  stomach. 

The  normal  position  of  the  stomach  and  its  re- 
lations in  the  anterior  aspect: 

Since  the  position  and  relation  of  the  stomach 
in  the  anterior  aspect  of  the  abdomen  are  familiar 
the  discussion  will  be  limited  to  a few  known 
anatomical  facts  for  the  purpose  of  completeness. 
The  stomach  occupies  chiefly  the  left  upper 
quadrant.  On  the  left  side  of  the  stomach  is  the 
spleen  the  outline  of  which  can  often  be  made  out 
distinctly.  Occasionally  the  spleen  produces  a 
regular  depression  upion  the  greater  cuiwature  of 
the  stomach.  On  the  right  side  of  the  stomach  is 
the  liver  shadow  which  occupies  the  right  upper 
quadrant.  The  left  lobe  of  the  liver  extends  into 
the  left  upper  quadrant  and  occupies  a position 
in  front  of  the  stomach.  The  outline  of  the  left 
lobe  of  the  liver  is  not  readily  made  out  unless  the 
stomach  is  inflated  with  air.  The  kidneys  lie  be- 
hind the  stomach  and  duodenum.  Their  position, 
shape,  and  size  can  usually  be  made  out  on  a plain 
view  of  the  abdomen.  The  pancreas  extends  from 
the  duodenal  loop  to  the  spleen  and  lies  between 
the  spine  and  stomach.  Its  shadow  can  never  be 
distinguished. 

The  position  and  relation  of  the  stomach  in  the 
lateral  aspect: 

In  the  erect  position  there  is  hardly  any  dif- 
ference in  the  position  of  the  stomach  whether  it 
is  viewed  from  the  left  or  right  side,  or  whether 
the  roentgenograms  are  taken  on  the  left  or  right 
side,  but  there  is  quite  a difference  in  the  position 
of  the  stomach  when  the  patient  is  in  the  re- 
cumbent posture.  These  latter  positions,  the  right 
and  left  lateral  decubitus,  will  be  described  in 
detail. 

The  right  lateral  decubitus: 

In  the  right  lateral  decubitus  the  stomach  oc- 
cupies the  anterior  portion  of  the  abdominal 
cavity.  The  anterior  wall  of  the  stomach  lies 
parallel  to  the  abdominal  wall  from  which  it  is 


often  separated  by  a thick  layer  of  fat  in  the 
obese  patients.  The  contour  of  the  wall  is  regular 
and  slightly  convex  and  its  outline  is  seldom  in- 
fluenced by  the  amount  of  fat  as  is  often  the  case 
with  other  conditions  of  which  more  will  be  said 
in  a later  paragraph.  The  left  lobe  of  the  liver  is 
in  front  of  the  antei'ior  wall  of  the  stomach,  but 
under  normal  conditions  its  shadow  cannot  be 
distinguished.  The  posterior  wall  of  the  stomach 
is  parallel  with  the  spine  and  its  contour  is  regu- 
lar and  its  outline  is  slightly  concave. 

The  width  between  the  anterior  and  posterior 
walls  of  the  stomach  varies  a great  deal  among 
different  individuals.  It  is  generally  wide  in  the 
sthenic  and  narrow  in  the  asthenic  individuals. 
The  distance  between  the  posterior  wall  of  the 
stomach  and  the  spine  is  also  variable,  being 
greater  in  the  sthenic  and  less  so  in  the  asthenic 
individuals. 

The  direction  of  the  pylorus  is  backward  and 
upward  and  occupies  a position  between  the  pos- 
terior wall  of  the  stomach  and  the  spine.  The 
duodenal  bulb  is  above  the  pylorus  from  which  it 
is  separated  by  the  pyloric  sphincter. 

The  descending  duodenum  is  parallel  to  the 
spine  and  is  close  to  it.  The  ascending  duodenum 
is  directed  upward  and  forward  and  joins  the 
jejunum  beneath  the  body  of  the  pancreas. 

The  shadow  of  the  pancreas  cannot  be  differ- 
entiated, but  knowing  its  approximate  position 
wh:ch  is  between  the  posterior  wall  of  the  stomach 
and  the  spine  one  can  obtain  a fair  idea  as  to  its 
size  by  noticing  the  distance  between  the  spine 
and  the  posterior  wall  of  the  stomach.  The  head 
of  the  pancreas  can  be  studied  with  a greater  de- 
gree of  accuracy  on  account  it  is  being  surrounded 
by  the  duodenal  loop  which  may  be  rendered 
opaque.  Thus  one  can  judge  by  the  size  of  the 
loop  and  its  inner  contour  the  probable  size  of  the 
head  and  its  contour.  The  right  kidney  lies  be- 
hind the  stomach  and  duodenum  and  under  normal 
conditions  does  not  affect  the  position  or  contour 
of  the  latter  structures. 

The  left  lateral  decubitus: 

In  the  left  lateral  decubitus  the  direction  of  the 
stomach  is  from  above  downward  and  forward. 
The  degree  of  inclination  depends  upon  the 
habitus  of  the  individual,  being  almost  at  right 
angle  to  the  spine  in  the  sthenic  or  parallel  to  the 
spine  in  the  asthenic  individual,  or  anywhere  be- 
tween these  two  extremes.  The  contours  of  the 
anterior  and  posterior  walls  are  regular  and  their 
outline  is  somewhat  convex.  Occasionally  the 
posterior  wall  of  the  stomach  may  be  found  some- 
what depressed  by  the  spleen  which  lies  behind  it. 
This  is  often  found  in  asthenic  individuals.  In 
front  of  the  anterior  wall  of  the  stomach  there  is 
usually  seen  a large  triangular  shadow  of  soft 
consistency  due  to  the  liver.  The  left  kidney  and 
the  tail  of  the  pancreas  lie  behind  the  stomach, 
but  under  normal  conditions  they  do  not  affect  the 


426 


The  Ohio  State  Medical  Journal 


July,  193.5 


position  of  the  latter  structure.  The  duodenum  is 
generally  obscured  in  the  left  lateral  decubitus. 

The  position  of  the  small  and  large  bowel: 

The  small  bowels  are  located  within  the  hollow 
of  the  colon.  The  jejunum  usually  occupies  the 
left  upper  quadrant  and  the  ileum  the  right  lower 
quadrant.  The  colon  is  located  at  the  periphery  of 
the  abdominal  cavity.  The  position  of  the  head  of 
the  cecum  varies  a great  deal.  It  may  be  found 
above  the  crest  of  the  ilium  or  below  it  depending 
upon  the  habitus  of  the  individual.  It  is  usually 
high  in  the  sthenic  and  low  in  the  asthenic.  The 
hepatic  flexure  is  in  close  relationship  with  the 
lower  border  of  the  liver  and  its  position  will 
depend  upon  the  position  of  the  liver  or  its  size. 
The  transverse  colon  follows  the  course  of  the 
greater  curvature  of  the  stomach  and  its  position 
will  depend  upon  the  position  of  the  stomach. 

The  splenic  flexure  is  always  on_a  higher  level 
than  the  hepatic  flexure  and  is  very  often  found 
to  lie  under  the  diaphragm  or  spleen.  The  position 
of  the  descending  colon  is  along  the  periphery  of 
the  left  side  of  the  abdomen.  It  lies  deeper  in  the 
abdomen  than  the  ascending  colon.  The  pelvic 
colon,  sigmoid  flexure,  and  rectum  lie  in  the  pelvic 
region.  Of  these  three  structures  the  pelvic 
colon  and  sigmoid  flexure  are  freely  movable  and 
their  position  will  depend  upon  the  condition  of 
the  pelvic  organs. 

The  effect  of  gastric  tumors  upon  the  position 
of  the  stomach : 

A tumor  arising  from  within  the  stomach  does 
not  affect  the  position  of  the  stomach.  A knowl- 
edge of  this  fact  enables  one  to  differentiate  be- 
tween an  intra-gastric  and  an  extra-gastric  tumor. 
Thus  given  a case  which  presents  a deformity  in 
the  contour  of  the  stomach  in  the  anterior  view 
one  should  examine  the  patient  both  in  the  left 
and  right  lateral  positions.  If  the  deformity  of 
the  stomach  is  due  to  an  intra-gastric  tumor  the 
position  of  the  stomach  will  be  found  to  be  normal 
with  the  deformed  contour  either  in  the  anterior 
or  posterior  walls.  If  the  deformity  in  the  contour 
of  the  stomach  in  the  anterior  view  is  due  to  an 
extra-gastric  tumor  the  stomach  will  be  found 
displace'd  either  forward  or  backward  in  the 
lateral  positions  depending  whether  the  tumor  is 
behind  or  in  front  of  the  stomach. 

The  effect  of  enlargement  of  the  liver  upon  the 
position  of  the  stomach: 

The  size  of  the  liver  varies  a great  deal  under 
abnormal  conditions.  The  enlargement  may  be 
general  or  it  may  be  localized  either  to  the  right 
or  left  lobes.  A study  of  the  position  and  relation 
of  the  stomach  to  the  liver  will  enable  one  to 
recognize  even  moderate  degrees  of  enlargement 
of  the  liver.  In  enlargements  of  the  liver  the 
stomach  is  found  displaced  to  the  left  in  the  an- 
terior position  and  backward  in  the  right  or  left 
lateral  position.  The  hepatic  flexure  is  displaced 
downward. 


The  effect  of  the  spleen  upon  the  position  of 
the  stomach: 

Under  normal  conditions  the  spleen  may  at 
times  produce  a slight  depression  upon  the 
greater  curvature  and  posterior  wall  of  the 
stomach.  This  is  often  found  in  the  case  of  the 
vertical  stomach.  When  the  spleen  is  enlarged 
the  stomach  is  invariably  displaced  to  the  right 
and  forward.  The  degree  of  displacement  will 
depend  upon  the  size  of  the  spleen.  The  splenic 
flexure  is  displaced  downward.  This  finding 
usually  helps  to  differentiate  a large  spleen  from 
a large  left  kidney.  In  the  latter  case  the  splenic 
flexure  is  not  displaced  downward. 

The  effect  of  a large  right  kidney  upon  the 
position  of  the  stomach: 

In  the  presence  of  a large  right  kidney  the 
stomach  is  displaced  to  the  left  like  in  the  case  of 
a large  liver,  but  unlike  the  liver  the  stomach  is 
displaced  forward  in  the  right  lateral  position. 
The  hepatic  flexure  in  the  case  of  a large  right 
kidney  may  be  found  displaced  upward  or  down- 
ward. In  the  case  of  the  liver  the  hepatic  flexure 
is  always  displaced  downward. 

The  effect  of  a large  left  kidney  upon  the 
position  of  the  stomach: 

In  the  presence  of  a large  left  kidney  the 
stomach  is  displaced  to  the  right  and  forward  and 
very  frequently  also  upward.  The  splenic  flexure 
is  found  in  normal  position.  The  descending  colon 
may  be  found  displaced  either  to  the  left  or  to  the 
right  side  of  the  abdomen. 

The  effect  of  tumors  of  the  pancreas  upon  the 
position  of  the  stomach: 

The  pancreas  is  one  of  the  most  elusive  organs 
to  deal  with.  Unlike  the  liver,  spleen,  and  kidneys 
its  shadow  can  never  be  differentiated  upon  the 
film.  The  usual  X-ray  examination  of  the  stomach 
in  the  anterior  position  often  fails  to  give  any  in- 
direct evidence  of  a tumor  of  the  pancreas.  It  is 
evident,  therefore,  that  the  radiological  study  of 
the  pancreas  is  beset  with  difficulties.  Notwith- 
standing the  above  discouraging  fact  the  study  of 
the  pancreas  in  relation  to  the  stomach  both  in  the 
anterior  and  lateral  positions  has  shown  that  it  is 
often  possible  to  make  an  accurate  diagnosis  of  a 
tumor  of  the  pancreas  where  even  the  clinical  and 
physical  findings  have  failed  to  suggest  its 
presence. 

The  effect  of  a pancreatic  tumor  upon  the  posi- 
tion of  the  stomach  and  duodenum  will  depend 
upon  the  particular  portion  of  the  pancreas  which 
is  involved.  Thus  a tumor  of  the  head  of  the  pan- 
creas will  displace  the  duodenum  and  pylorus  for- 
ward in  the  lateral  position.  There  may  be  no  dis- 
placement of  the  stomach  in  the  anterior  position 
and  if  any  is  present  the  stomach  and  duodenum 
are  displaced  in  opposite  direction.  A tumor 
arising  from  the  body  of  the  pancreas  will  dis- 
place the  stomach  forward.  In  this  case  the 
duodeno-jejunal  flexure  may  be  found  displaced 


July,  1933 


Radiological  Study  of  Tumor — Brown 


427 


downward.  A tumor  arising  from  the  tail  of  the 
pancreas  will  displace  the  stomach  forward  and 
at  times  to  the  right  depending  upon  its  size. 

The  effect  of  retro-peritoneal  tumors  upon  the 
position  of  the  stomach : 

A retro-peritoneal  tumor  of  whatever  origin 
will  displace  the  stomach  forward  in  the  lateral 
positions  and  to  the  right  or  left  in  the  anterior 
position.  If  the  tumor  is  located  in  front  of  the 
spine  the  stomach  is  generally  displaced  to  the 
left  and  the  duodenum  to  the  right.  It  is  not  al- 
ways easy  to  differentiate  between  a tumor  origi- 
nating from  the  pancreas  and  a tumor  originating 
from  the  retro-peritoneal  glands.  Evidence  of  a 
primary  lesion  elsewhere  in  the  body  is  sug- 
gestive of  glandular  metastasis.  A favorable  re- 
action under  X-ray  treatment  is  also  suggestive 
of  a glandular  origin  of  the  tumor.  At  times  one 
has  to  satisfy  himself  with  the  determination  of 
the  tumor  without  deciding  its  exact  origin. 

The  effect  of  abdominal  tumors  below  the 
stomach  upon  the  position  of  the  stomach: 

Most  of  the  abdominal  tumors  below  the  greater 
curvature  of  the  stomach  usually  arise  from  the 
pelvic  organs.  If  large  enough  they  usually 
elevate  the  stomach.  The  sigmoid  flexure  and 
pelvic  colon  is  generally  found  displaced  upward, 
and  when  the  small  bowels  contain  barium  one 
will  find  them  also  displaced  upward  or  to  the 
side. 

CONCLUSION 

The  radiological  study  of  the  abdomen  for  pos- 
sible abdominal  tumors  should  begin  with  a study 
of  the  chest  and  diaphragm.  One  should  look  for 
possible  pulmonary  metastasis.  The  position  of 
the  diaphragm  should  be  noted.  It  will  often  lead 
one  to  suspect  the  presence  of  a large  liver  or 
spleen.  The  study  of  the  chest  should  be  followed 
by  a study  of  a plain  view  of  the  abdomen  before 
any  opaque  medium  is  introduced  into  the  gastro- 
intestinal ti-act  or  urinary  tract.  A careful 
analysis  of  a plain  view  of  the  abdomen  may  often 
lead  to  an  accurate  diagnosis  without  any  further 
study.  If  this  is  impossible  one  may  obtain  a clew 
as  to  the  organ  requiring  special  attention. 

The  gastro-intestinal  tract  should  be  studied  by 
the  barium  meal  and  barium  enema.  The  presence 
of  a tumor  within  these  structures  will  be  recog- 
nized in  a very  large  percentage  of  cases.  This 
percentage  may  be  increased  if  the  study  also  in- 
cludes the  observation  of  the  stomach  and  bowels 
in  the  oblique  and  lateral  positions. 

The  study  of  the  gastro-intestinal  tract  should 
also  include  a careful  analysis  of  the  position  and 
relation  of  the  stomach  and  bowels  with  their 
neighboring  organs.  Such  a study  will  often 
lead  to  the  discovery  of  tumors  outside  of  the 
gastro-intestinal  tract. 

707  Race  Street. 


Drastic  Revision  of  Food  and  Drug  Act 
Proposed 

Declaring  that  nearly  27  years’  experience  in 
the  enforcement  of  the  national  pure  food  and 
drug  law  has  disclosed  many  serious  deficiencies 
in  its  provisions,  the  Secretary  of  Agriculture, 
Henry  A.  Wallace,  by  direction  of  President 
Roosevelt,  has  submitted  to  Senator  Ellison  D. 
Smith  and  to  Representative  Marvin  Jones,  chair- 
men respectively  of  the  Senate  Committee  on 
Agriculture  and  Forestry  and  the  House  Com- 
mittee on  Agriculture,  a bill  designed  to  supplant 
the  present  Federal  food  and  drugs  act. 

Among  the  provisions  of  the  new  draft  are 
clauses  giving  the  government  authority  to  pre- 
vent false  advertising  of  foods,  drugs,  and  cos- 
metics and  to  establish  tolerances  for  added 
poisons  in  foods.  Other  provisions  include  a 
section  which  brings  cosmetics  within  the  juris- 
dicton  of  officials  enforcing  the  food  and  drugs 
act  and  which  authorizes  the  Secretary  of  Agri- 
culture to  promulgate  definitions  and  standards 
for  foods  Which  will  have  the  force  and  effect 
of  law.  Power  to  require  manufacturers  to  pro- 
cure in  certain  cases  Federal  permits  is  also 
granted  the  government,  as  is  the  authority  to 
control  drug  products  on  the  basis  of  therapeutic 
claims  which  are  contrary  to  the  general  agree- 
ment of  medical  opinion.  Another  important  sec- 
tion of  the  bill  submitted  to  the  committees  to- 
day is  a requirement  for  more  informative  label- 
ing of  foods  and  drugs. 


New  Books  Received 

State  Medical  Board  Examinations , by  Harold 
Rypins,  M.D.,  secretary,  New  York  State  Board 
of  Medical  Examiners;  a tropical  summary  of 
questions  asked  at  state  board  examinations  and 
the  answers  to  these  questions  in  an  effort  to 
assist  the  medical  graduate  in  selecting  and  re- 
arranging his  material  intelligently  and  prac- 
tically; J.  B.  Lippincott  Company,  Philadelphia, 
publisher;  price,  $4.50. 

Senile  Cataract,  Methods  of  Operating,  by 
W.  A.  Fisher,  M.D.,  professor  of  ophthalmology, 
Chicago  Eye,  Ear,  Nose  and  Throat  College,  with 
the  collaboration  of  Professor  E.  Fuchs,  Vienna; 
Professor  I.  Barraquer,  Barcelona,  Spain;  Dr.  H. 
T.  Holland,  Shikarpur,  Sind,  India;  Dr.  John 
Wesley  Wright,  Columbus,  Ohio;  Dr.  A.  Van 
Lint,  Brussels,  Belgium,  and  Dr.  0.  B.  Nugent, 
Chicago.  Published  by  the  Chicago  Eye,  Ear, 
Nose  and  Throat  College,  Chicago. 


The  Cleveland  Nurses’  Apparel  Company  has 
announced  through  the  Cleveland  Retail  Credit 
Men’s  Company,  that  E.  C.  Millan,  formerly  a 
representative  of  that  company,  is  no  longer  em- 
ployed by  the  company  and  is  not  authorized  to 
take  orders  or  accept  deposits  for  articles  mar- 
keted by  the  nurses’  apparel  company. 


Familial  Hemolytic  Jaundice  # * $ Clinical  Study  of  a Case 
Before  and  After  Splenectomy* 

Donald  M.  Glover  M.D.,  and  Warren  C.  Fargo,  M.D.,  Cleveland,  Ohio 


THE  rationale  of  splenectomy  for  the  relief 
of  hemolytic  jaundice  has  been  pretty 
clearly  established.  A sufficient  number  of 
operative  cases  have  been  recorded  to  indicate 
that  splenectomy  here  carries  a relatively  low 
mortality  and  brings  a high  percentage  of  cures. 
There  is  no  other  form  of  treatment  for  hemoly- 
tic jaundice  which  offers  any  relief. 

Giffin1  and  Pemberton"  recently  summarized 
118  cases  of  hemolytic  jaundice  from  the  Mayo 
Clinic  in  which  splenectomy  was  done.  The  im- 
mediate hospital  mortality  was  3.4  per  cent.  Of 
the  109  patients  followed,  eleven  died  of  other 
diseases  and  five  died  of  conditions  probably  re- 
sulting from  the  hemolytic  anemia  and  cirrhosis 
of  the  liver.  Of  98  living,  82  reported  their  con- 
dition satisfactory;  twelve  were  in  fair  condition, 
and  four  were  in  poor  condition.  Dawson3  credits 
Spencer  Weils  with  doing  the  first  splenectomy  for 
acholuric  jaundice  in  1887,  three  years  before 
Minkowski  described  the  condition.  Wells’  patient 
was  under  Dawson’s  observation  when  she  was 
71. 

The  patient  who  is  the  subject  of  this  report 
presented  a type  of  hereditary  hemolytic  jaundice 
with  anemia  of  severe  degree  which  responded  to’ 
no  form  of  non-operative  therapy.  A response  to 
splenectomy  which  became  apparent  within  less 
than  24  hours  after  operation  is  recorded. 

CASE  HISTORY 

Irene  P.,  a twelve-year-old  American  bom  girl, 
was  admitted  to  the  Pediatric  Service  of  St. 
Luke’s  Hospital  on  July  17,  1929,  complaining  of 
jaundice  and  pain  in  the  epigastrium  and  right 
hypochondrium. 

Family  History : The  father,  mother,  and  four 
brothers  of  the  patient  were  living  and  well ; none 
of  them  had  been  jaundiced.  A younger  sister  of 
the  patient  died  at  two  years  of  age  with  jaundice 
and  anemia.  A paternal  aunt  and  uncle  had  been 
jaundiced  intermittently  for  years. 

Past  History:  The  patient  had  had  measles 

and  pertussis.  She  was  jaundiced  at  birth  and 
had  an  illness  with  jaundice  at  the  age  of  one 
year.  Her  sister  died  when  she  was  three,  and  it 
was  noted  by  the  attending  physician  at  that 
time  that  Irene  had  jaundice,  anemia  and  an  en- 
larged spleen.  She  was  sent  to  St.  Alexis  Hos- 
pital on  his  recommendation  on  August  31,  1921, 
and  remained  there  for  nearly  four  months. 
During  this  time  her  red  cell  count  ranged  from 
1,840,000  to  2,672,000,  hemoglobin  from  28  per 
cent  to  43  per  cent,  and  the  white  cell  count  from 
5,720  to  4,160.  A diagnosis  of  “anemia  splenica 
infantum”  was  made  at  that  time.  The  patient 
was  given  several  blood  transfusions  without  ef- 
fect. During  the  intervening  years  she  had  been 


From  the  Surgical  Service  and  Pediatric!  Service  of  St. 
Luke’s  Hospital.  Read  in  part  before  the  Clinical  and  Path- 
ological Section  of  the  Academy  of  Medicine  of  Cleveland, 
1931. 


fairly  well,  but  had  had  occasional  attacks  of 
gastro-intestinal  disturbance  with  jaundice  and 
weakness  which  had  at  times  been  severe  enough 
to  keep  her  out  of  school.  She  had  been  some- 
what below  the  average  height  and  weight  for  her 
age,  but  she  had  made  good  progress  in  school 
except  for  the  time  she  had  missed  because  of 
illness. 

Present  Illness:  For  two  or  three  months  prior 
to  admission  to  St.  Luke’s  Hospital,  th  oatient 
had  complained  frequently  of  attacks  or  severe 
epigastric  pain,  often  accompanied  by  abdominal 
distention.  At  one  interval  she  was  confined  to 
bed  for  two  weeks.  Her  family  physician  found 
her  spleen  to  be  enlarged  and  advised  that  she  be 
transfused.  On  July  16,  1929,  the  day  prior  to 
admission  to  the  hospital,  the  patient  suffered 
with  abdominal  cramps  and  faint  spells,  without 
nausea.  The  following  day  she  became  intensely 
jaundiced,  and  her  mother  brought  her  to  the  hos- 
pital. Her  mother  thought  her  urine  was  rather 
dark  during  the  attack  of  jaundice.  Her  stools 
had  been  of  normal  color  and  consistency  prior  to 
the  day  of  admission. 

Physical  Examination : The  patient  was  a 

rather  short,  plump  girl  of  twelve,  somewhat  small 
for  her  age,  with  intense  jaundice  of  her  sclerae, 
marked  pallor  of  her  mucous  membranes,  and 


skin  showing  a peculiar,  combination  of  jaundice 
and  pallor.  Her  head  was  well-formed  and 
symmetrical.  Pupillary  reactions  and  extraocular 
movements  were  normal.  Ears  and  nose  showed 
no  abnormalities.  Her  tongue  was  clean  with 
normal  appearing  papillae  and  protruded  in  the 
midline  without  tremor.  Her  teeth  were  clean  and 
in  fair  condition;  tonsils  were  large  and  full  of 
irregular  crypts.  Her  neck  showed  no  significant 
adenopathy  and  no  thyroid  enlargement.  Her 
chest  was  symmetrical  and  expanded  well.  Lungs 
were  clear  throughout.  The  heart  was  not  en- 
larged to  percussion,  and  sounds  were  regular  and 
of  good  quality,  with  a rate  of  100.  A faint 
systolic  murmur  was  heard  at  the  apex,  not  trans- 
mitted, but  there  was  no  palpable  thrill.  Her 
abdomen  was  moderately  distended  and  tympani- 
tic except  on  the  left  side  where  the  tympany  was 
obscured  by  an  enormous  spleen.  There  was 
moderate  tendei’ness  in  the  epigastrium  and  the 
right  hypochondrium.  The  liver  margin  was  just 
palpable  beneath  the  costal  margin,  with  a dis- 
tinct notch  just  to  the  left  of  the  midline  where 
the  smooth,  rounded  outline  of  the  spleen  curved 
medially  and  downward  toward  the  umbilicus. 
Laterally  the  lower  limit  of  the  spleen  was  pal- 


428 


July,  1933 


Hemolytic  Jaundice — Glover  and  Fargo 


429 


Fig-.  11.  Patient  aged  12  with  familial  hemolytic  jaundice. 
The  costal  margins  and  the  palpable  outline  of  the  spleen 
are  outlined  in  ink. 


pable  just  above  the  crest  of  the  ilium.  Its  sur- 
face was  smooth  and  regular  and  the  organ  was 
quite  freely  moveable.  The  right  kidney  was  not 
palpable,  and  no  costo-vertebral  tenderness  was 
elicited  on  either  side.  There  were  no  defects  in 
the  abdominal  wall.  The  genitalia  and  rectum 
showed  no  abnormalities.  The  extremities  were 
well-formed  and  symmetrical.  The  spine  showed 
no  irregularities  or  deformity.  No  abnormal  re- 
flexes were  noted. 

Laboratory  and  Clinical  Data:  Urine  exami- 

nation showed  nothing  abnormal.  Feces  was  of 
normal  color  and  consistency;  it  contained  bile 
and  tests  for  occult  blood  were  negative.  No  ova 
were  found.  The  icteric  index  soon  after  admis- 
sion was  38.8;  Van  den  Bergh  reaction — direct — 
faint  delayed,  indirect  5.3  units.  Wallace  Dia- 
mond test  was  positive  for  urobilinogen  at  60. 
Tuberculin  reaction  was  negative  in  1-1000  dilu- 
tion. Red  cell  count  was  1,310,000  on  admission, 
hemoglobin  40  per  cent  and  white  cell  count  4,250. 
A differential  count  showed  58  per  cent  polymor- 
phonuclear cells,  28  per  cent,  small  lymphocytes, 
four  per  cent  large  lymphocytes,  and  12  per  cent 
transitional  cells.  Three  nucleated  red  cells  were 
counted  while  making  the  differential.  Red  cells 
showed  marked  achromia,  anisocytosis,  with  pre- 
dominance of  microcytes,  poikylocytosis  and 
polychromataphylia.  The  percentage  of  reti- 
culocytes was  9.8.  The  bleeding  and  clotting  time 
were  both  witlr'n  normal  limits,  and  the  platelet 
count  was  301,000.  Red  cell  fragility  tests  showed 
beginning  hemolysis  at  0.50  per  cent;  complete  at 
0.36  per  cent. 

Roentgenograms  of  the  gall-bladder  region 
failed  to  show  any  evidence  of  calculus,  and  films 


of  long  bones  and  the  skull  showed  nothing  ab- 
normal. 

COURSE  PRIOR  TO  OPERATION 

On  the  basis  of  the  history,  the  anemia,  acho- 
luric jaundice  and  fragility  of  red  cells  a diag- 
nosis of  hemolytic  jaundice  seemed  reasonable. 
Splenectomy  seemed  to  be  the  only  logical  method 
of  treatment,  but  because  of  the  profound  anemia 
operation  was  delayed  for1  several  months  in  the 
hope  that  the  patient  might  have  a satisfactory 
remission  either  spontaneously  or  as  the  result  of 
some  form  of  therapy,  in  order  that  the  operation 
could  be  done  at  a more  favorable  time.  During 
this  interval,  the  patient  had  a number  of  hemo- 
lytic crises  similar  to  the  one  during  which  she 
was  admitted  to  the  hospital.  These  attacks  were 
usually  ushered  in  by  upper  abdominal  pain  and 
tenderness,  nausea  and  often  vomiting  lasting  one 
or  two  days,  followed  by  residual  tenderness  in 
the  right  upper  quadrant  of  the  abdomen,  more 
intense  jaundice,  increasing  anemia,  and  slight 
elevation  of  temperature,  rarely  over  38  degrees 
C.  She  occasionally  had  a slight  diarrhea  with 
these  attacks,  but  the  stools  showed  no  blood. 

During  or  following  the  attack  the  spleen  would 
usually  become  larger.  Between  the  attacks,  the 
spleen  became  a little  smaller,  the  jaundice  less 
marked,  the  red  cell  count  increased  moderately, 
and  the  patient  would  feel  quite  well  and  able  to 
be  up  and  about  the  ward.  During  all  this  time 
dietary  regime,  liver  extract,  various  iron  prep- 
arations and  ultraviolet  radiation  had  no1  signifi- 
cant effect  on  the  course  of  the  disease.  The 
changes  in  the  blood  picture  (See  Chart  in  Figure 
1)  seemed  to  bear  no  relation  to  the  therapy,  but 
varied  with  the  loss  of  blood  during  the  hemolytic 
crises,  and  recovery.  She  seemed  unable  to  main- 
tain a count  of  much  over  two  million  red  cells 
even  after  the  effect  of  an  acute  crisis  was  well 
over.  It  became  apparent  that  further  delay  was 


Fig.  III.  The  spleen  removed  at  operation  weighed  740 
grams. 

futile,  and  it  was  decided  to  proceed  with 
splenectomy  after  blood  transfusion.  She  was 
given  300  cc.  of  whole  blood  on  November  14, 
1929,  without  causing  any  change  in  her  appear- 


430 


The  Ohio  State  Medical  Journal 


July,  1933 


Fig.  IV.  Patient  one  month  after  splenectomy. 

ance  or  her  blood  picture.  On  November  19th,  she 
was  transfused  again  with  300  cc.  of  whole  blood 
immediately  before  splenectomy  was  performed. 

Immediately  prior  to  operation  the  red  cell 
count  was  2,160,000,  hemoglobin  46  per  cent, 
white  cell  count  5,250,  platelet  count  600,000. 
Differential  count  showed  61  per  cent  polymorpho- 
muclears,  34  per  cent  small  lymphocytes,  1 per 
cent  large  lymphocytes,  1 per  cent  transitionals 
and  3 per  cent  basophiles.  The  reticulocytes  were 
18.25  per  cent.  The  icteric  index  was  27.3. 

OPERATION 

Under  gas-oxygen  and  ether  anaesthesia,  a five 
inch,  left  rectus  muscle  splitting  incision  was 
made,  with  a right-angled  transverse  incision  ex- 
tending laterally  from  the  lower  end  of  the  ver- 
tical incision.  There  was  no  free  fluid  in  the 
peritoneal  cavity.  The  gall-bladder  was  soft- 
walled,  not  adherent,  emptied  readily,  and  was 
free  from  calculi.  The  liver  appeared  normal. 
The  spleen  (See  Figure  3)  was  smooth  and  only 
lightly  adherent  to  the  diaphragm  with  bands  that 
were  easily  separated  with  blunt  dissection.  The 
gastro-lienal  ligament  was  severed  together  with 
the  anastomotic  branches  of  the  left  gastro- 
epiploic artery  which  were  secured.  The  stomach 
and  intestines  were  then  protected  with  moist 
abdominal  packs  and  the  spleen  was  delivered  into 
the  wound.  The  tail  of  the  pancreas  was  carefully 
dissected  from  the  splenic  pedicle,  the  splenic 
artery  was  doubly  ligated  and  divided,  followed 
by  the  vein,  and  the  spleen  removed.  The  blood 
loss  was  only  trivial.  A small  accessory  spleen 
1 cm.  in  diameter  was  left  near  the  splenic  artery. 
The  wound  was  closed  in  layers  without  drainage 
and  the  patient  was  returned  to  her  bed  in  ex- 
cellent condition. 


Pathological  Examination:  (By  Dr.  R.  Domin- 
guez). The  weight  of  the  spleen  plus  the  weight 
of  the  blood  which  oozed  out  was  740  grams.  The 
organ  was  firm,  dark  bluish  in  color,  and  the  con- 
tour was  fairly  well  preserved.  Microscopic  ex- 
amination showed  the  capsule  to  be  slightly 
thickened.  The  lymph  follicles  were  not  very 
abundant  or  enlarged,  but  the  germinal  centers 
were  well  developed  and  active.  The  splenic  pulp 
was  intensely  infiltrated  by  red  cells.  There  was 
slight  hyperplasia  of  the  endothelial  cells,  but  the 
sinusoids  contained  less  blood  than  the  interstices. 
Eosionphiles  were  scattered  throughout  the  sec- 
tion. Diagnosis : Slight  endothelial  hyperplasia  of 
the  spleen  with  diffuse  hemorrhage  of  the  pulp. 

Postoperative  Course:  The  change  in  the  pa- 
tient’s appearance  and  blood  picture  after 
splenectomy  was  dramatic.  On  the  afternoon  fol- 
lowing operation  she  lost  her  sallow  pallor,  her 
skin  assumed  a more  normal  color  and  her  mucous 
membranes  became  pink.  Six  hours  after  opera- 
tion her  red  cell  count  was  3,144,000,  hemoglobin 
74  per  cent,  and  white  cell  count  19,600  (87  per 
cent  of  which  were  polymorphonuclears) . Fragil- 
ity of  the  red  cells  was  recorded  as  beginning  at 
0.42  complete  at  0.40.  Her  convalescence  was  un- 
eventful except  for  the  development  of  an  hema- 
toma in  the  bed  of  the  spleen,  with  slight  elevation 
of  temperature  and  pain  in  the  left  side  of  the 


Fig.  V.  The  patient  two  years  after  splenectomy. 
Aged  14. 


July,  1933 


Hemolytic  Jaundice- 


Glover  and  Fargo 


431 


neck  (presumably  from  pressure  on  the  dia- 
phragm). This  hematoma  discharged  through  the 
wound  at  the  end  of  a week,  and  after  this  the 
wound  healed  promptly.  She  left  the  hospital  on 
December  12,  1929,  with  a red  cell  count  of 
5,670,000,  hemoglobin  88  per  cent,  and  white  cell 
count  of  6,000,  At  this  time  red  cell  fragility 
was  0.44  and  0.40,  icteric  index  9,  and  Van  den 
Bergh  negative.  The  reticulocytes  had  fallen  to 
approximately  1 per  cent.  (Figure  4). 

During  the  two  years  which  have  elapsed  since 
operation,  the  patient  has  remained  free  from  any 
symptoms,  except  for  an  attack  of  acute  follicu- 
lar tonsilitis,  following  which  her  tonsils  were  re- 
moved. Her  blood  picture  has  remained  at  prac- 
tically normal  level,  as  shown  by  the  chart  (Fig. 
1),  with  the  exception  of  the  fragility  of  the  red 
cells  which  returned  to  its  original  level  and  has 
remained  there.  On  October  23,  1930,  hemolysis 
began  at  0.50  per  cent  and  was  complete  at  0.32 
per  cent.  On  November  13,  1981,  the  fragility 
was  almost  identically  the  same.  The  differential 
count  and  appearance  of  the  red  cells  remained 
normal. 

COMMENT 

The  famillial  character  of  hemolytic  jaundice  is 
recognized  by  most  authors.  Earlier  writers  sepa- 
rated the  cases  into  two  groups,  the  congenital 
or  familial  type  and  the  acquired  type,  but  there 
now  seems  to  be  considerable  doubt  if  there  is  a 
truly  acquired  form  of  the  disease.  Giffen1 
and  Dawson3  have  presented  evidence  to  show 
that  patients  may  live  for  years  with  increased 
red  cell  fragility  and  a moderate  degree  of  ane- 
mia without  suffering  any  symptoms  until  a sud- 
den hemolytic  crisis  disables  them.  Several  ob- 
servers have  found  increased  fragility  in  the  blood 
of  apparently  well  members  of  the  families  of 
patients  with  hemolytic  jaundice.  It  will  be  re- 
called that  the  sister  of  our  patient  died  from  the 
disease  in  infancy,  but  five  living  brothers  and 
her  mother  showed  no  increased  red  cell  fragility. 
Masters,  Zerfas  and  Mettel4  reported  splenec- 
tomies for  hemolytic  icterus  in  sisters  aged  5 and 
9.  Weber'  and  Gansslen7  call  attention  to  the  oc- 
currence of  such  congenital  deformities  as  “Turm- 
schadel”  in  hemolytic  jaundice  families,  and 
Cooley,  Witwer  and  Lee6  call  attention  to  these 
and  other  bone  changes  which  they  attx-ibute  to 
hematopoetic  activity  of  the  bone  marrow,  but  the 
patients  of  the  latter  authors  did  not  show  clear 
evidence  of  hemolysis  or  jaundice.  Weber  also 
describes  the  tendency  to  chronic  leg  ulcerations 
in  some  of  his  families. 

Chauffards  first  described  the  increased  fra- 
gility of  the  red  cells  which  seems  to  be  the  dis- 
tinctive feature  of  the  blood  picture  in  this  dis- 
sease.  Although  splenectomy  causes  return  of 
the  rest  of  the  blood  picture  to  normal  it  seems  to 
have  little  effect  on  fragility.  Fragility  is  some- 
times decreased  immediately  after  operation,  only 


to  return  to  a higher  level  which  is  maintained 
throughout  life.  The  fundamental  difficulty  seems 
to  rest  with  the  bone  marrow  which  produces  red. 
cells  with  less  than  normal  resistance  to  hemo- 
lysis, but  splenectomy  greatly  increases  the  re- 
sistance of  these  cells  to  hemolysis.  (It  may  be 
that  the  effect  is  entirely  due  to  removing  a large 
pai’t  of  the  reticuloendothelial  system.)  It  has 
been  shown  in  animals  that  splenectomy  or  pro- 
duction of  an  Eck  fistula  will  decrease  the  de- 
struction of  red  cells  by  hemolytic  agents.9' 
Whether  or  not  splenectomy  gives  permanent  re- 
lief from  hemolytic  jaundice  probably  depends 
chiefly  upon  the  presence  of  accessory  spleen  tis- 
sue within  the  abdomen.  It  is  known  that  small 
islands  of  splenic  tissue  and  even  hemolymph 
glands  may  increase  greatly  in  size  after  splenec- 
tomy and  may  take  over  part  of  the  function  of 
that  organ., 

There  is  no  characteristic  pathology  described 
for  hemolytic  jaundice.  The  spleen  usually  shows 
engorgement  of  the  pulp  with  red  cells,  but  this  is, 
not  distinctive.  In  long-standing  cases,  hemo- 
siderosis of  the  liver,  kidneys  and  even  lymph 
nodes  may  be  observed.  The  bone  marrow  shows 
hyperplasia  of  hemoblastic  rather  than  leuco- 
blastic  cells.  According  to  Dawson,  the  predom- 
inance of  normoblasts  over  megaloblasts  in  the 
marrow  distinguishes  this  condition  from  per- 
nicious anemia.  He  has  also  seen  deposits  of 
ectopic  marrow  (also  see  Brannan10).  Hemato- 
poesis  causing  bone  changes  has  been  mentioned 
already.  Friedman11  considers  these  osseous 
changes  characteristic  of  the  disease,  but  his  ob- 
servations have  not  been  confirmed  by  others. 
Reticulocyte  counts  usually  average  between  20 
and  30  per  cent,  but  Baty12  reports  a case  with 
92  per  cent  before  splenectomy.  His  patient  con- 
tinued to  have  hemolytic  crises  after  operation. 
Gall-bladder  disease,  with  or  without  stones  was 
found  in  68.6  per  cent  of  Giffin’s  series,  and  in  40 
per  cent  of  Dawson’s.  In  many  of  the  late  cases 
there  is  a definite  cirrhosis  of  the  liver.  In  the' 
cases  with  definite  liver  damage  the  mortality  is 
much  higher  than  for  the  average  of  the  group. 
This  fact  argues  in  favor  of  splenectomy  during- 
the  early  stages  of  the  disease.  Dawson  advocates 
splenectomy  in  patients  presenting  only  anemia, 
increased  red  cell  fragility  and  splenomegaly,  as  a 
prophylactic  procedure. 

It  has  been  repeatedly  demonstrated  that  no 
form  of  therapy  other  than  splenectomy  offers 
any  hope  of  cure  of  hemolytic  jaundice.  Trans- 
fusion is  futile  and  sometimes  hazardous,  and  is 
indicated  only  as  a temporizing  measure  in  the 
presence  of  severe  anemia.  Dawson  reports  a 
case  of  sudden  fatality  following  transfusion.  Re- 
sponse to  splenectomy  is  usually  prompt,  but  we 
have  found  no  instance  of  such  striking  changes 
in  the  blood  picture  as  Were  shown  by  our  patient 
within  a few  houi’s  after  operation. 


432 


The  Ohio  State  Medical  Journal 


summary" 

A clinical  study  of  a twelve-year-old  girl  with 
familial  hemolytic  jaundice  is  presented. 

The  blood  picture  was  unaffected  by  transfu- 
sions, liver  therapy  or  iron  preparations,  but 
splenectomy  caused  striking  improvement  which 
was  apparent  within  a few  hours. 

In  hemolytic  jaundice  splenectomy  offers  a high 
percentage  of  cures  and  low  mortality  of  opera- 
tion if  not  too  long  delayed  and  if  not  performed 
during  an  hemolytic  crisis. 

10515  Carnegie  Ave. 

BIBLIOGRAPHY 

1.  Giffin,  H.  Z.,  Diseases  of  the  Spleen,  Oxford  Loose 
Leaf  Medicine,  4:53-78  (45). 

2.  Pemberton,  J.  deJ.,  Results  of  Splenectomy  in  Splenic 
Anemia,  Hemolytic  Jaundice  and  Hemorrhagic  Purpura, 
Ann.  Surg.,  94:  755-765,  Oct.,  1931. 

3.  Lord  Dawson  of  Penn,  Hemolytic  Icterus,  Brit.  Med. 
J.,  1931,  1:921-928  and  963-966,  May  30th  and  June  6th. 


July,  1933 


4.  Masters,  J.  M.,  Zerfas,  Leon  G.,  Mettel,  Howard  B., 
Congenital  Hemolytic  Icterus,  Am.  J.  Dis.  Children,  37 : 
1254-1259;  June,  1929. 

5.  Weber,  F.  Parkes,  A Hemolytic  Jaundice  Family,  In- 
ternat..  Clinics,  3 : 148-156.  September,  1931. 

6.  Cooley,  Thos.  B.,  Witwer,  E.  R.,  and  Lee,  Pearl, 
Anemia  in  Children  with  Splenomegaly  and  Peculiar  Changes 
in  Bones.  Am.  J.  Dis.  Child.,  34  ; 347-363,  September,  1927. 

7.  Gansslen,  M.,  Observation  of  “Turmschadel”  in  Fami- 
lial Hemolytic  Icterus,  Deutsch  archiv.  f.  kllin.  med.,  140  ; 210, 
September,  1922. 

8.  Chauffard,  A.,  Pathologenie  de  l’ietere  congenital  de 
T adulte,  S_emaine  Med.,  Paris,  27 : 25-29,  1907. 

9.  Pearce,  R.  M.,  Krumbhaar,  E.  B.,  and  Frazier,  C.  H. 
The  Spleen  and  Anemia,  J.  B.  Lippincott  & Co.,  Phila.,  1918. 

Pearce,  R.  M.,  and  Peet,  Max  M.,  The  Effect  of  Hemoly- 
tic Serum  in  Splenectomized  Dogs.  J.  Exp.  Med.,  18 : 494- 
499,  1913. 

Krumbhaar,  E.  B.,  Musser,  J.  H.,  Jr.,  and  Peet,  Max, 
Changes  in  the  Blood  Following  Diversion  of  the  Splenic 
Blood  from  the  Liver.  A Control  Study  of  the  Effects  of 
Splenectomy,  J.  Exp.  Med.,  23 :87-95  also  97-106,  1916. 

10.  Brannan,  Dorsey:  Extramedullary  Hematopoiesis  in 

Anemia,  J.  H.  Hosp.,  Bull.,  41 : 104-136,  August,  1927. 

11.  Friedman,  Lewis  J.,  Osseous  Changes  in  Hemolytic 
Icterus,  Am.  J.  Roentg.,  20 : 440-444,  Nov.,  1928. 

12.  Baty,  James  M.,  A Case  of  Congenital  Hemolytic 
Jaundice  with  an  Unusually  High  Percentage  of  Reticulocy- 
tes, Am  J.  Med.  Sci.,  179:  546-549,  April,  1930. 


Practical  Consideration  of  Sphenoidal  Sinus  Infection 

Harris  H.  Vail,  M.D.,  Cincinnati,  Ohio 


A SHORT  while  ago  I saw  a patient  who 
some  fifteen  years  previously  had  been  a 
patient  of  a rhinologist  of  the  older  gen- 
eration. She  told  me  that  he  had  made  a diagnosis 
of  sphenoid  sinus  infection  but  begged  her  to 
postpone  the  operation  until  he  could  visit  an 
Eastern  clinic  where  operations  upon  the  sphenoid 
sinus  were  more  frequently  done.  I might  add 
that  he  did  a very  creditable  operation  upon  the 
sinus.  Nowadays  every  rhinologist  should  be 
familiar  with  the  surgical  anatomy  of  the  sphe- 
noid sinus.  For  this  reason  it  is  not  necessary  to 
say  anything  more  about  the  anatomy  of  the 
sphenoid  sinus  except  to  recall  to  your  minds  the 
enormous  variations  in  its  size.  This  fact  is  of 
great  importance  in  considering  disease  of  the 
sphenoid  sinus  as  it  explains  not  only  the  latency 
and  chronicity  of  the  disease  but  also  its  nervous 
complications. 

The  pneumatization  of  the  sphenoid  sinus  is 
limited  by  certain  unyielding  structures.  Two  of 
these  are  important  nerves,  namely,  the  optic  and 
vidian  nerves  which  pass  in  bony  canals  of  a 
rather  fixed  and  prearranged  position.  Any  ex- 
tensive pneumatization  of  the  sphenoid  will  en- 
croach upon  these  canals  with  the  result  that  they 
may  be  more  or  less  surrounded  by  the  sphenoid 
sinus.  Many  anatomical  specimens  show  the 
nerves  actually  projecting  into  the  cavity  of  the 
sinus  covered  by  a thin  bony  wall  in  which  there 
may  be  dehiscenses.  The  vidian  nerve  runs  on 
the  floor  of  the  sphenoid  sinus  and  any  excessive 
pneumatization  will  hollow  out  the  pterygoid 


Read  before  the  Section  on  Eye,  Ear,  Nose  and  Throat, 
Ohio  State  Medical  Association,  86th  Annual  Meeting,  Day- 
ton,  May  3-4,  1932. 


plate  lateral  to  the  nerve  in  such  a way  that  a 
deep  recess  may  be  formed.  Any  infection  getting 
into  the  sphenoid  sinus  usually  gravitates  towards 
this  recess  and  readily  forms  a focus  of  infection 
which  is  very  resistant  to  any  form  of  treatment. 
In  this  way  we  have  established  what  is  called 
latent  sphenoiditis.  I have  found  this  condition, 
clinically,  in  enough  cases  to  know  that  there  can 
be  a rather  extensive  infection  in  the  pterygoid 
recess  which  can  be  found  only  upon  the  closest 
examination. 

Not  long  ago  I had  occasion  to  examine  75  pairs 
of  sphenoid  sinuses  removed  routinely  at  autopsy 
at  the  Cincinnati  General  Hospital.  All  the  cases 
were  on  services  other  than  the  nose  and  throat. 
Five  specimens  showed  gross  infection  in  one  or 
both  sphenoid  sinuses.  Upon  looking  up  the 
clinical  histories  of  these  cases  there  was  nothing 
in  the  history  to  suggest  that  there  had  been  any 
suspicion  of  a sphenoid  sinus  infection  but  I must 
say  that  no  attempts  had  been  made  to  examine 
even  for  such  a possibility,  at  least  while  the 
patient  was  in  the  hospital.  Apparently  the  in- 
fection in  the  sinus  was  not  in  any  way  a factor 
in  the  death  of  the  patient  but  at  any  rate  in  five 
out  of  75  cases  there  existed  an  obvious  chronic 
suppurative  sphenoiditis  not  recognized  during 
life.  Thus  it  is  quite  possible  for  a sphenoiditis 
to  exist  without  giving  signs  of  its  presence. 
Perhaps  one  way  to  stimulate  our  attention  in  the 
consideration  of  sphenoiditis  is  to  discuss  the  dis- 
eases in  which  we  are  justified  to  suspect  the 
presence  of  a sphenoid  infection.  The  first  one  to 
be  considered  is  retrobulbar  optic  neuritis.  I 
have  seen  a fairly  large  number  of  such  cases  and 
recently1  have  written  upon  the  subject.  My  feel- 


July,  1933 


Sphenoidal  Sinus  Infection — Vail 


433 


ing  is  that  it  is  wise  to  go  on  the  basis  that  all 
cases  of  retrobulbar  optic  neuritis  which  can  not 
be  diagnosed  as  due  to  syphilis,  tobacco,  multiple 
sclerosis  or  any  toxic  agent  and  which  do  not 
show  any  improvement  after  a week  of  intensive 
local  treatment  to  the  nose,  should  receive  the 
benefit  of  the  operation  upon  the  sphenoid  and 
posterior  ethmoids. 

Many  authors  feel  that  the  most  important 
cause  of  retrobulbar  optic  neuritis  is  multiple 
sclerosis  and  that  none  of  the  cases  should  be 
operated  upon.  I believe  that  is  going  a little  too 
far.  We  are  entirely  in  ignorance  as  to  the 
method  in  which  the  infecting  agent  of  multiple 
sclerosis  gets  into  the  central  nervous  system. 
Because  eye  symptoms  appear  so  early  in  a cer- 
tain percentage  of  the  cases,  it  is  possible  that 
the  portion  of  the  central  nervous  system  first 
affected  is  the  optic  nerve  and  in  the  sphenoid 
sinus  we  have  the  only  situation  where  the  optic 
nerve  is  most  exposed  to  outside  influences.  I feel 
therefore  that  a diagnosis  of  early  multiple 
sclerosis  is  no  contra-indication  for  a sphenoid 
operation.  That  reminds  me  of  a very  intei’esting 
case: 

Miss  M.  B.,  age  42,  was  first  seen  April  6,  1927. 
She  gave  a history  that  four  days  previously  she 
awakened  in  the  morning  having  dreamed  that 
she  had  lost  the  sight  of  the  right  eye  and  found 
that  this  was  the  case.  For  the  past  ten  days  she 
had  had  a post  nasal  dripping,  an  unusual  symp- 
tom, and  all  the  week  before  had  had  swollen, 
puffy  eyes  and  the  eyeballs  were  sore  to  touch, 
especially  the  right.  When  she  turned  her  head 
to  the  right  it  was  painful. 

Examination  showed  a septal  deviation  to  the 
left,  a rather  large  pneumatic  right  middle  tur- 
binate and  thick  mucoid  secretion  in  the  middle 
meatus.  The  ostium  of  the  right  sphenoid  was  ex- 
posed and  the  sphenoid  sinus  irrigated.  The  wash 
was  clear.  Both  antra  were  bright,  the  tonsils  had 
been  cleanly  removed  and  there  were  no  adenoids 
present.  X-rays  of  the  sinuses  showed  moderately 
large  sphenoids  and  all  sinuses  were  clear.  The 
Wassermann  test  was  negative  and  white  blood 
count  normal.  Fundi  examination  by  my  father 
was  negative.  Vision  was  fingers  at  four  feet  and 
there  was  a large  central  scotoma.  By  the  9th  of 
April  there  was  no  improvement  in  the  vision  so 
on  that  day  I operated  doing  a posterior  ethmoid 
and  sphenoid  operation  under  local  anesthesia. 
After  a high  resection  of  the  septum  and  trim- 
ming of  the  right  middle  turbinate,  a large  open- 
ing was  made  in  the  front  wall  of  the  sphenoid. 
The  last  posterior  ethmoid  cell  was  quite  deep  and 
its  nasal  wall  was  removed.  There  was  no  path- 
ology in  these  sinuses.  Two  days  later  the  vision 
was  20/40,  six  days  after  the  operation  the 
vision  was  20/25  and  by  the  end  of  the  month 
it  was  20/20 — . 

Four  months  after  the  operation  she  stated  she 
had  some  pain  about  the  right  eye,  did  not  feel 
well,  was  losing  weight,  had  a discharge  from  the 
nose,  headaches,  shooting  pains  in  the  head 
(though  not  severe),  and  a little  stomach  trouble, 
but  the  eye  was  quite  normal.  I did  not  see  her 
again  until  December  16,  1931  (about  4%  years 
after  the  operation). 

At  that  time  she  told  me  that  two  years 
previously  she  had  had  X-ray  treatments  for 
fibroid  tumors  of  the  uterus.  This  was  followed 


by  sciatica  of  the  left  leg  and  fainting  spells.  A 
year  and  a half  ago  the  uterus  was  removed. 
Last  summer  she  had  a nervous  exhaustion  with 
bladder  trouble  and  difficulty  in  voiding.  She  has 
lost  22  pounds.  She  had  a blood  pressure  of  200 
which  fell  to  120. 

She  was  bom  with  defective  vision  in  the  left 
eye  which  according  to  Dr.  D.  T.  Vail,  Sr., 
measured  20/70. 

The  patient  had  been  to  a nerve  specialist  who 
recently  diagnosed  her  condition  as  multiple 
sclerosis. 

On  Feb.  11th,  1932,  the  vision  in  the  left  eye 
was  affected  so  that  she  was  unable  to  read  print 
which  she  had  been  able  to  do  previously.  The 
right  eye  was  unaffected.  Cocainization  of  the 
sphenoidal  recess  with  irrigation  of  the  sinus  was 
done  and  by  Feb.  17th  the  vision  was  better.  Feb. 
27th,  1932,  she  could  read  a few  small  words  in 
ordinary  print.  The  vision  then  was  not  quite  as 
good  as  it  had  been  previously.  On  account  of  her 
obvious  nervous  disease  all  the  consultants  in  the 
case  felt  that  surgery  to  the  nose  would  not  ac- 
complish any  good  results. 

This  case  could  be  discussed  at  great  length. 
However,  as  a matter  of  fact,  no  definite  con- 
clusions can  be  derived  from  this  one  case. 

Certainly  we  are  doing  the  best  for  our  patients 
if  we  advise  posterior  sinus  drainage  operations 
upon  cases  of  retrobulbar  optic  neuritis  when  the 
condition  can  be  due  to  an  infection  in  the  nasal 
sinuses. 

I pass  now  to  another  large  group  of  cases. 
This  is  the  group  with  the  painful  neuralgia  in 
the  face  and  head.  These  are  the  cases  falling 
under  the  classification  of  the  sphenopalatine 
ganglion  neuralgia  first  described  by  Sluder2.  The 
typical  symptomology  of  these  cases  is  a severe 
pain  beginning  along  side  of  the  nose,  passing 
into  the  eye,  temple,  ear,  mastoid,  back  of  head, 
neck,  shoulder,  down  the  arm  and  sometimes  into 
the  leg  on  the  same  side.  In  the  literature  you 
will  find  complete  anatomical  descriptions  of  the 
sphenopalatine  ganglion  and  its  nerves.  However, 
in  the  past  few  years  there  have  been  real  ad- 
vances made  in  the  study  of  the  painful  neural- 
gias of  the  face,  the  chief  of  which  is  the  work  of 
Vogel3,  who  has  shown  that  the  vidian  nerve  is 
completely  interrupted  in  the  sphenopalatine 
ganglion  and  that  there  is  an  anastomosis  between 
the  orbital  branches  of  the  ganglion  and  the  first 
division  of  the  5th  nerve. 

In  1929,  I4  reported  a case  presenting  the  classi- 
cal signs  of  sluder’s  Meckel’s  ganglion  neuralgia. 
The  cause  of  this  patient’s  symptoms  lay  in  the 
sphenoid  sinus  where  the  vidian  nerve  could  ac- 
tually be  seen  running  in  the  floor  of  the  sinus. 
With  each  attack  of  sphenoiditis  (and  this  was 
easily  demonstrated  by  the  nasopharyngoscope 
passed  into  the  sinus)  the  neuralgia  returned  and 
lasted  as  long  as  there  was  any  inflammation. 
This  case  caused  me  to  feel  for  the  first  time,  that 
the  syndrome  described  by  Sluder  was  not  due  to 
Meckel’s  ganglion  being  irritated  by  sinusitis,  but 
was  due  to  a dii’ect  inflammation  of  the  vidian 
nerve  in  the  floor  of  the  sphenoid  sinus.  Since 
then,  I have  seen  34  cases  presenting  this  typical 


434 


The  Ohio  State  Medical  Journal 


July,  1933 


syndrome.  Many  others  had  modifications  in  the 
severity  and  extent  of  the  pain.  Some  cases  had 
merely  the  pain  back  of  the  eye,  others  have  had 
it  in  the  ear  and  in  the  back  of  the  head.  All  the 
cases  were  relieved  by  treatment  to  the  sphenoid 
sinus.  The  large  majority  of  the  patients  were 
females.  These  patients  can  not  be  cured  in  the 
real  sense  of  the  term,  by  any  treatment,  because 
they  have  a latent  sphenoiditis  located  in  the 
pterygoid  recesses.  Recurrences  of  the  pain  with 
each  attack  of  posterior  sinusitis  is  the  rule. 

I would  like  to  report  just  one  case  of  vidian 
neuralgia : 

Mr.  G.,  age  52,  was  first  seen  on  Feb.  5th,  1932, 
with  a history  that  for  six  years  he  had  had  at- 
tacks of  severe  pain  in  the  right  eye  with  the 
feeling  that  his  eye  was  being  pushed  out.  The 
attacks  came  about  once  a week,  most  often  dur- 
ing the  night,  lasted  for  a few  hours  and  were 
relieved  by  hot  or  cold  applications.  Apparently 
there  was  no  relation  to  colds.  In  the  past  year 
he  has  noticed  in  addition,  pain  in  the  back  of  the 
head,  always  on  the  right  side.  In  the  past  five 
weeks  the  pains  have  been  constant  in  the  right 
eye  and  right  side  and  back  of  the  head.  He  has 
not  noticed  any  sensory  disturbances  of  the  face. 
The  nasal  septum  was  very  badly  deviated  to  the 
left  from  pressure  by  an  enlarged  pneumatic  right 
middle  turbinate. 

A septum,  middle  turbinate,  posterior  ethmoid 
and  right  sphenoid  operation  was  done  under  local 
anesthesia.  The  middle  turbinate  contained  a very 
large  turbinate  cell.  Polypi  were  present  in  the 
posterior  ethmoids.  The  sphenoid  sinus  mucosa 
was  grayish. 

For  the  first  two  days  after  operation  the  pain 
was  very  severe  and  just  as  bad  as  prior  to 
operation,  but  on  the  third  night  he  had  relief 
from  the  pain,  the  first  time  for  over  a month. 
In  the  next  few  days  there  was  a great  improve- 
ment, but  ten  days  after  operation  he  had  a 
severe  flare-up  of  pain  and  at  this  time  sphenoid 
irrigation  brought  out  quantities  of  dark  brown- 
clotted  blood.  Daily  sphenoid  irrigations  were 
done  and  by  a month  after  the  operation  the  sinus 
contained  very  little  pus.  Following  the  operation 
he  had  only  three  attacks  of  pain.  The  last  attack 
of  pain  was  probably  produced  by  the  injection 
of  6 cc.  of  iodized  oil  (40  per  cent)  into  the  right 
sphenoid  as  at  the  time  of  this  injection  the 
mucosa  was  only  slightly  congested  and  two  days 
later  when  the  pain  returned  the  mucosa  was 
very  much  congested  and  swollen  with  pus  to  be 
seen  in  the  cavity  of  the  sinus. 

As  the  inflammation  in  the  sphenoid  sinus 
cleared  up  the  pain  in  the  eye  and  back  of  the 
head  did  likewise. 

A nasopharyngoscope  passed  into  the  sphenoid 
sinus  showed  the  ridge  of  the  vidian  nerve  with 
a recess  on  either  side.  The  ridge  projected  al- 
most %"  above  the  floor  of  the  sinus.  The  A-ray 
films  with  iodized  oil  (40  per  cent)  injected  into 
the  sphenoid  sinus  show  the  peninsula-like  out- 
line of  the  vidian  canal  with  the  deep  recess 
lateral  and  below  it.  In  this  particular  case  the 
iodized  oil  lies  below  the  vidian  canal.  Of  all  the 
cases  I have  seen  this  is  the  one  which  shows  the 
most  extensive  surrounding  of  the  vidian  canal 
by  the  sphenoid  mucosa. 

The  two  factors  in  the  production  of  vidian 
neuralgia  are  first  an  infection  in  the  sphenoid 
sinus  and  second  a sphenoid  sinus  pneumatized  so 


that  there  is  very  close  relation  between  the  vidian 
nerve  and  the  sphenoid  mucosa.  This  presupposes 
the  existence  of  a pterygoid  recess.  If  I am  right 
in  believing  that  all  cases  falling  under  the  classi- 
fication of  Meckel’s  ganglion  neuralgia  are  really 
vidian  neuralgia  then  this  should  presuppose  the 
existence  of  a sphenoiditis. 

A lot  of  ground  must  be  covered  in  a short  time 
and  I now  pass  to  the  group  of  hay-fever  and 
bronchial  asthma.  I know  that  there  is  certainly 
room  for  arguments  pro  and  con  in  these  con- 
ditions. I am  quite  willing  to  grant  an  allergic 
basis  and  extranasal  conditions  as  etiological 
factors.  Some  years  ago  I had  a patient  who  had 
had  bronchial  asthma  for  several  months.  She 
came  to  my  office  because  she  was  unable  to 
breath  through  her  nose.  Roentgen  ray  examina- 
tion with  lipiodol  injected  into  both  antra  showed 
them  to  be  filled  with  polypi.  The  bilateral  radi- 
cal antrum  operation  was  done.  Only  slight  im- 
provement followed.  Polypi  in  the  posterior  part 
of  the  nose  were  found  at  a later  date  and  a 
bilateral  sphenoid  operation  was  done.  Both 
sphenoids  and  the  posterior  ethmoid  cells  were 
practically  filled  with  polypi.  Following  this 
operation  which  was  nearly  two  years  ago,  she 
has  been  greatly  improved — in  fact,  she  has  only 
a very  mild  attack  two  or  three  times  a year. 

In  the  next  case  of  bronchial  asthma  which  I 
had,  I decided  to  operate  not  only  upon  the  antra 
but  also  the  posterior  ethmoids  and  sphenoids.  In 
the  second  case  the  sphenoids  were  filled  with 
polypi.  This  patient  did  not  get  the  same  relief 
as  the  first  patient.  It  has  been  a very  trouble- 
some ordeal.  It  is  now  almost  a year  since  the 
sphenoid  operation  was  done  and  the  patient  is 
having  anywhere  from  four  to  six  attacks  of 
asthma  daily.  In  other  respects  there  is  an  im- 
provement. The  breathing  is  better,  the  head- 
aches are  absent  and  the  patient  is  not  bed-ridden 
as  before,  but  the  asthma  attacks  continue.  She  is 
sensitive  to  almost  everything — bacteria,  pollen 
and  foods.  She  has  had  tuberculosis  and  has  a 
chronic  bronchitis  and  probably  bronchiectasis. 
There  is  still  pus  in  both  sphenoids  and  with  the 
nasopharyngoscope  a polypoid  membrane  can  be 
seen  in  the  recesses. 

As  a result  of  the  observations  in  cases  of 
asthma  I determined  to  look  into  the  sphenoids  of 
patients  with  hay-fever.  Of  course,  I have  in- 
jected lipiodol  into  the  antra  of  these  cases,  with 
antral  lavages  during  the  acute  attacks  as  some 
authors  have  advocated,  but  never  found  any  par- 
ticular benefit  to  l’esult.  I operated  upon  the 
sphenoids  in  two  cases  who  had  very  bad  spring, 
summer  and  fall  hay-fever.  Polypi  were  present 
in  the  sphenoids  in  both  cases.  The  man  did  fine. 
His  operation  was  done  at  the  height  of  the  hay- 
fever  season  and  all  through  the  rest  of  the  year 
he  had  complete  relief.  Recently  his  symptoms 
have  returned.  The  girl  noticed  only  an  improve- 
ment in  breathing.  Her  hay-fever  was  as  bad  as 


July,  1933 


Sphenoidal  Sinus  Infection — Vail 


435 


ever  last  fall.  Skin  test  showed  her  to  be  sen- 
sitive to  many  foods,  and  all  the  spring,  summer 
and  fall  pollens.  Here  again  we  have  a good  re- 
sult in  one  case  and  no  improvement  in  the  other. 
Clinically,  the  hay-fever  patients  had  nothing 
whatever  to  suggest  the  presence  of  polypi  in  the 
sphenoid  sinuses  and  I would  not  ordinarily  have 
opened  these  sinuses — the  operations  were  in  the 
nature  of  experiments. 

I really  feel  encouraged  about  this  matter  and 
bring  it  to  your  attention  so  that  much  more  work 
and  study  can  be  done  along  this  line. 

The  group  of  chronic  bronchitis  and  bronchi- 
ecstasis  from  sinus  disease  is  an  important  one 
and  I can  sum  up  my  feelings  with  the  statement 
that  it  is  very  essential  in  all  such  cases  to  clear 
up  the  sinus  infection.  We  must  not  be  content 
with  just  cleaning  up  the  anterior  sinuses  but  we 
must  also  clean  up  the  posterior  sinuses  and  I 
think  a lot  of  our  patients  who  are  not  completely 
relieved  following  the  anterior  sinus  operation 
deserve  the  careful  examination  of  the  posterior 
sinuses  and  an  operation  if  indicated. 

Chronic  sphenoiditis  must  be  considered  in 
cases  where  we  have  made  a diagnosis  of  middle 
and  internal  ear  deafness,  progressive  deafness 
or  chronic  secretory  otitis  media.  Usually  by  the 
time  we  see  these  patients  the  deafness  is  so  far 
advanced  that  not  much  improvement  can  be  ob- 
tained by  treatment  of  the  sinus  condition  or  ears. 
However,  I can  recall  several  cases  where  there 
was  every  reason  to  believe  the  progress  of  the 
deafness  had  been  checked  and  there  happened  to 
be  just  enough  hearing  left  so  that  the  patient 
was  able  to  get  along  fairly  well.  The  treatment 
of  the  sphenoid  sinus  diseases  is  just  one  part  of 
the  problem  as  so  often  other  sinuses  may  be  in- 
volved. 

DIAGNOSIS 

The  diagnosis  of  sphenoid  sinus  disease  can  not 
be  made  by  a routine  examination  of  the  nose. 
The  mere  presence  of  a condition  which  can  be 
caused  by  sphenoid  sinus  disease  should  make  us 
feel  that  the  disease  is  present  in  the  sinus  and 
that  an  apparently  normal  appearance  of  the  nose 
is  not  sufficient  to  rule  out  its  presence.  Cer- 
tainly we  are  at  times  careless  I think  in  making 
a diagnosis  of  chronic  tonsillitis.  We  are  willing 
to  remove  tonsils  on  almost  anybody’s  say-so,  and 
yet  we  turn  around  and  say  that  there  is  no  sinus 
disease  when  we  have  not  given  the  patient  a real 
examination. 

To  perform  the  necessary  examination  requires 
first  of  all,  shrinking  up  of  the  nasal  mucosa. 
Weak  adrenalin  cocaine  spray  is  used  followed  by 
insertion  of  small  pledgets  of  cotton  with  10  per 
cent  cocaine  between  the  middle  turbinate  and 
septum  and  under  the  middle  turbinate  and 
against  the  front  wall  of  the  sphenoid.  After 
cocainization  is  complete  the  ostium  of  the  sinus 
is  searched  for.  Often  it  can  be  found.  If  it  can 


not  be  found,  I usually  make  a lateral  X-ray  to 
determine  the  size  of  the  sphenoid  and  with 
thorough  cocainization  push  a special  sphenoid 
canula  through  the  front  wall.  Rarely  it  is  im- 
possible to  inject  the  sinus. 

Often  a small  bead  of  muco-pus  will  be  seen 
coming  from  the  sinus  or  one  will  find  a mushy 
polypoid  thickening  of  its  front  wall  or  in  some 
cases  pus  will  be  seen.  Irrigation  of  the  sinus 
often  brings  out  some  secretion. 

Always  there  is  a generalized  atrophy  of  the 
posterior  part  of  the  nose,  pharyngitis  and  a his- 
tory of  post  nasal  discharge.  Nothing  more  than 
this  is  needed  to  make  a diagnosis  of  sphenoiditis. 
Whether  it  is  acute  or  chronic  depends  upon  his- 
tory and  findings.  The  history  is  often  not  re- 
liable. Many  writers  have  stressed  the  important 
fact  which  I can  verify,  namely:  that  persons 
with  an  acute  or  chronic  sphenoiditis  do  not  have 
the  usual  subjective  symptoms  of  a “coryza”. 
Often  their  only  complaint  is  a post  nasal  drop- 
ping and  suboccipital  headaches. 

To  complete  the  examination,  radio  opaque  oil 
for  roentgen-ray  study  should  be  injected  into  the 
sinus.  Of  course,  great  care  must  be  taken  that 
the  operator  keep  himself  fully  oriented  at  all 
times. 

TREATMENT 

The  treatment  of  sphenoiditis  is  not  entirely 
surgical.  Many  cases  can  be  greatly  improved  by 
shrinking  up  the  back  of  the  nose  by  means  of 
cocaine  and  ephedrine,  the  use  of  nasal  douching 
— silver  protein  solutions — infra-red  light  therapy 
■ — Dowling  tampon  treatment.  However,  where 
there  is  any  complication  surgery  is  strongly  in- 
dicated. This  should  consist  of  a submucous  re- 
section of  the  septum  always,  often  the  removal  of 
a part  of  the  middle  turbinate,  the  opening  of  the 
posterior  ethmoid  cells,  and  making  a large  open- 
ing in  the  front  wall  of  the  sphenoid  sinus. 
Polypi,  when  present  in  the  sinus,  should  be  re- 
moved. Rarely  the  external  approach  to  the 
sphenoid  sinus  may  be  necessary.  The  mucosa 
should  not  be  removed  unless  grossly  diseased. 
Care  of  course,  should  be  taken  not  to  injure  the 
optic  nerve  in  the  upper  outer  angle  of  the 
sphenoid. 

Some  of  the  recesses  of  the  sinus  can  be  quite 
deep,  hence  it  will  be  impossible  to  remove  all  the 
diseased  membi’ane.  In  such  cases  we  must  realize 
that  some  disease  in  the  sinus  will  remain.  This 
will  affect  the  prognosis. 

The  post-operative  treatment  consists  of  fre- 
quent irrigations  of  the  cavity,  and  inspection  by 
the  nasopharyngoscope  from  time  to  time.  The 
usual  antiseptic  solution  may  be  used  for  irrigat- 
ing. Post-operative  treatment  over  a long  period 
of  time  is  necessary. 

919  Carew  Tower. 


436 


The  Ohio  State  Medical  Journal 


July,  193:1 


REFERENCES 

1.  H.  H.  Vail,  Retrobulbar  Optic  Neuritis  Originating 
in  the  Nasal  Sinuses.  Archives  of  Otolaryngol.  Vol.  IB, 
June,  1931,  pp.  846-863. 

2.  Sluder,  Greenfield : The  Role  of  the  Sphenopalatine 

or  Meckel’s  Ganglion  in  Nasal  Headaches.  New  York  Med. 
J„  77  : 989  (May  23,  1908). 


3.  Klaus  Vogel:  Die  Beziehungen  des  Ganglion  Spheno- 

palatinum  zu  den  von  ihm  Ausgehenden  Nervenstammen. 
Zeitsch.  f.  Hals — Nasen  u Ohrenheilk,  Band  25,  No.  5, 
March,  1930,  pp.  435-502. 

4.  H.  H.  Vail : Vidian  Neuralgia  from  Disease  of  the 

Sphenoidal  Sinus.  Archives  of  Surgery,  April,  1929,  Vol.  18, 
pp.  1247-1255. 


Adult  Health  Education 

Robert  Lockhart,  M.D.,  Cleveland,  Ohio 


THE  average  man  as  a rule  has  very  little 
conception  of  the  nature  or  need  of  health 
until  he  begins  to  lose  it.  Until  the  last 
few  years,  for  that  matter,  our  most  highly  edu- 
cated people  had  little  more  scientific,  usable  in- 
formation with  regard  to  the  preservation  of 
health  than  their  more  ignorant  brothers. 

The  complexity  and  velocity  of  the  spiritual  and 
economic  changes  in  human  affairs  have  forced  it 
upon  the  attention  of  the  leaders  in  all  human  ac- 
tivities, that  more  and  more  attention  must  be 
given  to  the  health  and  well-being  of  the  human 
units  in  our  top-heavy  civilization.  These  leaders 
are  now  discovering  that  there  are  certain  funda- 
mental satisfactions  and  gratifications  which  must 
be  furnished  the  rank  and  file  if  the  present 
modus  operandi  is  to  endure  without  catastrophe 
and  revolution. 

Not  only  must  a man  have  a job  to  which  he  is 
suited.  Also,  he  must  have  certainty  of  tenure  of 
that  job.  And  in  addition,  he  and  his  family  must 
be  taken  care  of  during  his  periods  of  unemploy- 
ment. Besides  all  this,  he  must  have  adequate 
and  proper  forms  of  recreation  for  himself  and 
family  during  his  leisure  time  as  well  as  the  in- 
evitable periods  of  being  out  of  a job. 

It  would  seem  that  giving  every  man  a job  and 
recreation  for  himself  and  family  would  and 
should  be  a comparatively  easy  accomplishment 
for  this,  the  wealthiest  nation  in  the  world.  How- 
ever, this  ideal  of  a job  and  recreation  for  every 
man  has  never  been  approximated  even  in  our 
highest  tides  of  prosperity. 

Then  it  may  be  held  as  fundamental  that  every 
man  must  have  employment  and  recreation  if  he 
is  to  have  health.  Granting  that  in  a few  years 
the  stupidity  and  fear  which  now  hold  tightly  in 
their  grasp  many  of  our  economic  and  political 
leaders,  will  be  relaxed,  what  are  those  elements 
in  the  preservation  of  the  health  of  the  people 
which  should  be  called  to  the  attention  of  those 
responsible  for  human  welfare. 

The  most  important  element  in  the  preservation 
of  health,  is  the  prevention  of  diseases  and  ab- 
normal states  which  will  result  in  the  death  or  in 
the  physical  and  mental  incapacity  of  their  vic- 
tims. 

Read  before  the  Section  on  Public  Health  and  Industrial 
Medicine,  Ohio  State  Medical  Association,  at  the  86th  Annual 
Meeting,  Dayton,  May  3-4,  1932. 

Commissioner  of  Health,  Cuyahoga  County. 


How  can  so  desirable  a thing  as  the  largest  de- 
gree of  health  for  the  greatest  number  of  people 
be  accomplished?  First , by  a united  effort  of 
health  authorities  and  physicians  always  to  give 
their  people  only  the  most  accurate  information 
with  regard  to  health  and  disease.  Also,  a great 
deal  can  be  done  for  the  furthering  of  good  health 
by  impressing  upon  educated  people  who  are  the 
leaders  in  their  communities,  their  personal  re- 
sponsibility in  knowing  about  health  and  impart- 
ing this  knowledge  to  their  more  ignorant 
brethren. 

There  are  so  many  excellent  sources  of  good 
health  information  to  be  found  in  our  daily  news- 
papers and  magazines  and  over  the  radio,  that  it 
is  inexcusable  for  any  man  who  has  any  interest 
in  health,  not  to  acquire  the  necessary  knowledge 
for  the  preservation  of  his  own  and  his  family’s 
health. 

There  is  one  class  of  diseases  which  should  re- 
ceive much  more  attention  than  it  does  at  present. 
These  are  the  venereal  diseases,  namely,  gonor- 
rhea and  syphilis.  It  would  appear  that  our  pres- 
ent methods  of  prevention  and  control  have  proved 
most  inadequate.  Much  greater  facilities  for  the 
prophylaxis  and  early  diagnosis  and  cure  of  these 
diseases  must  be  provided.  Adequate  legislation, 
backed  up  by  enlightened  public  sentiment  must 
also  be  enacted  before  these  scourges  of  the  hu- 
man race  can  be  lessened. 

Finally,  those  of  us  who  really  believe  that 
health  is  the  basis  of  any  successful  common- 
wealth, must  insist  in  season  and  out  of  season, 
that  the  methods  and  content  of  education  be  im- 
proved. Our  schools  are  turning  out  each  year  a 
much  higher  percentage  of  physically  perfect 
specimens  than  they  did  twenty  or  thirty  years 
ago.  The  graduates  of  our  high  schools  and  col- 
leges are  bigger  physically  and'  have  a much 
larger  collection  of  knowledge  of  all  kinds  than 
their  fathers  and  grandfathers  ever  had.  Some 
of  them  have  learned  so  much  of  something  or 
other  that  they  can  no  longer  bear  even  to  wear 
a hat. 

It  is  not  for  us  who  are  not  members  of  the 
noble  and  hard-working  teaching  profession  to 
dictate  what  the  methods  and  curricula  of  the 
schools  shall  be.  Yet,  the  fact  is  that  many  lead- 
ers of  the  professions  and  of  business  are  com- 
plaining that  they  are  not  receiving  into  their 


Julx,  1933 


Adult  Health  Education— Lockhart 


437 


ranks  enough  graduates  of  the  right  kind  of  per- 
sonality to  succeed  in  their  respective  lines. 

Methods  of  education  of  our  youth  must  be 
worked  out  so  that  an  increasingly  large  number 
of  our  people  will  develop  those  time-honored  vir- 
tues of  self-control,  self-knowledge  and  self-reli- 
ance. As  Professor  Pitkin  states  in  a recent 
work,  “Personality,  rather  than  mere  intellect  or 
animal  cunning  or  family  influence,  will  determine 
one’s  position  and  potency  in  the  upper  levels  of 
business,  finance  and  government.  A man  will 
come  closer  than  ever  before  to  winning  or  losing 
on  the  basis  of  his  own  merits”. 

One  last  thing  must  be  accomplished  if  our  civ- 
ilization is  to  continue  to  advance.  Methods  must 
be  worked  out  and  perfected  whereby  those  who 
have  the  necessary  qualities  of  leadership  shall  be 
allowed,  nay  shall  be  forced  to  come  to  the  front 
and  take  charge.  We  must  not  any  longer  permit 
the  ignorant,  the  stupid  and  the  inept  to  occupy 
high  positions  which  will  affect  injuriously  the 
health  and  welfare  of  the  people.  Education  must 
be  paced  to  meet  the  needs  of  its  forward  looking 
and  aspiring  members. 

DISCUSSION 

J.  J.  Sutter,  M.D.,  Lima,  Ohio. 

We  have  listened  to  a very  timely,  a very  inter- 
esting and  an  exceptionally  good  paper.  Dr. 
Lockhart  has  the  habit  of  doing  just  the  right 
thing,  in  the  right  way,  and  at  the  right  time. 

All  physicians  are  trained  to  serve — their 
motto  is  “Service”.  I believe  that  the  greatest 
service  we  can  do  a human  being  is  to  give  him  a 
right  education— a right  physical  education,  a 
right  intellectual  education,  also  a right  moral 
and  a right  religious  education.  Material  relief, 
medical  relief  or  any  other  relief  is  a great  serv- 
ice and  good  service,  but  it  is  never  as  great  and 
helpful  as  to  educate. 

The  question  “Who  is  to  educate?”  is  not  an 
easy  one  to  answer.  The  function  of  the  board  of 
education  is  the  education  of  the  youth — the  child, 
and  the  adolescent,  but  does  not  include  the  adult. 
Who  shall  educate  the  adult?  I agree  with  the 
essayist,  that  it  is  the  duty  of  the  individual 
physician,  the  medical  society,  the  board  of  health, 
the  local  community,  and  all  educated  people  to 
give  our  adult  population  a right  health  educa- 
tion. But  each  of  these  should  be  limited  to  their 
own  field  of  activity.  For  instance,  official  or- 
ganizations, such  as  the  boards  of  health,  were 
created  for  a particular  purpose  and  their  duties 
are  fairly  well  described  by  law.  The  primary 
function  of  the  board  of  health  is  to  protect  the 
health  of  the  general  public,  now  interpreted  as 
meaning  not  only  the  control  of  communicable 
diseases,  but  also  to  protect  the  public  from  the 
menace  of  disease.  This  means  the  securing  of 
a pure  and  safe  water  supply,  pure  and  safe  food 
supply,  pure  and  safe  milk  supply,  a pure  air 
supply,  good  housing  and  lighting  conditions,  good 
sanitation,  good  environment,  freedom  from  dis- 
ease-producing insects,  parasites,  rodents  dogs,  etc. 

The  board  of  health,  therefore,  should  limit 
health  education  of  the  adult  to  their  particular 
field.  No  matter  who  educates,  education  should 
never  include  the  treatment  of  diseases  or  ail- 
ments. No  health  publicity  should  ever  go  far- 
ther than  prevention.  This  may  seem  to  some  of 
you  as  a very  selfish  motive.  It  may  seem  that 


the  health  commissioner  is  to  take  the  attitude  of 
the  Levite  or  Priest  rather  than  to  act  as  did  the 
good  Samaritan.  Not  so — the  good  Samaritan 
did  only  what  he  could,  and  left  the  injured  man 
with  others  for  further  treatment,  and  for  what- 
ever services  he  needed.  He  left  the  man  to  those 
educated  along  the  line  the  injured  man  needed. 
As  I said  before,  the  duty  of  the  board  of  health 
is  to  teach  the  adult  population  “prevention”  and 
should  never  include  “treatment”. 

Once  the  person  igi  ill,  then  it  becomes  a case 
for  the  practitioner,  and  none  other.  It  is  the 
duty  of  the  health  commissioner  to  direct  the 
patient  to  the  physician.  Now  the  duties  of  the 
individual  physician  and  the  medical  society,  I 
believe,  are  very  much  the  same.  The  individual 
physician,  or  the  medical  society  may  teach  all 
forms  of  prevention,  but  like  the  health  commis- 
sioner they  should  never  teach  the  public  thera- 
peutics or  the  treatment  of  diseases.  For  a little 
knowledge  of  medicine  is  dangerous.  Each  should 
educate  the  adult  population,  but  each  should 
know  their  limitation. 

The  public,  at  present,  is  over-fed  with  a diet  of 
germs  and  too  little  is  taught  the  public  of  the 
many  other  causes  of  ailments.  The  individual 
physician,  the  medical  society  and  the  health  de- 
partment should  teach  our  adult  population  some 
of  the  other  causes  of  diseases — such  as  deficiency 
diseases,  diseases  due  to  food,  milk,  water,,  insects, 
rodents,  worry,  grief,  anxiety,  fatigue,  etc. 

The  many  hints  and  suggestions  of  treatments 
for  diseases  appearing  in  the  daily  press,  or  heard 
over  the  radio,  especially  the  press  ads  of  the  Eu- 
ropean yeast  advertisers,  are  dangerous  and  will 
result  in  an  increased  mortality  rate,  because 
the  more  the  people  know  or  think  they  know 
about  medicines,  the  more  they  will  prescribe  for 
themselves  and  postpone  the  services  of  a phy- 
sician. 

It  is  everybody’s  duty  to  take  an  interest  in  wel- 
fare and  health  of  the  people — by  educating  the 
adult  population  “how  to  keep  well”,  but  it  is  the 
physician’s  duty  to  care  for  and  treat  the  person 
when  sick. 


Many  members  of  the  Toledo  Academy  of 
Medicine  attended  the  All-Star  Clinic  held  at  the 
University  Hospital,  Ann  Arbor,  Michigan,  and 
which  was  arranged  by  the  Post-Graduate  Com- 
mittee of  the  Academy  in  cooperation  with  the 
Department  of  Post  Graduate  Medicine  of  the 
University  of  Michigan.  Demonstrations  in  eye, 
ear,  nose  and  throat;  psychiatry,  neurology,  der- 
matology, general  medicine  and  surgery  were 
presented  by  the  staff  of  the  hospital. 


Tentative  arrangements  have  been  made  by  the 
Mahoning  County  Medical  Society  to  present  a 
quartet  of  professors  from  McGill  University  at 
its  next  Annual  Post-Graduate  Day  Assembly, 
scheduled  to  be  held  in  April,  1934.  Those  in- 
vited to  address  the  assembly  are:  Dr.  J.  C.  Mea- 
kins,  professor  of  medicine;  Dr.  Wilder  Penfield, 
professor  of  neurology  and  neurosurgery;  Dr. 
John  R.  Fraser,  professor  of  obstetrics  and 
gynecology,  and  Dr.  J.  B.  Collip,  professor  of 
biochemistry. 


Archbold — Dr\  J.  E.  Petcoff,  formerly  of  Toledo, 
has  opened  offices  here. 


Preliminary  Note  on  the  Treatment  of  Undmlant  Fever  in 
Man  with  Detoxified  Vaccine  and  with  Antiserum 

Alfred  E.  O’Neil  M.S.,  Cincinnnati,  Ohio 


TREATMENT  WITH  DETOXIFIED  VACCINE 

Hypersensitivity  to  the  bacterial  pro- 
tein in  patients  ill  with  Brucella  abortus 
infection  (undulant  fever)  has  been 
clearly  shown  in  attempts  to  treat  such  cases 
with  heat  killed  vaccine  and  in  the  use  of  the 
intradermal  test  in  diagnosis.  Accounts  in  the 
literature  are  common  in  which  severe  reactions 
resulting  in  abscess  formation  and  requiring 
drainage  followed  deep  subcutaneous  or  intra- 
muscular injection  of  heat  killed  Brucella  abortus 
or  melitensis  suspensions.  Many  patients  as  early 
as  the  sixth  week  of  disease  when  given  a skin 
test  with  0.05  cc.  of  a heated  suspension  of  a 
density  of  100  million  per  cc.  develop  after  48 
hours  a hard  indurated  area  6 to  10  mm.  in 
diameter  with  an  outer  erythematous  zone  meas- 
uring 2.5  to  3 cm.  In  some  cases  the  central  area 
becomes  necrotic  after  four  to  seven  days.  Heal- 
ing is  slow,  often  requiring  four  to  six  weeks.  In 
one  case  evidence  of  the  intradermal  test  remained 
in  the  form  of  a reddened  4 mm.  spot  for  seven 
months.  A careful  study  of  a few  cases,  during 
which  time  observations  extended  over  a period 
of  two  years,  has  indicated  that  the  prominent 
clinical  manifestations  of  the  disease,  especially  in 
the  chronic  form,  parallel  closely  the  hyper- 
sensitive state  as  shown  by  the  skin  test.  In  the 
acute  stages  clinical  improvement  has  been  seen 
as  the  patient  has  been  able  to  tolerate  larger 
doses  of  vaccine.  It  is  believed  that  the  rational 
treatment  must  proceed  logically  in  the  direction 
of  accomplishing  desensitization  to  the  bacterial 
protein. 

In  view  of  the  severe  reactions  seen  when 
heated  vaccine  is  given  and  in  the  light  of  ex- 
perimental studies  which  have  shown  that  guinea 
pigs  can  be  sensitized  with  the  heated  antigen,  it 
was  decided  to  attempt  to  detoxify  the  abortus 
bacillus  so  that  more  could  be  given  to  patients  in 
the  acute  stages  of  the  disease.  This  was  finally 
done  by  the  use  of  nitrous  acid.  Skin  tests  on  sen- 
sitized animals  and  man  showed  a marked 
diminution  in  the  reaction,  especially  in  the  de- 
crease in  the  size  of  the  central  indurated  area 
and  in  the  absence  of  necrosis.  The  extent  of 
erythema  was  often  but  not  always  reduced  when 
compared  with  heated  antigen  of  equal  density. 

Febrile  patients  have  been  able  to  tolerate  an 
initial  dose  of  0.05  cc.  of  a suspension  of  200  mil- 
lion per  cc.  density.  The  injections  are  given  sub- 
cutaneously and  daily.  The  dose  is  gradually  in- 
creased according  to  the  patient’s  tolerance,  avoid- 


From  the  Department  of  Bacteriology  and  Hygiene,  Medi- 
cal College,  University  of  Cincinanti  and  the  Bethesda 
Hospital. 


ing  any  marked  local  reactions.  In  some  of  the 
patients  the  dosage  reached  a maximum  of  0.5  cc. 
Four  cases  so  treated  made  prompt  recovery  with- 
out constitutional  effects  in  the  form  of  hectic 
pyrexial  reactions  following  the  injections.  One 
patient  who  had  been  given  a course  of  com- 
mercial stock  vaccine  was  so  sensitive  that  she 
could  take  but  .05  cc.  of  the  detoxified  antigen  of 
75  million  density,  without  severe  local  reaction. 
Injections  were  given  on  alternate  days  for  a 
period  of  three  months,  during  which  time  the 
dose  was  gradually  increased  to  .25  cc.  By  this 
time  the  patient  became  free  of  symptoms  which 
were  general  malaise  and  joint  pains.  In  a word, 
the  patient  improves  as  he  becomes  less  reactive 
to  the  detoxified  vaccine.  When  recovery  ac- 
companies desensitization  one  feels  that  this  pro- 
cedure is  of  fundamental  immunological,  as  well 
as  clinical,  importance. 

While  effective  and  sure  the  vaccine  method  has 
certain  disadvantages  in  that  considerable  time 
and  care  are  required.  In  this  series  of  five  cases 
the  time  necessary  to  bring  about  a degree  of  re- 
lative desensitization  as  shown  by  skin  tests 
varied  from  six  weeks  to  six  months.  This  method 
is  of  particular  value  in  treating  the  sequellae  or 
in  treating  serum  sensitive  patients. 

TREATMENT  WITH  ANTISERUM 

Goats  were  given  nitrous  acid  treated  vaccine 
for  a period  of  eight  months.  The  suspension 
used  represented  about  5 billion  Brucella  abortus 
bacilli  per  cc.  Inoculations  were  given  on  alter- 
nate days.  The  dose  can  be  gradually  increased 
until  2 cc.  can  be  given  without  effect  upon  the 
animal.  Skin  tests  made  at  intervals  have  shown 
that  the  goats  have  not  been  sensitized. 

Three  patients  were  treated  with  goat  serum. 
One  patient  was  given  serum  from  a man  (one 
of  the  vaccine  treated  series)  who  had  been  given 
detoxified  vaccine  to  the  point  of  complete  de- 
sensitization. Brief  accounts  of  these  cases  fol- 
low: 

Case  I.  Acute.  First  seen  on  about  the  22nd 
day  of  disease  with  daily  temperature  range  of 
99  to  103  degrees.  Diagnosis  by  blood  agglutina- 
tion and  skin  test.  Prominent  symptoms  were 
severe  joint  pains,  headaches  and  sweats.  Marked 
clinical  improvement,  reduction  in  temperature 
and  skin  sensitivity  followed  within  ten  days  after 
intravenous  injection  of  30  cc.  of  antiserum.  No 
remissions  have  occurred  in  five  months. 

Case  II.  Acute.  The  diagnosis  was  made  dur- 
ing the  eighth  week  by  blood  agglutination  and 
skin  test.  Daily  temperature  range  from  99  to  101 
degrees.  Severe  myalgias  and  sacro-iliac  pain 
were  the  chief  symptoms.  Ten  days  after  re- 
ceiving 30  cc.  of  antiserum  by  vein  the  patient 
was  able  to  resume  his  work  as  a coppersmith, 
and  has  remained  well  for  12  months. 


438 


July,  1933 


Adult  Health  Education — Lockhart 


439 


Case  III.  Chronic,  of  about  two  years’  duration. 
Low  grade  temperature  at  times  to  100  degrees 
in  the  afternoon.  Severe  myalgias  and  arthralgias 
were  prominent  symptoms.  Diagnosis  was  made 
by  skin  test  in  which  a severe  reaction  was  noted. 
The  blood  agglutination  test  was  negative.  The 
relative  desensitization  following  intravenous  in- 
jection of  40  cc.  of  antiserum  was  very  pro- 
nounced. Joint  and  muscle  pains  became  mild  and 
all  sense  of  fever  and  chilliness  disappeared. 

Case  IV.  Acute.  Seen  during  the  seventh 
week.  Daily  temperature  range  from  99  to  102.4 
degrees.  Prominent  symptom  was  general  ma- 
laise. Diagnosis  made  by  blood  agglutination  and 
skin  test.  Three  days  after  intravenous  injection 
of  25  cc.  of  human  hyper-immune  serum  the  maxi- 
mum temperature  was  99  degrees.  In  ten  days  it 
returned  to  normal.  A mild  degree  of  desensitiza- 
tion and  unusual  clinical  improvement  was  ac- 
complished. No  remissions  have  occurred  in  14 
months. 

SUMMARY 

Five  cases  of  undulant  fever  have  been  treated 
with  detoxified  Brucella  abortus  vaccine.  In  every 
instance  clinical  improvement  exactly  paralleled 
desensitization  to  the  bacterial  protein.  None 
have  had  remissions  within  a maximum  period  of 
two  years  after  infection. 

Goats  immunized  with  nitrous  acid  treated 
vaccine  yielded  a serum  which  was  used  to  treat 
three  patients.  One  patient  was  treated  with 
human  hyper-immune  serum.  In  all  cases  the 
serum  treatment  brought  about  a drop  in  tem- 
perature to  normal  and  a considerable  reduction 
in  hypersensitivity  as  shown  by  the  skin  test. 

It  is  believed  that  a preliminary  note  is  justi- 
fied in  view  of  the  fundamental  immunological  re- 
sponses seen  in  the  management  of  these  cases. 
It  is  hoped  that  others  will  use  these  methods  and 
report  their  results.  A detailed  account  of  these 
and  other  cases  will  be  reported  later. 


Depression  Accelerating  Decline  In 
Nation’s  Birth  Rate 

The  present  birth  rate  in  the  United  States  is 
too  low  to  maintain  the  population  at  its  present 
level. 

If  it  were  not  for  the  fact  that  there  is  a large 
proportion  of  persons  in  the  younger  age  groups, 
due  to  the  much  larger  birth  rate  20  to  25 
years  ago,  there  would  now  be  a decline  in  the 
nation’s  population  instead  of  an  annual  increase 
of  about  800,000. 

Preliminary  figures  received  by  the  Bureau  of 
the  Census,  covering  a majority  of  the  states, 
indicate  that  the  number  of  births  for  each 
1,000  of  population  in  1932  fell  below  18,  the 
lowest  on  record.  In  1915,  when  the  Bureau 
began  making  annual  reports  of  births  in  this 
country,  the  rate  was  25.1.  The  indicated  rate 
for  1932  is  about  4 per  cent  below  that  for  1931. 

This  information  is  revealed  by  Willard  C. 
Smith,  assistant  statistician  of  the  Division  of 
Vital  Statistics,  Bureau  of  the  Census,  who 
says  that  the  effects  of  the  depression  have 
merely  accelerated  the  downward  trend  in  the 
number  of  births,  already  pronounced  in  the 
decade  before  1929. 


During  the  last  10  years  the  birth  rate  has 
declined  nearly  25  per  cent  while  the  death  rate 
has  remained  about  the  same.  The  number  of 
children  born  annually  has  decreased  almost  500,- 
000  in  spite  of  the  increase  in  the  total  popula- 
tion. 

This  decline  in  the  birth  rate  has  been  most 
accelerated  in  the  cities.  Whereas  10  years  ago 
there  were  about  enough  children  in  the  large 
cities  to  maintain  the  city  population  stationary 
without  accessions  from  the  outside  there  now  is 
about  a 25  per  cent  deficit. 

San  Francisco  and  Los  Angeles  and  other  cities 
which  are  most  purely  American,  have  had  the 
largest  drop  in  birth-rate.  In  San  Francisco  the 
births  no  longer  are  more  numerous  than  deaths. 

In  the  smaller  cities,  those  under  100,000  popu- 
lation, there  is  a 10  to  15  per  cent  deficit  in  num- 
ber of  births  necessary  to  maintain  a stationary 
population. 

These  facts  indicate,  says  Mr.  Smith,  that  the 
cities  of  the  future  will  be  dependent  for  their 
growth  to  an  increasing  extent  upon  the  people 
attracted  to  them  from  the  rural  areas. 

The  rural  nonfarm  areas,  consisting  chiefly  of 
the  smaller  villages  now  have  a 25  per  cent  sur- 
plus of  children  and  the  farm  population  has  a 
50  per  cent  surplus  above  the  number  necessary 
to  maintain  a stationary  level  of  population. 

It  is  possible,  Mr.  Smith  points  out,  that  a 
part  of  the  decrease  which  has  occurred  in  recent 
years  may  be  due  to  the  fact  that  registration  of 
births  is  somewhat  less  complete  than  it  was  in 
1929.  Lack  of  funds  has  hampered  the  work  of 
a number  of  states  in  gathering  vital  statistical 
data. 

There  has  been  an  acceleration  of  voluntary 
restriction  of  families  during  the  last  10  years, 
Mr.  Smith  believes,  due  to  the  increasing  desire 
of  the  American  population  to  maintain  a higher 
standard  of  living. 

The  most  striking  result  of  the  decline  in  the 
birth  rate  is  the  great  increase  in  the  proportion 
of  older  persons  in  the  population.  The  number 
of  people  more  than  65  years  old  increased  34 
per  cent  between  1920  and  1930. 

This  change  in  the  age  composition  will  result 
in  radically  altering  the  demands  for  industrial 
products,  he  says,  pointing  out  that  another  effect 
of  the  slowing  up  in  population  increase  will  be 
to  alter  the  production  schedules  of  manufactur- 
ing concerns.  Where  production  projects  are  now 
planned  in  expectation  of  a constant  growth  in 
the  population  they  may  have  to  be  altered  to  fit 
the  demands  of  a stationary  or  even  declining 
population. 

With  the  return  of  prosperity  and  an  in- 
crease in  the  number  of  marriages  the  birth  rate 
may  show  an  increase,  Mr.  Smith  points  out. 


The  President’s  P&ge 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


Economics  and  ethics  while  separate  fields  should  not  be  incompatible.  They  may 
easily  become  so  if  over-emphasis  is  placed  on  economics  alone. 

The  world  of  business  appears  sadly  in  need  of  higher  standards.  Apparently 
many  irregularities  have  been  practical  in  high  places,  social,  ecomic,  financial  and 
governmental.  The  duties  and  obligations  which  men  incur  should  be  scrupulously 
observed  and  laws  should  be  universal  in  application,  in  order  that  justice  and  oppor- 
tunity may  be  uniform,  in  a^  far  as  our  system  of  human  knowledge  may  permit. 

The  readiness  with  which  astute  attorneys  are  able  to  advise  their  clients  how  to 
evade  a statute  is  to  be  deplored,  for  a high  standard  of  business  ethics  should  observe 
the  spirit  as  well  as  the  letter  of  the  law.  If  medicine  were  to  be  practiced  in  a similar 
manner  there  would  be  a reason  for  much  criticism. 

Monetary  experts  are  attempting  a solution  of  many  vexatious  problems  which  now 
face  us  because  of  past  extravagances  or  worse.  It  is  not  to  the  credit  of  business  or 
government  that  contracts  are  violated  with  impunity  and  that  expediency  appears  to 
be  the  order  of  the  moment.  Apparently  the  whole  world  needs  a rededication  to  ideal- 
ism and  business  most  of  all  needs  to  learn  once  more  that  honesty  is  the  best  policy. 

Fortunate  is  the  profession  of  medicine  in  that  it  has  a code  which  we  must  pre- 
scribe and  never  before  has  it  been  so  necessary  to  follow  it.  We  physicians  are 
harassed  at  the  present  moment  by  many  problems;  none  of  them  demands  a more  press- 
ing solution  than  the  maintenance  of  economic  security  for  the  individual  practitioner. 
Have  we  not  the  right  to  insist  that  recognition  be  made  of  the  vastly  increasing  free 
service  we  render,  and  that  the  budgets  of  hospitals  and  clinics  include  compensation  to 
physicians  for  services  which  up  to  the  present  have  been  taken  too  much  for  granted? 
In  normal  times  the  physician  willingly  renders  a service  to  indigents  and  gladly  extends 
credit  or  concessions  in  lower  fees  to  those  of  his  clientele  who  are  confronted  with 
financial  problems;  but  it  is  unfair  to  expect  him  to  assume  the  staggering  load  of  “free 
service”  which  is  now  placed  on  his  shoulders  while  all  others  on  the  social  program  of 
relief  are  rewarded.  It  should  be  possible  for  ethics  and  economics  to  agree  on  this 
problem  and  solve  it  for  the  benefit  of  all. 

* * * * 

Many  economic  problems  confront  us  which  can  be  met  satisfactorily  only  through 
combined  and  united  effort.  These  and  other  serious  questions  of  the  moment  should 
be  given  consideration  by  each  component  county  unit  of  medical  organization,  taking 
into  account  the  combination  of  circumstances  peculiar  to  each  community.  It  is  hoped 
that  opportunity  may  also  be  given  of  consideration  of  such  important  questions  at  the 
annual  meeting  of  our  State  Associatioin  in  Akron  the  first  week  in  September.  Each 
member  who  can  should  make  a special  effort  to  attend. 


440 


.ems 


W orkmen's 


Finance  and  Reduction  of  Medical  and  Surgical  Fee 
Schedule^  Subject  of  Report  by  Committee  of 
The  Ohio  State  Medical  Association 


AS  ONE  feature  of  drastic  procedure  by  the 
State  Industrial  Commission,  in  order  to 
preserve  the  solvency  of  the  state  work- 
men’s compensation  fund,  a temporary  reduction 
of  20%  on  medical  and  surgical  bills  for  services 
rendered  in  workmen’s  compensation  cases  has 
been  inaugurated  retroactive  as  of  April  1,  1933. 

For  some  time  the  Industrial  Commission  has 
been  confronted  by  serious  financial  and  admin- 
istrative problems.  These  have  been  the  subject 
of  conferences  and  consideration  by  the  under- 
signed Special  Workmen’s  Compensation  Commit- 
tee of  the  State  Medical  Association,  which  has 
opposed  a reduction  in  the  medical  and  surgical 
fee  schedule,  and  instead  has  recommended  to 
the  Commission  improvement  in  administrative 
procedure  with  the  hope  that  stricter  enforcement 
and  closer  adherence  to  the  rules  and  regulations 
would  be  much  more  effective  in  saving  the  fund 
from  abuses  and  dissipation  than  would  be  a re- 
duction in  the  amount  paid  physicians  for  services 
in  such  cases. 

It  has  also  been  the  opinion  of  this  committee 
and  officers  of  the  State  Medical  Association  that 
the  Industrial  Commission  should  proceed 
promptly  and  fearlessly  against  all  those  sus- 
pected of  submitting  false  reports  and  claims.  It 
has  also  been  the  opinion  of  this  committee  that 
a reduction  in  fee  schedule  would  be  unfair,  dis- 
criminatory against  the  great  majority  of  hon- 
est and  competent  doctors,  and  would  not  elimi- 
nate the  frauds  and  abuses  by  unscrupulous  mem- 
bers of  the  profession  who  might,  in  fact,  find  in 
a reduction  in  the  fee  schedule  still  further  in- 
ducement to  pad  bills,  prolong  treatment,  and 
enter  into  collusion  with  dishonest  claimants. 

However,  the  Industrial  Commission,  while 
agreeing  that  the  recommendations  made  by  the 
State  Medical  Association  for  improvement  in 
administrative  procedure  were  all  “meritorious”, 
felt  that  even  if  they  could  be  placed  in  effect  at 
once,  they  would  not  result  in  the  necessary  and 
immediate  decrease  in  expenditures  for  medical 
services,  which  was  considered  imperative. 

FACTORS  RELATIVE  TO  REDUCTIONS 

The  State  Medical  Association’s  Workmen’s 
Compensation  Committee,  together  with  officers 
of  the  Association,  have  held  a number  of  con- 
ferences with  officials  of  the  Industrial  Commis- 
sion and  the  State  Department  of  Industrial  Re- 
lations over  recent  months,  in  an  effort  to  im- 
prove the  situation  and  avoid  radical  action. 


However,  with  continued  industrial  unemploy- 
ment, radical  reduction  in  premium  income,  in- 
crease in  the  average  cost  per  claim,  and  the  de- 
preciated value  of  securities  constituting  the  “re- 
serve” of  the  Commission,  and  with  approxi- 
mately $5,000,000  being  paid  out  annually  from 
the  workmen’s  compensation  fund  in  excess  of 
premium  income,  with  the  further  impossibility 
of  raising  premiums  on  already  over-burdened  in- 
dustry and  business  at  this  time  (an  average  pre- 
mium increase  of  17%  having  been  made  last 
year),  the  Commission,  under  date  of  May  24, 
took  formal  action  on  the  problem  of  medical 
fees. 

In  the  resolution  adopted  by  the  Commission, 
it  stated  that  the  “fees  fixed  in  the  schedule  are 
somewhat  excessive,  in  view  of  the  present  eco- 
nomic conditions  and  the  extraordinary  demands 
upon  the  state  insurance  fund,  and  that  the  medi- 
cal cost  in  many  cases  is  out  of  proportion  to  the 
compensation  allowed  to  claimants”.  The  Com- 
mission, in  its  order,  instructed  the  Medical  and 
Claims  Departments  of  the  Commission  “that 
there  be  deducted  from  all  bills  for  medical  ser- 
vices rendered  on  and  after  April  1,  1933,  after 
they  have  been  approved  as  to  amount  and  the 
necessity  for  the  service,  an  amount  equal  to 
20%  of  each  bill,  except  bills  for  initial  treat- 
ments immediately  following  an  injury  which  are 
not  in  excess  of  $3.00,  such  bills,  however,  to  be 
subject  to  approval  as  to  the  necessity  for  the 
treatment  and  the  reasonableness  of  the  charge. 
The  20%  reduction  shall  not  apply  to  bills  for 
necessary  X-ray  service  and  for  special  medical 
examinations  made  at  the  instance  of  the  Com- 
mission or  the  Medical  Department.  However, 
these  bills  are  to  undergo  approval  as  to  the  rea- 
sonableness of  the  amounts”. 

X-RAY,  CASTS  AND  SPECIAL  SERVICES 

In  a communication  from  the  Medical  Depart- 
ment of  the  Commission  under  date  of  May  31,  it 
was  stated  that  “for  the  time  being,  no  reduction 
is  being  made  on  fees  for  X-ray,  except  that 
X-rays  for  fingers  and  toes  will  be  approved  at 
$5.00.  Fees  for  all  other  X-rays  will  be  $10.00 
as  in  the  past,  with  the  exceptions  noted  below: 

Examination  of  gastro-intestinal  tract  after  in- 


gestion (or  both)  of  barium  . ..  $25.00 

Complete  skull  X-ray $15.00 

Pyelograms  ____$15.00 


Stereoscop'c  negatives — 50  per  cent  extra  when 
authorized. 


441 


442 


The  Ohio  State  Medical  Journal 


July,  1933 


Location  of  a foreign  body  in  the  eye  by  a 
Sweet  Localizer  or  its  equivalent — additional  fee 
of  $5.00. 

In  approving  bills  for  X-ray  services,  the  Medi- 
cal Department  will  consider  cervical,  dorsal  and 
lumbar  regions  of  the  spine  as  separate  parts. 
The  entire  pelvis  and  upper  one-third  of  the 
femur  will  be  considered  as  one  part.  The  wrist 
and  hand  will  be  considered  as  one  part  and 
views  in  two  directions  of  the  same  part  will  be 
considered  as  one  examination  of  the  part  and 
therefore  will  be  covered  by  one  fee. 

CASTS 

Fees  for  casts,  including  the  cost  of  materials, 
are  as  follows,  and  also  are  not  subject  to  the  20 
per  cent  cut: 

Hand,  wrist  and  one-half  of  the  forearm  5.00 


Arm,  including  elbow 10.00 

Foot,  ankle  and  lower  leg 5,00 

Entire  leg,  ankle  and  foot 15.00 

Axillae  to  trochanters. 25.00 

Lower  chest  to  trochanters 20.00 

Lower  chest  and  single  leg  spica 25.00 

Lower  chest  and  double  leg  spica 35.00 

Axillae  to  knee  or  below  (one  leg)  ... 30.00 

Axillae  to  knee  or  below  (two  legs) 40.00 


MISCELLANEOUS  OPERATIONS 
For  authorized  operations  not  listed  in  the  fee 
schedule,  the  following  fees  will  be  paid,  includ- 
ing after-care  and  first  cast,  if  a cast  is  applied 
and  are  not  subject  to  the  20  per  cent  reduction: 


Submucous  resection  1 $ 35.00 

Tonsillectomy  25.00 

Bone  graft  and  other  operations  on  spine 

or  sacro-iliacs  150.00 

Knee  joint  operations 100.00 

Arthrodesis — Tarsal  100.00 

Nephrectomy  100.00 


All  other  operations  in  proportion. 

GENERAL  RULES 

As  interpreted  by  the  Commission,  the  20% 
reduction  is  intended  to  be  temporary  during  the 
emergency  and  with  the  idea  that  there  be  little, 
if  any,  change  in  the  official  fee  schedule  as  it 
now  exists.  Physicians  are  expected  to  render 
bills  in  accordance  with  the  present  fee  schedule, 
following  which  the  Medical  Department  and 
the  Claims  Department  of  the  Commission  will 
audit  the  bills  and  issue  vouchers  with  a 20% 
reduction  of  the  bill;  such  reduction  to  be  applied 
on  all  medical  bills  with  the  following  exceptions : 

1.  All  bills  of  $3.00  or  less. 

2.  All  bills  for  services  ordered  for  special 
examinations.  The  fee  for  these  is  not  to  ex- 
ceed $15.00  net,  without  some  very  good  rea- 
son, and  if  the  charge  is  in  excess  of  $15.00, 
the  entire  bill  is  subject  to  the  20%  reduc- 
tion. $5.00  will  be  approved  for  review  of 
file  when  ordered  in  writing. 

3.  Fees  for  plaster  casts  are  to  be  net.  These 
fees  have  already  been  reduced  and  a 20% 
reduction  on  the  rates  established  then  would 
be  too  much. 

4.  The  above  paragraph  also  applies  to  the  mis- 
cellaneous operations  mentioned  in  the  sec- 
tion above,  beginning  with  ‘submucous  re- 
section’. 

5.  X-rays  are  not  subject  to  the  20%  cut.  How- 


ever, $5.00  only  is  to  be  paid  for  X-rays  of 
fingers  and  toes;  $25.00  for  complete  exam- 
ination of  the  G.  I.  tract;  $15.00  for  complete 
X-ray  of  skull  (not  less  than  two  views  in 
different  directions)  ; $15.00  for  pyelograms 
and  50%  extra  for  stereoscopic  negatives 
when  authorized. 

Cervical,  dorsal  and  lumbar  regions  of  the 
spine  are  considered  as  separate  parts  in  ap- 
proving bills  and  both  A-P  and  lateral  views 
must  be  submitted.  Entire  pelvis  and  upper 
one  third  of  the  femurs  is  considered  one 
part. 

Wrist  and  hand  considered  as  one  part. 
Views  in  two  directions  of  the  same  part  are 
considered  as  one  examination  of  the  part 
and  are  covered  by  one  fee. 

Re-examinations  according  to  rules  in  fee 
schedule. 

6.  For  minor  cuts,  bruises  and  other  slight  in- 
juries which  require  not  more  than  three  (3) 
treatments,  the  maximum  amount  allowed 
will  be  $3.00. 

OPPOSITION  PREVIOUSLY  EXPRESSED  TO  FEE 
REDUCTION 

Following  action  by  the  Council  of  the  State 
Medical  Association  on  May  7 (subsequent  to  a 
number  of  conferences  with  the  Industrial  Com- 
mission), the  Workmen’s  Compensation  Commit- 
tee submitted  a formal  report  and  communication 
to  the  Industrial  Commission,  which  was  pub- 
lished in  full  as  a part  of  a detailed  article  re- 
lating to  problems  of  workmen’s  compensation, 
published  on  pages  377  to  380,  inclusive,  of  the 
June,  1933,  issue  of  the  Ohio  State  Medical  Jour- 
nal; which  report  and  analysis  should  be  consid- 
ered a part  of  this  report. 

It  will  be  remembered  that  among  the  recom- 
mendations made  to  the  Industrial  Commission 
was  more  authority  to  be  vested  in  local  regional 
offices;  more  prompt,  accurate  and  constant 
check-up  on  prolonged,  chronic  or  revived  cases; 
fuller  information  on  the  progress  of  prolonged 
cases  to  be  made  to  employers;  closer  adherence 
by  the  Commission  and  its  Medical  Department 
to  the  rules  and  regulations  already  adopted,  es- 
pecially in  regard  to  the  requirements  for  reports 
by  physicians  and  hospitals;  prompter  action  by 
the  Commission  on  requests  for  authorization  for 
those  types  of  treatment  for  which  permission 
must  be  granted  in  advance;  provision  for  re- 
gional medical  boards  of  review  to  act  promptly 
on  chronic,  prolonged,  unusual  or  revived  cases; 
that  in  flagrant  cases  of  abuse  or  fraud  prosecu- 
tions be  undertaken  promptly;  that  a plant  be  de- 
vised whereby  there  could  be  furnished  to  the 
Medical  Department  of  the  Industrial  Commis- 
sion, confidentially,  information  on  cases  of  sus- 
pected malingering  on  all  cases  of  disability  not 
compensable  because  not  traceable  to  employ- 
ment; and  that  greater  effort  be  made  by  the 
Commission  and  its  departments  to  cooperate, 
support  and  safeguard  the  great  majority  of  hon- 
est physicians  in  their  frank  reports  to  the  Com- 
mission, especially  in  cases  where  compensation 
is  disallowed  to  claimants  on  the  basis  of  such 


July,  1933 


State  News 


443 


medical  reports.  Instances  were  cited  to  the  Com- 
mission of  unwarranted  delay  in  correspondence 
and  in  handling  claims,  weaknesses  in  procedure 
through  which  honest  physicians  were,  in  effect, 
penalized,  and  where  the  system  developed  be- 
came, in  effect,  an  inducement  to  dishonest 
physicians. 

In  the  report  to  the  Industrial  Commission 
from  this  committee,  it  was  emphasized  that  the 
present  medical  and  surgical  fee  schedule  was 
adopted  in  1920,  an  average  year,  and  that  a re- 
duction at  this  time  would  discriminate  against 
and  penalize  honest  physicians.  The  report  also 
pointed  out  to  the  Commission  that  the  rela- 
tively few  dishonest  physicians  who,  in  the  total 
number  of  cases  handled  by  them,  add  excessively 
to  medical,  hospital,  nursing  and  compensation 
costs,  would  not  abate  their  illegitimate  practices 
merely  because  of  a fee  schedule  revision  imposed 
on  all  physicians  generally.  Attention  was  also 
called  in  the  report  to  the  rapid  changes  in  the 
entire  governmental  and  monetary  situation,  with 
the  possibility  of  “cheapened  money”  through 
currency  inflation,  thus  reducing  the  value  of  the 
present  dollar.  At  that  time,  this  committee  also 
offered  to  submit  suggestions  as  an  alternative  to 
the  reduction  in  the  fee  schedule  in  case,  through 
a trial  of  the  suggestions  for  improvement  in  ad- 
ministrative procedure,  sufficient  economies  were 
not  affected. 

EMPLOYERS  ADOPT  SIMILAR  POSITION 

Realizing  that  employers,  from  whose  premi- 
ums the  workmen’s  compensation  fund  is  created 
and  maintained,  were  vitally  interested  in  policy 
and  administrative  procedure,  the  Workmen’s 
Compensation  Committee  of  the  State  Medical  As- 
sociation has  held  a number  of  conferences  with 
representatives  of  industry.  The  employers  in 
formal  communication  to  the  Industrial  Commis- 
sion, subsequent  to  the  official  report  made  by  this 
committee  to  the  Commission,  pointed  out  that 
employers  have  watched  developments  of  recent 
months  with  increasing  apprehension,  and  that 
the  causes  of  present  conditions  in  regard  to  work- 
men’s compensation  are  two-fold — statutory  and 
administrative.  Employers  have  also  pointed  out 
the  unnecessary  and  improper  burdens  upon  the 
state  insurance  fund  through  present  court  con- 
struction of  Section  1465-90,  the  appeal  statute 
in  regard  to  workmen’s  compensation  cases. 

Employers  have  also  recommended  to  the  Com- 
mission that  immediate  steps  be  taken  to  discover 
those  employers  who  are  failing  to  comply  with 
the  Workmen’s  Compensation  Law,  not  only  to 
include  an  audit  of  pay-rolls,  but  particularly  to 
discover  delinquencies  among  employers  and  busi- 
nesses which  come  within  the  terms  of  the  Work- 
men’s Compensation  Law,  but  who  have  refused 
or  neglected  to  pay  their  premiums,  thereby  in- 
creasing the  burdens  on  those  industries  who  have 
faithfully  contributed  to  the  workmen’s  compen- 
sation fund. 


In  relation  to  medical  matters  in  administra- 
tion, employers  point  out  that  it  is  of  primary 
importance  that  the  Commission’s  Medical  De- 
partment “abide  by  its  own  rules,  clamp  down 
upon  improper  cases,  consult  employers  more 
frequently,  investigate  large  medical  bills  in  the 
same  manner  in  which  claims  are  now  investi- 
gated and  dispose  of  cases  with  firmness  and 
dispatch”. 

In  a formal  communication  from  the  Ohio 
Manufacturers  ’ Association  to  the  Industrial 
Commission,  which  organization  realizes  that  ad- 
ministrative improvement  is  imperative  rather 
than  reduction  of  medical  fees,  it  was  declared 
that  “a  horizontal  cut  in  medical  fees  might  be 
a temporary  palliative  but  might  accomplish  no 
lasting  good  and  probably  would  increase  the 
present  evils.  We  are  in  accord  with  the  report 
and  recommendation  of  the  special  committee  on 
Workmen’s  Compensation  of  the  Ohio  State  Med- 
ical Association.  We  realize  that  much  depends 
upon  the  cooperation  of  honest  doctors  and  the 
ferreting  out  by  the  commission  of  dishonest  prac- 
titioners. We  believe  that  a few  initial  steps 
taken  towards  cooperation  with  honest  practi- 
tioners and  weeding  out  dishonest  ones  will  go 
far  toward  minimizing  costs,  permitting  prompt 
rehabilitation  and  preventing  collusion  and  ma- 
lingering”. 

IMPROVEMENT  IN  ADMINISTRATIVE  PROCEDURE 
REQUESTED 

On  the  question  of  disposition  of  claims,  that 
communication  from  industry  also  stated  that  “in 
general  we  are  inclined  to  believe  that  a great 
deal  of  delay  and  some  loss  may  be  avoided  by 
more  positive,  unhesitating  action  on  the  part 
of  the  commissioners  and  of  the  employes  of  the 
Department  of  Industrial  Relations.  We  believe 
that  a great  deal  of  time  is  wasted  by  the  re- 
opening of  cases,  by  postponements  and  by  the 
efforts  of  employes  of  the  commission  to  con- 
sider a number  of  cases  partially  at  one  time  in- 
stead of  considering  one  ease  wholly  at  one 
time”. 

As  to  disciplinary  measures,  the  report  from 
the  Manufacturers’  Association  states:  “We  are 

of  the  opinion  that  the  commission  now  has  ade- 
quate powers  to  deal  with  claimants,  employers, 
doctors  and  attorneys  and  that  if  these  powers 
are  used  aggressively  and  promptly  in  instances 
which  come  to  the  attention  of  the  commission, 
the  effect  will  be  salutary  and  the  necessity  for 
further  disciplinary  action  will  markedly  decrease. 
The  statutory  powers  to  punish  claimants  and 
employers  are  extremely  broad.  The  power  to 
suspend  from  practice  before  the  commission 
should  be  sufficient  to  enable  the  commission  to 
correct  abuses  in  that  respect.  The  power  of  the 
commission  to  refuse  to  pay  fees  of  doctors,  hos- 
pitals and  nurses  is  sufficient  to  enable  the  com- 
mission to  take  prompt  and  decisive  action  with 
respect  to  medical  costs.” 


444 


The  Ohio  State  Medical  Journal 


July,  1933 


In  a further  development  in  the  series  of  con- 
ferences with  manufacturers,  a suggestion  was 
made  that  the  Industrial  Commission  require  phy- 
sicians to  transmit  to  employers  for  official  signed 
endorsement,  approval  or  rejection,  the  reports 
by  physicians — itemized  fee  bill,  supplementary 
reports,  hospital  and  nurses  fee  bills — on  official 
Industrial  Commission  Forms  C-16,  C-19,  C-20, 
C-26,  and  C-84,  in  addition  to  such  approval  and 
endorsement  now  required  on  C-3  (medical  only) 
cases. 

Believing  that  unnecessary  delays  and  misun- 
derstandings might  be  created  by  the  inaugura- 
tion of  such  a system,  this  committee  made  the 
alternative  suggestion,  already  approved  by  the 
Ohio  Manufacturers’  Association  for  recommen- 
dation to  the  Industrial  Commission,  that  con- 
densed post  card  reports  be  immediately  sent  by 
the  Industrial  Commission  to  employers  upon  re- 
ceipt of  the  various  report  forms  from  physi- 
cians, in  order  that  employers  might  be  promptly 
and  constantly  informed  of  the  progress  of  work- 
men’s compensation  cases  among  their  employes. 

HOPE  FOR  EARLY  ACTION 

While  this  committee  regrets  that  because  of 
serious  financial  complications  the  Industrial 
Commission  feels  it  necessary,  even  as  a tem- 
porary measure,  to  reduce  medical  and  surgical 
fee  bills  on  the  average  of  20%,  we  realize  that 
the  Industrial  Commission  has  full  legal  author- 
ity for  such  procedure,  and  we  are  also  aware 
of  and  sympathetic  to  the  Commission  in  the  im- 
mense and  unprecedented  complications  with 
which  it  is  now  confronted.  We  hope  that  the 
reduction  from  the  medical  fee  schedule  may  be 
rescinded  in  the  near  future,  and  in  the  mean- 
time we  urge,  as  we  have  frequently  in  the  past, 
that  physicians  generally  cooperate  fully  with 
the  Commission  and  with  all  others  earnestly  and 
constructively  concerned  with  workmen’s  compen- 
sation administration. 

We  are,  of  course,  hopeful  and  expectant  that 
some  of  the  practical  and  constructive  suggestions 
made  by  the  Ohio  State  Medical  Association  and 
the  Ohio  Manufacturers’  Association  to  the  In- 
dustrial Commission  may  be  promptly  in- 
augurated. 

As  indicated,  this  report  is  made  to  the  mem- 
bership of  the  Ohio  State  Medical  Association, 
and  may,  if  the  House  of  Delegates  deems  it  of 
official  importance,  be  considered  by  that  body 
at  the  forthcoming  annual  meeting. 

Signed : 

Special  Workmen’s  Compensation  Com- 
mittee, Ohio  State  Medical  Association. 
Geo.  Edw.  Follansbee,  M.D.,  Chairman. 
John  A.  Caldwell,  M.D. 

B.  J.  Hein,  M.D. 

H.  M.  Platter,  M.D.,  President. 

Don  K.  Martin,  Executive  Secretary. 


Championship  Portage  Club  Layout  To  Be 
Scene  of  State  Medical  Golf  Meet, 

On  Wednesday,  September  6 

The  Golf  Committee  of  the  Summit  County 
Medical  Society,  headed  by  Dr.  J.  L.  McEvitt,  is 
rapidly  completing  plans  for  the  annual  tourna- 
ment of  the  Ohio  State  Medical  Golfers’  Asso- 
ciation to  be  held  on  Wednesday,  September  6, 
the  day  preceding  the  opening  of  the  87th  Annual 
Meeting  of  the  Ohio  State  Medical  Association 
in  Akron. 

As  previously  announced  the  golf  event  will 
be  held  at  the  Portage  Country  Club,  one  of  the 
best  courses  in  the  state  and  a championship 
layout  in  every  particular.  The  club  is  located 
inside  the  city  limits,  about  an  eight-minute  ride 
from  the  center  of  Akron.  To  reach  the  course, 
motorists  should  go  out  West  Market  Street  to 
North  Portage  Path  and  turn  north  (right).  The 
club  is  located  on  the  left  side  of  Portage  Road 
about  three  blocks  from  Market  Street. 

Present  plans  contemplate  having  the  first 
foursome  tee  off  at  8:30  A.M.  so  as  to  leave 
plenty  of  time  for  the  celebration  in  the  evening 
when  the  prizes  will  be  distributed. 

The  playing  fee  has  not  been  fixed  as  yet  but 
the  committee  has  announced  that  it  will  be  lower 
than  for  any  tournament  ever  staged  by  the 
golfers’  organization.  However,  the  committee 
believes  that  the  prize  list  will  be  the  finest  ever 
offered. 

Those  who  have  participated  in  any  of  the 
past  tournaments  are  life  members  of  the  golfers’ 
association  and  will  not  have  to  pay  a member- 
ship fee.  Those  who  have  not  played  in  previous 
years  will  be  assessed  $2.00.  The  fee  can  be  sent 
at  any  time  to  Dr.  John  B.  Morgan,  Medical  Arts 
Building,  Cleveland,  secretary  of  the  golfers’ 
association,  or  it  can  be  paid  at  No.  1 tee  on  the 
morning  of  the  tournament. 

It  is  understood  that  several  cities  are  plan- 
ning to  send  their  strongest  teams  to  the  Akron 
tournament  in  an  effort  to  take  the  team  cham- 
pionship cup  away  from  the  Akron  golfers  who 
won  it  last  year  at  Dayton. 


The  board  of  directors  of  the  Cleveland  Acad- 
emy of  Medicine,  upon  recommendation  of  the 
Academy’s  Committee  on  Economics,  has  de- 
clared the  plan  of  operation  of  Friendship  Hos- 
pital by  including-  professional  services  in  its 
insurance  plan  unethical  and  against  sound  pub- 
lic policy  for  the  following  reasons:  There  is  soli- 
citation of  patients;  the  annual  fee  of  $33  per 
family  out  of  which  only  $2.80  is  paid  for  pro- 
fessional care  is  insufficient  to  furnish  adequate 
service  to  the  patients;  the  hospital  is  injecting 
unfair  competition  into  the  practice  of  medicine; 
the  control  of  the  medical  staff  interposes  a lay 
body  between  patient  and  physician. 


Akron  Committees  Busy  Completing  Arrangements  for 
Entertaining  State  Association  on  September  7 and  8 ^ 
Tentative  Program  for  Clinics  and  Scientific 
Exbibits  Announced 


Preliminary  arrangements  for  entertaining-  the 
medical  profession  of  the  state  at  the  87th  An- 
nual Meeting  of  the  Ohio  State  Medical  Associa- 
tion on  Thursday  and  Friday,  September  7 and 
8,  in  Akron,  are  rapidly  taking  shape  under  the 
well-organized  committees  of  the  Summit  County 
Medical  Society. 

Last  Spring  when  it  was  found  advisable  to 
delay  holding  the  Annual  Meeting  until  Fall,  the 
Akron  committees  in  charge  of  local  arrange- 
ments were  fully  organized  and  functioning. 
These  committees  have  been  kept  intact  during 
the  summer  and  have  had  an  additional  oppor- 
tunity to  prepare  and  complete  their  plans  for 
making  the  Akron  meeting  one  of  the  best  ever 
held  by  the  State  Association. 

Under  the  direction  of  an  Executive  Committee, 
composed  of  Dr.  E.  A.  Weeks,  general  chairman; 
Dr.  J.  H.  Selby  of  the  Summit  County  Medical 
Society,  and  Dr.  H.  S.  Davidson,  councilor  of  the 
Sixth  District  and  chairman  of  the  Council  Com- 
mittee on  Arrangements,  the  Akron  committees 
have  gone  ahead  with  their  preparations  and  are 
now  awaiting  the  time  when  they  can  extend  the 
hospitality  of  the  Akron  profession  and  the  Rub- 
ber City  to  their  medical  colleagues  throughout 
the  state. 

The  personnel  of  the  various  local  committees 
follows : 

Registration  and  Information — E.  A.  Freeman, 
Chairman,  M.  D.  Ailes,  H.  R.  Baremore,  R.  S. 
Friedley,  J.  G.  Gage,  R.  F.  Jolley,  A.  W.  Jones, 
C.  H.  Kent. 

Halls  and  Meeting  Places — R.  E.  Amos,  Chair- 
man, G.  E.  Black,  M.  B.  Crafts,  H.  E.  Groom, 
G.  M.  Logan,  W.  D.  Lyon,  G.  K.  Parke,  R.  E. 
Pinkerton,  U.  D.  Seidel. 

Commercial  Exhibits — C.  H.  Franks,  Chairman, 
C.  R.  Anderson,  0.  J.  Chaney,  M.  G.  Gibans,  W. 
L.  Hogue. 

Scientific  Exhibits — P.  A.  Davis,  Chairman, 
R.  T.  Allison,  A.  E.  Davis,  P.  C.  Langan,  R.  H. 
Markwith,  A.  P.  Ormond,  A.  S.  Robinson,  E.  L. 
Saylor,  F.  A.  Smith. 

Projection  Apparatus — G.  A.  Ferguson,  Chair- 
man, H.  E.  Bliss,  M.  F.  Bossart,  R.  A.  Breckin- 
ridge, P.  C.  Doran,  K.  H.  Harrington,  I.  L. 
Houghton,  V.  C.  Malloy,  T.  J.  Murphy,  J.  P.  Sau- 
vageoit,  R.  P.  Vivian. 

Reception — J.  G.  Blower,  Chairman,  L.  L.  Botts- 
ford,  L.  E.  Brown,  G.  M.  Campbell,  H.  I.  Cozad, 
R.  F.  Drury,  E.  B.  Dyson,  L.  C.  Eberhard,  G.  E. 
Gardner,  C.  E.  Held,  Carrie  A.  Herring,  C.  T. 


Hill,  T.  D.  Hollingsworth,  W.  McK.  Johnston, 

B.  E.  Miller,  D.  H.  Morgan,  A.  S.  McCormick, 
S.  E.  McMaster,  J.  H.  Seiler,  J.  R.  Shoemaker, 
H.  L.  Smallman,  A.  H.  Stall,  E.  R.  Stumpf,  R.  F. 
Thaw,  M.  C.  Tuholske,  R.  G.  Werner,  L.  A.  Witze- 
man,  S.  St.  J.  Wright. 

Entertainment — J.  S.  Millard,  Chairman,  D.  C. 
Brennan,  B.  H.  Gillespie,  W.  McD.  Johnston,  J.  G. 
Kramer,  R.  V.  Luce,  T.  K.  Moore,  S.  Morgenroth, 
R.  G.  Pearce,  J.  E.  Springer,  Eliz.  M.  Weaver, 
J.  N.  Weller. 

Banquet — J.  H.  Weber,  Chairman,  E.  C. 
Banker,  R.  Barnwell,  R.  H.  Cather,  S.  B.  Conger, 
H.  R.  Conn,  C.  E.  Jelm,  A.  A.  Kohler,  J.  G.  Lem- 
mon, J.  E.  Monnig,  D.  M.  McDonald,  J.  L.  Mc- 
Evitt,  G.  K.  Parke,  W.  A.  Parks,  M.  J.  Pierson, 
F.  C.  Potter,  H.  V.  Sharp,  J.  D.  Smith,  G.  R. 
Taylor,  J.  M.  Ulrich,  C.  E.  Updegraff. 

Hospital  Clinics — W.  A.  Hoyt,  Chairman,  J.  G. 
Blower,  C .L.  Hyde,  D.  B.  Lowe,  H.  H.  Musser, 
F.  B.  Roberts. 

Publicity — C.  C.  Pinkerton,  Chairman,  W.  S. 
Chase,  C.  M.  Clark,  H.  J.  Gordon,  R.  H.  Mark- 
with, F.  E.  Read,  C.  R.  Steinke. 

^ 

Under  the  direction  of  Dr.  W.  A.  Hoyt  and  his 
committee  on  Hospital  Clinics,  the  following  ten- 
tative program  of  clinics  to  be  held  Wednesday 
morning  and  afternoon,  September  6,  has  been 
arranged. 

AKRON  CITY  HOSPITAL 

Medicine — Drs.  R.  E.  Pinkerton,  F.  A.  Smith, 
J.  N.  Weller. 

Surgery — Drs.  L.  C.  Eberhard,  C.  C.  Pinker- 
ton, C.  R.  Steinke  and  J.  H.  Weber. 

Orthopedics — Drs.  H.  R.  Conn,  W.  A.  Hoys, 
R.  V.  Luce  and  W.  A.  Parks. 

Eye,  Ear,  Nose  and  Throat — Drs.  L.  E.  Brown, 

C.  M.  Clark,  F.  H.  Cook,  M.  J.  Pierson  and  L. 
A.  Witzeman. 

Obstetrics — Drs.  R.  Barnwell,  S.  B.  Conger, 
J.  L.  McEvitt  and  R.  G.  Werner. 

Urology — Dr.  C.  E.  Jelm. 

Pathology — Dr.  E.  L.  Saylor. 

children’s  hospital 

Surgery — Drs.  H.  H.  Musser,  C.  C.  Pinkerton, 
J.  D.  Smith. 

Medicine — Drs.  R.  S.  Friedley,  J.  G.  Kramer, 
N.  Miller,  J.  M.  Ulrich  and  K.  D.  Way. 

Eye,  Ear,  Nose  and  Throat — Drs.  U.  D.  Seidel 
and  R.  F.  Thaw. 


445 


446 


The  Ohio  State  Medical  Journal 


July,  1933 


Orthopedics — Drs.  W.  A.  Hoyt  and  F.  D. 
Roberts. 

PEOPLES  HOSPITAL 

Surgery — Drs.  J.  G.  Blower,  B.  H.  Hildreth, 
R.  H.  McKay,  J.  D.  Smith,  and  associates. 

Medicine — Drs.  E.  B.  Dyson,  C.  E.  Held,  J.  C. 
McClelland,  S.  E.  McMaster,  and  associates. 
Genito-urinary — Dr.  S.  Miller. 

Proctology — Dr.  K.  H.  Harrington. 

Eye,  Ear,  Nose  and  Throat — Drs.  R.  C.  Ander- 
son, C.  M.  Clark,  D.  Pond,  J.  R.  Shoemaker,  J.  E. 
Springer  and  L.  A.  Witzeman. 

Obstetrics — Dr.  L.  L.  Bottsford  and  associates. 
Pathology— Dr.  F.  C.  Potter. 

Roentgenology — Dr.  E.  L.  Voke. 

SPRINGFIELD  LAKE  SANATORIUM 
Medicine — Drs.  T.  L.  Bliss,  C.  L.  Hyde  and 
J.  T.  Villani. 

Surgery — Drs.  W.  A.  Hoyt  and  C.  R.  Steinke. 
ST.  THOMAS  HOSPITAL 

Medicine — Drs.  J.  E.  Monning,  S.  Morgenroth 
and  F.  A.  Smith. 

Surgery — Drs.  E.  C.  Banker,  H.  H.  Musser  and 
C.  R.  Steinke. 

Eye,  Ear,  Nose  and  Throat — Drs.  J.  E.  Shoe- 


maker and  L.  A.  Witzeman. 

Roentgenology — Dr.  P.  C.  Langan. 

* * * 

One  of  the  features  of  the  Akron  meeting  will 
be  the  Scientific  Exhibit  being  arranged  by  Dr. 
P.  A.  Davis  and  his  committee  (named  in  the 
above  list  of  local  committees).  To  date  the  com- 
mittee has  arranged  for  the  following  Scientific 
Exhibits : 

1.  “Intestinal  Obstruction”,  Dr.  Harry  Gold- 
blatt  and  associates,  Cleveland. 

2.  “Lung  Abscess  and  Gangrene”,  Dr.  B.  S. 
Kline  and  associates,  Mt.  Sinai  Hospital,  Cleve- 
land. 

3.  “Dermatological  Exhibit”,  Dr.  H.  N.  Cole 
and  Dr.  J.  R.  Driver,  Cleveland. 

4.  “Some  Phases  of  Tubercular  Work”,  Dr. 
C.  L.  Hyde,  Spring-field  Lake  Sanatorium,  Akron. 

5.  “Radiological  Exhibit”,  Cleveland  Radio- 
logical Society. 

6.  “Complete  Filtration  Plant  in  Operation”, 
F.  L.  Rollins,  Barberton. 

7.  “Glucose  Tolerance”,  Dr.  F.  A.  Smith, 
Akron. 

8.  “Blood  Studies  in  Anemias”,  the  Cleveland 
Clinic. 


Hotel  Reservations  Should  Be  Made  Soon  For  the  1933 
Annual  Meeting  in  Akro%  September  7 and  8 


Members  of  the  State  Association  should  in  the 
near  future  make  their  hotel  reservations  for  the 
87th  Annual  Meeting  to  be  held  in  Akron,  Thurs- 
day and  Friday,  September  7 and  8.  The  Golf 
Tournament  will  be  held  on  Wednesday,  Septem- 
ber 6. 

Requests  for  rooms  should  be  made  direct  to 
the  management  of  the  hotel  selected,  accom- 
panied by  a request  for  verification  of  the  reserva- 
tion. 

For  the  information  of  those  who  have  not  as 
yet  made  hotel  reservations,  The  Journal  herewith 
publishes  a list  of  Akron  hotels,  their  rates  and 
conveniences : 

THE  MAYFLOWER 
Headquarters  Hotel 
Main  and  State  Streets 

450  rooms,  all  with  bath;  single  room,  $2.50  to 
$4.50;  room  with  double  bed,  $3.50  to  $6.00;  room 
with  twin  beds,  $5.50  to  $6.50;  suites  $10.00, 
$12.00  to  $21.00. 

THE  PORTAGE 
Main  and  Market  Streets 

320  rooms;  59  rooms  with  lavatory  and  toilet, 
$1.50  single;  $2.50  double;  85  rooms  with  lavatory 
and  toilet,  single,  $2.00,  double,  $3.00;  30  rooms 

with  bath,  $2.00  single,  $3.00  double;  65  rooms 

with  bath,  $2.50  single,  $3.50  double;  49  rooms 

with  bath,  $3.00  single,  $4.00  double;  12  rooms 

with  bath  and  twin  beds,  $4.00;  14  rooms  with 


bath  and  twin  beds,  $4.50. 

THE  ANTHONY  WAYNE 
314  South  Main  Street 

150  rooms;  single  room  with  bath,  $2.00  to 
$2.50;  double,  $3.00  to  $3.50. 

THE  AKRON 

East  Market  Street  and  Broadway 

200  rooms;  single  room  with  bath,  $2.50  to 
$3.00;  double  room  with  bath,  $3.50  and  $4.00; 
room  with  bath  and  twin  beds,  $4.00;  two-room 
suites  with  connecting  bath,  $2.00  per  room. 

THE  HOWE 
11  South  Main  Street 

175  rooms;  single  room  with  bath,  $1.50  to 
$2.50;  double  room  with  bath,  $3.00  to  $3.50; 
single  room  without  bath,  $1.00  to  $1.25;  double 
room  without  bath,  $2.00. 

THE  MARNE 

South  Main  Street  near  State  Street 

175  rooms;  single  room  with  connecting  shower, 
$1.50;  double  room  with  connecting  shower,  $2.00; 
single  room  with  tub  bath,  $2.50;  double  room 
with  tub  bath,  $3.00. 

THE  TAYLOR 
85  East  Market  Street 

185  rooms;  35  rooms  with  bath,  $1.50;  35  rooms 
with  bath  and  radio,  $2.00;  15  rooms  with  twin 
beds  and  bath,  $3.50  to  $4.00;  100  rooms  with 
running  water,  $1.00  to  $2.00. 


Hectic  and  Colorful  Session  of  Ohio  Legislature  Established 
Various  ^Records^  but  It  Properly  Refrained  From 
Damaging  Present  Health  and  Medical  Statutes 


LABELED  by  many  as  one  of  the  most  tur- 
bulent sessions  ever  held  by  the  State  Leg- 
islature, the  regular  session  of  the  90th 
Ohio  General  Assembly  was  nearing  its  close  as 
this  issue  of  The  Journal  went  to  press. 

Deadlocked  almost  from  the  beginning  by  con- 
troversies and  unprecedented  maneuvering  on  the 
part  of  numerous  small  but  persistent  blocs  in- 
terested in  legislation  of  minor  importance,  the 
General  Assembly,  during  the  first  five  months  of 
its  session  made  comparatively  little  progress 
toward  a solution  of  the  major  and  important 
problems  confronting  it,  such  as  taxation,  finance, 
unemployment,  poor  relief,  schools,  etc. 

After  numerous  bitter  clashes  between  con- 
flicting forces  on  the  taxation  and  school  pro- 
grams and  constant  log-rolling  among  special- 
interest  groups  and  those  with  special  axes  to 
grind,  the  General  Assembly  three  weeks  ago  by 
joint  resolution  “killed  off”  the  genei’al  run-of- 
mine  legislation  still  pending  and  settled  down 
in  a concentrated  effort  to  meet  the  serious  finan- 
cial and  relief  problems  confronting  the  state  and 
local  subdivisions. 

The  temper  of  the  Legislature  was  revealed  to 
a marked  degree  during  the  week  preceding  the 
deadline  for  enactment  of  general  legislation.  The 
final  rush  for  the  passage  of  pending  proposals, 
most  of  which  were  of  minor  or  purely  local  im- 
portance, was  the  most  hectic  staged  at  the  Capi- 
tol for  many  years.  Terrific,  high-pressure 
methods  were  resorted  to  by  those  backing  con- 
troversial proposals,  adding  to  the  uncertainty 
and  confusion.  Unnecessary  and  even  undesir- 
able measures  which  were  thought  to  have  been 
buried  in  committees  were  hastily  resurrected 
through  pressure  and  manipulation  on  the  part 
■of  their  supporters  and  placed  before  the  As- 
sembly for  consideration.  Some  of  the  old 
"wheezes  and  chestnuts  which  previous  Ohio  Leg- 
islatures had  seen  fit  to  defeat  and  a variety  of 
new  faddish  and  silly  proposals  were  included  in 
the  measures  passed  during  the  bill  passing  orgy 
immediately  preceding  the  general  legislation 
deadline. 

As  anticipated,  cultists  and  those  with  anti- 
medical and  anti-health  complexes  joined  in  the 
drive  to  get  their  destructive  proposals  away  from 
committees  where  they  had  been  side-tracked. 

In  the  face  of  severe  pressure,  importunities 
and  demands,  however,  most  of  the  members  of 
the  Legislature  stood  firm  and  refused  to  be  mis- 
led into  support  for  measures  which  would  have 
been  destructive  to  the  present  medical,  health 
and  welfare  statutes.  No  measures  inimical  to 


public  health  and  sound  medical  practice  were 
enacted,  in  spite  of  the  numerous  proposals  to 
amend  or  cripple  the  health  statutes  and  medi- 
cal practice  act,  despite  the  insidious  propaganda 
and  desperate  efforts  of  groups  unfriendly  to  the 
present  health  and  medical  laws. 

In  general,  comparatively  little  damage  was 
actually  done  through  legislative  action.  Fan- 
tastic results  occurred  in  some  instances  and  a 
crusading  spirit  on  the  part  of  some  members  of 
the  General  Assembly  furnished  considerable  mo- 
mentum for  an  unprecedented  number  of  ultra- 
modern and  socially  experimental  proposals. 
With  few  exceptions,  the  results  so  far  have  been 
sane  and  most  of  the  questionable  measures 
enacted  might  logically  be  classified  as  unneces- 
sary and  silly,  rather  than  definitely  destructive 
and  harmful. 

Although  it  started  out  with  the  laudable  in- 
tention of  keeping  legislation  at  a minimum  and 
of  considering  only  questions  of  major  impor- 
tance, the  present  Legislature  deviated  consider- 
ably from  this  course  before  the  “killing  off” 
stage  was  reached.  Approximately  1100  meas- 
ures of  every  variety  and  vintage  were  cast  into 
the  legislative  hopper.  Up  to  the  time  of  the 
deadline  for  general  legislation,  171  proposals 
had  been  enacted. 

In  all,  the  Policy  Committee  and  headquarters 
office  of  the  State  Medical  Association  followed 
closely  almost  100  measures  which  had  medical 
or  health  angles. 

CHANGES  MADE  IN  GARNISHMENT  LAW 

One  of  the  major  pieces  of  legislation  enacted 
so  far  is  an  emergency  measure  (House  Bill 
No.  51)  amending  and  recodifying  the  statutes 
relating  to  garnishment  and  attachment.  Being 
an  emergency  proposal  it  went  into  effect  imme- 
diately. 

This  proposal,  which  had  the  strong  support 
of  the  Administration,  undoubtedly  was  accorded 
greater  and  more  thorough  consideration  both  in 
committee  and  on  the  floor  of  the  Assembly 
than  almost  any  other  single  piece  of  legisla- 
tion, with  the  exception  of  matters  relating  to 
finance,  taxation,  schools,  etc. 

Strong  sentiment  in  favor  of  radical  revision 
of  the  laws  pertaining  to  garnishment  and  at- 
tachment developed  early  in  the  session.  Those 
favoring  such  action  based  their  contention  on  the 
fact  that  abuses  on  the  part  of  “gyp”  merchants 
and  shady  collection  agencies  have  been  increas- 
ing rapidly;  that  investigations  have  shown  in 
many  instances  where  garnishment  actions  have 
been  filed  against  persons  receiving  work  relief 


447 


448 


The  Ohio  State  Medical  Journal 


financed  by  poor  relief  funds,  and  that  an  over- 
abundance of  credit  was  being-  extended  to  low- 
wag-e  earners  for  the  purchase  of  luxuries  and 
non-essentials  because  of  the  liberal  safeguards 
given  such  creditors  in  the  old  garnishment  stat- 
utes. In  fact,  there  was  considerable  sentiment 
in  favor  of  repeal  of  the  garnishment  provisions 
entirely  in  this  state. 

Confronted  with  this  possibility  and  on  the 
other  hand  with  the  probability  of  the  enactment 
of  a measure  which  would  have  worked  an  ex- 
treme hardship  on  creditors  and  prevented  the 
extension  of  credit  almost  entirely  to  small  wage 
earners,  representatives  of  groups  interested  in 
preserving  the  garnishment  system  cooperated 
with  committees  of  the  Legislature  in  working 
out  a compromise  measure  which  makes  a num- 
ber of  important  changes  in  the  old  garnishment 
statutes  but  which  provides  protection  for  both 
creditors  and  debtors,  especially  creditors  who 
supply  “necessaries”  and  debtors  who  find  them- 
selves confronted  with  unanticipated  financial 
difficulties. 

The  major  provisions  of  the  new  garnishment 
law  are  as  follows: 

1.  “Work,  labor  or  necessaries”  shall  be  one  of 
the  specific  grounds  for  attachment  (which  in- 
clude medical  services)  as  provided  in  the  old  law. 

2.  Every  single  person  shall  be  entitled  to  a flat 
exemption  of  $30  on  wages  or  earnings  for  the 
period  of  30  days  preceding  the  attachment  action. 

3.  The  head  of  family  shall  he  entitled  to  an 
exemption  of  80%  of  the  first  $200  of  his  wages 
or  earnings  during  such  30-day  period  and  60% 
of  the  balance  of  his  earnings,  but  in  no  case  shall 
the  exemption  be  less  than  $60.  It  was  contended 
by  some  interested  in  the  measure  that  there 
should  be  no  exemptions  from  garnishment  for 
“necessaries”.  Proponents  of  the  bill,  however, 
insisted  on  some  type  of  flat  exemption,  pointing 
out  that  exempted  income  undoubtedly  would  be 
used  largely  for  “necessaries”  anyway. 

4.  Costs  of  attachment  proceedings  shall  be 
taken  out  of  the  unexempted  portion  of  the  earn- 
ings of  the  defendant  debtor. 

5.  Establishes  a trusteeship  arrangement 
which  permits  any  debtor  to  apply  to  a munici- 
pal or  justice  of  peace  court  for  a trustee  to -whom 
he  may  turn  over  his  unexempted  earnings  for 
distribution  among  his  creditors  without  cost  to 
him.  This  provision  is  regarded  by  proponents 
of  the  measure  as  one  of  the  most  important 
changes  in  the  garnishment  system  since  it  pre- 
vents the  filing  of  numerous  separate  attachment 
actions  against  a single  debtor,  thus  reducing  ma- 
terially the  costs,  a factor  beneficial  both  to  the 
debtor  and  the  creditors. 

6.  Provides  chattel  loan  creditors  may  exercise 
a lien  against  merchandise  included  in  the  classi- 
fication of  “necessaries”  or  may  participate  in 
the  trusteeship  arrangement  but  are  enjoined 
from  using  both  means  of  collecting  their  debts. 


July,  1933 

7.  Provides  that  under  the  trusteeship  arrange- 
ment, claims  for  “work,  labor  or  necessaries” 
shall  be  given  preference  over  claims  for  non- 
essentials  and  that  twice  as  much  shall  be  dis- 
tributed to  creditors  of  work,  labor  or  neces- 
saries as  to  other  unsecured  creditors. 

8.  Establishes  a moratorium  on  wage  assign- 
ments until  April  1,  1933. 

MEDICINAL  LIQUOR  LEGISLATION 

On  June  14,  the  Smolka-McNamee  Act  relat- 
ing to  the  prescribing  of  medicinal  liquor  in  Ohio, 
enacted  by  the  Legislature  in  March,  became 
effective. 

Under  the  provisions  of  the  Smolka-McNamee 
Act  which  amends  Section  6212-15  of  the  Gen- 
eral Code  of  Ohio,  the  Grabbe  Act,  by  striking 
out  the  quantitative  limitation  on  the  amount  of 
medicinal  liquor  which  might  be  prescribed,  me- 
dicinal liquor  may  be  prescribed  in  Ohio  in  an 
amount  “now  permitted  by  federal  statutes  and 
regulations”. 

As  pointed  out  in  the  May  and  June  issues  of 
The  Journal,  this  piece  of  legislation  has  been 
the  source  of  considerable  controversy  because 
of  the  different  interpretations  placed  upon  the 
word  “now”  due  to  changes  which  were  made  in 
the  Federal  regulations  pertaining  to  medicinal 
liquor  since  the  enactment  of  the  measure. 

At  the  time  the  bill  was  signed  by  the  Governor 
(March  15),  the  Federal  statutes  provided  that 
the  quantitative  limitation  was  one  pint  in  any 
period  of  10  days.  On  March  31,  Congress  elim- 
inated from  the  Federal  law  any  reference  to 
quantitative  limitation.  On  May  15,  new  Federal 
regulations  governing  medicinal  liquor  went  into 
effect,  leaving  to  the  judgment  of  the  physician 
the  amount  of  medicinal  liquor  which  should  be 
prescribed  to  meet  the  medicinal  needs  of  the 
individual  patient. 

The  legal  controversy  which  developed  over  the 
Smolka-McNamee  Act  hinged  on  whether  the  act 
removes  all  quantitative  limitation  on  the  amount 
of  medicinal  liquor  which  may  be  prescribed  in 
Ohio  or  whether  it  limits  individual  prescriptions 
to  one  pint,  the  limitation  which  was  provided 
in  the  Federal  statutes  at  the  time  the  Ohio  meas- 
ure was  enacted. 

In  an  effort  to  settle  this  controversy  and 
clarify  the  meaning  and  intent  of  the  Smolka- 
McNamee  Act,  a bill  was  introduced  the  last  week 
before  the  postponement  of  general  legislation, 
eliminating  the  word  “now”  from  the  Smolka- 
McNamee  Act.  The  measure  passed  the  Senate 
by  a comfortable  majority  and  got  onto  the  House 
general  calendar.  However,  in  the  last  minute 
jam  it  failed  to  get  onto  the  House  “jitney”  cal- 
endar and  did  not  get  before  the  House  for  final 
action  before  the  general  legislation  deadline. 

Although  legal  opinions  differ  on  the  provisions 
of  the  Smolka-McNamee  Act,  its  sponsors  still 
feel  that  the  courts  wifi  probably  hold  that  the 


July,  1933 


State  News 


449 


act  does  conform  to  the  Federal  regulations  and 
that  Ohio  physicians  will  be  permitted  to  proceed 
in  accordance  with  the  provisions  of  the  Federal 
regulations. 

HOSPITAL  BILL  IS  ENACTED 

A bill  sponsored  and  supported  by  the  Ohio 
Hospital  Association  providing  for  reimburse- 
ment of  hospitals,  organized  not  for  profit,  for 
services  rendered  to  indigents  injured  in  automo- 
bile accidents  from  the  Highway  Maintenance 
and  Repair  Fund,  derived  from  a percentage  of 
automobile  license  tag  fees,  made  the  final  hurdle 
in  the  closing  moments  before  the  deadline  for 
general  legislation. 

As  amended  on  the  floor  at  the  request  of  the 
Governor,  the  provisions  of  the  measure  are  lim- 
ited in  operation  and  effect  to  March  1,  1935.  It 
carried  no  emergency  clause  and  will  not  become 
effective  until  some  time  in  September. 

There  was  apparently  little  opposition  to  the 
bill  because  of  the  general  sentiment  prevalent 
in  support  of  all  “poor  relief”  legislation.  How- 
ever, it  is  understood  that  some  members  of  the 
Legislature  were  hesitant  about  approving  the 
proposal  because  of  the  fundamental  policy  of 
providing  compensation  for  one  type  of  injury 
from  a specific  state  fund  designated  for  other 
purposes.  Moreover,  some  of  the  groups  inter- 
ested in  highway  and  road-building  funds  are 
understood  to  have  raised  questions  as  to  its  con- 
stitutionality and  intimated  that  it  may  be  tested 
in  the  courts. 

STRONG  SUPPORT  FOR  WELFARE  PROPOSALS 

Reacting  to  the  serious  results  of  the  pro- 
longed economic  disturbance  and  of  the  social 
upheaval  which  has  been  taking  place,  the  Leg- 
islature gave  a sympathetic  ear  to  the  demands 
of  sponsors  of  so-called  humanitarian  and  social 
welfare  legislation,  involving  modification  of  the 
traditional  theory  that  the  role  of  government 
in  business  and  in  private  affairs  should  be  minor 
and  only  supervisory  in  nature. 

Proponents  of  social  legislation  succeeded  in 
promoting  their  legislation  to  a further  point  this 
session  than  ever  before.  The  minimum  wage 
bill,  establishing  a state  commission  under  the 
Director  of  Industrial  Relations,  to  set  up  sched- 
ules of  wages  in  various  industries,  was  enacted 
shortly  before  the  deadline  at  the  insistence  of 
the  Governor.  The  unemployment  insurance  and 
old  age  pensions  proposals  failed  of  enactment  up 
to  the  time  this  was  written,  but  were  advanced 
much  further  than  at  any  previous  session  of  the 
Ohio  Legislature.  Numerous  measures  providing 
for  drastic  changes  in  state  and  local  systems  of 
welfare  administration  were  introduced  and  given 
prolonged  consideration,  but  none  was  enacted. 
Early  in  the  session,  a joint  resolution  ratifying 
the  child  labor  amendment  to  the  U.  S.  Consti- 
tution was  adopted,  climaxing  a battle  of  years 
.standing  to  Rave  Ohio  lined  up  with  the  small 


group  of  states  which  has  approved  this  program. 

Persistent  efforts  to  provide  new  laws  regu- 
lating motor  vehicles  and  promote  safer  driving 
failed  to  bring  about  enactment  of  a drivers’  li- 
cense law  and  the  drivers’  financial  responsibility 
law.  However,  it  is  quite  possible  that  at  least 
one,  if  not  both,  of  these  measures  would  have 
been  enacted  had  the  majority  of  the  legislators 
not  felt  that  now  was  no  time  to  increase  the 
financial  burden  of  the  public. 

MORE  BOARDS  AND  GREATER  SUPERVISION  PROVIDED 

The  90th  General  Assembly  probably  estab- 
lished a record  for  itself  in  the  matter  of  creating 
new  boards,  commissions,  and  licensing  bodies. 
Seven  such  governmental  agencies  were  estab- 
lished. They  include  the  now  famous  and  much 
discussed  beer  commission ; the  milk  commission 
to  stabilize  the  milk  industry  and  regulate  milk 
prices;  the  state  employes’  retirement  system 
board;  the  engineers  and  surveyors  examining 
and  licensing  board;  the  horse  racing  commission; 
the  funeral  directors’  and  embalmers’  licensing 
board;  the  board  to  examine  and  license  cosmeto- 
logists, and  the  barbers’  examining  and  licensing 
board. 

The  cosmetology  and  barbers’  licensing  bills  re- 
ceived some  support  because  of  the  insistence  by 
their  promoters  that  they  were  “public  health” 
measures.  Both  measures  were  amended  (at  the 
demand  of  public  health  authorities  and  medical 
organization)  to  “cure”  them  of  medical  and 
health  objections  and  to  make  certain  that  they 
would  not  permit  those  artisans  to  intnide  into 
the  practice  of  medicine.  Enactment  of  these  two 
proposals,  according  to  one  observer,  is  an  exam- 
ple of  how  easy  it  is  to  sell  an  idea  by  means  of 
sentimental  ballyhoo  even  if  the  proposition  is 
silly  and  unnecessary.  Moreover,  they  are  exam- 
ples of  the  type  of  frivolous  legislation  which  can 
slip  through  during  hectic  last-minute  drives  when 
the  merit  of  measures  is  given  little  considera- 
tion. Of  course,  the  real  purpose  of  these  bills  is 
to  restrict  competition,  and  to  “organize”  those 
artisans  licensed  under  these  measures.  The  bar- 
ber bill  is  quite  similar  to  the  measure  passed  in 
the  previous  session,  but  which  then  was  vetoed 
by  Governor  White. 

TERM  EXTENDERS 

Considerable  dust  was  raised  by  the  passage  of 
the  term— extender  proposals  for  county  recorders 
and  county  clerks  and  the  pressure  brought  to 
bear  for  passage  of  measures  extending  the  terms 
of  other  county  elective  officials.  Following  a de- 
cision by  the  attorney  general  that  such  legisla- 
tion is  unconstitutional,  the  clerk-extender  meas- 
ure was  vetoed;  a bill  repealing  the  recorder-ex- 
tender which  had  been  signed  by  the  Governor 
was  introduced  and  was  still  pending,  and  the 
move  to  extend  the  terms  of  other  county  officials 
was  dropped. 


450 


The  Ohio  State  Medical  Journal 


July,  1933 


The  90th  General  Assembly  outdid  previous 
Legislatures  in  the  matter  of  special  investiga- 
tions, special  committees  having  been  authorized 
for  probing  beer  racketeering,  sale  of  bonds  and 
securities,  price  of  school  books,  activities  of  one 
elective  state  official,  handling  of  banks  and  build- 
ing and  loans,  the  chattel  loan  “bribery”  incident, 
etc. 

Regardless  of  what  progress  the  Legislature 


may  have  made  to  date  in  solving  the  taxation, 
financial  and  schools  muddles,  the  possibilities  are 
strong  that  the  90th  General  Assembly  will  be 
called  into  special  session  on  more  than  one  oc- 
casion before  it  passes  from  the  picture  because 
of  rapidly  changing  economic  and  social  con- 
ditions and  because  of  the  difficulty  in  determin- 
ing what  the  future  permanent  financial  and  tax- 
ation program  of  the  state  should  be. 


Cleveland  Academy  Inaugurates  Plan  to  ^Rate”  Patients 
"Who  Are  Unable  to  Provide  Full  Medical  Payment 


In  an  effort  to  establish  under  professional  con- 
trol a plan  to  meet  the  medical  needs  of  the  citi- 
zens of  Cleveland  who  are  financially  unable  to 
provide  complete  medical  care  for  themselves  and 
their  families,  the  Cleveland  Academy  of  Medi- 
cine has  established  a Part-Pay  Diagnostic  and 
Consulting  Service. 

The  following  article  published  in  the  June 
issue  of  the  Academy  Bulletin  reveals  the  pur- 
poses and  workings  of  the  service: 

“Effective  as  of  June  5th,  the  Board  of  Direc- 
tors of  the  Academy  announce  the  establishment 
of  an  Academy  part-pay  Diagnostic  and  Consult- 
ing service  for  persons  to  whom  full  payment  for 
such  service  would  bring  undue  hardship.  The 
plan  was  the  result  of  several  months  of  study 
and  conference  by  the  Committee  on  Economics, 
composed  of  Drs.  G.  E.  Follansbee,  Chairman,  M. 
A.  Blankenhorn,  M.  B.  Cohen,  D.  M.  Glover,  H. 
G.  Sloan  and  C.  W.  Stone.  The  service  will  be 
operated  under  the  direction  of  a special  com- 
mittee composed  of  the  following,  Drs.  H.  G. 
Sloan,  Chairman,  M.  B.  Cohen,  M.  A.  Blanken- 
horn and  D.  M.  Glover. 

“The  Academy  will  establish  a Social  Service 
Department  with  trained  workers  to  which  the 
family  physician  can  send  patients  for  rating. 
This  department  will  charge  the  patient  50c  for 
a rating,  which  fee  will  cover  any  re-rating  within 
one  year,  will  make  an  investigation  of  his  finan- 
cial condition,  and  will  determine  whether  he  can 
afford  to  pay  a full  fee,  a percentage  of  a full 
fee  (the  percentage  to  be  indicated) , or  is  prop- 
erly a subject  for  charity.  Physicians  are  expected 
to  send  for  rating  only  those  persons  who  are 
in  need  of  diagnostic  or  consulting  service  by 
specialists. 

“The  patient  will  be  given  a card  indicating 
the  percentage  of  payment  which  he  can  afford, 
and  is  to  be  sent  back  to  the  family  practitioner, 
or  to  a specialist  previously  chosen  by  the  latter 
from  a list  of  all  co-operating  specialists  and 
furnished  to  all  Academy  members. 

‘The  Academy  will  refer  no  patients  to  special- 
ists under  this  plan.  Should  a patient  apply  on 
his  own  volition  for  a rating,  he  will  not  be  rated 
but  will  be  referred  to  his  family  physician;  or  if 


he  has  none,  he  will  be  furnished  with  the  names 
of  several  general  practitioners  in  his  location 
from  which  he  can  make  a selection.  This  physi- 
cian then  will  follow  the  procedure  outlined  above, 
if,  in  his  opinion,  the  circumstances  so  indicate. 

“It  is  understood  that  the  co-operating  special- 
ists will  agree  to  furnish  the  diagnostic  procedure 
at  the  percentage  of  their  regular  fee  indicated 
on  the  card  of  the  patient.  It  is  also  understood 
that  payment  of  these  part-fees  shall  be  made  in 
cash. 

“The  termination  date  on  each  card  will  be 
established  by  the  Social  Service  Department  in 
accordance  with  the  facts  in  the  case.  For  ex- 
ample, anticipated  change  of  employment  within 
a year  might  indicate  need  for  a change  in  the 
rating.  It  is  understood  that  the  card  applies  to 
all  dependents  in  the  family. 

“In  referring  the  patient  to  a specialist,  the 
family  practitioner  will  follow  the  usual  routine 
procedure  of  personal  contact  with  the  specialist 
either  by  visit,  ’phone  or  letter.  The  specialist 
will  return  the  patient  to  the  family  physician, 
and  will  report  his  findings  to  him,  unless  other- 
wise instructed  by  the  family  physician. 

“The  Academy  will  furnish  to  the  specialist  a 
supply  of  form  postcards  on  which  he  will  write 
the  name  and  number  of  the  patient,  and  the  date 
first  seen,  mailing  the  same  immediately  to  the 
Academy,  so  that  the  Committee  on  Economics 
may  evaluate  the  plan  as  it  progresses. 

“At  the  beginning,  and  until  further  notice,  the 
Social  Service  Department  at  the  Academy  office 
will  be  open  for  ratings  from  9 a.  m.  to  11  a.  m. 
on  Mondays,  11  a.  m.  to  1 p.  m.  on  Wednesdays 
and  3 p.  m.  to  5 p.m.  on  Fridays.” 

The  Bulletin  points  out  editorially  that: 

“The  plan  * * * has  the  advantages  of  giving 
the  family  practitioner  practically  free  choice  of 
all  the  available  specialists;  no  special  clinic 
facilities  will  be  required;  and  the  desirable  re- 
lationship existing  between  general  practitioner, 
patient  and  specialist  will  be  maintained,  just  the 
same  as  in  ordinary  private  practice.  In  accord- 
ance with  this  plan,  the  family  doctor  remains  in 
the  key  position  in  medical  practice  in  the  com- 
munity, as  he  should.” 


Midsummer  Medical  Board  Exa  mi  eat  ions  Taken  By  348 
Applicants  in  Columbia  June  6^9;  Questions 
Asked  Medical  Graduates 


Summer  examinations  for  348  applicants  for 
licenses  to  practice  medicine  and  surgery  and 
limited  branches  of  medicine  in  Ohio  were  held 
in  Columbus,  June  6-9,  by  the  State  Medical 
Board. 

Applicants  totaling  242  took  the  medical  and 
surgical  examinations.  Others  examined  were: 
20  osteopaths,  9 chiropractors,  4 mechano-thera- 
pists,  5 cosmetic-therapists,  9 masseurs,  and  58 
chiropodists. 

Results  of  the  examinations  will  be  announced 
and  licenses  awarded  at  the  next  meeting  of  the 
Board,  scheduled  for  July  11. 

The  following  questions  were  asked  in  the  ex- 
aminations given  to  medical  school  graduates: 

ANATOMY 

1.  Locate  the  stylo-mastoid  foramen. 

What  has  its  exit  and  what  has  its  entrance  through 
this  foramen  ? 

2.  Give  origin,  insertion,  nerve  supply  and  action  of  the 
popliteus  muscle. 

3.  Name  the  ligaments  found  in  the  shoulder  joint. 
Classify  this  articulation. 

4.  How  is  the  solar  plexus  formed?  Where  located  and 
what  does  it  supply  ? 

5.  Describe  the  common  carotid  arteries.  Give  origin  and 
branches  of  both. 

PHYSIOLOGY 

1.  What  important  functions  are  performed  by  hemo- 
globin in  respiration? 

2.  What  influence  does  oxygen  have  on  the  control  and 
adjustment  of  breathing? 

3.  Discuss  very  briefly  the  role  played  by  the  liver  in 
the  metabolism  of  (a)  carbohydrates  (b)  proteins  (c)  fats 
(d.)  iron. 

4.  (a)  How  does  severe  liver  disease  affect  clotting  time? 

(b)  What  do  you  understand  by  the  terms  “detoxify- 
ing power  of  the  liver"  ? 

5.  Describe  briefly  the  physiology  of  ovulation. 

6.  How  does  the  body  compensate  for  the  decrease  in 
circulating  blood  volume  in  severe  hemorrhage? 

7.  Enumerate  the  functional  changes  in  secondary  shock. 

8.  Summarize  the  events  that  occur  during  a single 
cardiac  cycle. 

9.  Outline  the  series  of  events  following  failure  of  the 
myocardium. 

10.  (a)  What  is  the  function  of  the  parathyroids?  (b) 
What  is  the  result  of  parathyroidectomy  ? 

DIAGNOSIS 

1.  What  symptoms  would  lead  you  to  suspect  carbon 
monoxide  poisoning? 

2.  Differentiate  between  acute  post-operative  dilatation  of 
the  stomach  and  the  intestinal  distention  of  peritonitis. 

3.  Given  a complete  Potts  fracture  with  absence  of  pain, 
what  would  you  suspect  ? 

4.  Differentiate  between  hemorrhage  from  esophageal 
ulcer  and  gastric  ulcer. 

5.  Make  a diagnosis  of  infantile  paralysis.  Differentiate 
from  paralysis  caused  by  brain  embolus. 

6.  In  what  portion  of  the  ureter  is  kidney  stone  most  apt 
to  lodge?  Give  reasons. 

7.  Differentiate  simple  and  syphilitic  stricture  of  the 
Tectum. 

8.  Make  a diagnosis  of  a mediastinal  abscess. 

9.  How  would  you  proceed  to  type  pneumonias? 

10.  What  would  erosion  of  the  clino-id  processes  of  the 
sella  lead  you  to  suspect? 

How  would  you  proceed  to  complete  the  diagnosis  ? 

MATERIA  MEDICA 

1.  State  symptoms  of  the  overaction  of  (a)  santonin  (b) 
thymol  (c)  morphine  sulphate. 

2.  Explain  the  action  upon  the  stomach  and  intestines  of 
(a)  nux  vomica  (b)  rhubarb  (c)  bismuth  subnitrate. 

3.  Explain  the  emetic  action  of  (a)  apomorphine  (b) 
ipecac. 

4.  Give  average  dose  of  Tr.  aconite,  fluid  extract  of  digi- 
talis, Fowler’s  solution  and  artopine.  About  what  is  the 


difference  in  strength  between  the  tincture  and  fluid  ex- 
tract of  most  drugs? 

5.  Give  origin  of  podophyllin,  its  action  and  dose. 

6.  What  are  the  uses  and  dangers  of  chloral  hydrate? 
Give  proper  dose. 

7.  What  are  the  therapeutic  actions  of  iron? 

8.  What  is  the  physiologic  action  of  opium  and  toxic 
effect  ? 

9.  Give  indications  and  dosage  for  two  remedies  you  use 
in  jaundice,  rheumatism  and  influenza. 

10.  State  the  medicinal  action  of  hyascyamus.  Give  dose. 

CHEMISTRY 

1.  What  is  the  most  important  member  of  the  sterols 
and  where  found  in  the  human  body  ? 

2.  How  are  sugars  decomposed  in  the  body  ? 

3.  Compare  an  alcohol  and  a phenol. 

4.  What  is  the  difference  between  metals  and  non-metals  ? 

5.  Name  principal  substances  composing  human  body  and 
classify. 

PRACTICE 

1.  Discuss  aortic  valvular  insufficiency,  etiology,  diagnosis 
and  prognosis. 

2.  Give  the  syptoms  and  treatment  of  chronic  bronchiec- 
tasis. 

3.  Give  the  blood  findings  and  treatment  of  anejnia  oc- 
curring as  a result  of  the  use  of  lead  in  industry. 

4.  Discuss  the  etiology,  symptoms  and  treatment  of 
acute  catarrhal  jaundice. 

5.  Discuss  the  etiology,  symptoms  and  treatment  of  an 
acute  diarrhea  in  a child  of  three  years. 

6.  Discuss  the  significance  of  the  symptoms  of  a patient 
showing  marked  prostration,  a fetid  sore  throat  with  a 
blood  count  of  less  than  1500  leukocytes  with  mononuclear 
cells  predominating. 

7.  Discuss  the  possibilities,  diagnosis  and  treatment  of 
enlarged  cervical  (anterior)  glands  in  a child  of  seven 
years. 

8.  Give  the  treatment  of  a child  sick  with  measles  with 
a complicating  mastoiditis. 

9.  What  is  tic  douloreux  and  outline  treatment. 

10.  Discuss  the  early  symptoms  of  paresis,  the  prognosis 
and  the  modern  treatment. 

BACTERIOLOGY,  PATHOLOGY  AND  HYGIENE 

1.  What  is  meant  by  hemolytic  streptococci? 

2.  How  many  types  of  pneumococci  are  recognized  and 
how  are  they  differentiated  ? 

3.  Give  a smear  of  pus  from  a urethral  discharge,  how 
would  you  diagnose  the  presence  of  gonococci  ? 

4.  What  is  meant  by  the  agglutination  test  of  bacteria? 
Give  an  illustration,  describing  briefly  the  method  of  using 
the  test. 

5.  Wha.t  is  the  pathology  of  a peri-tonsillar  abscess  and 
its  terminations  (a)  favorable  (b)  unfavorable. 

6.  Discuss  the  usual  pathology  of  a spontaneous  pneu- 
mothorax. 

7.  What  morbid  changes  often  follow  an  enlarged  pros- 
tate gland  ? 

8.  What  pathologic  changes  may  follow  as  the  result  of 
a gallstone  lodged  in  the  common  duct? 

9.  Discuss  the  value  of  immunization  of  school  children 
to  diphtheria ; scarlet  fever. 

10.  Discuss  the  health  hazards  in  sand-blast  operators, 
lead-workers,  garage  employes  and  coal  miners. 

SURGERY 

1.  What  symptoms  may  be  caused  by  suprarenal  tumors  ? 

2.  What  are  the  dangers  of  intraperitoneal  injections  ? 

3.  What  do  you  understand  by  the  term  “secondary 
hemorrhage"  ? Name  the  causes  of  the  same. 

4.  Mr.  A.  P.,  a man  35  years  old,  was  injured  in  the 
following  manner:  while  running  he  stepped  into  a hole 
and  fell  forward.  His  toes  were  on  the  edge  and  his  heel 
went  into  the  hole  so  that  his  foot  went  into  extreme  dorsi- 
flexion.  He  was  unable  to  walk  or  balance  himself  when 
he  attempted  to  lean  slightly  forward.  Give  your  diagnosis 
and  treatment. 

5.  In  your  opinion,  can  radiation  change  an  inoperable 
Carcinoma  into  an  operable  one? 

6.  Upon  opening  the  abdomen  and  finding  a ruptured 
gangrenous  appendix,  how  would  you  proceed  to  care  for 
same  ? Give  post-operative  treatment. 

7.  Given  a case  of  multiple  myeloma  with  fracture  of 
the  clavicle,  outline  the  general  treatment.  State  prognosis. 

8.  Evaluate  the  following  anesthetics  : Spinal — Rectal  and 
Ether.  State  advantages,  disadvantages  and  precautions  to 
be  taken  with  each  to  insure  safety. 

9.  State  probable  causes  of  post-operative  lung  collapse. 
Give  symptoms  and  treatment. 


451 


452 


The  Ohio  State  Medical  Journal 


July,  1933 


10.  Name  three  types  of  bone  tumors.  Give  diagnostic 
differentiation,  prognosis  and  treatment. 

OBSTETRICS 

1.  What  is  the  cause  of  phlegmasia  alba  dolens?  Give 
treatment. 

2.  Give  diagnosis  and  management  in  a case  of  occipito 
posterior  presentation. 

3.  Outline  the  diagnosis  and  management  in  labor  of 
twin  pregnancy. 

4.  Wliat  can  be  determined  by  external  palpation  of  the 
pregnant  woman  at  the  eighth  month?  Give  manner  in 
which  you  would  go  about  to  make  a diagnosis  of  the 
position  of  the  child. 

5.  Discuss  placenta  previa  from  standpoint  of  (a)  causa- 
tive factors  (b)  diagnosis  (c)  treatment. 


SPECIALTIES 

1.  Define  the  following  terms: 

dacryocystitis  mydriatic 

diplopia  hypopyon 

miotic  pannus 

ectropion  myopia 

keratitis  pterygium 

2.  Is  the  retinitis  of  Bright’s  disease  unilateral  or  bi- 
lateral ? 

3.  Outline  the  treatment  of  acute  purulent  otitis  media. 

4.  In  approximately  what  strengths  would  you  use  the  fol- 

lowing solutions  in  opthalmological  practice? 

cocain  dionin  pilocarpine  atropine  eserin 

5.  Give  the  symptoms,  prognosis  and  treatment  of  nasal 
diphtheria. 


Ohio  Supreme  Court  Establishes  Principle  that  Husband  not 
Necessarily  Liable  for  Necessities  **  Medical 
Service  Furnished  Wife 


A husband  is  not  liable  for  necessaries  fur- 
nished his  wife  unless  they  are  furnished  on  his 
credit,  the  Ohio  Supreme  Court  held  on  May  31 
in  deciding  the  case  of  Hari'y  Tille  v.  Dr.  Robert 
K.  Finley  arising  from  a suit  filed:  in  the  Muni- 
cipal Court  of  Dayton  by  Dr.  Finley,  a Dayton 
physician,  to  collect  a bill  for  medical  services 
rendered  to  Tide’s  wife,  Mrs.  Grace  Tille. 

Decision  of  the  Supreme  Court  in  the  Tiile- 
Finley  case  is  of  far-reaching  importance  to 
physicians  and  others  engaged  in  the  furnishing 
of  necessaries,  and  is  a reversal  of  the  ruling  case 
law  in  Ohio  of  many  years  standing  that  the  mar- 
riage relation  creates  an  unconditional  liability  on 
the  part  of  the  husband  for  necessaries  furnished 
his  wife. 

In  effect,  the  Ohio  Supreme  Court  has  warned 
creditors  engaged  in  supplying  the  necessaries  of 
life  that  in  the  future  they  must  look  to  the  wife 
for  payment  of  obligations  arising  from  the  ex- 
tension of  credit  unless  there  is  a mutual  under- 
standing on  the  part  of  the  three  parties  in- 
terested that  such  necessaries  were  furnished  her 
on  the  credit  of  the  husband. 

The  history  of  the  case  is  briefly  this: 

Dr.  Finley  rendered  medical  services  and  atten- 
tion to  Grace  Tille,  wife  of  Harry  Tille.  He 
charged  Mrs.  Tille  for  the  services  and  attention, 
and  entered  the  charge  on  his  account  book.  There 
were  two  credits  made  on  the  account,  one  of 
$3.00  and  one  of  $2.00,  both  payments  having  been 
made  by  Mrs.  Tille.  The  account,  less  credits, 
amounted  to  $103.00.  Dr.  Finley  brought  suits 
against  Harry  Tille  for  this  sum  in  the  Municipal 
Court  of  Dayton  and  secured  a judgment  against 
him  for  the  amount  claimed.  The  Montgomery 
County  Common  Pleas  Court  affirmed  the  judg- 
ment of  the  Municipal  Court  and  the  Court  of 
Appeals,  with  one  judge  dissenting,  affirmed  the 
judgment  of  the  common  pleas  court.  Upon  the 
contention  that  the  judgment  of  the  Court  of 
Appeals  of  Montgomery  County  was  in  conflict 


with  the  judgment  of  the  Court  of  Appeals  of  the 
Fourth  Appellate  District  in  the  case  of  Attorneys 
Service  Co.  v.  Monk  (19  Ohio  App.,  16),  the  case 
was  certified  to  the  Ohio  Supreme  Court  for  re- 
view and  final  judgment. 

The  decision  of  the  Supreme  Court,  written  by 
Judge  Will  P.  Stephenson,  is  in  part  as  follows: 

“There  is  just  one  question  here:  Is  there  a 
scintilla  of  evidence  in  this  case  entitling  Dr. 
Finley  to  the  judgment  against  Harry  Tille,  hus- 
band of  Grace  Tille? 

“In  their  briefs,  counsel  have  quoted  excerpts 
from  the  record,  and  they  are  correct.  Medical 
services  and  attention  are  necessaries.  In  years 
gone  by,  the  courts  of  this  and  other  states  were 
inclined  to  hold  that  the  marriage  relation  created 
an  unconditional  liability  on  the  part  of  the  hus- 
band for  necessaries  furnished  the  wife,  and  at 
that  time  there  was  strong  reason  why  the  courts 
should  so  hold.  In  those  days  the  wife  was 
mother,  matron  and  maid.  She  was  likewise 
shackled  to  her  husband  by  common  law.  If  she 
performed  the  duties  required  of  her  in  her  trium 
capacity,  she  had  no  independent  earning  power, 
and  her  right  to  her  keep  was  absolute.  The  law 
did  not  go  beyond  the  obligation  imposed  by  the 
marriage  contract  in  fixing  the  liability,  and  the 
duty  of  the  husband  to  furnish  the  wife  with 
necessaries  of  life  was  none  the  less  absolute. 

“As  woman  gradually  entered  man’s  former 
sphere,  the  law  in  its  wisdom  relaxed  its  require- 
ments so  far  as  the  man  and  husband  was  con- 
cerned. It  shifted  some  of  the  responsibility  from 
his  shoulders  to  the  shoulders  of  the  woman  and 
wife. 

“In  Ohio  this  gradual  process  of  alleviation  has 
changed  the  husband’s  duty  to  furnish  his  wife 
necessaries  from  an  unconditional  to  a conditional 
duty.  Consequently,  the  liability  arising  from  a 
breach  of  this  duty  is  conditional. 

“It  is  unnecessary  to  cite  authorities  in  support 
of  this  contention.  Reference  to  our  statutes 


July,  1933 


State  News 


453 


which  treat  with  the  relation  of  husband  and  wife 
is  all-sufficient. 

“From  the  statement  of  counsel,  the  courts  be- 
low seemed  to  tie  to  the  proposition  that  Dr.  Fin- 
ley knew  Grace  Tille  had  a husband  when  the 
medical  services  were  rendered.  The  record  does 
not  fully  bear  out  this  contention.  If  there  was 
such  an  inclination,  there  was  a reason  for  it. 

“In  construing  the  opinion  of  the  judge  ren- 
dering the  opinion  in  the  case  of  Attorneys  Ser- 
vice Co.  v.  Monk,  supra,  those  courts  must  have 
attached  particular  significance  to  the  fact  that 
the  merchant,  the  creditor  in  that  case,  was  un- 
aware that  the  lady  to  whom  he  extended  credit 
had  a husband.  Counsel  contend  that  the  Court 
of  Appeals  applied  the  converse  of  this  proposi- 
tion in  the  instant  case. 

“Dr.  Finley  testified  that  he  knew  Grace  Tille 
was  the  wife  of  Harry  Tille  when  he  performed 
the  services  in  question.  The  lower  courts  rteated 
the  fact  that  Dr.  Finley  knew  that  Grace  Tille 
had  a husband  at  the  time  he  rendered  the  ser- 
vices as  largely  controlling,  and  that  little  or 
nothing  further  was  needed  in  order  to  create 
liability  on  the  part  of  Harry  Tille  for  Grace 
Tille’s  debt. 

‘The  record  does  not  support  this  contention, 
as  the  majority  court  delivering  the  opinion  cite 
authorities  tending  to  hold  the  husband  liable, 
independent  of  this  fact.  We  admit  that  it  is  an 
important  fact,  but  we  do  not  admit  that  it  is 
controlling.  A careful  reading  of  the  Monk  case 
divulges  that  the  learned  judge  who  wrote  the 
opinion  was  influenced  very  little  by  the  fact  that 
the  merchant  was  unaware  that  the  debtor-wife 
had  a husband  living  when  she  incurred  the  debt. 
He  based  his  opinion  on  more  substantial  grounds, 
as  will  be  noted  from  the  following  excerpts: 

“After  citing  13  Ruling  Case  Law,  1200,  Sec- 
Don  233,  he  adopts  the  following  rule: 

“ ‘Though  there  are  decisions  to  the  contrary, 
the  better  view  seems  to  be  that  in  order  to  render 
a husband  liable  for  necessaries  furnished  his 
wife  they  must  have  been  furnished  on  his  credit.’ 

“In  conclusion  he  stated : 

“ ‘We  are  content  to  follow  the  current  of  au- 
thority and  hold  the  husband  not  liable  for  debts 
contracted  upon  the  sole  responsibility  of  his 
wife.’ 

“We  regard  this  as  a clear,  succinct  statement 
of  the  law,  and  the  dissenting  judge  in  the  in- 
stant case  was  right  in  his  pronouncement. 

“Upon  whose  credit  did  Dr.  Finley  render  the 
medical  services  in  question?  When  this  question 
is  properly  answered,  this  case  is  decided. 

“Dr.  Finley  wavered  in  his  testiimony  as  to 
whether  or  not  he  knew  Grace  Tille  was  a married 
woman  when  he  rendered  the  services  in  question ; 
but  we  regard  this  as  inconsequential.  He  did 
testify  that  he  made  the  charge  on  his  account 
book  against  Grace  Tille ; that  she  paid  the  only 


moneys  credited  on  such  account,  and  he  gave  her 
account  credit  for  the  payments.  His  testimony 
as  shown  by  the  bill  of  exceptions  is  conclusive  as 
to  whom  the  credit  was  extended  and  to  whom  he 
looked  for  his  pay.  He  stated  baldly  that  he 
looked  to  Grace  Tille  for  his  pay. 

“We  must  conclude  from  this  testimony  that 
Dr.  Finley  at  no  time  regarded  the  fact,  if  he 
knew  it,  that  Grace  Tille  was  married,  as  giving 
his  account  added  security.  He  rendered  the  ser- 
vices at  her  request.  He  made  all  charges  against 
her  on  his  account  book,  and,  as  he  says,  he 
looked  to  her  for  his  pay. 

“In  view  of  all  these  facts  it  is  only  fair  to 
assume  that  it  was  not  until  Dr.  Finley  learned 
that  his  account  against  Grace  Tille  was  uncol- 
lectible that  he  proceeded  against  Harry  Tille. 

“The  court,  coming  now  to  finally  determine 
this  case,  finds  that  Dr.  Finley  furnished  medical 
services  as  claimed  by  him  to  Grace  Tille,  at  her 
solicitation  and  request;  that  he  extended  the 
credit  to  Grace  Tille,  and  that  he  looked  to  Grace 
Tille  alone  for  his  pay,  and  that  Harry  Tille  was 
the  husband  of  Grace  Tille  at  the  time  the  ser- 
vices were  rendered.  Under  this  state  of  facts, 
there  is  no  liability  on  the  part  of  Harry  Tille  to 
pay  Dr.  Finley  for  medical  services  rendered  to 
Grace  Tille.  Judgment  reversed.” 

The  decision  was  concurred  in  by  Chief  Justice 
Weygandt  and  Judges  Day,  Allen,  Jones  and 
Matthias. 


Sale  of  Theronoid  Belt  Enjoined 

A “cease  and  desist”  order  has  been  issued  by 
the  Federal  Trade  Commission  against  Theronoid, 
Inc.,  a Delaware  corporation,  and  Theronoid  Cor- 
poration, an  Ohio  corporation,  restraining  them 
from  advertising  and  selling  an  electrically- 
charged  belt  while  claiming  for  it  therapeutic 
value.  Columbus  newspapers  have  quoted  the  Co- 
lumbus manager  of  the  firm  as  stating  that  be- 
tween 12,000  and  15,000  of  the  belts  have  been 
sold  in  Columbus  alone  during  the  past  five  years, 
at  an  average  price  of  $67.50. 


In  answer  to  a query  as  to  whether  or  not  a 
licensed  dentist  may  be  appointed  health  com- 
missioner of  a county,  the  attorney  general  of 
Ohio  has  ruled  that  the  requirement  of  the 
General  Code  that  a health  commissioner  shall 
be  a “licensed  physician”  must  be  construed  to 
mean  a licensed  practitioner  of  medicine  and  not 
a licensed  dentis^ 


Cleveland — Dr.  Lawrence  A.  Pomeroy  has  been 
appointed  chairman  of  the  work  in  the  Cleveland 
area  of  the  American  Society  for  the  Control  of 
Cancer. 


s From 

d Academies 


First  District 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(George  B.  Topmoeller,  M.D.,  Secretary) 

May  29 — Annual  election  of  officers  as  follows: 
President,  Dr.  John  A.  Caldwell;  treasurer,  Dr. 
E.  0.  Swartz;  secretary,  Dr.  Harold  F.  Downing; 
trustee,  Dr.  Edward  King;  delegates  to  State 
Association  meeting,  Dr.  Charles  Kiely  and  Dr. 
Howard  Schriver;  alternates,  Dr.  L.  B.  Johns- 
ton and  Dr.  E.  0.  Swartz.  The  new  officers  will 
be  installed  at  the  first  regular  meeting  of  the 
Academy  next  Fall. 

June  5 — Presentation  of  reports  of  the  special 
committees  on  telephone  exchange  service  and 
medical  credit  and  material  services. 

Clinton  County  Medical  Society  was  addressed 
by  Dr.  Kennon  Dunham,  Cincinnati,  at  its  regular 
meeting  June  6 at  the  General  Denver  Hotel, 
Wilmington.  Dr.  Dunham  spoke  on  “Home  Care 
of  Pulmonary  Tuberculosis  and  Some  Modern 
Aspects  of  Its  Treatment”. — News  Clipping. 

Fayette  County  Medical  Society  at  its  meeting 
June  1 at  Washington  C.  H.,  heard  an  interesting 
talk  on  “The  Significance  of  Abdominal  Pain”, 
by  Dr.  F.  W.  Harrah,  Columbus. — News  Clipping. 

Second  District 

Clark  County  Medical.  Society  held  its  annual 
outing  June  14  with  a large  attendance  including 
many  guests  from  surrounding  counties.  The 
morning  program  consisted  of  clinics  at  the 
Springfield  City  Hospital.  Following  a luncheon 
at  the  hospital,  the  members  and  guests  went  to 
the  Springfield  Country  Club  where  the  afternoon 
was  spent  in  golf,  swimming,  and  cards.  The 
outing  was  climaxed  with  a banquet  in  the  eve- 
ning.— News  Clipping. 

Darke  County  Medical  Society  was  addressed 
by  Dr.  M.  W.  Coleman,  Dayton,  on  “Relief  of 
Prostatic  Obstruction”  at  its  meeting  May  26  at 
the  Greenville  First  Christian  Church.  The  ad- 
dress followed  dinner  in  the  basement  auditorium. 
— News  Clipping. 

Montgomery  County  Medical  Society  held  its 
annual  outing  and  election  of  officers  on  June  2 at 
the  Dayton  Country  Club.  Officers  elected  were: 
President,  Dr.  C.  D.  Smith;  first  vice  president, 
Dr.  H.  F.  Koppe;  second  vice  president,  Dr.  R.  K. 
Finley;  delegate  to  State  Association  meeting,  Dr. 
H.  V.  Dutrow;  alternate,  Dr.  G.  L.  Erbaugh;  cen- 
sor, Dr.  C.  N.  Chrisman;  legislative  committee- 
man, Dr  W.  S.  Smith.  In  the  afternoon  a golf 
tournament  was  held,  followed  by  a dinner  and  an 
address  by  Dr.  R.  W.  Scott,  Cleveland,  on  “Treat- 
ment of  Patients  With  Cardio-Vascular  Disease”. 
An  additional  feature  of  the  program  was  a sym- 


posium on  meningitis  and  encephalitis  presented 
by  Drs.  C.  C.  Payne,  W.  B.  Taggart,  R.  D.  Hos- 
tetter  and  S.  J.  Winters. — News  Clipping. 

Third  District 

Auglaize  County  Medical  Society  met  in  bi- 
monthly session  on  June  7 at  Minster  with  a large 
attendance.  The  program  was  presented  by  Dr. 
Donald  F.  McGrath,  Dr.  Raymond  C.  King,  Dr. 
J.  J.  Collins  and  Dr.  Frank  C.  Clifford,  all  of  To- 
ledo. Dr.  McGrath  gave  a paper  on  “Analgesia 
and  Anesthesia  During  Labor”;  Dr.  King  spoke 
on  “Diagnosis  and  Treatment  of  Common  Ob- 
stetrical Complications”  and  illustrated  his  talk 
with  lantern  slides.  Drs.  Collins  and  Clifford 
opened  the  general  discussion  of  the  two  presen- 
tations. Following  the  prog'ram  a social  hour 
was  enjoyed,  accompanied  by  a Dutch  lunch. 
Twenty  members  of  the  society  and  nine  visitors 
from  surrounding  counties  were  present.  Dr.  C. 
W.  Berry,  Wapakoneta,  and  Dr.  E.  A.  Gomolski, 
Minster,  were  elected  to  membership. — Charles  C. 
Berlin,  M.D.,  Secretary. 

Hardin  County  Medical  Society  at  its  meeting 
May  18  at  Kenton  was  entertained  by  a sympo- 
sium on  “Benign  and  Malignant  Lesions  of  the 
Stomach  and  Duodenum”  presented  by  Dr.  W.  B. 
Morrison,  Dr.  J.  H.  Warren  and  Dr.  J.  J.  Coons, 
all  of  Columbus.  Dinner  was  served  preceding 
the  program. — News  Clipping. 

Logan  County  Medical  Society  met  in  regular 
session  June  2 at  the  home  of  Dr.  J.  P.  Harbert. 
Dr.  Hai'bert  presented  the  principal  paper  on 
“Mendelism  In  Man — The  Science  of  Heredity”. 
The  round-table  discussion  was  opened  by  Dr.  M. 
L.  Pratt.  A buffet  luncheon  was  served  follow- 
ing the  meeting. — News  Clipping. 

Seneca  County  Medical  Society  gave  a dinner 
on  May  18  at  the  Shawhan  Hotel,  Tiffiin,  in  honor 
of  Dr.  R.  G.  Steele,  Melmore,  who  recently  com- 
memorated his  50th  year  as  a practicing  physi- 
cian. Dr.  John  C.  Tritch  and  Dr.  T.  S'.  Wiison, 
both  of  Findlay,  made  complimentary  addresses 
concerning  Dr.  Steele,  and  Dr.  H.  L.  Wenner, 
Tiffin,  and  Dr.  N.  C.  Miller,  Fostoria,  who  re- 
cently were  similarly  honored  by  the  society, 
spoke  briefly.  The  arrangements  for  the  gather- 
ing were  made  by  Dr.  E.  H.  Porter.  Among  those 
in  attendance  was  Dr.  O.  P.  Klotz,  Findlay,  coun- 
cilor of  the  Third  District. — News  Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO  AND 
LUCAS  COUNTY 

(A.  P.  Haneuff,  M.D.,  Secretary) 

June  2 — General  meeting.  Program:  Address, 
“The  Development  of  Pollen  Therapy”,  Dr.  Harry 


454 


July,  1933 


State  News 


455 


Lee  Huber,  University  of  Chicago,  Graduate 
School  of  Medicine.  The  next  scientific  meeting 
of  the  Academy  will  be  held  next  Fall. 

Putnam  County  Medical  Society  met  in  regular 
session  June  2 at  the  DuMont  Hotel,  Ottawa.  The 
program  was  presented  by  Dr.  Andrews  Rogers 
and  Dr.  H.  A.  Davis,  both  of  Columbus. — News 
Clipping. 

Sandusky  County  Medical  Society  held  its  last 
meeting  until  next  Fall  on  May  25  at  the  Council 
Hall,  Fremont. The  program  was  presented  by  Dr. 
E.  M.  Ickes,  Fremont,  who  spoke  on  “Vaccines”. — 
News  Clipping. 

Wood  County  Medical  Society  at  its  May  18 
meeting  was  addressed  by  Dr.  C.  H.  Bayha  and 
Dr.  J.  A.  Magoun,  both  of  Toledo,  on  “Removal 
of  the  Prostate  Through  the  Urethra”. — R.  E. 
Rasor,  M.D.,  Correspondent. 

Fifth  District 

Erie  County  Medical  Society  at  its  regular- 
meeting  May  25  had  as  its  guests,  Dr.  H.  V. 
Paryzek,  Cleveland,  councilor  of  the  Fifth  Dis- 
trict, and  Dr.  James  N.  Wychgel,  Cleveland.  Dr. 
Paryzek  spoke  on  organization  matters  and  Dr. 
Wychgel  presented  a paper  on  “Treatment  of 
Gangrene  of  the  Extremities”. — News  Clipping. 

Trumbull  County  Medical  Society  met  in  regu- 
lar session  May  18  at  the  Warner  Hotel,  Warren. 
Following  a brief  business  meeting,  Dr.  A.  Carl- 
ton Ernstene,  Cleveland,  addressed  the  society  on 
“Rheumatic  Heart  Disease”.  Dinner  was  served 
preceding  the  program. — Bulletin. 

Sixth  District 

Joint  meeting  of  the  Mahoning  County  Medical 
Society  and  the  Mahoning  County  Bar  Associa- 
tion was  held  on  the  evening  of  June  27  at  the 
Youngstown  Club.  The  principal  speakers  were 
Dr.  Edwin  A.  Hamilton,  Columbus,  and  F.  Rollin 
Hahn,  Youngstown  attorney.  Dr.  Hamilton  dis- 
cussed the  subject  “Medico-Legal  Considerations 
From  the  Standpoint  of  the  Doctor”  and  Mr. 
Hahn  “Medico-Legal  Considerations  From  the 
Standpoint  of  the  Lawyer”. — Bulletin. 

Portage  County  Medical  Society  met  June  1 at 
the  Robinson  Memorial  Hospital,  Ravenna.  The 
guest  speaker  was  Dr.  E.  W.  Netherton,  Cleve- 
land, who  discussed  “Common  Disorders  of  the 
Skin”.  The  talk  was  illustrated  with  many  in- 
teresting slides. — E.  J.  Widdecombe,  M.D.,  Secre- 
tary. 

Richland  County  Medical  Society  held  a dinner 
meeting  May  25  at  the  Leland  Hotel,  Mansfield. 
The  guest  speakers  were  Dr.  Norman  Wetzel  and 
Dr.  Charles  F.  Good,  Cleveland. — News  Clipping. 

Summit  County  Medical  Society  at  its  meeting 
June  6 at  the  Mayflower  Hotel,  Akron,  held  a 
round-table  discussion  on  the  subject  “Observa- 
tions and  Experiences  in  the  Clinics  of  Europe”. 
Many  members  of  the  society  who  had  attended 
European  clinics  during  the  past  few  years  took 
part  in  the  discussion. — Bulletin. 


Wayne  County  Medical  Society  held  a chicken 
dinner  meeting  May  16  at  the  home  of  Mrs.  Leick- 
heim,  Orrville.  The  program  was  presented  by 
Dr.  W.  A.  Hoyt,  Akron,  who  gave  an  interesting 
and  instructive  talk  on  “The  Hip  Joint”,  illus- 
trated with  numerous  slides  showing  hip  joint 
diseases  and  the  modes  of  treatment. — R.  C.  Paul, 
M.D.,  Secretary. 

Seventh  Disrtict 

Annual  meeting  of  the  Seventh  Councilor  Dis- 
trict was  held  June  22  at  the  Belmont  Hills  Coun- 
try Club,  St.  Clairsville.  A golf  tournament  was 
held  preceding  the  program  which  was  as  fol- 
lows: Address  of  welcome,  Dr.  W.  Miles  Garri- 

son ; “The  Inter-relation  of  the  Female  Sex  Hor- 
mones and  the  Uterus”,  Dr.  Philip  Reel,  Colum- 
bus; “Nausea  of  Pregnancy”,  Dr.  Andrews 
Rogers,  Columbus;  “Cholecystitis”,  Dr.  R.  H.  Mc- 
Kay, Akron;  “Organization  Problems”,  Dr.  E.  B. 
Shanley,  New  Philadelphia,  councilor  of  the  Sev- 
enth District;  “A  Few  Comments  on  Some  Ques- 
tions that  Plague  the  Profession  Today”,  Dr. 
Theodore  Diller,  Pittsburgh.  A banquet  was 
served  preceding  the  address  by  Dr.  Diller.'  A 
musical  program  was  presented  during  the  pro- 
gram, including  a cello  solo  by  Dr.  F.  H.  Stoup, 
Barnesville. — Bulletin. 

Belmont  County  Medical  Society  met  in  regular 
session  June  1 at  Bellaire.  An  ilustrated  talk  on 
“The  Role  of  Surgery  in  Tuberculosis”  was  pre- 
sented by  Dr.  Louis  Mark,  Columbus. — Bulletin. 

Jefferson  County  Medical  Society  held  its  an- 
nual dinner  meeting  May  26  at  the  Steubenville 
Country  Club.  Following  an  afternoon  of  golf, 
a banquet  was  served.  Following  the  dinner,  the 
society  was  addressed  by  Dr.  J.  H.  J.  Upham,  Co- 
lumbus, on  “The  Costs  of  Medical  Care”.  Dr.  E. 
B.  Shanley,  New  Philadelphia,  councilor  of  the 
Seventh  District,  was  present  and  discussed  or- 
ganization problems.  Dr.  S.  A.  Harris  was  toast- 
master. The  meeting  was  well-attended,  among 
those  present  being  wives  of  the  members,  mem- 
bers of  the  Ohio  Valley  Hospital  administration 
staff  and  local  public  health  workers. — John  Y. 
Bevan,  M.D.,  Secretary. 

Tuscarawas  County  Medical  Society  was  en- 
tertained May  11  at  the  home  of  Dr.  Edgar  C. 
Davis,  Dover.  Dr.  Davis  presented  a paper  on 
“Ethics  in  Practice”.  Following  the  discussion, 
a buffet  supper  was  served. — News  Clipping. 

Eighth  District 

Annual  meeting  of  the  Eighth  Councilor  Dis- 
trict was  held  June  22  at  the  Rocky  Glen  Sana- 
torium, McConnelsville.  The  program  was  ar- 
ranged by  H.  A.  Phillips,  superintendent  of  the 
institution;  Dr.  Ward  D.  Coffman,  president  of 
the  district  society,  and  Dr.  E.  R.  Brush,  coun- 
cilor of  the  Eighth  District.  The  following  scien- 
tific presentations  were  made:  “Sinusitis  in  Re- 

lation to  Chronic  Bronchitis”,  Dr.  Russell  G. 
Means,  Columbus;  “Gynecological  Problems”,  Dr. 


456 


The  Ohio  State  Medical  Journal 


July,  1933 


Fred  Fletcher,  Columbus;  “Management  of  Infec- 
tions Complicating  Diabetes”,  Dr.  Eugene  W. 
Masters,  Columbus. — News  Clipping. 

Guernsey  County  Medical  Society  discussed  the 
handling  of  charity  cases  in  the  county  at  its 
meeting  on  May  18  at  the  Romance  Restaurant, 
Cambridge.  The  discussion  was  led  by  Dr.  H.  R. 
Neeland. 

At  its  meeting  June  1,  the  society  was  ad- 
dressed by  Dr.  W.  N.  Taylor,  Columbus,  on  genito- 
urinary problems. — News  Clipping. 

Perry  County  Medical  Society  met  in  regular 
session  May  15  at  New  Lexington  with  Dr.  R.  W. 
Miller,  Hemlock,  as  the  principal  essayist.  He 
spoke  on  “Tubal  Pregnancy”. 

The  June  meeting  of  the  society  was  held  June 
19  with  the  program  in  charge  of  Dr.  Harry  L. 
Hite,  Thorn ville. — News  Clipping. 

Washington  County  Medical  Society  was  ad- 


dressed by  Dr.  W.  B.  Morrison,  Columbus,  at  its 
meeting  June  14  at  the  Marietta  Memorial  Hos- 
pital. Dr.  Morrison  spoke  on  “The  Modern  Treat- 
ment of  Benign  and  Malignant  Lesions  of  the 
Stomach  and  Duodenum”.  Dr.  Robert  L.  Barnes, 
also  of  Columbus,  addressed  the  society  on  “Re- 
cent Advances  in  the  Treatment  of  Ai’thritis”.- — 1 
G.  M.  James,  M.D.,  Secretary. 

Tenth  District 

ACADEMY  OF  MEDICINE  OF  COLUMBUS 

(John  H.  Mitchell,  M.D.,  Secretary) 

June  5 — Clinical  meeting  at  Columbus  State 
Hospital  with  demonstrations  by  members  of  the 
hospital  staff.  Last  meeting  until  September  11. 

Knox  County  Medical  Society  on  May  31  jour- 
neyed to  Columbus  to  attend  a clinic  arranged  for 
the  society  by  the  staff  of  White  Cross  Hospital. 
Many  interesting  demonstrations  were  presented. 
— News  Clipping. 


Herbert  A.  Brown,  M.D.,  Cincinnati;  Medical 
College  of  Ohio,  Cincinnati,  1905;  aged  51;  mem- 
ber of  the  Ohio  State  Medical  Association;  the 
American  Medical  Association,  and  Associated 
Anesthetists  of  the  United  States  and  Canada; 
died  May  21  of  heart  disease.  Dr.  Brown  had 
practiced  in  Cincinnati  since  his  graduation,  and 
was  a member  of  the  staff  of  Jewish  Hospital. 
He  served  overseas  during  the  World  War.  One 
brother  survives  him. 

Thomas  Teasdale  Church,  M.D.,  Salem;  Cleve- 
land University  of  Medicine  and  Surgery,  Cleve- 
land, 1882;  aged  73;  member  of  the  Ohio  State 
Medical  Association;  Fellow  of  the  American 
Medical  Association,  and  member  of  the  Asso- 
ciated Anesthetists  of  the  United  States  and 
Canada;  died  May  27  at  Cleveland  Clinic,  after  a 
brief  illness.  After  graduation,  Dr.  Church  spent 
a year  in  the  hospitals  of  Vienna  and  Berlin.  For 
nearly  forty  years  he  was  in  active  practice  in 
Salem.  In  1922  he  was  appointed  city  health 
commissioner,  and  for  the  last  eight  years  also 
had  been  health  commissioner  of  Columbiana 
County.  He  was  secretary  of  staff  at  Salem  City 
hospital,  vice  president  of  the  Northeastern  Ohio 
Federation  of  Public  Health  Officials,  and  secre- 
tary-treasurer of  the  Columbiana  County  Medical 
Society.  Surviving  him  are  his  widow,  one  son, 
c:: " daughter,  and  one  sister. 

W.  D.  Frederick,  M.D.,  Sidney;  Physio-Medic 
College  of  Indiana,  Indianapolis,  1884;  aged  84; 
died  May  17.  He  retired  from  active  practice  sev- 
eral years  ago. 


Morton  Byron  Fishbaugh,  M.D.,  Celina;  Col- 
lege of  Physicians  and  Surgeons,  Baltimore, 
Maryland;  1893;  aged  68;  member  of  the  Ohio 
State  Medical  Association  and  the  American 
Medical  Association ; died  May  30  at  Lima  City 
hospital,  following  an  operation  for  gallstones. 
Dr.  Fishbaugh  had  practiced  in  Mercer  County 
for  forty  years.  Surviving  are  his  widow  and 
two  sons,  one  sister  and  three  brothers,  one  of 
whom  is  Dr.  P.  W.  Fishbaugh  of  Mendon. 

Schuyler  O.  Giffin,  M.D.,  Columbus;  Medical 
College  of  Ohio,  Cincinnati,  1886;  aged  73;  for- 
mer member  of  the  Ohio  State  Medical  Associa- 
tion; died  June  3 of  heart  disease.  Dr.  Giffin  had 
practiced  in  Columbus  for  fifty  years,  and  was  a 
former  member  and  chairman  of  the  City  Council. 
He  is  survived  by  a daughter,  a son  and  one  sister. 

Ira  B.  Hamblin,  M.D.,  Columbus;  Medical  Col- 
lege of  Ohio,  Cincinnati,  1884 ; aged  77 ; member 
of  the  Ohio  State  Medical  Association  and  Fellow 
of  the  American  Medical  Association;  died  May 
25.  Dr.  Hamblin  had  practicied  in  Columbus  for 
thirty  years,  and  at  one  time  was  on  the  staff  of 
the  Columbus  State  hospital,  and  for  five  years 
served  as  superintendent  of  the  government  hos- 
pital at  Phoenix,  Arizona.  His  widow  and  one 
brother  survive  him. 

Joseph  W.  Lowry,  M.D.,  Ironton;  University  of 
Louisville  School  of  Medicine,  Louisville,  Ken- 
tucky; aged  66;  died  May  23  of  cerebral  hemor- 
rhage. Dr.  Lowry  opened  an  office  in  Ironton  im- 


July,  1933 


State  News 


457 


mediately  following  his  graduation,  and  later  was 
associated  in  practice  with  his  brother,  the  late 
Dr.  A.  Clai-k  Lowry.  At  one  time  he  served  as 
city  health  commissioner.  Because  of  the  demands 
of  business  interests,  he  had  confined  his  practice 
to  office  work  during  the  past  several  years.  One 
sister  survives  him. 

Walter  David  Moccabee,  M.D.,  Cardington: 
Ohio  Medical  University,  Columbus,  1897;  aged 
59;  former  member  of  the  Ohio  State  Medical 
Association;  died  June  5 at  Mt.  Carmel  Hospital, 
Columbus.  Dr.  Moccabee  had  practiced  for  many 
years  at  Cardington,  and  was  a veteran  of  the 
Spanish-American  and  World  Wars.  He  is  sur- 
vived by  his  widow,  a daughter  and  a sister. 

George  W.  Pickering,  M.D.,  Urbana;  Starling 
Medical  College,  Columbus,  1886;  aged  73;  died 
June  7 following  a long  illness.  Dr.  Pickering  had 
practiced  in  Champaign  County  and  Urbana  since 
his  graduation.  For  several  years  he  served  on 
the  county  Pension  Board  and  also  on  the  local 
Board  of  Health.  Surviving  him  are  two  daugh- 
ters. 

Clarence  D.  Romans,  M.D.,  Columbus;  Medical 
College  of  Ohio,  Cincinnati,  1884;  aged  79;  died 
June  13  after  an  illness  of  three  months.  Dr. 
Romans  practiced  at  Quaker  City  and  Cambridge 
before  his  retirement  several  years  ago.  He  is 
survived  by  his  widow,  one  daughter  and  one 
brother. 

Hershel  A.  Snorf,  M.D.,  Greenville;  Miami 
Medical  College,  Cincinnati,  1886;  aged  70;  for- 
mer member  of  the  Ohio  State  Medical  Associa- 
tion; died  May  15  after  an  extended  illness.  Dr. 
Snorf  practiced  at  Ansonia  before  moving  to 
Greenville  in  1907.  Prior  to  his  retirement  be- 
cause of  ill  health,  he  was  actively  identified  with 
medical  organization.  He  is  survived  by  two  sons, 
one  daughter  and  one  sister. 

William  H.  Taylor,  M.D.,  Youngstown;  Rush 
Medical  College,  Chicago,  1902;  aged  57;  members 
of  the  Ohio  State  Medical  Asociation  and  the 
American  Medical  Association;  died  June  1.  Dr. 
Taylor  served  his  internship  at  Lakeside  Hospital, 
Cleveland,  and  was  resident  physician  at  Youngs- 
town Hospital  before  entering  private  practice. 
He  was  a senior  member  of  the  medical  staff  of 
the  hospital,  and  for  many  years  held  classes  and 
lectures  for  nurses.  A resolution  in  memory  of 
Dr.  Taylor  was  adopted  by  the  Mahoning  County 
Medical  Society.  Surviving  him  are  his  widow, 
two  daughters,  three  brothers  and  a sister. 

William.  H.  Tucker,  M.D.,  Bradner;  Ohio  Medi- 
cal University,  Columbus,  1900;  aged  64;  member 
of  the  Ohio  State  Medical  Association  and  the 
American  Medical  Association;  died  at  Com- 
munity Hospital,  Fremont,  May  27  of  diabetes. 
Dr.  Tucker  practiced  in  Darke  and  Preble  coun- 
ties before  locating  at  Bradner,  eleven  years  ago. 
Surviving  him  are  his  widow,  two  brothers  and 
three  sisters. 


George  B.  Twitchell,  M.D.,  Cincinnati;  Miami 
Medical  College,  Cincinnati,  1891;  aged  68;  died 
April  27  at  Jewish  Hospital.  Dr.  Twitchell  was  a 
lifelong  resident  of  Cincinnati.  He  leaves  his 
widow  and  two  sons. 

Corwin  G.  Warden,  M.D.,  Berea;  University  of 
Wooster,  Medical  Department,  Cleveland,  1878; 
aged  76;  died  May  26.  Dr.  Warden  had  been  an 
invalid  since  1920  when  he  was  injured  in  a fall. 
From  1890  to  1894  he  served  as  postmaster  of 
Berea.  His  widow  survives  him. 

Samuel  A.  Weisenberg,  M.D.,  Cleveland;  Cleve- 
land College  of  Physicians  and  Surgeons,  1898; 
aged  60;  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  May  17.  Dr.  Weisenberg  practiced  in  Cleve- 
land for  more  than  thirty  years  prior  to  his  re- 
tirement two  years  ago.  Surviving  are  his  widow 
and  three  daughters. 

Thomas  B.  Williams,  M.D.,  Cleveland;  Western 
Reserve  University  School  of  Medicine,  Cleveland ; 
1882;  aged  84;  former  member  of  the  Ohio  State 
Medical  Association;  died  May  24.  Dr.  Williams 
practiced  at  West  Austintown,  Ohio,  before  lo- 
cating in  Cleveland,  where  he  had  practiced  for 
the  past  45  years.  He  is  survived  by  two  sons. 

Henry  A.  Wilson,  M.D.,  Bowdil;  University  of 
Western  Ontario  Medical  School,  London,  Ontario, 
Canada,  1891 ; aged  67 ; member  of  the  Ohio  State 
Medical  Association  and  Fellow  of  the  American 
Medical  Association;  died  June  1,  of  pneumonia. 
Dr.  Wilson  was  on  the  staff  of  Victoria  Hospital, 
London,  Ontario,  for  four  years.  For  the  past  23 
years  he  had  practiced  at  Bowdil.  Surviving  him 
are  his  widow,  one  son,  one  daughter,  and  two 
sisters. 

Edward  J.  Ziegler,  M.D.,  New  Madison;  Rush 
Medical  College,  Chicago,  1882;  aged  76;  died 
May  13  following  a long  illness.  Dr.  Ziegler  had 
practiced  in  Wisconsin,  Dayton,  West  Sonora  and 
Akron,  Ohio,  retiring  two  years  ago  because  of 
ill  health.  He  is  survived  by  two  sons  and  a 
brother. 


KNOWN  IN  OHIO 

Joseph  Esch,  M.D.,  Daytona,  Florida;  Uni- 
versity of  Wooster,  Medical  Department,  Cleve- 
land; 1876;  aged  84;  Fellow  of  the  American 
Medical  Association;  died  May  10.  Dr.  Esch 
practiced  for  a number  of  years  at  Huron,  Ohio, 
before  moving  to  Florida.  Surviving  are  his 
widow,  a son,  a daughter,  and  one  brother,  Dr. 
William  Esch,  of  Cleveland. 

Fred  W.  Vance,  M.D.,  Mannington,  West  Vir- 
ginia; Eclectic  Medical  College  of  Ohio,  Cincin- 
nati, 1905;  aged  59;  died  May  20.  He  had  resided 
in  Mannington  for  several  years  and  at  one  time 
served  as  mayor  of  that  city. 


458 


The  Ohio  State  Medical  Journal 


July,  1933 


POSTGRADUATE  COURSE 


LABORATORY  COURSE 


For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

A house  doctor  is  appointed  July  1st  and 
January  1st 


For  Nurses  and  Graduates  of  High  School 
CLASSES  LIMITED  TO  SIX 
X-ray,  Basal  Metabolism,  Electro-cardiography  and 
Physical  Therapy 


150  clinical  patients  daily  provide  material  for  classes. 

Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 


For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


2VEW5  NOTESs^OHIO 


Martins  Ferry — Dr.  and  Mrs.  R.  H.  Wilson 
have  sailed  for  Europe  where  Dr.  Wilson  will  take 
postgraduate  work  at  various  clinics  and  medical 
centers. 

Lancaster — Dr.  James  M.  Lantz  has  been 
elected  president  of  the  Lancaster  Chamber  of 
Commerce. 

Columbus — Dr.  and  Mrs.  H.  M.  Brundage  and 
son,  Robert,  have  returned  from  a vacation  in 
Florida. 

Pomeroy — The  commencement  address  at  the 
Pomeroy  High  School  was  delivered  by  Dr.  George 
G.  Hunter,  Ironton. 

Xenia — At  the  annual  meeting  of  the  volunteer 
medical  and  surgical  consulting  staff  of  the  Ohio 
Soldiers’  and  Sailors’  Orphans’  Home,  Dr.  Ben  R. 
McClellan  was  elected  dean.  Dr.  A.  C.  Messenger, 
resident  physician,  who  resigned  recently  because 
of  ill  health,  reconsidered  his  resignation  and  de- . 
cided  to  remain  in  charge  of  the  medical  work  at 
the  institution.  He  was  elected  secretary.  Dr. 
Warren  Briedenbach,  Dayton,  and  Dr.  R.  E. 
Bushong,  superintendent  of  the  Lima  State  Hos- 
pital, were  voted  membership  on  the  staff. 

Cleveland — Dr.  L.  P.  Herd,  captain  in  the 
Medical  Reserve  Corps,  is  on  six-months  active 
service  duty  in  the  citizens’  reforestation  corps. 

Van  Wert — Dr.  S.  A.  Edwards  addressed  the 
local  Kiwanis  Club  on  “Looking  Backward  in 
Medicine”. 

Findlay — Dr.  D.  J.  King  will  serve  as  Hancock 
County  coroner  during  the  six-months  absence  of 
Dr.  H.  O.  Crosby  who  is  on  active  duty  in  the 
medical  division  of  the  citizens’  reforestation 
corps. 

New  Philadelphia — Dr.  R.  J.  Foster  has  been 
taking  postgraduate  work  at  the  Cooke  County 
Hospital,  Chicago. 

Ottawa — Dr.  Joseph  N.  Rappaport  who  has 
been  visiting  his  parents,  Mr.  and  Mrs.  Samuel 
Rappaport  here,  has  sailed  for  Europe  where  he 
will  take  postgraduate  work.  He  recently  com- 
pleted his  internship  following  graduation  from 
Rush  Medical  School. 


Cleveland — Dr.  George  B.  Ray  has  resigned  as 
assistant  professor  of  physiology  at  the  School  of 
Medicine,  Western  Reserve  University,  to  become 
a member  of  the  faculty  of  the  Long  Island  Col- 
lege of  Medicine,  Brooklyn,  as  professor  of 
physiology  and  pharmacology.  He  joined  the 
Western  Reserve  faculty  nine  years  ago. 

Dayton — The  following  officers  were  elected  at 
the  annual  meeting  of  the  Ohio  Eclectic  Medical 
Society  at  Dayton:  President-elect,  Dr.  J.  K. 

Bailey,  Dayton;  vice  president,  Dr.  E.  M.  Wright, 
Coshocton;  treasurer,  Dr.  F.  L.  Thomas,  Marion; 
recording  secretary,  Dr.  G.  E.  Jones,  Lima; 
corresponding  secretary,  Dr.  G.  M.  Hite,  Toledo. 
Dr.  H.  E.  Dwire,  Bucyrus,  was  installed  as  presi- 
dent for  the  ensuing  year. 

Cleveland — Dr.  James  A.  Doull,  head  of  the 
Department  of  Public  Health,  School  of  Medicine, 
Western  Reserve  University,  has  sailed  for  the 
Philippines  where  he  will  establish  experimental 
work  for  the  Leonard  Wood  Memorial  Founda- 
tion for  the  Eradication  of  Leprosy. 

Toledo — Dr.  Roy  K.  Evans  has  been  elected 
president  of  the  Toledo  Medical  Study  Club. 

Clevelayid — The  Steuer  Prize  given  annually  by 
the  School  of  Medicine,  Western  Reserve  Uni- 
versity, for  outstanding  work  done  by  undergrad- 
uates in  anatomy  has  been  awarded  to  William  B. 
Seymour,  Jr.,  Jackson,  Michigan,  a sophomore, 
for  research  in  bone  scars  revealed  by  X-ray  in 
the  limb  bones  of  children  caused  by  piling  up  of 
lime. 

Clevelayid — Two  major  prizes  offered  annually 
by  the  School  of  Medicine,  Western  Reserve  Uni- 
versity, have  been  awarded  to  Frederick  Robert 
Mautz,  Marion,  a member  of  the  1933  graduating 
class.  Mautz  was  awarded  the  prize  in  ob- 
stetrics and  the  prize  in  surgery. 

Wooster — Dr.  Robert  N.  Wright  has  been  ap- 
pointed physician  at  Wooster  College,  succeeding 
Dr.  H.  A.  Wildman  who  resigned  to  enter  private 
practice  in  Lapere  County,  Michigan. 

Mansfield — Dr.  Harro  K.  Woltmann  was  a re- 
cent speaker  before  the  local  Kiwanis  Club. 


July,  1933 


State  News 


459 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 


We  Announce 


FOR  THE  GENERAL  PRACTITIONER 

A combined  course  comprising 


INTERNAL  MEDICINE 
PEDIATRICS 
GASTRO-ENTEROLOGY 
DERMATOLOGY 
NEUROLOGY 
OBSTETRICS 
PHYSICAL  THERAPY 
PATHOLOGY  and 
BACTERIOLOGY 


OPTHALMOLOGY 

OTOLOGY 

RHINOLARYNGOLOGY 


SURGERY 
NEURO-SURGERY 
UROLOGY 
PROCTOLOGY 
GYNECOLOGY  (Surgical- 
Medical) 

ORTHOPEDIC  SURGERY 
TRAUMATIC  SURGERY 
THORACIC  SURGERY 


For  Information  Address 

Medical  Executive  Officer,  345  West  50th  Street,  New  York  City 


COOK  COUNTY  GRADUATE  SCHOOL  OF  MEDICINE 

(In  affiliation  with  Cook  County  Hospital) 

ANNOUNCES  CONTINUOUS  COURSES— JUNE  1ST  TO  NOVEMBER  1ST 

MEDICINE — General  and  Intensive  Courses,  all  branches  (Intensive  One  Week  Course,  Tuition  $30.00) 
PEDIATRICS — Informal  Course 

OBSTETRICS — Course — Two  Weeks  Intensive  Course 

GYNECOLOGY — Three  Months  Course — Two  Weeks  Course 

FRACTURES  AND  TRAUMATIC  SURGERY— General  Course— Intensive  Course 
UROLOGY — Two  Months  Course — Two  Weeks  Course 

CYSTOSCOPY — Intensive  Two  Weeks  Course 

SURGERY — Three  Months  General  Course — Two  Weeks  Intensive  Course  Surgical  Technique  (Laboratory).  General, 
Intensive  or  Special  Courses,  Tuberculosis,  Orthopaedic  Surgery,  Roentgenology,  Dermatology  and  Syphilis, 
Ophthalmology,  Ear,  Nose  and  Throat,  Anatomy,  Pathology,  Nervous  and  Mental  Diseases. 

Teaching  Faculty — Attending  Staff  of  Cook  County  Hospital 

Address:  Registrar,  427  South  Honore  Street,  CHICAGO,  ILLINOIS 


CURDOLAC  FOODS 

FULFILL  THE  A.  B.  C.’s  OF  THE 
DIABETIC  DIET  PERFECTLY  — 

Curdolac  Breakfast  Cereal 

Curdolac  Soya  Flour 

Curdolac  Wheat-Soya  Flour 

Curdolac  Soya  Cereal  Johnny  Cake  Flour 

Curdolac  Soya-Bran  Breakfast  Food 

Curdolac  Soya-Bran  Flour 

Adequate  in  nourishment 
Beautiful  to  the  sight 
Correct  in  food  value 

Samples  and  Literature  on  request 

CURDOLAC  FOOD  COMPANY 

Box  299  Waukesha,  Wis. 


PUBLIC  HEALTHNOTES 


— Regulations  recently  adopted  by  the  Cincin- 
nati city  board  of  health  and  promulgated  to  the 
public  and  especially  to  makers  and  purveyors  of 
dairy  products,  are  designed  to  draw  yet  tighter 
the  safety  lines  with  which  that  city  guards  an 
important  part  of  its  food  supply.  By  regulations 
adopted  May  12  last,  it  is  provided  that  on  and 
after  September  1,  1933,  all  butter  sold  or  offered 
for  sale  in  Cincinnati  shall  be  made  of  cream  from 
tuberculin-tested  cows  in  officially  accredited 
areas,  and  that  certification  of  that  fact  shall  be 
printed  on  the  label  under  which  it  is  sold.  It 
will  be  unlawful  even  to  have  in  possession  butter 
not  so  certified,  with  intent  to  sell  or  to  give  away. 

Stiff  penalties  are  provided  for  violations 
ranging  from  $25  to  $100  fine  and  costs  on  the 
first  conviction  and  for  subsequent  offenses  $100 
fine  and  costs  or  imprisonment  up  to  90  days,  or 
both. 

Coupled  with  the  announcement  of  these  regu- 
lations the  board  is  tightening  up  its  supervision 
of  food  handlers.  Dr.  W.  H.  Peters,  city  health 
commissioner,  in  announcing  the  new  regulations, 
points  out  that  experience  and  observation  both 
indicate  that  there  are  many  food  handlers  in  Cin- 
cinnati who  are  suffering  from  communicable  dis- 
eases which  endanger  the  public  health.  He  cites 
that  during  last  year  107  food  handlers  were  sent 
by  the  food  inspectors  to  the  health  center  for  ex- 
amination, and  that  37  of  this  number  were  ex- 
cluded from  their  occupations  as  the  result.  They 
included  both  men  and  women,  were  waiters  and 
waitresses,  or  worked  in  ice  cream  plants,  candy 
and  confectionery  shops,  groceries,  meat  markets 
and  public  kitchens,  and  among  them  were  those 
infected  with  tuberculosis  and  various  forms  of 
venereal  disease. 

All  food  handlers  are  urged  to  go  to  their 
family  physicians  twice  a year  for  the  required 
physical  examination;  procurement  of  the  health 
department  certificate  is  requested,  and  employers 
are  advised  that  if  physical  fitness  and  freedom 
from  communicable  diseases  are  made  require- 
ments for  employment,  additional  credit  will  be 
given  in  the  departmental  rating  of  the  establish- 
ment. 

— Dr.  Myron  D.  Miller  has  been  appointed  su- 
perintendent of  the  Franklin  County  Tuberculosis 
Hospital,  succeeding  the  late  Dr.  C.  O.  Probst, 
under  whom  Dr.  Miller  worked  as  assistant  for 
four  years.  Dr.  E.  M.  Blake  has  been  named  Dr. 
Miller’s  assistant. 

- — Dr.  Paul  E.  Gilnor,  Canal  Fulton,  has  been 
elected  to  the  Stark  County  Board  of  Health  for  a 
five-year  term. 

— At  a meeting  of  the  Fulton  County  Advisory 


Council,  Dr.  E.  E.  Patterson,  Fayette,  was  re- 
elected a member  of  the  county  board  of  health. 

— Dr.  J.  R.  Moorehead,  Seville,  has  been  elected 
a member  of  the  Medina  County  Board  of  Health. 

— The  advisory  council  of  Clermont  County  has 
elected  Di\  Allan  Rapp,  Owensville,  a member  of 
the  Clermont  County  Board  of  Health. 

— Dr.  B.  B.  Barber  has  been  re-appointed  health 
commissioner  of  Delaware  County. 


HOSPITAL  NOTES 


— Members  of  the  stalf  of  Robinson  Memorial 
Hospital,  Ravenna,  gave  a surprise  party  for  Dr. 
J.  J.  Waggoner,  dean  of  the  staff,  on  his  68th 
birthday. 

— Lima’s  new  $550,000,  144-bed  City  Hospital 
was  dedicated  on  Memorial  Day. 

— The  staff  at  Peoples’  Hospital,  Akron,  has 
organized  by  electing  Dr.  Fowler  B.  Roberts,  chief 
of  staff;  Dr.  M.  C.  Tuholske,  vice  chief,  and  Dr. 
G.  K.  Parke,  secretary. 

— Miss  Coral  M.  Page,  Conneaut,  formerly  su- 
perintendent of  the  Lancaster  Municipal  Hospital, 
has  been  appointed  superintendent  of  the  Piqua 
Memorial  Hospital,  succeeding  R.  A.  Bates,  re- 
signed. 

— The  following  officers  have  been  elected  by 
the  staff  of  the  Middletown  Hospital : President, 
Dr.  F.  W.  Brosius;  vice  president,  Dr.  Mildred 
White  Gardiner,  and  secretary-treasurer,  Dr.  C. 
A.  Spitler. 

— Miss  Edith  Martin  has  been  appointed  su- 
perintendent of  the  Stouder  Memorial  Hospital, 
Troy.  Miss  Martin  had  been  supervisor  of  nurses 
for  the  past  few  years. 


CLASSIFIED  ADVERTISEMENTS 

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Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  Place,  Chicago, 
Illinois. 


For  Sale  or  Trade — Location  for  doctor  or  surgeon.  South- 
ern Ohio  town,  10,000  population.  Bargain.  Address,  W. 
S.  J.,  care  Ohio  State  Medical  Journal. 


For  Sale — Established  practice  of  deceased  physician,  in 
town  of  700  population,  including  country  radius  of  seven 
miles.  Complete  office  equipment,  drugs,  record  of  patients, 
fine  library.  For  details,  write  Mrs.  IT.  A.  Wilson,  Box  22, 
Bow'dil,  Ohio. 


460 


July,  1933 


State  News 


461 


Edward  Reinert 


Ph.G.,  M.D. 


247  East  State  Street 


Columbus,  Ohio 


Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 


FRANK  GALLEN,  M.D., 

Dermatology 

Tel.  Main  1537 


LEE  A.  HAYS,  M.D., 
Roentgenology 

University  5842 


W.  H.  MILLER,  M.  D. 


328  East  State  St. 

Office  Telephone,  MAin  3743 


Columbus,  Ohio 
Residence,  EVergreen  5644 


Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

Prompt  and  Full  Report 


Luut 


462 


The  Ohio  State  Medical  Journal 


July,  1933 


U.  S.  Birth  and  Infant  Mortality  Rates 
Show  Decline  During  Year  1932 

The  Bureau  of  the  Census  announces  that  in 
the  birth  registration  area  of  continental  United 
States  (exclusive  of  Massachusetts  and  Utah) 
during  the  calendar  year  1932  there  were  1,961,- 
618  births,  113,661  deaths  of  infants  under  one 
year  of  age,  and  75,175  stillbirths.  These  figures 
are  equivalent  to  a birth  rate  of  17.3  per  1,000 
population,  an  infant  mortality  rate  of  57.9  per 
1,000  live  births,  and  a stillbirth  rate  of  3.8  per 
100  live  births.  The  corresponding  final  rates  for 
1931  for  the  same  area  were  18.0,  61.9,  and  3.8, 
respectively. 

The  birth  rate  of  17.3  for  the  44  states  and  the 
District  of  Columbia  covered  by  this  press  release 
is  the  lowest  since  the  establishment  of  the  Fed- 
eral birth  registration  area  in  1915.  The  infant 
mortality  rate  (57.9)  is  also  lower  than  for  any 
previous  year.  The  stillbirth  rate  (3.8)  is  the 
same  as  for  1931  and  has  varied  but  very  little 
since  1922,  in  which  year  the  annual  collection 
of  stillbirth  records  was  begun. 

The  urban  part  of  the  birth  registration  area 
of  1932,  except  Massachusetts  and  Utah,  includes 
864  cities,  towns,  and  townships,  with  an  esti- 
mated total  population  of  54,979,000  on  July  1, 
1932.  In  this  urban  area  there  were  896,334 
births,  51,136  deaths  of  infants  under  one  year 
of  age,  and  35,317  stillbirths.  The  rural  part  had 
an  estimated  population  of  58,367,000,  among 
which  there  were  1,065,284  births,  62,525  infant 
deaths,  and  39,858  stillbirths.  In  the  urban  por- 
tion of  the  area  the  birth  rate  was  16.3  per 
1,000  population,  the  infant  mortality  rate  57.1 
per  1,000  live  births,  and  the  stillbirth  rate  3.9 
per  100  live  births.  The  corresponding  rates  for 
the  rural  portion  of  the  area  were  18.3,  58.7,  and 
3.7,  respectively. 

Naturally,  the  greatest  number  of  births  oc- 
curred in  the  four  most  populous  states — New 
York,  having  198,353,  Pennsylvania,  168,533,  Illi- 
nois, 111,512,  and  Ohio,  101,043.  The  highest 
birth  rates,  however,  were  for  New  Mexico,  28.0, 
North  and  South  Carolina,  each  23.7,  and  Ala- 
bama, 23.5.  Nevada,  Wyoming,  and  Delaware 
had  the  smallest  number  of  births,  1,244,  4,231 
and  4,264,  respectively,  but  the  states  having  the 
lowest  birth  rates  were  California  and  Oregon, 
each  with  13.1,  Nevada  and  Washington,  each 
with  13.4,  and  Illinois,  with  a rate  of  14.4. 

The  greatest  number  of  deaths  of  infants  under 
one  year  of  age  occurred  in  New  York  (10,446), 
Pennsylvania  (10,107),  and  Ohio  (5,961).  The 
highest  infant  mortality  rate  was  for  New  Mexico 
(113.6),  which  was  the  only  state  with  a rate 
higher  than  100.0.  Other  states  with  high  in- 
fant mortality  rates  were  Arizona,  Colorado,  Dis- 
trict of  Columbia,  South  Carolina,  and  West  Vir- 
ginia. 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLdOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 

LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Association- 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Coup,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


July,  1933 


State  News 


463 


r 


FOR  DIGESTIVE  DISTURBANCES. 

<«*  this  LACTIC  ACID  MILK 


with  these  practical  advantages 


In  the  treatment  of  digestive  disturbances  of  infants  and  for 
the  premature  or  athreptic  infant,  Merrell-Soule  Powdered 
Whole  Lactic  Acid  Milk  (Cultured)  offers  these  very  prac- 
tical advantages: 


It  is  easily  digested  — Approxi- 
mates breast  milk  in  digestive 
qualities  — the  spray  process  of 
drying  breaks  up  the  fat  and  pro- 
teins into  fine  particles  which 
combine  readily  with  the  gastric 
juices. 

Its  correct  acidity  promotes  the 
assimilation  of  calcium. 

It  is  nutritious— Contains  all  the 
vitamins  and  nutritive  proper- 
ties of  grade  A pasteurized  milk. 
It  is  more  palatable — The  process 
of  culturing  results  in  a pleasing 
flavor — no  sharp  and  bitter  taste 


such  as,  in  uncultured  milks, 
may  be  caused  by  the  addition 
of  the  chemica  lly-prepared  acid. 
It  is  uniform — No  possibility  of 
variation  in  quality  or  content 
or  in  the  resulting  formula. 

It  is  pure — Made  only  from  pas- 
teurized milk  obtained  from  rig- 
idly-controlled sources. 

It  is  economical  and  easy  to  use — 
Reliquefied  by  mixing  in  the 
proportion  of  one  packed  level 
tablespoon  of  the  powder  to  two 
ounces  of  warm  water  — then 
stirred  into  complete  solution. 


Samples  and  literature  on  Merrell-Soule  Powdered  Whole 
Lactic  Acid  Milk  and  Merrell-Soule  Powdered  Skimmed 
Lactic  Acid  Milk  are  available  to  Physicians  on  request. 

The  Borden  Co.,  Dept.  L-60,  350  Madison  Ave.,  New  York,  N.  Y. 


(CULTURED) 


464 


The  Ohio  State  Medical  Journal 


July,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

John  B.  Alcorn,  Chairman,  (1933) 


Columbus 

J.  H.  J.  Upham  (1934) Columbus 

C.  W.  Stone  (1935) Cleveland 

H.  M.  Platter,  (ex-officio) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

D.  C.  Houser,  (special) : Urbana 

C.  W.  Waggoner,  (special) Toledo 

A.  H.  Freiberg,  (special) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

A.  B.  Denison,  (1933) Cleveland 

Gilbert  Micklethwaite,  (1935)  ....Portsmouth 


MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

W.  H.  Snyder,  (1933) Toledo 

F.  P.  Anzinger,  (1935) Springfield 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) Toledo 

R.  H.  Birge,  (1935) Cleveland 

MEDICAL  ECONOMICS 

J.  Craig  Bowman,  Chairman,  (1933) 

Upper  Sandusky 

A.  B.  Brower,  (1934) Dayton 

E.  0.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 

V.  C.  Rowland,  Chairman Cleveland 

Jonathan  Forman  Columbus 


Beatrice  T.  Hagen . 

Zanesville 

R.  R.  Hendershott _ 

Tiffin 

C.  I.  Stephen _ 

Ansonia 

MILITARY  AND  VETERANS’ 

AFFAIRS 

C.  W.  Stone,  Chairman 

Cleveland 

Fred  K.  Kislig  (deceased) 

A.  E.  Brant 

Dayton 

Youngstown 

COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

S.  J.  Goodman,  Chairman 

John  A.  Caldwell 

Columbus 

Cincinnati 

T P,  Reilpr 

Piket.on 

ARRANGEMENTS  1933  ANNUAL 

MEETING 

H.  S.  Davidson,  Chairman __ 

..  Akron 

E.  M.  Huston Dayton 

E.  B.  Shanley New  Philadelphia 


PROGRAM  1933  ANNUAL  MEETING 

C.  L.  Cummer,  Chairman Cleveland 

B.  J.  Hein Toledo 

E.  R.  Brush Zanesville 


SECTION  OFFICERS  FOR  1932-1933 


MEDICINE 

Carll  S.  Mundy Chairman 

125  15th  St.,  Toledo 

Cecil  Striker Secretary 

700  Provident  Bank  Bldg-,  Cincinnati 


EYE,  EAR,  NOSE  AND  THROAT 

W.  V.  Mullin Chairman 

Euclid  at  93rd  St.,  Cleveland 

Ivor  G.  Clark Secretary 

188  E.  State  St.,  Columbus 


SURGERY 

Carl  R.  Steinke  Chairman 

1027  Second  Natl.  Bldg.,  Akron 

Norris  Gillette Secretary 

320  Michigan  St.,  Toledo 


NERVOUS  AND  MENTAL  DISEASES 


J.  Fremont  Bateman Chairman 

Box  36,  Elmwood  Place 

Henry  C.  Schumacher Secretary 


2525  Euclid  Ave.,  Cleveland 


OBSTETRICS  AND  PEDIATRICS 


B.  H.  Carroll Chairman 

240  Michigan  St.,  Toledo 

Edward  A.  Wagner Secretary 


2660  Grandin  Rd..  Cincinnati 


PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 
R.  H.  Markwith Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 

J.  P.  DeWitt,  (1933) 

C.  E.  Kiely,  (1933) 

C.  W.  Waggoner,  (1933) 

Wells  Teachnor,  Sr.,  (1934) 

Ben  R.  McClellan,  (1934) 

E.  R.  Brush,  (1934) 

C.  W.  Stone.  (1934) 


Canton 

Cincinnati 

Toledo 

Columbus 

Xenia 

Zanesville 

Cleveland 


ALTERNATES 

G.  F.  Zinninger,  (1933) 

L.  H.  Schriver,  (1933) 

John  Sprague,  (1933) 

D.  H.  Morgan.  (1934) 

A.  C.  Messenger,  (1934) 

A.  Howard  Smith,  (1934) 

C.  L.  Cummer,  (1934) 


Canton 

Cincinnati 

Athens 

Akron 

Xenia 

Marietta 

..Cleveland 


EIGHTY- SEVENTH  ANNUAL  MEETING, 
AKRON,  SEPTEMBER  7th  and  8th,  193  3 


August,  1933 


Advertisements 


465 


THE  SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 


TREATS  NERVOUS  AND  MENTAL  DISEASES 


THE  ENTRANCE 


Treatment  is  provided  for  the  neurotic  or  psychoneurotic  with  compulsive  and 
obsessive  symptoms  at  the  Sawyer  Sanatorium. 

Send  For  House  Book.  Address 

Sawyer  Sanatorium,  White  Oaks  Farm,  Marion,  Ohio 


The  Ohio  State  Medical  Association 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879  : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918, 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

Subscription  $3.00  per  year ; single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 

PUBLICATION  COMMITTEE 

Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1933) Cleveland 

Gilbert  Micklethwaite,  M.D.  (1935) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager 


Officers  1932-1933 

PRESIDENT 

H.  M.  Platter,  M.D Columbus 

PRESIDENT-ELECT 

C.  L.  Cummer,  M.D Cleveland 

TREASURER 

James  A.  Beer,  M.D Columbus 


EXECUTIVE  SECRETARY 
Don  K.  Martin 


..Columbus 


State  Council 

First  District 

John  A.  Caldwell,  M.D Cincinnati 

Second  District 

E.  M.  Huston,  M.D Dayton 

Third  District 

0.  P.  Klotz,  M.D Findlay 

Fourth  District 

B.  J.  Hein,  M.D. Toledo 

Fifth  District 

H.  V.  Paryzek,  M.D. Cleveland 

Sixth  District 

H.  S.  Davidson,  M.D Akron 

Seventh  District 

E.  B.  Shanley,  M.D New  Philadelphia 

Eighth  District 

E.  R.  Brush,  M.D Zanesville 

Ninth  District 

1.  P.  Seiler,  M.D Piketon 

Tenth  District 

S.  J.  Goodman,  M.D Columbus 

Ex-Officio,  The  Ex-President 
D.  C.  Houser,  M.D Urbana 


466 


The  Ohio  State  Medical  Journal 


August,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 

Societies  President  Secretary 

First  District 


Brown  _ 

R.  B. 

..H.  0. 

. J.  K. 

F.  A. 

Fayette 

S.  E. 

Hamilton 

.Parke 

C.  C. 

-J.  E. 

Second  District 

Cyril  ] 

Champaign 

N.  M. 

-C.  w. 

Darke  ..  _ 

W.  T. 

Greene 

L.  L. 

Miami 

F.  D. 

Montgomery 

A.  F. 

Preble  . 

C.  M. 

R.  E. 

Third  District  __ 

. V.  H. 

Allen  _ . 

E.  C. 

Auglaize 

E.  F. 

Hancock 

A.  E. 

Hardin 

F.  M. 

_Wm.  L.  Regan,  Wilmington 


— Geo.  B.  Topmoelier,  Cincinnati.. 


James  Arnold,  Lebanon 


-H.  R.  Huston,  Dayton_ 


3d  Wednesday  in  April,  Juna,  Aas„ 

Oct. 

4th  Wednesday  in  Feb.,  May  and 
Nov. 

2d  Wednesday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Monday  evening  of  each  weak. 

1st  Wednesday,  monthly. 

1st  Tues.  Apr.,  May,  Juna, 

Sept.,  Oct.,  and  Nov. 


2d  Thursday,  monthly. 


C.  W.  Evans,  Springfield . 


_L.  A.  Woodburn,  Urbana 

—Roger  Marquart,  Springfield 2d  and  4th  Wednesday  noon. 

-W.  D.  Bishop,  Greenville 2nd  Friday,  monthly. 

H.  C.  Schick,  Xenia 1st  Thursday,  monthly. 


Miss  M.  E.  Jeffrey,  Dayton 

~C.  J.  Brian,  Eaton 


C.  E.  Hufford,  Toledo.. 

H.  L.  Stelzer,  Lima 


Logan 

Marion 

Mercer 

Seneca 

Van  Wert. 


. O.  C.  Amstutz,  Bellefontaine_ 
— E.  L.  Brady,  Marion 


... C.  C.  Berlin,  Wapakoneta 

... H.  0.  Crosby,  Findlay 

_W.  N.  Mundy,  Forest 

— W.  H.  Carey,  B.'llefontaine 

— J.  W.  Jolley,  Marion 


— M.  B.  Fishbaugh,  Celina F.  E.  Ayers,  Celina.. 

. Paul  Leahy,  Tiffin 

— A.  T.  Rank,  Van  Wert 


R.  E.  Hershberger,  Tiffin 

— R.  H.  Good,  Van  Wert 


Wyandot B.  A.  Moloney,  Upper  Sandusky W.  L.  Naus,  Upper  Sandusky.. 

Fourth  District—  (With  Third  District  in  Northwestern  Ohio  District) 

Defiance S.  E.  DeMuth,  Hicksville D.  J.  Slosser,  Defiance 


1st  Friday,  monthly,  except  July 
and  August. 

1st  and  3d  Friday  each  month. 

3d  Thursday,  monthly. 


Tiffin,  Oct.  3,  1933 
3d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 
1st  Thursday,  monthly. 
17th  of  each  month. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Thursday,  monthly. 

3rd  Thursday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


__P.  S.  Bishop,  Delta 

T.  P.  Delventhal,  Napoleon 

— L.  R.  Effler,  Toledo. 

— R.  A.  Willett,  Elmore 


Fulton 

Henry 

Lucas 

Ottawa 

Paulding 

Putnam E.  Blackburn,  Kalida 

Sandusky D.  W.  Philo,  Fremont 

Williams B.  C.  Bly,  Bryan 

Wood F.  L.  Sterling,  Bowling  Green 


Geo.  McGuflfin,  Pettisville 

— F.  M.  Harrison,  Napoleon 

A.  P.  Hancuff,  Toledo 

Cyrus  R.  Wood,  Port  Clinton — 


C.  E.  Houston,  Paulding Gaile  L.  Doster,  Paulding 

W.  B.  Light,  Ottawa 

J.  C.  Boyce,  Fremont 

_H.  R.  Mayberry,  Bryan 


..R.  N.  Whitehead,  Bowling  Green. 


Flflh  District H.  V.  Paryzek,  Councilor Chrm.  Com.  on  Arrangements — 

Ashtabula J.  F.  Docherty,  Conneaut A.  M.  Mills,  Ashtabula 

Cuyahoga H.  V.  Paryzek,  Cleveland .Clarence  H.  Heyman,  Cleveland  . 


Erie 

Geauga  _ 
Huron 


- J.  C.  Kramer,  Sandusky  . 


-G.  A.  Stimson,  Sandusky. 


— H.  E.  Shafer,  Middlefield Isa  Teed-Cramton,  Burton 

_Geo.  F.  Linn,  Norwalk 

B.  T.  Church,  Painesville 


Lake 

Lorain 

Medina 

— Harry  Streett,  Litchfield- 

J. 

Trumbull 

E.  P.  Adams,  Warren 

....  R. 

J.  K.  Durling,  Wadsworth 

R.  H.  McCaughtry,  Warren. 


3d  Thursday,  monthly,  except 
July,  August,  December. 

2nd  Thursday  monthly. 

1st  Wednesday,  monthly. 

Friday,  each  week. 

2d  Thursday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Thursday,  monthly. 

3d  Thursday,  monthly. 

Cleveland. 

2nd  Tuesday,  monthly. 

3d  Fri.  Feb.,  March,  May,  Sept., 
Nov.,  Dec. 

Last  Wednesday,  monthly,  except 
July,  Aug.,  Sept. 

Last  Wednesday,  Apr.  to  Oct. 

3d  Tuesday,  Feb.,  May, 

August,  Nov. 

4th  Tuesday,  monthly. 

2d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  monthly,  except 
June,  July,  August. 


August,  1933 


The  Ohio  State  Medical  Journal 


467 


Societies 


President 


Secretary 


Sixth  District A.  E.  Brant,  Youngstown J.  H.  Seiler,  Akron 2d  Wed.,  Jan.,  April  & Oct. 


Ashland H.  M.  Gunn,  Ashland  . Paul  E.  Kellogg,  Ashland 2nd  Friday,  Sept,  to  May. 

Holmes L.  E.  Anderson,  Mt.  Hope C.  T.  Bahier,  Walnut  Creek 1st  Tuesday,  quarterly,  Jan.,  April, 

July,  October. 

Hahoning J.  P.  Harvey,  Youngstown W.  M.  Skipp,  Youngstown 3d  Tuesday,  monthly. 

Portage J S.  U.  Sivon,  Ravenna E.  J.  Widdeeombe,  Kent 1st  Thursday,  monthly.  - 

Richland C.  H.  Bell,  Mansfield Mabel  Emery,  Mansfield Last  Thursday,  monthly. 

Stark H.  Welland,  Canton F.  S.  VanDyke,  Canton 2d  Tuesday,  monthly. 

Summit J.  H.  Selby,  Akron A.  S.  McCormick,  Akron 1st  Tuesday,  monthly. 

Wayne W A.  Morton,  Wooster R.  C.  Paul,  Wooster 2d  Tuesday,  monthly. 


Seventh  District 


Belmont G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire 


Carroll (With  Stark  Co.  Society! 

Columbiana J.  W.  Robinson,  Lisbon John  Fraser,  East  Liverpool 

Coshocton Floyd  Craig,  Coshocton J.  D.  Lower,  Coshocton 

Harrison A.  C.  Grove,  Jewett W.  C.  Wallace,  Hopedale 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville 

Monroe G.  W.  Steward,  Woodsfield A.  R.  Burkhart,  Woodsfield 

Tuecarawas F.  B.  Larimore,  New  Phila G.  L.  Sackett,  New  Phila 


1st  Thurs.,  monthly,  4 p.  m., 
except  July  and  August. 

2d  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Wednesday,  monthly. 

Last  Thursday,  monthly. 

2d  Wednesday,  monthly. 

2d  Thursday,  monthly. 


Klghth  District 

Athens C.  E.  Welch,  Nelsonville _ 


Fairfield 

E.  B.  Roller,  Lithopolis 

C. 

w. 

-E. 

F. 

Geo.  W.  Sapp,  Newark- 

. G. 

A. 

Morgan 

D.  G.  Ralston.  McConnelsville 

C. 

E. 

T.  A.  Copeland,  Athens 


Muskingum- 
Noble 

Parry 


C.  M.  Rambo,  Zanesville 


Beatrice  T.  Hagen,  Zanesville 


1st  Monday,  monthly. 

2d  Tuesday,  monthly. 

1st  and  3rd  Thursday  each  month 
Last  Friday,  monthly. 

3d  Wednesday,  monthly. 

1st  Wednesday,  monthly. 


James  Miller,  Corning 

Washington W.  W.  Sauer,  Marietta.. 


_F.  J.  Crosbie,  New  Lexington 
_G.  M.  James,  Marietta 


3d  Monday,  monthly. 

2d  Wednesday,  monthly 


Ninth  District 


Gallia O.  A.  Vornholt,  Gallipolis Milo  Wilson,  Gallipolis 1st  Wed.,  Feb.,  May,  Sept,  and  Dec 

Hocking H.  M.  Boocks,  Logan — M.  H.  Cherrington,  Logan Quarterly . 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 2nd  Tuesday,  monthly. 

Lawrenca Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 1st  Thursday,  monthly. 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy . 3d  Thursday,  bi-monthly. 

Pike L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly 1st  Monday,  monthly. 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 2d  Monday,  monthly. 

Vinton O.  S.  Cox.  McArthur H.  S.  James.  McArthur 3d  Wednesday,  monthly 


Tenth  District 

Crawford E-  C.  Brandt,  Crestline R.  L.  Solt,  Bucyrus 1st  Monday,  monthly. 

Delaware Geo.  D.  Lowry,  Delaware J.  G.  Parker,  Delaware 1st  Tuesday,  monthly. 

Franklin Jonathan  Forman,  Columbus .John  H.  Mitchell,  Columbus Every  Monday,  8:30  p.  m. 

Knox S.  O.  Gantt,  Centerburg R.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly. 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  Jefferson 4th  Wednesday,  monthly. 

Morrow F.  M.  Hartsook,  Cardington — _T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly. 

Pickaway C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville — 1st  Friday,  monthly. 

Ross Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 1st  Thursday,  monthly. 

Union E.  J.  Marsh.  Broadway Angus  Maclvor.  Marysville 2d  Tuesday,  monthly 


468 


Advertisements 


August,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 

This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL,  M.D. 

Medical  Directors. 

Dayton,  Ohio 

MRS.  GEORGE  V.  SHERIDAN, 
President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

NAOMI  VOGE,  R.  N. 

Resident  Superintendent 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


A MODERN  ETHICAL  HOSPITAL 

Rates:  $25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alcohol,  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  Not  limited  as  to  the  quantity 
used  but  can  give  the  patient  as  much  whiskey  as  his  condition  requires. 

NERV OUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoscine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  that  their  own 
home  affords. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 

tal. Female  attendants  only ; absolute  privacy ; com- 
fortable, well-appointed  ladies’  lounge. 

Cherokee  Road  (Long  Distance  Phone  East  1488) 

THE  STOKES  SANATORIUM 

Louisville,  Ky.  27  Years  Treating  Nervous  Patients. 


THE  OXFORD  RETREAT 

Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 
FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


WHITING  MINERAL  SPRINGS 


SANITARIUM  AND  BATHS 

L.  A.  WHITING,  Owner 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and  allied  diseases, 
together  with  cases  for  elimination  and  rest  cure. 

Medical  department  thoroughly  proficient  and  STRICTLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

WHITING  SANITARIUM  » » M A R T I N S VI L L E , I N D . 

VAN  W.  WHITING,  Manager  DR.  R.  H.  RICHARDS,  Medical  Director 


THE  MERCER  SANITARIUM  - MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristoivn,  Pa.) 


PUBLIC  HEALTH^  SOCIAL  WEBFAR: 
MEDICAL  ECO 
csmd  OIECANIEATUC 

‘With  Editorial  Comment  by  D.K.M. 


Elsewhere  in  this  issue  of  The  Journal  appears 
the  official  program  for  the  Eighty-Seventh  An- 
nual Meeting  of  the  Ohio  State  Medical  Associa- 
tion, to  be  held 
Thursday  and  Fri- 
day, September  7 
and  8 at  Akron. 

Through  the  un- 
tiring efforts  of  the 
Council  Program  Committee,  consisting  of  Dr.  C. 
L.  Cummer,  Cleveland,  chairman,  Dr.  B.  J.  Hein, 
Toledo,  and  Dr.  E.  R.  Brush,  Zanesville,  and  the 
officers  of  the  various  scientific  sections,  a pro- 
gram of  unusual  attractiveness,  interest  and  merit 
has  been  arranged  for  the  Akron  gathering. 

In  conclusion  with  a growing  sentiment  among 
the  membership,  the  Program  Committee  has  ar- 
ranged for  more  general  scientific  sessions  at  the 
forthcoming  meeting. 

Instead  of  holding  two  sessions,  the  scientific 
sections  will  meet  but  once — on  Thursday  after- 
noon, September  7.  Six  papers  will  be  presented 
at  each  of  sectional  meetings  on  subjects  of  par- 
ticular interest  in  the  fields  covered  by  the  six 
scientific  sections. 

On  Friday,  two  general  scientific  sessions  will 
be  held.  The  first  will  open  at  8:30  a.  m.  Seven 
papers  covering  a wide  range  of  subjects  will  be 
presented.  The  second  general  scientific  session 
will  open  at  1:30  p.  m.  At  that  session  a sym- 
posium will  be  presented  on  “Intestinal  Obstruc- 
tion” by  members  of  the  teaching  staff  of  W estern 
Reserve  University. 

Every  effort  has  been  made  to  have  presented  at 
the  general  scientific  sessions,  papers  of  general 
interest  and  of  value  to  both  the  specialist  and 
the  general  practitioner. 

A definite  time  schedule  for  the  general,  as  well 
as  the  section,  meetings  has  been  worked  out — as 
indicated  in  the  program — and  the  session  chair- 
men have  promised  to  make  every  possible  effort 
to  have  the  program  conducted  according  to 
schedule  from  beginning  to  end. 

Members  of  the  State  Association  are  urged  to 
study  the  program  carefully.  It  is  one  of  the  best 
which  has  ever  been  arranged  for  an  annual  meet- 
ing of  the  Association.  After  reading  it,  every 
member  who  can  possibly  do  so  will  no  doubt, 
arrange  his  plans  so  that  he  can  be  in  Akron  on 
September  7 and  8.  The  usual  golf  tournament 
will  be  held  on  Wednesday,  September  6,  at  the 
Portage  Country  Club. 


TMs  Year's 
Animal  Meeting  an 
Important  Event 


Those  who  are  contemplating  attending  the 
Akron  meeting  should  make  their  hotel  reserva- 
tions immediately.  A list  of  Akron  hotels,  with 
their  locations,  rates  and  type  of  conveniences, 
was  published  in  the  July  issue  of  The  Journal 
and  is  being  presented  again  in  this  issue  for  the 
convenience  of  those  who  have  not  as  yet  made 
room  reservations. 

Other  features  of  the  Annual  Meeting  also  are 
summarized  in  this  issue  of  The  Journal  and  more 
details  concerning  them  will  be  published  in  the 
September  issue,  which  will  contain  the  annual 
reports  of  the  standing  and  special  committees  of 
the  State  Association. 

Every  member  of  the  State  Association  who  can 
possibly  do  so  should  attend  the  1933  Annual 
Meeting.  That  it  may  be  a sacrifice  on  the  part 
of  all  to  do  so,  is  readily  admitted.  However,  due 
to  the  present  unrest  and  uncertainty  it  is  more 
vital  than  ever  before  that  strong  and  active 
medical  organization  be  maintained.  We  are  con- 
fronted with  critical  problems.  We  must  present 
a united  front  and  be  fully  informed  concerning 
the  important  issues  affecting  us  individually  and 
our  profession.  The  Annual  Meeting  should  serve 
as  a rallying  point — an  occasion  where  we  can 
improve  our  knowledge,  not  only  of  scientific  mat- 
ters, but  of  economic,  social,  governmental  and 
professional  questions,  and  where  we  can  formu- 
late ways  and  means  of  meeting  present  as  well 
as  future  problems  affecting  the  practice  of 
medicine. 


Vital  Factor  of 
Human  Nature 


Those  engaged  in  the  practice  of  medicine  have 
learned  that  the  successful  practitioner  owes 
much  to  his  judgment  of  human  nature  and 

his  ability  to  maintain 
an  intimate  personal 
relationship  with  his 
patients. 

Unfortunately,  those 
sponsoring  new  sys- 
tems and  programs  which  have  been  painted  in 
alluring  colors  and  designed  to  revitalize  medical 
practice  have  in  most  instances  overlooked  this 
fundamental  factor.  Likewise,  the  same  point  has 
been  disregarded  in  many  of  the  new  and  more 
extensive  economic,  social  and  political  ventures 
which  have  been  launched  or  considered. 

Merle  Thorpe  illustrated  the  point  quite  well  in 
a recent  issue  of  Nation’s  Business  by  quoting  the 
following  conversation : 


481 


482 


The  Ohio  State  Medical  Journal 


August,  1933 


“I  fear  that  some  of  these  grand  new  plans 
are  leaving  human  nature  out  of  account,”  said  a 
business  man  to  a prominent  government  official. 
‘‘Too  much  slide  rule  management,  and  too  little 
knowledge  of  people. 

“And  sometimes  even  the  slide  rules  and  form- 
ulas fail.  For  instance,  let  me  ask  you  a question.” 

“What  is  it?”  the  official  replied. 

“Suppose”,  continued  the  business  man,  “that 
there  were  one  hundred  sheep  in  a pasture  and 
one  of  them  jumped  the  fence.  How  many  would 
there  be  left? 

“Ninety-nine.” 

“That  isn’t  the  answer  a sheep  man  gave  me.” 

The  modern  physician  cannot  expect  to  hold  his 
clientele  for  long  merely  by  conducting  his  prac- 
tice with  “slide  rules  and  formulas”.  The  instant 
he  permits  one  of  his  patients  to  become  dis- 
satisfied and  desert  him,  the  rest  may  follow, 
sooner  or  later.  Unless  the  physician  keeps  him- 
self abreast  of  the  times  and  prepares  himself 
to  render  the  service  which  his  clientele  needs 
and  demands,  the  fence  which  he  has  built  around 
his  practice  undoubtedly  will  be  too  low  to  pre- 
vent wholesale  desertion.  The  same  holds  good 
for  new,  commercial,  mass-production  ventures 
which  have  enjoyed  a phenomenal  growth  during 
the  past  few  years.  The  slide-rule  and  formula 
will  be  adequate  for  a limited  time  but  in  the 
final  analysis  the  sick  and  distressed  patient 
wants  something  more  than  scientific  words  and 
expensive  equipment.  The  average  private  prac- 
titioner, if  he  wills,  can  provide  his  patients  with 
that  touch  of  human  kindness  and  understanding 
which  human  natui’e  demands.  Fences  that  are 
built  high  enough  cannot  be  jumped — even  by 
temperamental  sick  people. 


In  this  issue  of  The  Journal  appears  an  article 
relative  to  the  lifting  of  the  quantitative  limita- 
tion on  the  amount  of  medicinal  liquor  which  may 
be  prescribed  in  Ohio  and 
setting  forth  the  new 
Federal  regulations  now 
governing  medicinal  liquor 
prescribing  in  Ohio. 

Careful  reading  of  the 
new  Federal  regulations  will  convince  physicians 
holding  a permit  to  prescribe  medicinal  liquor  of 
the  greater  responsibility  which  has  been  placed 
upon  them.  * 

The  medical  profession  has  constantly  main- 
tained the  l’ight  of  the  physician  to  prescribe  at 
any  time  anything  which  he  considers  necessary 
for  the  benefit  of  his  patient,  including  medicinal 
liquor  if  indicated.  The  new  Federal  regulations 
relative  to  medicinal  liquor  grant  to  a physician 
this  right  which  is  in  accord  with  scientific  and 
professional  principles. 

In  exercising  this  new  privilege  which  has  been 
conferred  upon  them,  physicians  should  exert  ex- 
treme caution.  They  must  demonstrate  that  the 


Medicinal 

Liquor 

Prescriptions 


confidence  which  has  been  accorded  them  has  not 
been  misplaced.  As  one  authority  has  pointed  out 
the  right  to  prescribe  medicinal  liquor  has  never 
been  an  unmixed  blessing  for  the  medical  profes- 
sion. Now  that  quantitative  limitation  has  been 
eliminated  and  the  guiding  factor  is  the  honest 
and  professional  judgment  of  the  individual  phy- 
sician, his  responsibility  has  been  proportionately 
increased. 

Such  headlines  as  “Hike  in  Ohio  Whiskey  Pre- 
scription Limit  Fails  to  Boost  Consumption”  and 
similar  headings  which  have  been  appearing  in 
Ohio  newspapers  would  seem  to  be  a good  omen 
and  indicate  that  the  physicians  of  Ohio  are  de- 
termined to  regard  the  medicinal  liquor  question 
as  a professional  and  scientific  matter. 

We  believe  that  the  physicians  of  Ohio  general- 
ly will  use  this  new  privilege  in  such  a way  that 
the  profession  as  a whole  will  continue  to  merit 
the  honor,  respect  and  confidence  of  the  public  and 
administrative  officials. 


“Why  State  Medicine  Is  Necessary”  is  the  title 
of  an  article  published  in  a recent  issue  of  The 
Forum  and  written  by  Edgar  Sydenstricker,  ex- 
ecutive director  of  the  Milbank 
Fund. 

It  will  be  remembered  that 
Mr.  Sydenstricker  was  a mem- 
ber of  the  Committee  on  the 
Costs  of  Medical  Care.  He  re- 
fused to  sign  any  of  the  final  reports  made  by 
that  committee  for  the  reason  that  in  his  opinion 
“the  recommendations  do  not  deal  adequately 
with  the  fundamental  economic  questions  which 
the  committee  was  formed  primarily  to  study  and 
consider”. 


Is  State 

Medicine 

Necessary 


Those  who  have  read  Mr  Sydenstricker’s  con- 
tribution in  The  Forum  can  easily  understand 
why  he  did  not  participate  in  the  majority  or 
minority  reports  of  the  costs  of  medical  care 
committee.  Radical  as  some  of  the  majority 
recommendations  of  that  committee  actually  are, 
they  appear  mild  in  contrast  to  the  governmen- 
tally-operated  and  subsidized  medical  program 
which  Mr.  Sydenstricker  believes  should  be  in- 
augurated to  solve  what  he  terms  an  “anomalous 
situation  of  medical  care  in  the  United  States”. 

In  brief,  Mr.  Sydenstricker’s  plan  is  for  the 
establishment  of  a system  of  medical  care  serving 
the  entire  population,  directed  by  the  government, 
either  state  or  national,  and  financed  from  funds 
raised  by  taxes  and  compulsory  health  insurance. 

Mr.  Sydenstricker  takes  the  view  that  improve- 
ment in  medical  care  is  not  nearly  so  pressing  a 
problem  as  that  of  “making  what  medical  care  we 
now  have  available  to  all  the  people”.  In  other 
words,  he  assumes  that  under  an  extensive  system 
of  state  medicine  the  present  efficient  and  effective 
medical  services  would  be  available  to  everyone, 
without  cost  or  at  a nominal  fee,  and  that,  there- 


August,  1933 


Editorial 


483 


fore,  a “ridiculous  economic  anomaly”  would  be 
solved. 

However,  Mr.  Sydenstricker  offers  no  guarantee 
or  assurance  that  under  his  or  any  other  system 
of  governmental  medicine  the  quality  of  medical 
care  would  be  maintained  at  its  present  high  and 
satisfactory  level.  This  is  an  important  oversight 
on  his  part.  We  gravely  doubt  the  advisability  of 
sacrificing  an  efficient  and  effective  medical  ser- 
vice to  solve  an  “economic  anomaly”. 

It  is  difficult  to  understand  how  the  public  gen- 
erally would  benefit  from  any  program  which  as- 
sumes quantity  production  is  more  important 
than  preservation  of  the  quality  of  the  service 
rendered. 

The  inevitable  result  of  any  medical  system 
which  breaks  down  personal  relationship  between 
physician  and  patient,  removes  the  incentive  for 
improvement  of  knowledge  and  technique,  and 
throttles  individual  initiative  and  personal  re- 
sponsibility is  cheap,  mediocre  or  inferior  medical 
care. 

We  are  not  willing  to  concede  that  the  public 
favors  tearing  down  the  existing  system  of  medi- 
cal service  which  has  served  it  long  and  well. 
Nor  are  we  at  all  sure  that  the  public  is  en- 
thusiastic over  the  idea  of  subjecting  itself  to 
inferior  medical  care  at  bargain  prices.  It  has 
learned  pretty  well  the  lesson  that  in  most  in- 
stances one  gets  what  he  pays  for,  whether  it  in- 
volves the  purchase  of  groceries  or  the  purchase 
of  medical  attention.  Any  program  designed  to 
distribute  medical  services  on  a more  equitable 
basis,  economically  and  geographically,  is  certain 
to  fail  in  its  purpose  unless  it  guarantees  that  the 
quality  of  such  services  shall  be  preserved. 


“About  the  only  effective  weapon  against  the 
trend  to  socialize  medicine  is  a healthy,  whole- 
some state  organization  with  its  component  county 
and  city  societies”,  Dr.  W. 
L.  Allee,  president-elect  of 
the  Missouri  State  Medical 
Fortification  Association,  warned  the 
membership  of  that  so- 
ciety in  a recent  discussion  of  some  of  the  im- 
portant questions  confronting  the  medical  pro- 
fession. 

Emphasizing  the  need  for  collective  and  in- 
dividual activity  on  the  part  of  the  profession  to 
achieve  results  and  make  the  machinery  of  or- 
ganization function  effectively,  Dr.  Allee  said: 

“We  have  all  had  an  increase  in  our  charity 
cases  and  we  have  all  made  concessions  in  our 
usual  fees  which  have  seriously  impaired  our 
earnings.  With  the  addition  of  delayed  collec- 
tions we  naturally  look  about  for  ways  of  paring 
expense.  Under  these  conditions  it  is  human, 
wise  and  for  most  of  us  compulsory  to  economize. 

“Unfortunately,  many  of  us  do  not  evaluate 
very  thoughtfully  the  various  items  selected  for 
paring.  There  will  be  some  doctors  that  will  try 


to  balance  their  budget  by  paring  their  member- 
ship to  the  State  Association  and  forget  to 
economize  in  the  number  of  fraternal  and  social 
orders,  not  to  mention  the  quasi  social  organiza- 
tions, that  are  supposed  to  be  so  necessary  to 
properly  animate  Main  Street.  I mention  this  be- 
cause I am  one  of  those  joiners  and  know  the 
drain  in  the  course  of  a year  and  also  know  that 
the  annual  dues  to  the  State  Association  are  but 
a few  cents  more  than  the  price  in  a month  of  one 
of  the  almost  weekly  luncheon  tickets  we  are 
called  upon  to  purchase  by  some  local  committee. 

“Why  not  select  some  small  item  once  a month 
for  elimination  rather  than  our  state  membership 
dues  which  are  but  sixty-seven  cents  a month.*** 
I realize  the  fact  that  most  of  our  members  ap- 
preciate and  accept  their  responsibility  to  or- 
ganized medicine  but  every  profession  has  some 
members  with  backsliding  tendencies  who  are 
careless  and  indifferent  and  are  willing  to  share 
the  protection  and  influence  of  a great  organiza- 
tion but  refuse  to  contribute  with  time,  effort  or 
dues.” 

Dr.  Allee’s  keen  analysis  sums  up  in  a few 
words  one  of  the  important  problems  confronting 
the  medical  profession  today — that  of  keeping  its 
own  ranks  intact  and  of  maintaining  enthusiasm 
for  a concerted  and  group  attack  on  the  grave 
questions  which  have  arisen. 

The  serious  problems  he  speaks  of  are  not 
those  peculiar  to  his  own  state.  The  medical  pro- 
fession in  Ohio,  too,  is  confronted  with  critical 
economic  and  social  situations.  It  is  just  as  im- 
portant for  the  physicians  in  Ohio  to  maintain 
strong  and  active  medical  organization  as  it  is 
for  their  colleagues  in  Missouri.  It  is  just  as 
necessary  and  advisable  that  the  physicians  in 
Ohio  properly  evaluate  the  benefits  which  they 
have  derived  and  will  continue  to  enjoy  from 
membership  in  organized  medicine.  It  is  just  as 
important  that  the  units  of  organized  medicine  in 
Ohio  continue  to  receive  the  support,  financial  and 
otherwise,  of  all  eligible  physicians  in  every  com- 
munity— perhaps  more  important  at  this  time 
than  ever  before.  Our  line  of  offense  and  defense 
has  been  well  established.  It  is  up  to  us  to  keep 
it  firmly  fortified. 


The  problem  of  conducting  out-patient  depart- 
ments of  hospitals  in  such  a way  that  only  the 
deserving  will  benefit  and  no  injustices  will  be 
done  to  individual  prac- 


Some Examples 
of  Unfair 


titioners  of  medicine 
has  long  been  the 
source  of  considerable 
misunderstanding  and 
friction  between  the 
medical  profession  and  some  hospital  authorities. 

Troublesome  as  it  is  in  normal  times,  the  prob- 
lem is  now  more  acute  than  ever  and,  in  recent 
months,  has  led  to  almost  open  breaks  between 
physicians  and  hospital  officials  in  some  com- 


484 


The  Ohio  State  Medical  Journal 


August,  1933 


munities,  where  there  has  been  insufficient  plan- 
ning to  meet  emergency  conditions  resulting  from 
unsettled  economic  conditions,  or  where  hospitals 
have  deliberately  invaded  the  field  of  the  private 
practitioner. 

The  medical  profession  would  be  the  last  to  be- 
little the  generosity  of  most  hospitals  or  to  refuse 
to  recognize  the  economic  crisis  which  many  of 
them  are  facing.  Physicians  always  have  been 
only  too  willing  to  assist  hospitals  with  which 
they  are  connected  in  caring  for  the  charity  load. 

However,  many  members  of  the  medical  pro- 
fession believe,  and  rightly  so,  that  hospitals 
should  avoid  competing  unfairly  with  individual 
medical  practitioners.  Such  abuses  are  most 
prevalent  among  patients  seeking  care  at  clinics 
run  in  connection  with  hospitals  where  a consider- 
able number  of  persons  able  to  pay  something  for 
medical  care  to  some  private  practitioner  are 
being  treated  in  some  instances  gratis  or  for  a 
fee  below  that  customarily  charged  by  the  private 
practitioners  of  the  community. 

In  some  instances,  this  situation  has  arisen  be- 
cause of  the  lack  of  proper  investigating  mediums 
by  the  hospital.  In  others,  it  is  the  result  of  a 
tendency  on  the  part  of  short-sighted  hospital 
officials  to  use  the  members  of  their  medical  staffs 
to  improve  the  economic  condition  of  their  in- 
stitution. 

Whatever  the  cause,  unfair  competition  has  re- 
sulted in  some  instances  and  is  a situation  which 
should  be  corrected.  Physicians  are  just  as  hard- 
pressed  financially,  perhaps  more  so,  than  any 
other  group.  They  have  a right  to  protest  unjust 
competition,  especially  by  institutions  to  which 
they  have  contributed  much  gratuitous  service. 

A lot  of  sound  advice  to  hospitals  generally  on 
this  question  is  contained  in  the  following  edi- 
torial, entitled  “The  Hospital  as  a Competitor  of 
the  Family  Physician”,  published  in  a recent 
issue  of  The  Modem  Hospital,  to  which  the  medi- 
cal profession,  we  believe,  will  add  a solemn 
amen : 

“Dispensary  abuse  has  been  the  shibboleth  of 
doctors  and  laymen  alike  for  almost  as  long  as 
out-patient  departments  have  been  in  existence”, 
the  editor  of  The  Modern  Hospital  declares. 

“Moreover,  the  reputed  dimensions  of  the  prob- 
lems have  consistently  been  in  direct  ratio  to  the 
vividness  of  the  imagination  of  the  narrator.  To 
some,  every  patient  who  is  able  to  pay  a fee  of 
any  size  should  be  referred  to  a local  practicing 
physician.  It  is  believed  by  others  that  only  those 
able  to  pay  the  customary  office  fee  of  near-by 
doctors  should  be  refused  by  the  hospital  clinic. 

“There  are  those  who  without  question  will  and 
do  abuse  any  gratuitious  service.  Many  no  doubt 
secure  treatment  from  the  institutional  out-pa- 
tient department  who  could  and  should  afford 
private  care.  But  the  technique  for  routinely  fer- 
reting out  the  imposter,  for  separating  the  unde- 
serving from  the  worthy,  has  not  as  yet  been  de- 
veloped. Moreover,  the  hospital  during  the  past 
few  months  has  often  permitted  an  abuse  to  de- 
velop which  places  it  in  direct  competition  with 
the  family  doctor.  Not  only  in  the  dispensary  but 


in  the  accident  ward  as  well  are  patients  treated 
for  all  types  of  not  trivial  and  potentially  serious 
ailments  when  the  only  explanation  of  the  pres- 
ence of  such  persons  there  is  an  effort  on  their 
part  to  secure  gratis  a service  for  which  they 
should  pay.  No  institution  can  expect  the  full 
cooperation  of  its  local  physicians  which  thus  un- 
fairly competes  with  them.  To  refer  such  pa- 
tients promptly  to  their  family  doctor  is  not  only 
an  act  of  justice  to  the  physician,  but  also  one 
frought  with  sound  business  sense.” 


A review  of  some  of  the  pressing  economic 
questions  confronting  the  medical  profession  was 
prepared  and  distributed  recently  by  the  board  of 
trustees  of  the  Medical  So- 

Procedure  ciety  of  the  state  of  Pennsy]- 

„ . vania. 

on  social  In  the  closing.  chapter  of 

Problems  that  review,  the  trustees  of 

the  Pennsylvania  society  of- 
fered some  advice  as  to  how  county  societies 
might  proceed  to  meet  some  of  these  important 
problems. 

Problems  confronting  the  profession  in  Penn- 
sylvania do  not  differ  materially  from  those  be- 
fore Ohio  physicians.  For  that  reason,  some  of 
the  suggestions  offered  to  the  component  county 
societies  in  Pennsylvania  most  certainly  would  be 
useful  and  valuable  as  guides  to  county  society 
activities  in  Ohio. 

Some  of  the  points  made  in  the  Pennsylvania 
review  which  are  exceptionally  appropriate  and 
meritorious  and  which  could  be  considered  with 
benefit  by  the  county  societies  in  this  state,  are: 

1.  Bend  every  energy  at  this  time  to  enroll  as 
members  every  nonmember  physician  in  the 
county  deemed  worthy  of  membership. 

2.  Arrange  and  conduct  study  courses  and 
groups  to  consider  the  economics  of  medical  ser- 
vice. 

3.  Boldly  assume  and  maintain  a definite  posi- 
tion against  forms  of  conteact  practice  that  in- 
volve solicitation  of  patients,  prevent  actual  free 
choice  of  physician,  or  inject  a profit-seeking  third 
person,  institution,  or  organization  between  phy- 
sician and  patient. 

4.  Take  an  active  interest  in  public  health  ad- 
ministration. 

5.  Take  a definite  position  against  all  unfair 
forms  of  government  competition  with  medical 
and  hospital  practice. 

6.  Discuss  with  lay  groups  and  individuals  the 
ultimate  deteriorating  effects  on  the  quality  of 
medical  service  which  accompany  the  socializa- 
tion of  medical  practice. 

7.  Plan  and  cooperate  with  other  professional 
groups  and  organizations  interested  in  medical 
and  health  questions. 

8.  Work  out  with  public  officials  a satisfactory 
plan  for  the  care  of  the  indigent  sick. 

9.  Educate  the  membership  as  to  practical  ways 
of  cooperating  with,  advising,  and  assisting  pa- 
tients in  reducing  the  costs  of  illness. 


Keport  of  a Case  of  Thrombosis  of  the  Inferior  Vena  Cava 
and  Extensive  Skin  Necrosis 

Folloiving  Scarlet  Fever.  Recovery. 

William  H.  Bunn,  M.D.,  F.A.C.P.,  Youngstown,  Ohio 


WE  have  been  unable  to  find  in  medical 
literature  the  record  of  a case  of  skin 
necrosis  occurring  in  scarlet  fever  ac- 
accompanied  by  thrombosis  of  the  inferior 
vena  cava.  Extensive  skin  necrosis  is  not  a 
common  condition,  neither  is  thrombosis  of  the  in- 
ferior vena  cava.  The  combination  of  the  two 
with  the  recovery  of  the  patient  seems  unusual 
enough  to  warrant  a report  of  this  case. 

Hofmeier,  in  1923, 1 could  collect  from  the 
literature  only  fifteen  cases  of  necrosis  following 
scarlet  fever.  The  first  reported  case  dates  from 
I8602:  a nine  year  old  boy  entered  the  hos- 
pital with  scarlet  fever  and  nephritis;  six  days 
later  showed  bluish-red  spots  on  the  left  foot, 
which  developed  further  from  thrombus  forma- 
tion to  necrosis  and  loss  of  the  left  lower  leg, 
ending  fatally  on  the  forty-second  day. 

REPORT  O'F  CASE 

R.  W.,  age  8%,  white,  male,  first  seen  October 
24,  1922,  at  8 P.  M.  Illness  began  suddenly  seven 
hours  before  he  came  under  observation.  The 
chief  complaints  were  sore  throat  and  fever. 

The  family  history  was  negative.  The  lad’s 
father,  mother,  two  brothers,  one  eleven  and  one 
two  and  one-half  years,  were  living  and  well. 

There  was  a past  medical  history  of  mild  per- 
tussis and  measles  at  the  age  of  six  years.  In 
July,  1922,  the  patient  had  a deep  infection  on  the 
left  heel,  which  was  opened  and  drained  under 
local  anesthesia.  A week  later  an  identical  area 
on  the  right  heel  developed.  Both  areas  healed 
promptly  after  incision. 

PRESENT  ILLNESS 

This  was  marked  by  an  abrupt  onset  with  high 
fever  and  vomiting,  accompanied  by  definite  diffi- 
culty in  swallowing  because  of  sore  throat.  The 
patient  was  quite  drowsy.  The  pulse  rate  was 
130  and  the  temperature  104.  The  tonsils  were 
extremely  red  and  swollen.  On  the  right  tonsil 
was  a definite  patch  of  grayish  membrane  about 
0.5  cm.  in  diameter.  There  was  slight  enlargement 
of  both  tonsillar  nodes.  There  was  no  rash  present 
at  this  time.  Because  of  the  characteristic  ap- 
pearance of  the  small  patch  of  membrane  on  the 
right  tonsil  and  the  fact  that  a playmate  next 
door  was  in  bed  with  diphtheria,  10,000  units  of 
diphtheria  antitoxin  were  administered  immedi- 
ately. Twelve  hours  later  the  patient  presented 
the  typical  picture  of  a severe  scarlet  fever.  The 
temperature  was  104,  pulse  134,  respiration  34. 
The  throat  was  terribly  sore,  the  patient  swallow- 
ing with  great  difficulty.  There  was  a definite 
heavy  membrane  on  both  tonsils. 

PROGRESS 

The  following  notes  are  taken  from  the  prog- 
ress record: 

Two  days  after  onset  (October  26th)  the  pa- 
tient was  delirious  with  a temperature  of  104.4, 


The  membrane  on  the  tonsils  was  unchanged, 
10,000  additional  units  of  diphtheria  antitoxin 
were  administered. 

The  next  day  there  was  bright  red  blood  in  the 
mucous  from  the  throat.  This  was  expectorated  in 
considerable  quantity.  The  entire  body  was  cov- 
ered with  the  typical  rash  of  scarlet  fever. 

On  October  28th  the  rash  was  fading  rapidly. 
The  next  day  there  was  desquamation. 

By  October  30th  there  were  many  urticarial 
wheals  on  the  abdomen  near  the  cite  of  the  anti- 
toxin injection. 

On  November  6th,  thirteen  days  after  onset  of 
illness,  the  temperature  was  normal  for  the  first 
time. 

The  following  day  the  eyelids  were  swollen  and 
red  and  there  were  more  urticarial  spots  about 
the  face.  These  signs  persisted,  diminishing  in 
severity,  for  three  days.  Then  on  November  10th 
there  was  a sudden  onset  of  severe  cervical 
adenitis.  The  temperature  was  103,  pulse  T30. 

Within  twenty-four  hours  (November  11th) 
the  temperature  was  104  and  there  was  definite 
pain  in  the  right  ear  on  swallowing.  Some  redness 
of  the  drum  membrane  was  observed. 

On  November  14th  an  important  sign,  paraly- 
sis of  the  soft  palate,  was  noted. 

Two  days  later  (November  16th)  there  was  a 
chill  lasting  about  five  minutes. 

ONSET  OF  PURPURA 

On  November  17th  the  patient  showed  priapism 
and  in  a few  hours  the  penis  was  swollen,  red  and 
painful.  He  was  unable  to  void  during  the  next 
twelve  hours.  Soon  the  scrotum  became  edema- 
tous. Within  ten  hours  there  was  an  area  of 
bluish  redness  on  the  outside  of  the  right  elbow 
about  as  large  as  a silver  dollar.  The  next  morn- 
ing there  was  a definite  hemorrhage  beneath  this 
area  on  the  right  arm.  Four  hours  later  the  left 
leg  became  swollen  and  there  was  a large  pur- 


Fig.  1.  Showing  marked  edema  of  both  extremities, 
dilated  abdominal  veins,  extensive  deep  skin  necrosis — De- 
cember 15,  1923. 


485 


486 


The  Ohio  State  Medical  Journal 


August,  1933 


Fig.  2.  Showing  almost  complete  healing,  very  deep 
sears — October,  1924. 

puric  area  on  the  outer  surface  of  the  thigh. 
Within  a few  hours  an  area  similar  to  the  origi- 
nal lesion  appeared  on  the  left  arm  in  approxi- 
mately the  same  location. 

A single  blood  culture  was  reported  negative  on 
November  18th.  The  coagulation  time  was  two' 
minutes,  fifteen  seconds.  The  patient’s  condition 
was  so  serious  that  a blood  transfusion  of  400  cc. 
was  given. 

On  November  19th  there  was  a small  purpuric 
area  on  the  right  lower  quadrant  of  the  abdomen 
which  increased  in  size  so  that  it  was  finally 
three  inches  in  diameter. 

The  response  to  the  first  transfusion  was  so 
satisfactory  that  on  November  20th  a second 
transfusion  of  500  cc.  of  blood  was  given.  The 
temperature  was  103,  pulse  150,  and  respiration 
30.  A new  purpuric  area  the  size  of  a.  fifty  cent 
piece  appeared  over  the  right  hip  joint.  The 
lesion  on  the  left  leg  was  discharging  dark  red 
fluid.  The  blood  count  on  this  day  was  Hg.  60 
per  cent;  Rbc.  3,340,000;  Wbc.  17,400;  Polys.  78 
per  cent;  Trans.  3 per  cent;  Lg.  Lymphs  3 per 
cent;  Sm.  Lymphs.  15  per  cent.  Qn  this  date  both 
legs  were  extremely  swollen,  mottled  in  appear- 
ance, and  very  painful. 

The  veins  on  the  abdomen  which  form  the  col- 
lateral circulation  of  the  inferior  Vena  Cava  were 
markedly  distended. 

The  third  blood  transfusion  of  500  cc.  was 
given  on  November  25th.  The  blood  count  on  this 
date  was  as  follows:  Rbc.  not  reported;  Wbc. 

22,600;  Polys.  76  per  cent;  Eosin.  2 per  cent;  Lg. 


Lymphs.  7 per  cent;  Sm.  Lymphs  15  per  cent. 
From  this  time  improvement  was  rapid,  until  on 
December  10th  the  patient’s  general  condition  was" 
very  much  better,  although  all  hemorrhagic  areas 
were  sloughing.  These  gangrenous  areas  became 
so  offensive  that  on  December  25th  a large,  very 
foul,  necrotic,  sloughing  area,  including  the 
superficial  facia,  was  removed  from  the  left  thigh 
and  day  by  day  a smaller  amount  cleaned  from 
other  areas. 

On  January  3rd  skin  was  grafted  on  the  large 
denuded  area  on  the  left  thigh.  The  patient  was 
gaining  in  weight  and  strength,  the  collateral 
circulation  of  the  inferior  vena  cava  disappearing. 
The  legs  were  . less  swollen. 

RECOVERY 

From  this  time  on,  the  patient  improved  daily. 
All  hemorrhagic  areas  sloughed  and  granulated 
rapidly.  Three  skin  grafts  were  done  on  the  large 
areas  on  the  left  thigh  but  this  never  entirely 
healed  over  until  August,  1925,  (almost  three 
years  after  onset).  The  usual  various  forms  of 
stimulating  ointments,  cauterization  by  silver 
nitrate,  clipping  the  granulations  and  sunlight 
failed  to  heal  the  small  resistant  sluggish  area 
(seen  in  the  photograph).  After  several  ex- 
posures to  the  quartz  lamp  the  entire  area  healed 
promptly,  leaving  a pliable  firm  scar. 

DISCUSSION 

The  patient  is  now  (March,  1933)  in  good 
health,  excepting  varicose  ulcers  on  both  ankles. 
He  is  a premedical  student.  There  is  deep  scar- 
ring of  the  left  hip  and  prominent  veins  on  the 
abdomen.  Canalization  of  the  thrombus  of  the 
inferior  vena  cava  was  evidently  fairly  complete, 
for  there  is  no  marked  edema  of  the  legs,  no  re- 
tarded development.  During  the  fall  of  1928  a 
sluggish  variocose  ulcer  developed  on  the  left 
ankle  and  in  November,  1932,  another  on  the  right 
ankle.  It  is  difficult  to  keep  these  healed.  The 
abdominal  collateral  venous  circulation  is  still 
active,  as  evidenced  by  definite  distension  of  these 
veins. 

The  lateral  veins  of  the  abdomen  have  re- 
mained larger  than  the  anterior,  which  sign  helps 
to  confirm  the  diagnosis  of  thrombosis  of  the  vena 
cava.  We  feel  that  this  blocking  must  have  oc- 
curred below  the  level  of  the  renal  veins,  else  the 
outcome  would  probably  have  been  fatal. 

The  possibility  of  a concomitant  infection  of 
scarlet  fever  and  diphthria  must  be  considered,  in 
spite  of  a single  negative  throat  culture.  This 
impression.was  strengthened  by  the  appearance  of 
a paralysis  of  the  soft  palate,  which  is  so  often 
seen  in  diphtheria.  What  influence  the  diph- 
theria antitoxin  might  have  exerted  in  the  pro- 
duction of  the  hemorrhagic  condition  cannot  be 
stated.  We  know  no  method  of  proving  this  re- 
lationship. However,  the  patient  had  never  had 
any  serum  previous  to  this  illness  and  conse- 
quently could  not  have  been  sensitized. 

1.  Hofmeier,  K. : Skin  Necrosis  after  Scarlet  Fever, 

Ztschr.  F.  Xinderhlk  36:  151,  1923. 

2.  Jahr  F.  Kinderhlk,  Vol.  3. 

603  Home  Savings  & Loan  Blg. 


Pathologic  Hemorrhage* 

Russell  L.  Haden,  M.D.,  Cleveland,  Ohio 


PATHOLOGIC  hemorrhage  is  the  loss  of 
blood  without  injury,  or  hemorrhage  out  of 
proportion  to  an  injury.  The  bleeding  may 
occur  in  the  skin  and  subcutaneous  tissues,  from 
the  mucous  membranes,  into  body  cavities  or 
joints,  or  from  points  of  trauma.  Normally,  the 
blood  can  not  penetrate  the  endothelial  barrier  of 
the  capillaries  and  if  a vessel  is  injured  a clot  is 
formed  quickly  and  prevents  an  excessive  loss  of 
blood.  Abnormal  bleeding  can  occur  only  when 
(1)  there  is  an  increased  tendency  for  the  blood 
to  penetrate  the  capillary  walls  such  as  in  ex- 
treme anemia,  where  there  is  marked  lowering  of 
viscosity,  (2)  the  permeability  of  the  endothelium 
is  increased,  or  (3)  the  clotting  mechanism  is 
disturbed. 

The  first  factor  is  relatively  unimportant.  In- 
creased permeability  of  the  vascular  endothelium 
allows  blood  to  escape  from  the  vessels  and  is  a 
most  important  factor  in  many  cases  of  abnormal 
bleeding.  The  capillary  wall  may  be  injured:  (1) 
by  impairment  of  nutrition  (scurvy  or  other 
specific  food  deficiency,  malnutrition,  congenital 
heart  disease)  ; (2)  by  infections  (typhus  fever, 
meningitis,  sepsis  from  any  cause)  ; (3)  by  al- 
lergic conditions  (serum  reactions)  ; or  (4)  by' 
toxins  (drugs,  snake  venom,  uremia.) 

The  coagulation  of  the  blood  may  be  disturbed 
by  any  one  of  its  components.  According  to 
Howell,  in  normal  clotting:  (1)  prothrombin,  the 
precursor  of  thrombin  is  held  neutral  in  the  blood 
plasma  by  antiprothrombin  (heparin)  ; (2)  on 

adding  zymoplastic  substances  (tissue  juice,  plate- 
lets) to  blood,  the  thromboplastin  (cephalin) 
which  these  subtsances  contain  neutralizes  the 
anti-prothrombin,  leaving  the  prothrombin  in  an 
active  state,  (3)  prothrombin  combines  with 
ionized  calcium  to  form  thrombin;  and  (4)  throm- 
bin unites  with  fibrinogen  to  form  fibrin,  the  clot. 
Antithrombin  which  prevents  the  action  of 
thrombin  on  fibrinogen  may  be  present.  It  is  the 
active  anti-coagulating  substance  in  the  leech  and 
may  be  formed  by  the  liver  after  the  intravenous 
injestion  of  peptone  and  possibly  of  other  sub- 
stances. 

The  important  factors  in  blood  coagulation  are: 
(1)  prothrombin,  derived  partly,  but  not  solely, 
from  platelets;  (2)  antiprothrombin,  formed  prob- 
ably in  the  liver;  (3)  calcium,  derived  from  cal- 
cium salts  in  the  blood  plasma;  (4)  fibrinogen,  a 
globulin  formed  principally  in  the  liver;  and  (5) 
thromboplastin,  a phospholipin  derived  from  tis- 
sue juices  or  platelets.  This  summary  emphasizes 
the  importance  in  normal  coagulation  and  patho- 
logic hemorrhage  of:  (1)  the  liver  which  is  the 


* Clinical  lecture  given  October  28,  1932,  before  the 

Medical  Society  of  the  County  of  Kings,  Brooklyn,  N.  Y. 


source  of  antiprothrombin  and  fibrinogen;  (2)  the 
bone  marrow  in  which  are  formed  the  platelets, 
which  supply  prothrombin  and  thromboplastin; 
and  (3)  the  endothelial  lining  of  the  blood  ves- 
sels which  normally  holds  the  blood  within  the 
lumen. 

SPECIAL  BLOOD  EXAMINATIONS  FOR  THE  DETECTION 
OF  HEMORRHAGIC  DISEASE 

A carefully  elicited  history  and  a thorough 
physical  examination  often  suggests  the  diagnosis 
in  instances  of  abnormal  hemorrhage,  but  pa- 
tients can  be  classified  definitely  only  by  special 
blood  studies  in  addition  to  the  routine  counts 
and  the  estimation  of  hemoglobin.  The  following 
examinations  should  be  made  in  studying  a pa- 
tient suffering  from  hemorrhagic  disease: 

1.  Determination  of  the  coagulation  time.  For 
this  examination  the  blood  must  be  obtained  from 
the  vein  and  must  be  free  from  admixture  of  tis- 
sue juices.  The  Lee  and  White  modification  of  the 
Howell  method1  is  the  method  of  choice.  Blood  is 
obtained  from  the  vein  by  means  of  a syringe  and 
a fairly  large  needle.  After  the  needle  has  been 
removed  from  the  vein,  1 cc.  of  blood  is  run  into  a 
test  tube  8 mm.  in  diameter,  and  slightly  dam- 
pened with  salt  solution.  Clotting  should  be  com- 
plete so  that  the  tube  may  be  inverted  in  from 
eight  to  ten  minutes  without  altering  the  form  of 
the  clot. 

2.  Determination  of  the  prothrombin  time.  The 
prothrombin  time  should  be  determined  in  all 
cases  in  which  the  coagulation  time  is  prolonged. 
Varying  amounts  of  a 0.5  per  cent  solution  of 
calcium  chloride  are  added  to  a set  of  tubes  each 
containing  5 drops  of  oxalated  plasma.  Normal 
values  are  as  follows: 

PROTHROMBIN  TIME 

Tube  No 1 2 3 4 5 6 7 

Plasma  (drops)  5 5 5 5 5 5 5 

0.5  per  cent  calcium 

chloride  solution  (drops)  2 3 4 5 6 7 8 

Normal  prothrombin 

time  6 8 8 10  10  12  12 

3.  Measurement  of  clot  retraction.  A sample  of 
blood  is  obtained  by  the  method  used  for  de- 
termining the  coagulation  time.  Agitation  of  the 
specimen  should  be  avoided  as  this  inhibits  clot 
retraction.  The  specimen  should  be  placed  in  an 
incubator  at  37°  C.  and  observed  for  twelve  to 
twenty-four  hours.  Normally,  a definite  retrac- 
tion is  observed  in  one  hour  although  the  process 
is  not  complete  until  eighteen  hours  have  elapsed. 
Retraction  often  is  satisfactory  at  room  tem- 
perature and  may  take  place  in  a very  short  time. 
Pathologic  blood  may  show  no  retraction  even 
after  days.  Absence  of  clot  retraction  usually  is 


487 


488 


The  Ohio  State  Medical  Journal 


August,  1933 


asociated  with  a diminution  of  platelets,  since  the 
phenomenon  is  caused  by  some  substance  derived 
from  the  platelets. 

4.  Enumeration  of  blood  platelets.  An  idea  of 
the  number  of  platelets  present  is  obtained  from 
a strained  film  properly  made  on  a cover  glass. 
The  platelets  may  be  satisfactorily  counted  by  the 
Rees-Ecker2  method.  The  platelet  diluting  fluid 
(sodium  citrate,  3.8  gm.,  formalin,  0.2  cc.,  bril- 
liant cresyl  blue,  0.1  gm.,  distilled  water,  100  cc.) 
is  drawn  to  the  0.5  mark  in  a red  cell  counting 
pipette  and  fresh  flowing  blood  to  the  1.0  mark. 
The  pipette  is  then  filled  with  the  diluting  fluid. 
After  shaking  well,  the  counting  chamber  is  filled 
and  allowed  to  stand  ten  minutes.  The  red  cells 
are  not  hemolyzed.  The  platelets  appear  as 
sharply  outlined  round  or  oval  lilac-colored 
bodies.  With  the  Neubauer  ruling,  the  total  num- 
ber of  platelets  in  80  small  squares  multiplied  by 
10,000,  equals  the  number  of  platelets  per  cubic 
millimeter.  The  normal  number  of  platelets  is 
250,000  to  300,000  per  cubic  millimeter. 

5.  Measurement  of  the  bleeding  time.  This  de- 
termination is  made  by  Duke’s3  method.  The  lobe 
of  the  ear  or  the  finger  tip  is  punctured  with  a 
sharp  needle  or  a blood  lancet  and  the  blood  is 
wiped  up  at  regular  intervals  on  filter  paper, 
preferably  each  minute.  Normally,  bleeding 
ceases  in  less  than  three  minutes,  a bleeding  time 
of  over  ten  minutes  being  definitely  prolonged.  A 
diminution  of  platelets  is  nearly  always  present 
with  a prolonged  bleeding  time. 

6.  Estimation  of  the  fibrinogen.  This  is  not 
necessary  in  all  cases  of  hemorrhagic  disease,  but, 
if  indicated,  may  be  estimated  by  the  method  of 
Foster  and  Whipple.4 

7.  Calcium  time.  In  cases  of  jaundice,  the  effect 
of  the  addition  of  calcium  on  the  clotting  time  is 
determined  by  the  addition  of  3 drops  of  a 1 per 
cent  solution  of  calcium  chloride  to  1 cc.  of  blood. 
If  a calcium  deficiency  is  a factor  in  the  prolonged 
coagulation  time,  this  tube  should  clot  more 
quickly  than  a similar  tube  to  which  no  calcium 
is  added. 

8.  Capillary  resistance  test  ( Leede-Rumpel 
test.)  A blood  pressure  band  is  placed  on  the 
upper  arm  and  the  pressure  maintained  at  100 
mm.  for  two  to  three  minutes.  If  the  test  is  posi- 
tive a crop  of  petechiae  appears  below  the  arm 
band  and  under  it.  The  appearance  of  petechiae 
indicates  an  increased  permeability  of  the  cap- 
illary walls  and  usually  is  associated  with  a plate- 
let deficiency. 

The  antithrombin  and  antiprothrombin  content 
and  the  degree  of  platelet  lysis  can  not  be  meas- 
ured by  any  simple  procedure. 

CLASSIFICATION  OF  PATHOLOGIC  HEMORRHAGE 

Pathologic  hemorrhage  may  be  dependent  prim- 
arily on  an  abnormality  of  the  blood  or  blood- 
forming  organs,  and  if  so,  is  primary  hemorrhagic- 


disease.  In  this  group  are  included:  (1)  hemo- 
philia, (2)  acute  and  chronic  essential  thrombocy- 
topenia (purpura  hemorrhagica)  and  (3)  hemor- 
rhage of  the  newborn.  More  frequently  abnormal 
bleeding  is  secondary  to  some  disease  in  the 
course  of  which  the  blood  or  blood  vessels  are  so 
altered  as  to  lead  to  hemorrhage.  The  designa- 
tion, secondary  hemorrhagic  disease,  is  applied  to 
abnormal  bleeding  due  to  : (1)  a platelet  de- 

ficiency in  aplastic  anemia,  in  some  intoxications, 
as  benzol  poisoning,  in  leukemia,  and  in  infec- 
tions; (2)  injury  to  capillary  endothelium  from 
the  causes  mentioned  above  (nutritional  dis- 
turbances, infections,  allergy,  and  toxemias) ; (3) 
a deficiency  in  fibrinogen  in  liver  disease,  as  cir- 
rhosis or  chloroform  poisoning;  (4)  a decrease  in 
ionized  calcium  in  jaundice;  and  (5)  prolonged 
coagulation  time  due  to  a disturbance  in  one  or 
more  of  the  clotting  components  secondary  to 
some  disease,  dietary  deficiency,  or  impaired 
nutrition.  In  many  cases  of  secondary  hemor- 
rhagic disease  more  than  one  factor  is  operative 
in  causing  the  abnormal  bleeding. 

A.  PRIMARY  HEMORRHAGIC  DISEASE 

1.  Hemophilia.  This  is  a constitutional  disease 
characterized  by  a tendency  to  prolonged  hemor- 
rhage due  to  markedly  delayed  coagulation  time. 
It  is  an  inherited  anomaly  occurring  only  in  males 
and  is  transmitted  only  by  unaffected  females. 
The  abnormal  tendency  to  bleed  appears  early  in 
life  with  spontaneous  hemorrhages  into  sub- 
cutaneous tissues  and  into  joints,  or  excessive  loss 
of  blood  from  slight  injuries.  Spontaneous  bleed- 
ing from  mucous  membranes  does  not  occur.  Re- 
latively few  persons  afflicted  with  hemophilia 
reach  adult  life. 

The  typical  blood  findings  in  hemophilia  are  an 
increased  coagulation  and  prothrombin  time  with 
normal  clot  retraction,  and  a normal  platelet 
count  and  bleeding  time.  The  capillary  resistance 
test  (Leede-Rumpel)  is  normal.  The  prolonga- 
tion of  coagulation  apparently  is  due  to  a qualita- 
tive defect  in  the  platelets  in  which  there  is  an 
increased  resistance  to  dissolution,  with  a very 
slow  release  of  thromboplastin. 

ILLUSTRATIVE  CASES 

Case  1.  A boy,  aged  thirteen  years,  since  in- 
fancy has  bled  excessively  on  receiving  the 
slightest  injury.  He  often  bleeds  for  one  to  three 
weeks  from  an  injury,  and  has  had  recurrent 
hemorrhages  into  the  joints.  His  mentality  is 
subnormal  and  there  is  a speech  impairment 
which  probably  is  attributable  to  cerebral  hemor- 
rhage at  birth.  There  have  been  thirteen  known 
male  bleeders  in  the  family  but  no  hemorrhagic 
disease  has  been  found  in  the  females. 

The  patient  was  admitted  to  the  hospital  on 
account  of  prolonged  bleeding  following  the  ex- 
traction of  a tooth.  The  hemorrhage  was  relieved 
by  transfusion.  The  examination  showed  no 
petechiae  or  abnormality  of  the  joints.  The  ton- 
sils were  large  and  there  was  a slight  general 
adenopathy. 


August,  1933 


Pathologic  Hemorrhage — Haden 


489 


The  blood  findings  were  as  follows:  erythrocy- 

tes, 3,050,000;  leucocytes,  10,500;  differential 
count,  normal;  hemoglobin,  56  per  cent;  coagula- 
tion time  22  minutes;  prothrombin  time,  22  min- 
utes; clot  retraction,  normal;  platelets,  abundant; 
bleeding  time,  normal;  and  capillary  resistance 
test,  normal. 

Case  2.  A boy,  six  years  of  age,  had  been  cir- 
cumcised when  he  was  one  week  old  and  had  had 
a severe  hemorrhage  from  the  wound  lasting  two 
days,  which  finally  was  relieved  by  transfusion. 
He  had  had  many  hemorrhages  into  all  the  large 
joints  and  into  the  skin  and  subcutaneous  tissues 
of  various  parts  of  the  body  but  there  had  been 
no  bleeding  from  the  mucous  membranes.  The  boy 
had  been  perfectly  well  except  for  the  abnormal 
bleeding. 

The  physical  examination  revealed  no  ab- 
normalities except  swelling  in  the  right  elbow  and 
in  the  left  knee.  Roentgenograms  of  the  knees 
and  elbows  revealed  joint  changes  characteristic 
of  hemophilia.  The  patient  had  no  brothers  and 
there  was  no  family  history  of  hemorrhagic  dis- 
ease. 

The  blood  findings  were  as  follows:  red  blood 
cells,  3,790,000;  white  blood  cells,  7,000;  hemo- 
globin, 76  per  cent;  differential  count,  normal; 
coagulation  time,  2 hours  (slight  clot  formation  at 
one  hour)  ; prothrombin  time,  45  minutes ; clot  re- 
traction, normal;  platelets,  384,000;  bleeding 
time,  3 minutes;  and  capillary  resistance  test, 
normal. 

This  is  a typical  case  of  sevex’e  true  hemo- 
philia in  the  absence  of  familial  hemorrhagic  dis- 
ease. The  patient  was  made  sensitive  to  sheep 
serum,  and  at  intervals,  small  doses  of  serum  were 
administered  intradermally  to  induce  a mild 
anaphylactic  reaction.  No  improvement  followed 
this  treatment. 

2.  Essential  thrombocytopenia  ( purpura  hemor- 
rhagica). In  this  disease  there  are  petechiae  in 
the  skin  and  hemorrhages  from  the  mucous  mem- 
branes. Not  infrequently  nose  bleed,  menorrhagia, 
or  bleeding  from  some  other  mucous  membrane, 
may  be  the  only  clinical  evidence  of  the  disease. 
The  disease  may  be  congenital  or  acquired  and 
occurs  at  any  age,  but  is  more  common  in  children 
and  young  adults.  Several  theories  have  been 
proposed  to  explain  the  characteristic  decrease  in 
platelets  such  as:  (1)  some  abnormality  of  the 

megakaryocytes,  the  parent  cells  of  the  platelets ; 
(2)  an  inhibitory  action  of  the  spleen  on  platelet 
formation;  (3)  increased  destruction  of  the  plate- 
lets in  the  spleen,  and  (4)  capillary  damage  by 
which  the  platelets  are  consumed  in  excess. 

The  characteristic  blood  findings  are  diminu- 
tion in  platelets,  prolonged  bleeding  time,  and 
absence  of  clot  retraction.  The  coagulation  time 
is  normal  or  only  slightly  prolonged.  The  capil- 
lary resistance  test  usually  is  positive. 

ILLUSTRATIVE  CASES 

Case  3.  A school  teacher,  aged  twenty-three, 
i or  two  months  had  noticed  large  hemorrhagic 
areas  and  numerous  petechiae  on  the  skin  fol- 
lowing slight  injury  or  even  without  injury.  She 
also  had  had  three  attacks  of  nosebleed  without 
apparent  cause.  Recently  she  had  noted  bleeding 
4rom  the  gums  and  also  the  menstrual  flow  had 


been  excessive.  There  had  been  no  previous  in- 
fections. 

The  physical  examination  gave  negative  find- 
ings except  for  the  hemorrhagic  disease.  There 
were  many  petechiae  over  the  entire  body  and 
several  large  ecchymoses. 

The  blood  examination  showed:  3,250,000  red 
cells;  4,850  leucocytes;  differential  count,  normal; 
hemoglobin,  42  per  cent;  coagulation  time,  15 
minutes;  clot  retraction  time,  none;  platelets, 
10,000;  bleeding  time,  35  minutes;  capillary  re- 
sistance test,  positive. 

This  patient  showed  no  improvement  after  the 
administration  of  viosterol  and  ulti'a-violet  radia- 
tion, and  numerous  blood  transfusions  produced 
but  little  benefit.  Roentgen  irradiation  of  the 
spleen  was  of  no  avail.  A few  hours  before  the 
death  of  the  patient,  antivenin  serum  was  ad- 
ministered without  cessation  of  the  bleeding. 

In  a serious  case  of  purpura  hemorrhagica  a 
great  increase  in  permeability  evidently  occurs  for 
which  treatment  avails  little.  Splenectomy  in 
acute  cases  usually  has  ended  fatally. 

Case  4.  A boy,  seven  years  of  age,  two  weeks 
before  admission  had  had  a rash  which  had  been 
considered  German  measles  by  his  father,  a 
physician.  One  week  later,  petechiae  had  de- 
veloped. There  also  had  been  some  bleeding,  f rom 
the  nose  and  gums. 

In  addition  to  the  evident  anemia,  physical  ex- 
amination revealed  ecchymoses  and  petechiae  over 
the  entire  body.  The  tonsils  were  enlarged  and 
cryptic  and  the  cervical  and  inguinal  glands  were 
enlarged.  The  spleen  was  not  palpable. 

The  blood  examination  showed:  red  blood  cells, 
4,000,000;  white  blood  cells,  8,500;  hemoglobin, 
70  per  cent;  differential  count,  normal;  coagula- 
tion time,  10  minutes;  prothrombin  time,  8 min- 
utes; clot  retraction,  none;  platelets,  32,000; 
bleeding  time,  much  prolonged;  and  capillary  re- 
sistance test,  positive.  Blood  transfusion  brought 
about  a rapid  diminution  of  symptoms.  Later  a 
tonsillectomy  was  performed  without  hemorrhage. 
After  four  years  the  child  is  entirely  well  and 
has  had  no  recurrence  of  the  abnormal  bleeding. 

In  this  case,  the  decrease  in  platelets  evidently 
was  due  to  infection  and  was  transitory.  It  is 
very  probable  that  the  infection  was  tonsillar  in 
origin,  and  was  permanently  relieved  by  the  ton- 
sillectomy. 

Case  5.  For  two  years  previous  to  admission, 
the  patient,  a boy  nine  years  old,  had  had  severe 
epistaxis  repeatedly,  lasting  for  hours  in  each  in- 
stance. He  bruised  easily,  with  the  formation  of 
large  ecchymotic  areas,  and  some  bleeding  from 
the  gums  constantly  was  present.  The  patient 
was  unable  to  attend  school,  and  other  activities 
were  much  limited  by  the  abnormal  tendency  to 
bleed. 

When  the  boy  was  admitted  to  the  hospital  he 
was  suffering  from  nose  bleed.  There  were  many 
petechiae  over  the  entire  body.  The  liver  and 
spleen  were  not  palpable.  The  tonsils  were  large 
and  infected. 

The  blood  findings  were  as  follows:  red  blood 
cells,  3,440,000;  white  blood  cells,  4,100;  hemo- 
globin, 64  per  cent;  differential  count,  normal; 
coagulation  time,  12  minutes;  prothrombin  time, 
10  minutes;  clot  retraction,  none;  platelets, 
50,000;  bleeding  time,  much  prolonged;  and  cap- 
illary resistance  test,  positive. 

A splenectomy  was  performed,  followed  by  a 
normal  convalescence.  The  pathologic  diagnosis 


490 


The  Ohio  State  Medical  Journal 


August,  1933 


was  chronic  splenitis  with  an  unusual  eosinophilic 
infiltration. 

The  patient  continued  occasionally  to  have  nose 
bleed  which,  however,  was  not  severe.  He  gained 
weight,  improved  rapidly,  and  was  able  to  lead  a 
normal  life  which  had  been  impossible  before 
splenectomy  was  performed.  The  platelet  count 
rose  immediately  after  operation  and  then  fell  and 
remained  low.  The  counts  were  as  follows: 


Platelets 

Before  operation  50,000 

24  hours  after  operation 150,000 

72  hours  after  operation 100,000 

5 months  after  operation..  64,000 
2 years  after  operation .....  80,000 


Hemoglobin 

64  per  cent 
55  per  cent 

65  per  cent 
80  per  cent 
80  per  cent 


The  only  satisfactory  treatment  in  chronic 
cases  of  purpura  hemorrhagica  is  splenectomy. 

3.  Hemorrhagic  disease  of  the  newborn.  This 
condition,  which  occurs  only  in  infants,  is  char- 
acterized by  spontaneous  hemorrhage,  usually  not 
later  than  the  second  week  of  life.  The  bleeding 
may  be  from  the  gastro-intestinal  tract,  from  the 
site  of  separation  of  the  umbilical  cord,  or  sub- 
dural. Relatively  few  careful  blood  studies  have 
been  made  in  such  cases.  The  platelets  are  normal 
but  the  coagulation  and  bleeding  times  are  pro- 
longed, due,  apparently,  to  a prothrombin  de- 
ficiency. 


ILLUSTRATIVE  CASE 

Case  6.  The  patient  was  born  of  healthy  par- 
ents prematurely.  For  prophylactic  purposes,  15 
c.c.  of  whole  blood  was  given  intramuscularly  im- 
mediately after  birth.  There  was  some  jaundice 
which  disappeared  promptly.  On  the  thirteenth 
day  there  was  an  alarming  hemorrhage  from  the 
point  of  separation  of  the  cord.  The  blood  showed 
no  tendency  to  clot.  There  was  no  bleeding  else- 
where except  that  evidenced  by  small  ecchymoses 
over  the  sacrum.  Whole  blood  was  given  again 
intramuscularly  without  effect  on  the  hemorrhage. 
A transfusion  of  100  c.c.  of  citrated  blood  was 
then  given  through  the  fontanelle  with  immediate 
cessation  of  the  bleeding.  Recovery  was  com- 
plete. 

B.  SECONDARY  HEMORRHAGIC  DISEASE 

In  secondary  hemorrhagic  disease  the  tendency 
to  bleed  is  only  a part  of  the  clinical  picture,  and 
is  secondary  to  some  disease  which  results  in  de- 
creased platelets,  damage  to  the  capillary  endo- 
thelium with  resulting  increase  in  permeability,  a 
deficiency  in  fibrinogen,  insufficiency  of  calcium 
available  for  the  activation  of  prothrombin  to 
thrombin,  or  diminution  of  some  other  element 
necessary  to  the  coagulation  process.  Often  a 
combination  of  factors  is  responsible  for  the 
bleeding.  The  blood  findings  vary  with  the  under- 
lying clinical  condition. 

ILLUSTRATIVE  CASES 

1.  Platelet  deficiency.  Here  the  blood  findings 
are  those  of  essential  thrombocytopenia  together 
with  those  characteristic  of  the  underlying  dis- 
ease. 


Case  7.  (Aplastic  anemia) — A boy,  fifteen 
years  of  age,  had  been  well  until  one  month  be- 
fore admission,  when  his  throat  became  sore  and 
began  to  bleed.  Soon  afterward  hemorrhagic 
areas  appeared  in  the  skin.  Three  weeks  previous 
to  admission,  toothache  had  developed,  the  neck 
had  become  swollen,  and  the  gums  had  begun  to 
bleed.  For  two  weeks  the  patient  had  passed  blood 
in  stools  and  urine. 

The  physical  examination  revealed  many 
petechiae,  retinal  hemorrhages  and  several  in- 
fected carious  teeth  with  enlarged  cervical  glands 
on  the  side  of  the  infection.  The  liver  and  spleen 
were  not  palpable.  The  urine  examination  was 
negative. 

The  blood  examination  showed:  erythrocytes, 

800,000;  leucocytes,  400;  a differential  count  with 
polymorphonuclears,  46  per  cent;  lymphocytes,  50 
per  cent;  monocytes,  4 per  cent;  hemoglobin,  13 
per  cent;  coagulation  period,  12  minutes;  clot 
retraction,  none;  platelets,  10,000;  bleeding  time, 
45  minutes ; and  capillary  resistance  test,  positive. 

After  transfusion  the  patient  showed  much  im- 
provement. The  infected  teeth  were  removed. 
The  leucocyte  count  remained  low,  however,  and 
the  number  of  platelets  did  not  rise  above  60,000. 
Death  resulted  from  lobar  pneumonia  which  de- 
veloped two  weeks  after  the  patient  was  ad- 
mitted to  the  hospital.  At  autopsy  the  diagnosis 
of  aplastic  anemia  was  confirmed. 

In  this  case  the  abnormal  bleeding  was  due  i ' 
the  platelet  deficiency  which,  however,  was  only 
a phase  of  the  aplastic  anemia. 

Case  8.  (Tuberculosis  of  the  liver  and  spleen)  — 
A woman,  aged  thirty-five  years,  had  had  re- 
curring attacks  of  fever  accompanied  by  few 
other  symptoms.  On  examination  the  liver  was 
found  to  be  much  enlarged  and  the  spleen  was  a 
hand’s  breadth  below  the  costal  margin.  An  ex- 
ploratory operation  was  performed  and  examina- 
tion of  tissue  removed  showed  a pathologic  pic- 
ture typical  for  tuberculosis.  The  avian  type  of 
tuberculosis  was  suggested  but  not  proved. 
Several  months  later  this  patient  returned,  com- 
plaining of  bleeding  from  the  kidneys,  uterus, 
nose  and  gums.  There  were  many  petechiae.  The 
liver  and  spleen  were  unchanged  in  size. 

The  blood  findings  were  as  follows:  red  blood 
cells,  3,100,000 ; white  blood  cells,  6,300 ; dif- 
ferential count,  normal;  hemoglobin,  55  per  cent; 
coagulation  time,  twenty-five  minutes ; clot  re- 
traction, none;  platelets,  none;  and  bleeding  time, 
much  prolonged. 

This  patient  responded  well  to  transfusion  and 
the  abnormal  bleeding  ceased.  The  platelet  de- 
ficiency probably  was  due  to  the  tuberculous  in- 
fection of  the  spleen. 

2.  Injury  to  capillary  endothelium  with  re- 
sulting increased  permeability.  Capillary  injury 
may  result  from  numerous  infections  and  toxins. 
The  characteristic  hemorrhages  seen  in  gas  bacil- 
lus infection  or  venom  poisoning  are  due  to  an 
almost  specific  effect  of  such  poisons  on  the 
capillary  endothelium.  In  scurvy  the  injury  is 
primarily  vascular.  The  purpura  of  Henoch’s- 
Schonlein’s  disease  is  supposedly  an  allergic 
manifestation.  In  this  group  of  cases  the  blood 
shows  no  abnormality  other  than  a possible 
anemia.  The  following  is  a typical  case: 

Case  9.  (Henoch-Schonlein’s  disease) — For  the 
past  year  a clerk,  aged  twenty-five,  had  had  re- 


August,  1933 


Pathologic  Hemorrhage — Haden 


491 


current  attacks  of  abdominal  pain  accompanied 
by  nausea  and  vomiting.  During  each  attack  the 
large  joints  had  been  painful  and  red  splotches 
had  appeared  on  the  extremities.  After  the  first 
attack  of  pain  the  appendix  had  been  removed 
with  no  resultant  improvement. 

When  the  patient  was  examined,  a generalized 
petechial  rash  was  present.  Several  joints  were 
painful  and  tender  on  palpation.  The  tonsils  were 
of  moderate  size,  evidence  of  chronic  prostatitis 
was  found,  and  thei'e  were  several  infected  teeth. 

The  blood  examination  showed:  red  blood  cells, 
5,590,000;  white  blood  cells,  11,600;  differential 
count,  essentially  normal;  hemoglobin,  102  per 
cent;  coagulation  time,  9 minutes;  clot  retraction, 
normal;  platelets  290,000;  bleeding  time,  five 
minutes,  and  capillary  resistance,  negative. 

Following  tonsillectomy  and  the  removal  of 
the  infected  teeth  the  patient  gained  40  pounds  in 
weight  and  made  a complete  recovery.  In  this 
case,  the  abnormal  bleeding  undoubtedly  was  due 
entirely  to  increased  permeability  of  the  capil- 
laries. 

3.  Fibrinogen  deficiency.  Abnormal  bleeding 
due  to  a deficiency  in  fibrinogen  is  uncommon  and 
occurs  only  in  extreme  hepatic  disease.  Fibrino- 
gen is  an  exceedingly  labile  substance  which 
seemingly  is  easily  mobilized.  A slight  injury  to 
the  liver  or  to  other  tissues  causes  a rapid  and 
usually  marked  increase  in  fibrinogen.  Extensive 
hepatic  injury,  however,  causes  a decrease  in  the 
circulating  fibrinogen.  The  following  is  an  illus- 
trative case: 

Case  10.  (Cirrhosis  of  liver  with  pathologic 
hemorrhage) — A man,  aged  sixty-eight  years, 
presented  the  typical  clinical  picture  of  chronic 
portal  cirrhosis  with  ascites.  While  under  treat- 
ment for  the  ascites  he  developed  large  subcutan- 
eous hemorrhages  and  bled  excessively  through 
small  wounds,  such  as  the  transfusion  incision. 

Blood  findings  showed:  i-ed  blood  cells,  3,800,- 
000;  white  cells,  6,000;  differential  count,  normal; 
hemoglobin,  78  per  cent;  icterus  index,  15;  plate- 
lets, 210,000;  clot  retraction,  normal;  bleeding 
time,  2 minutes;  coagulation  time,  20  minutes; 
fibrinogen,  165  mg.  (normal  516  mg.) 

Here  the  significant  finding  was  prolonged 
coagulation  time  with  an  extreme  fibrinogen  de- 
ficiency evidently  due  to  the  liver  disease. 

4.  Altered  coagulation  time  due  to  a decrease 
in  calcium  ions  in  the  blood  plasma.  Calcium  ions 
are  necessary  for  the  activation  of  prothrombin 
to  thrombin.  It  is  quite  unusual  to  have  the  cal- 
cium decreased  below  the  level  necessary  for 
blood  coagulation.  Hemorrhage  is  seen  but  seldom 
in  tetany  due  to  a decrease  in  total  calcium.  If 
jaundice  is  marked  and  of  long  standing  there  is 
a great  decrease  in  ionized  calcium,  although  the 
total  calcium  is  normal,  due  to  the  combination  of 
the  bile  pigment  with  calcium  which  forms  a non- 
ionizable  salt.  For  this  reason,  hemorrhage  is  a 
common  complication  of  jaundice  as  illustrated 
below. 

Case  11.  (Obstructive  jaundice) — A woman, 
seventy-eight  years  of  age,  had  chronic,  progres- 
sive, painless  jaundice.  Mild  diabetes  and  hyper- 
tension had  been  present  for  many  years.  On  ad- 


mission, marked  jaundice  was  present,  accom- 
panied by  extreme  itching.  The  liver  was  only 
slightly  enlarged  and  the  gall  bladder  was  not 
palpable.  The  icterus  index  was  100. 

The  blood  examination  showed : erythrocytes, 

4,460,000;  leucocytes,  9,400;  differential  count, 
normal;  hemoglobin,  78  per  cent;  coagulation 
time,  35  minutes;  prothrombin  time,  5 minutes; 
clot  retraction,  normal;  platelets,  440,000. 

An  exploratory  operation  disclosed  gall  stones 
with  blockage  of  the  common  duct.  The  patient 
had  been  given  calcium  chloride  intravenously 
preoperatively  and  did  not  bleed  excessively  fol- 
lowing operation.  The  jaundice  cleared  up  slowly; 
the  convalescence  otherwise  was  satisfactory  al- 
though prolonged.  Three  weeks  after  operation 
the  patient  had  multiple  hemorrhages  from  the 
intestines  which  caused  her  death.  The  hemor- 
rhagic disease  evidently  was  due  to  the  jaundice 
and  liver  disease.  The  coagulation  time  was  much 
prolonged  with  normal  prothrombin  time. 

5.  Prolonged  coagulation  time  may  result  from 
an  impairment  of  undetermined  clotting  com- 
ponents with  resulting  hemorrhage.  Antiproth- 
rombin may  be  increased;  the  dissolution  of 
platelets  may  be  delayed  with  a resulting  de- 
crease in  thromboplastin;  prothrombin  may  be 
decreased;  or  there  may  be  undetermined  qualita- 
tive damages  in  the  subtsances  necessary  for 
normal  coagulation.  The  only  characteristic  find- 
ing in  the  blood  examination  is  the  prolonged 
coagulation  time.  Such  variations  may  be  due  to 
disease  or  to  nutritional  changes.  Kugelmass5  has 
emphasized  especially  the  relation  of  diet  to  such 
changes.  He  has  shown  that  coagulability  is  in- 
creased by  a high  protein  intake,  while  an  in- 
creased tendency  to  hemorrhage  follows  the  use 
of  carbohydrates  and  minerals. 

The  characteristic  blood  finding  in  this  group 
of  cases  is  the  prolonged  coagulation  time,  with- 
out change  in  platelets,  retraction  of  clot  or  bleed- 
ing time,  and  with  a negative  capillary  resistance 
test.  The  following  is  a typical  case  record. 

Case  12.  A woman,  aged  twenty-five,  had  had 
recurring  attacks  of  pyelonephritis  with  lumbar 
pain,  chills,  fever,  and  pyuria.  During  treatment 
for  this  infection  she  began  to  have  large  hemor- 
rhagic spots  on  the  extremities  without  known  in- 
jury. There  was  no  menorrhagia,  epistaxis,  or 
abnormal  bleeding  elsewhere.  The  patient  had 
noticed  that  the  hemorrhages  came  with  an  ex- 
acerbation of  the  kidney  infection.  The  only 
positive  findings  on  examination  were  the  large 
purpuric  spots  on  the  extremities.  The  tourniquet 
test  was  negative. 

The  blood  examination  showed  no  anemia.  The 
white  count  was  10,000  with  no  abnormal  white 
cells.  The  platelet  count  was  250,000;  the  bleed- 
ing time,  1 minute;  the  clot  retraction,  normal; 
and  the  coagulation  time,  22  minutes.  In  this  case 
the  bleeding  evidently  was  due  to  the  disturbance 
in  coagulation,  for  which  the  infection  probably 
was  responsible. 

TREATMENT 

1.  Primary  hemorrhagic  disease.  The  treat- 
ment of  hemophilia  in  the  past  has  been  most  un- 
satisfactory. Cephalin  and  other  thromboplastic 
substances  help  but  little.  The  transfusion  of 


492 


The  Ohio  State  Medical  Journal 


August,  1933 


blood  usually  stops  the  bleeding  for  a short  time. 
In  some  cases,  improvement  has  followed  periodic 
intradermal  injections  of  serum  in  a patient 
previously  made  sensitive  by  an  injection  of  the 
homologous  serum,  preferably  from  sheep.  Re- 
cently Birch8  has  reported  excellent  results  from 
the  intensive  use  of  ovarian  extract.  The  fact 
that  this  disease  never  occurs  in  females  and  that 
the  urine  of  afflicted  males  does  not  contain  the 
normal  amount  of  the  female  sex  hormone,7  affords 
a reasonable  basis  for  such  therapy.  This  method 
of  treatment  should  be  given  a thorough  trial  in 
all  cases. 

The  acute  phases  of  essential  thrombocytopenia 
(purpura  hemorrhagica)  usually  respond  well  to 
transfusion,  but  the  platelets  supplied  by  the  nor- 
mal blood  live  only  for  three  or  four  days,  so 
bleeding  usually  begins  again  even  after  relief 
has  been  obtained  by  the  transfusion.  Often, 
however,  the  patient  can  be  tided  over  the  acute 
phase  of  the  disease  by  transfusion.  Since  in 
many  cases  infection  seems  to  be  a very  definite 
etiologic  factor  in  idiopathic  thrombocytopenic 
purpura,  the  eradication  of  infection  is  most  im- 
portant. Foci  of  infection  usually  can  be  removed 
safely  after  transfusion.  Radiation  of  the  spleen 
with  roentgen  rays  or  radium,  the  use  of  ultra- 
violet light  and  vitamin  D all  may  increase  the 
platelet  count,  and  hence  should  be  tried.  The 
various  styptic  agents  may  be  of  help  locally.  A 
diet  high  in  proteins  and  fats  is  indicated. 
Splenectomy  in  the  acute  cases  seldom  is  suc- 
cessful. 

In  chronic  cases  of  purpura  due  to  platelet  de- 
ficiency, a splenectomy  always  should  be  con- 
sidered and  usually  is  indicated.  The  results  in 
properly  selected  cases  are  brilliant.  Ligation  of 
the  splenic  artery  has  been  successful  in  some 
cases  and  is  a less  hazardous  surgical  procedure. 

Hemorrhagic  disease  of  the  newborn  usually 
responds  quickly  to  normal  blood  given  intramus- 
cularly. Serum  often  has  the  same  effect.  If  the 
bleeding  does  not  cease  following  the  use  of  whole 
blood  or  serum  intramuscularly,  a transfusion 
should  be  given.  Kugelmass8  thinks  that  this  dis- 
ease may  result  from  a deficient  protein  intake  of 
the  mother  during  pregnancy,  and  has  found  that 
the  feeding  of  gelatin  to  the  infant  may  prevent 
the  disease. 

2.  Secondary  Hemorrhagic  Disease.  In  second- 
ary hemorrhagic  disease  the  first  indication  is 
the  treatment  of  the  disease  on  which  the  abnor- 
mal bleeding  depends.  The  hemorrhage  must  be 
treated  systematically  in  view  of  the  fundamental 
blood  defect  which  is  responsible  for  the  exces- 
sive bleeding.  Transfusion  is  of  value  in  all  types, 
since  this  is  the  only  simple  way  in  which  normal 
blood  constituents  may  be  added.  Probably  too 
little  attention  has  been  given  to  diet  in  the 
treatment  of  hemorrhagic  disorders.  A diet  high 
in  protein,  fat,  and  vitamins  should  be  used  in 
all  cases. 


If  the  bleeding  is  due  to  a platelet  deficiency, 
the  treatment  is  identical  with  that  indicated  in 
idiopathic  thrombopenia  except  that  splenectomy 
seldom  is  indicated  except  when  the  primary 
cause  is  in  the  spleen.  Calcium  salts  intraven- 
ously are  of  great  value  when  decreased  capillary 
permeability  is  a factor.  Antivenin  serum  has 
been  used  similarly  with  good  results.  It  is  ap- 
parent that  the  oral  and  intravenous  use  of  cal- 
cium salts  is  indicated  when  there  is  a calcium 
deficiency,  as  in  jaundice. 

Cleveland  Clinic. 

REFERENCES 

1.  Lee,  R.  I.,  and  White,  P.  D.  A clinical  study  of  the 
coagulation  time  of  the  blood.  Amer.  J.  Med  Sci,  165 : 
495-503,  1913. 

2.  Rees,  H.  M.,  and  Ecker,  E.  E.  An  improved  method 
for  counting  blood  platelets.  Jour.  Amer.  Med.  Assoc.  80 : 
621-622,  1923. 

3.  Duke,  W.  W.  The  pathogenesis  of  purpura  hemor- 
rhagica with  especial  reference  to  the  part  played  by  the 
blood  platelets.  Arch.  Int.  Med.  10 :445-469,  1912. 

4.  Whipple,  Geo.  H.,  and  Foster,  D.  P.  Blood  fibrin 
studies ; an  accurate  method  for  quantitative  analysis  of 
blood  fibrin  in  small  amounts  of  blood.  Am.  J.  Physiol. 
58:365-378,  1922. 

5.  Kugelmass,  I.  N.,  and  Samuel,  E.  L.  Dietary  pro- 
tein and  blood  clotting  function.  Amer.  J.  Dis.  Child. ^ 
41:48-52,  1931. 

6.  Birch,  C.  L.  Hemophilia.  Proc.  Soc.  Exper.  Biol. 
& Med.  28:752-753,  1931. 

7.  Birch,  C.  L.  Hemophilia  and  the  female  sex  hor- 
mone ; Preliminary  report.  Jour.  Amer.  Med.  Assoc.  97  :244- 
245,  1931. 

8.  Kugelmass,  I.  N-,  and  Tritsch,  J.  E.  Prenatal  pre- 
vention of  potential  hemorrhagic  disease  of  the  newborn. 
Jour.  Amer.  Med.  Assoc.  92 :531-532,  1929. 


Pamphlet  on  Cancer  “Cures” 

The  Bureau  of  Investigation  of  the  American 
Medical  Association  has  issued  a new  edition  of 
its  pamphlet  on  “Cancer  Cures  and  Treatments”, 
available  for  15  cents  from  the  Bureau  office, 
535  North  Dearborn  Street,  'Chicago.  The 
pamphlet  deals  with  39  “cures”  or  “treatments”, 
exploited  from  15  different  states.  Some  of  them 
are  now  out  of  existence;  others  are  still  being 
exploited.  The  booklet  deals  with  “cures”  and 
“treatments”  ranging  from  palpable  frauds  to 
others  which  represent  the  optimistic  claims  of 
misguided  enthusiasts. 


Dr.  William  M.  Donald,  professor  of  Medi- 
cine, Detroit  University,  on  June  25  entertained 
the  officers  of  the  Northern  Tri-State  Medical 
Association  at  dinner  at  the  Detroit  Boat  Club, 
Belle  Isle.  The  purpose  of  the  meeting  was  to 
arrange  for  the  Sixty-First  Annual  Meeting  of 
the  association  to  be  held  the  second  Tuesday 
in  April,  1934,  at  Flint,  Michigan.  Those  pres- 
ent at  the  dinner  meeting  were:  Dr.  G.  0.  Lar- 
son, Laporte,  Indiana,  president;  Dr.  H.  F.  Ran- 
dall, Flint,  treasurer;  Dr.  G.  E.  Jones,  Lima, 
secretary,  and  Drs.  Norris  Gillette,  Toledo;  B. 
F.  Thut,  Elida,  Ohio;  Edward  B.  Pedlow,  Lima; 
J.  A.  Dempster,  Detroit;  W.  H.  Marshall,  Flint, 
and  Dr.  Donald. 


Celina — Dr.  Frank  E.  Ayers  has  been  elected 
vice  president  of  the  Lima  District  Tubercu- 
losis Hospital. 


A Consideration  of  the  Late  Effect  of  Head  Injuries* 

H.  E.  LeFever,  A.B.,  M.D.,  Columbus,  Ohio 


ANEW  type  of  “Termerian  mischief”  has 
appeared  upon  the  horizon  in  the  form  of 
the  automobile.  This  one  agent  is  largely 
responsible  for  the  marked  increase  in  head  in- 
juries during  the  past  few  years.  From  the  large 
number  of  persons  who  yearly  received  cranial 
trauma,  a certain  percentage  are  incapacitated 
because  of  a definite  group  of  vague  or  wide- 
spread symptoms.  The  original  injury  may  or 
may  not  have  been  severe,  the  vital  area  has  been 
unaffected  but  a more  or  less  extensive  damage 
has  resulted  to  the  meninges,  the  cortex  or  both, 
producing  a disturbance  of  the  gnostic  area. 

As  one  would  expect,  the  pathologic  lesions  en- 
countered in  patients  suffering  from  the  sequelae 
of  head  injuries  are  numerous. 

Depressed  Fractures.  This  deformity  is  not  in- 
frequently discovered  in  patients  who  have  sus- 
tained head  injuries.  It  occurs  in  the  vault  and 
may  be  discerned  by  palpation  or  by  A-ray  ex- 
amination. From  a clinical  review  of  two  hun- 
dred and  fifty-five  cases  of  head  injury,  Glaser 
and  Shafer1  found  that  in  those  patients  suffer- 
ing from  depressed  fractures,  symptoms  were 
less  likely  to  develop  than  in  those  without  frac- 
ture. It  is  very  probable  that  most  of  the  damage 
resulting  to  the  meninges  and  the  brain  cortex 
occurs  at  the  time  of  the  original  injury  and  that 
but  little  is  due  to  the  depression  per  se. 

Chronic  Subdural  Hemorrhage.  Following 
trauma,  a small  vein  running  unprotected  from 
the  cortex  to  the  dura  may  rupture  and  hemor- 
rhage into  the  subdural  space  result.  While  the 
falx  prohibits  lateral  change  in  the  position  of 
the  cerebral  hemispheres,  a small  amount  of 
anteroposterior  dislocation  can  follow  a sharp 
trauma.  Movements  of  a hemisphere  in  this  direc- 
tion carry  it  at  right  angles  to  the  course  of  veins 
passing  from  the  longitudinal  sinus  to  the  cortex 
or  from  the  dura  to  the  surface  of  the  cerebrum 
in  the  frontal  or  occipital  regions.  It  would  there- 
fore follow  that  this  lesion  is  most  likely  to  occur 
when  the  force  is  applied  to  either  the  frontal  or 
occipital  regions.  Virchow  first  described  this 
lesion  as  pachymeningitis  haemorrhagica.  As  a 
result  of  the  bleeding  a clot  forms  and  the  en- 
suing pathologic  processes  are  merely  the  result 
of  an  effort  by  the  dura  to  organize  the  clot. 

Consequent  on  the  reaction,  a definite  cyst  wall 
forms  on  the  under  surface  of  the  dura  and  is 
extended  over  that  part  of  the  clot  lying  against 
the  arachnoid  as  a very  thin  web  of  fibrous  tissue 
covered  by  a layer  of  mesothelial  cells.  Definite 
fine  adhesions  are  formed  between  the  clot  and  the 
underlying  dura;  but  there  is  no  attachment  to 

M *Riendiqll°re  the  Washington  County  Medical  Society, 


the  arachnoid  unless  it  has  been  torn.  The  dura 
in  the  region  involved  is  thickened  and  its  under 
surface  is  covered  with  a reddish,  velvety  tissue, 
resembling  granulations,  on  which  delicate  bleed- 
ing points  appear  when  it  is  stripped  from  the 
clot.  After  a long  lapse  of  time  the  clot  may 
undergo  almost  complete  organization.  Gardner* 
has  explained  the  long  latent  period  between  the 
inception  of  the  trauma  and  the  appearance  of 
the  pressure  signs  on  the  grounds  that,  following 
encystment  and  liquefaction  of  the  hematoma,  the 
latter  absorbs  cerebrospinal  fluid  by  osmosis 
through  the  semipermeable  arachnoid  and  cyst 
membranes,  with  progressive  enlargement  of  the 
hemorrhagic  cyst,  until  pressure  signs  ensue. 

Meningocerebral  Adhesions:  Cortical  lacera- 

tions or  the  presence  of  whole  blood  in  the  cere- 
brospinal fluid  may  result  in  arachnoidal  ad- 
hesions following  trauma.  Clinically  we  may  now 
recognize  the  different  types  of  arachnoiditis  by 
means  of  encephalography.  Trauma  and  inflam- 
mation are  the  most  frequent  causes  for  the 
localized  or  diffuse  arachnoidal  proliferations 
which  produce  these  adhesions.  Davis  and  Haven’ 
have  separated  changes  in  the  arachnoid  mem- 
brane into  three  groups  as  determined  by  the 
histo-pathological  picture.  First:  those  in  which 
the  thickening  was  definitely  inflammatory  in 
nature.  Second;  those  in  which  the  predominat- 
ing picture  in  the  thickening  was  fibrosis.  Third; 
those  in  which  the  primary  picture  of  the  thicken- 
ing was  a marked  hyperplasia  of  the  arachnoid 
cells.  Clinically  we  attempt  to  recognize  a cystic 
and  a plastic  type  as  determined  by  the  en- 
cephalogram. The  cystic  type  is  due  to  a circum- 
scribed arachnoiditis  and  the  plastic  type  due  to. 
a diffuse  arachnoiditis. 

Cortical  Contusions  and  Lacerations : All  types 
of  trauma  followed  by  elemental  or  total  disin- 
tegration of  the  cortex  brings  forth  the  mobiliza- 
tion of  the  microglial  elements  residing  in  the  in- 
jured focus  of  its  vicinity.  They  begin  their 
phagocytic  activities  and  the  destroyed  cerebral 
elements  are  removed,  and  subsequently  with  the- 
microglia  still  in  predominance,  cicatrical  gliosis 
begins.  Related  neuroglia  astrocytes  and  oligo- 
dendroglia  undergo  multiplication  and  enlarge- 
ment and  become  fibrous,  so  that  finally  cicatrical 
contraction  of  the  scar  results  with  secondary 
brain  tissue  deformity.  Thus  simple  brain  lacera- 
tion may  result  in:  (1)  Destruction  of  brain  cel- 
lular elements;  (2)  Brain  scarring  with  or  with- 
out related  meningeal  adhesions  and  finally;  (3) 
Brain  deformity,  often  demonstrable  by  means  of' 
the  encephalogram. 

Especially  interesting  and  important,  par- 
ticularly when  the  development  of  post-traumatic 


493 


494 


The  Ohio  State  Medical  Journal 


August,  1933 


symptoms  is  under  consideration,  are  the  findings 
of  Martland4.  In  a series  of  patients  who  died 
following  cranial  trauma,  it  was  noted  that  deep 
multiple  hemorrhages  were  present  in  ten,  with- 
out fracture  of  the  skull  or  gross  surface  lesions. 
The  portions  of  the  brain  chiefly  involved  were 
the  corpus  callosum,  the  corpora  striata  and  the 
corona  radiata.  Microscopic  examination  showed 
that  most  of  these  punctate  hemorrhagic  areas 
consisted  of  cross  sections  of  capillaides  filled 
with  red  blood  cells  which  had  leaked  into  the 
surrounding  perivascular  spaces  and  distended 
them.  The  perivascular  space  limited  the  hemor- 
rhage, causing  it  to  encircle  the  vessel  in  a ring- 
like manner.  Its  anatomic  location  is  similar  to 
that  observed  in  epidemic  encephalitis  as  the  re- 
sult of  an  inflammatory  defense  reaction.  Kas- 
anin5  found  neurological  evidence  of  the  Parkin- 
sonian state  in  many  who  had  received  head  in- 
juries, so  that  it  may  be,  in  view  of  the  ring 
hemorrhages  described  by  Martland,  that  trauma 
may  produce  a picture  similar  to  that  caused 
by  epidemic  encephalitis.  Certainly  they  may  be 
responsible  for  the  development  of  sequelae  of  a 
severity  out  of  all  proportion  to  the  degree  of 
original  trauma. 

Alterations  in  the  Ventricular  System  Due  to 
Trauma:  Perhaps  the  most  illuminating  revela- 
tion of  encephalography  is  the  evidence  of  a 
“wandering”  of  the  lateral  and  third  ventricles 
toward  the  traumatized  side.  This  observation 
was  first  made  by  Foerster  in  1924  and  later  con- 
firmed by  many.  The  alteration  in  position  of  the 
ventricles  is  due  to  a pull  exerted  by  a cortical 
scar  or  meningocerebral  adhesions.  There  is 
often  a dilatation  of  the  lateral  ventricle  on  the 
same  side  as  the  lesion  in  contra-distinction  to  a 
mass  lesion  which  always  produces  a partial  col- 
lapse of  the  lateral  ventricle  on  the  same  side  and 
a displacement  of  the  ventricular  system  to  the 
opposite  side. 

Variable  degrees  of  internal  hydrocephalus  may 
result  from  trauma  which  may  affect  the  entire 
ventricular  system.  This  ventricular  enlargement 
may  be  diagnosed  by  means  of  the  encephalogram. 
Friedman6  believes  the  first  expression  of  internal 
hydrocephalus  consists  of  a blunting  and  round- 
ing out  of  the  upper  outer  pole  of  the  lateral  ven- 
tricle. 

Cortical  Atrophy  Due  to  Trauma:  Cerebral 

trauma  associated  with  bloody  cerebrospinal  fluid 
may  be  responsible  for  temporary  as  well  as 
permanent  damage  to  the  pacchionian  bodies.  As 
Weed  has  demonstrated  these  bodies  to  be  the 
most  important  structures  concerned  with  the 
elimination  of  the  cerebrospinal  fluid ; it  therefore, 
may  be  seen  that  a failure  upon  their  part  to 
function  will  cause  a consequent  increase  of  the 
intracranial  pressure.  Clinically  it  has  been  our 
experience,  almost  without  exception,  to  find  a 
moderate  increase  of  the  intracranial  pressure 


when  we  have  been  able  to  demonstrate  an  or- 
ganic background  for  the  post-traumatic  symp- 
toms. This  increase  of  pressure  will  eventually 
cause  a secondary  cortical  atrophy  of  an  ischemic 
type  and  largely  confined  to  the  fronto-parietal 
area.  The  chronic  increase  of  intracranial  pres- 
sure may  account  for  the  progressive  development 
of  symptoms  in  some  cases  of  late  head  injuries. 

Bennett  and  Hunt’  have  expressed  the  opinion 
that  the  atrophy  following  trauma  is  due  to  a 
combination  of  cerebral  edema,  subarachnoid 
hemorrhage  and  intracerebral  diffuse  minute 
hemorrhages. 

SYMPTOMS 

Bielschowsky  first  suggested  the  term  “post- 
traumatic  cerebral  syndrome”  to  apply  to  patients 
who  complain  of  symptoms  following  head  injury. 
Clinically,  the  cases  fall  into  three  groups:  (1) 

Injuries  to  the  head  without  focal  symptoms  but 
with  general  symptoms,  i.e.,  headache,  tinnitus 
and  vertigo.  (2)  Cases  with  general  and  focal 
symptoms,  and  (3)  Cases  of  traumatic  epilepsy. 

Headache  is  by  all  odds  the  most  frequent  com- 
plaint following  head  injury.  The  pain  is  usually 
described  as  throbbing,  piercing  or  aching  and 
tends  to  be  localized  rather  than  diffuse.  It  may 
be  continuous  but  subject  to  diurnal  variations; 
often  it  occurs  in  bouts  of  brief  duration.  The 
pain  is  ordinarily  aggravated  by  change  of  pos- 
ture, physical  exertion  and  mental  effort.  The 
headache  is  often  referred  to  the  situation  of  the 
initial  injury  and  is  sometimes  associated  with 
superficial  tenderness. 

The  vei’tigo  of  which  these  patients  complain 
occurs  usually  at  the  height  of  the  headache  with 
a definite  relation  to  posture.  It  may  last  from 
one  to  ten  minutes  and  is  caused  by  stooping,  ex- 
ertion, exposure  to  sunlight  and  rising  from  a 
sitting  position.  There  is  no  sense  of  rotation  and 
typically,  there  is  no  nystagmus  or  other  evidence 
of  a vestibular  lesion. 

In  the  absence  of  a demonstrable  lesion  to  the 
auditory  nerve,  the  tinnitus  is  not  localized  to 
one  side.  It  is  described  as  a throbbing,  whistling, 
buzzing  and  simulating  escaping  steam.  The  de- 
gree of  the  tinnitus  often  varies  with  the  in- 
tensity of  the  headache. 

Other  symptoms  of  which  these  patients  com- 
plain are:  scotomas  exhaustion  following  modei'- 
ate  exertion,  emotional  lability,  tendency  to  de- 
pression, irritability,  together  with  decrease  in 
mental  capacity  and  inability  to  concentrate. 

In  some  cases  the  mental  changes  may  be  so 
profound  that  they  may  be  classed  as  traumatic 
insanity. 

In  addition  to  these  generalized  symptoms  there 
may  be  signs  and  symptoms  of  a localized  nature 
depending  upon  the  site  of  injury.  Any  of  the 
cranial  nerves  may  be  injured  producing  sub- 
jective or  objective  disturbances.  The  various 


August,  1933 


Late  Effects  of  Head  Injuries — LeFever 


495 


lobes  of  the  brain  may  be  injured,  producing 
localized  signs  in  proportion  to  the  degree  of  dam- 
age. 

Convulsive  states  following  trauma  may  be 
divided  into  three  groups:  focal  epilepsy,  gen- 

eralized epilepsy  and  hystero-epilepsy. 

Focal  epilepsy  often  results  from  depressed 
fractures  over  the  motor  area.  True  post-trau- 
matic epilepsy  rarely  develops  earlier  than  six 
months  after  the  injury  and  may  make  its  ap- 
pearance as  late  as  fourteen  years.  Therefore, 
one  should  view  with  suspicion  the  diagnosis  of 
true  post-traumatic  epilepsy  if  the  onset  is  upon 
the  heels  of  the  injury  and  should  rather  suspect 
a functional  background. 

A subdural  hematoma  may  produce  the  gen- 
eralized signs  of  an  increased  intracranial  pres- 
sure, i.e.,  headache,  vomiting  and  choked  disc, 
with  or  without  localizing  signs.  The  onset  of 
symptoms  may  not  be  until  weeks  or  months  fol- 
lowing the  initial  injury.  Often  it  may  be  difficult 
to  obtain  a history  of  the  injury  which  produced 
the  lesion. 

DIAGNOSIS 

A carefully  taken  history  is  of  the  utmost  im- 
portance in  attempting  to  determine  whether  or 
not  an  organic  lesion  exists  in  a patient  who  has 
suffered  a head  injury.  It  should  include  the  date 
of  the  original  injury  whether  there  was  X-ray 
evidence  of  a skull  fracture,  whether  there  was 
bleeding  from  the  orifices,  especially  from  the 
ears.  If  a lumbar  puncture  had  been  performed 
one  should  ascertain  the  cerebro-spinal  fluid  pres- 
sure and  whether  the  fluid  was  bloody  or  clear. 
In  this  manner  absolute  evidence  may  be  detailed 
to  show  that  the  head  injury  was  sufficient  to 
produce  organic  change  in  the  brain.  One  should 
always  inquire  into  the  length  and  degree  of  any 
unconsciousness  which  followed  trauma,  and 
whether  or  not  there  was  vomiting.  In  the  words 
of  Foster  Kennedy,  “One  must  seek  harmony  be- 
tween the  degree  of  injury,  the  subsequent  history 
of  the  patient’s  symptoms  and  his  physical  con- 
dition ; dissonance  in  this  trilogy  must  be  viewed 
askant  and  awake  a suspicion  of  a suggested 
neurosis.” 

A complete,  painstaking  and  detailed  neurologi- 
cal examination  should  be  performed  upon  every 
patient  who  has  suffered  a severe  head  injury. 
The  eye  grounds  should  be  carefully  examined 
and  often  the  vestibular  tests  are  of  extreme 
value. 

The  post-traumatic  cerebral  syndrome  must  be 
differentiated  from  post-traumatic  psychoneurosis 
and  malingering.  Often  this  may  be  most  difficult. 
In  the  light  of  the  present  knowledge  of  the  un- 
derlying pathologic  lesions,  it  would  seem  that  in 
the  past,  the  diagnosis  of  post-traumatic  psycho- 
neurosis has  been  made  too  frequently. 

A lumbar  puncture  may  reveal  the  presence  of 


an  increase  of  the  intra-cranial  pressure,  which 
would  imply  a retardation  in  the  resorption  of 
the  cerebrospinal  fluid. 

A neutral  form  of  phenolsulphonephthalein  may 
be  introduced  into  the  spinal  canal  through  a lum- 
bar puncture  needle  and  in  this  manner  a de- 
fective resorptive  mechanism  may  be  demon- 
strated. 

The  encephalogram  presents  three  characteris- 
tics in  traumatic  cases  : (1)  Inability  to  fill  the 
ventricles  (this  defect  must  not  be  confused  with 
an  error  of  technic)  ; (2)  Change  in  form  or 

position  of  the  ventricles,  and  (3)  Change  in  the 
distribution  of  the  air  over  the  cerebral  surfaces 
(either  an  increase  or  a decrease). 

TREATMENT 

Until  rather  recently  the  treatment  of  patients 
who  complain  of  symptoms  following  head  trauma 
has  been  directed  solely  toward  a symptomatic  re- 
lief without  regard  for  the  underlying  pathologic 
lesion  responsible.  Therefore,  in  the  past,  the 
administration  of  anodynes  and  sedatives  has 
been  the  accepted  form  of  treatment. 

We  believe  it  is  a sound  surgical  principle  to 
advise  the  elevation  of  an  old  depressed  fracture, 
recognizing  that  the  results  are  often  disappoint- 
ing due  to  the  fact  that  the  meninges  and  the 
cortex  of  the  brain  were  damaged  at  the  time  of 
the  original  injury,  in  which  event  little  good  can 
accrue  from  the  elevation.  Nevertheless,  brilliant 
results  often  follow  the  operation  and  we  feel  it 
is  justified  if  the  facts  are  explained  to  the 
patient. 

The  treatment  of  chronic  subdural  hemorrhage 
is  purely  surgical.  The  clot  is  removed  either  by 
means  of  an  anterior  and  posterior  trephine  open- 
ing with  through  and  through  irrigation  or  by 
means  of  an  osteoplastic  flap. 

Penfields  was  the  first  to  call  attention  to  the 
therapeutic  value  secured  from  the  lumbar  in- 
sufflation of  air.  It  has  since  come  to  occupy  a 
prominent  place  in  the  treatment  of  the  post- 
traumatic  cerebral  syndrome.  In  our  experience 
we  have  obtained  relief  of  post-traumatic  symp- 
toms in  about  40  per  cent  of  patients  so  treated. 
The  more  extensive  the  meningocerebral  adhesions 
the  less  likely  that  a therapeutic  benefit  will  fol- 
low the  procedure. 

Adson  has  advised  the  ligation  and  section  of 
the  middle  meningeal  artery  at  the  foramen 
spinosum,  in  cases  of  intractable  localized  head- 
ache. 

When  traumatic  epilepsy  has  resulted  from 
cortical  laceration  with  scar  formation,  Foerster 
and  Penfield0  have  advised  the  excision  of  the 
cicatrical  tissue. 

In  the  event  that  a chronic  increase  of  intra- 
cranial pressure  exists,  it  is  best  managed  by  re- 
peated lumbar  punctures  and  a dehydration  diet. 
The  total  fluid  intake  is  limited  to  one  thousand 


496 


The  Ohio  State  Medical  Journal 


August,  1933 


cubic  centimeters  in  twenty-four  hours,  the  use  of 
salt  is  minimized  and  once  each  week  three  fluid 
ounces  of  magnesium  sulphate  is  administered. 
In  this  manner  the  cerebrospinal  fluid  pressure 
may  be  maintained  within  normal  limits,  and  a 
secondary  atrophy  of  the  cortex  prevented. 

137  E.  State  Street. 

BIBLIOGRAPHY 

1.  Glaser  and  Shafer.  Skull  and  Brain  Traumas:  Their 
Sequelae.  J.A.M.A.  Vol.  98,  Jan.  23,  1932. 

2.  Gardner.  Traumatic  Subdural  Hematoma : Archives 

of  Neurology  and  Psychiatry.  Vol.  27,  Auril,  1932. 


3.  Davis  and  Haven.  A Clinico-pathological  Study  of 

the  Intracranial  Arachnoid  Membrane:  Journal  of  Nervous 

and  Mental  Disease.  Vol.  73,  Feb.,  1931. 

4.  Martland.  J.A.M.A.  1928,  91,  1103. 

5.  Kasanin.  Journal  of  Nervous  and  Mental  Disease, 
1929,  69,  385. 

6.  Friedman.  Head  Injuries.  Archives  of  Neurology 
and  Psychiatry.  April,  1932. 

7.  Bennett  and  Hunt.  Traumatic  Encephalitis.  Archives 
of  Surgery,  Vol.  26,  March,  1933. 

8.  Penfield,  W.  Chronic  Meningeal  (Post-traumatic) 
Headache  and  Its  Specific  Treatment  by  Lumbar  Air  In- 
sufflation ; Encephalography,  Surgery,  Gynecology  and  Ob- 
stetrics, Vol.  45,  Dec.,  1927,  p.  747. 

9.  O.  Foerster  and  W.  Penfield.  The  Structural  Basis  of 
Traumatic  Epilepsy  and  Results  of  Radical  Operation. 
Brain,  Vol.  53,  page  99,  1930. 


George  A.  Palmer,  M.D.,  Akron,  Ohio 


OF  THE  frequent  complications  in  obstetrics, 
the  occipito-posterior  position  is  without 
question  the  most  important.  This  im- 
portance can  be  attributed  to  its  extremely  fre- 
quent occurrence,  to  the  fetal  morbidity  and 
mortality,  and  the  maternal  morbidity  as  well  as 
the  unnecessary  suffering  and  fatigue  of  the 
patient.  This  condition,  however,  if  correctly 
handled  can  be  done  so  with  ease  and  satisfaction. 

If  one  makes  a careful  diagnosis  of  position 
early  in  labor  the  incidence  of  occipito-posterior 
positions  will  be  found  to  be  approximately  30 
per  cent.  That  the  question  of  management  of 
this  complication  is  not  a settled  one  is  evidenced 
by  the  tremendous  amount  of  literature  on  the 
subject  by  writers  in  various  localities,  both  here 
and  abroad.  Bearing  this  fact  in  mind,  I do  not 
present  this  plan  of  management  as  the  only  one, 
but  rather  as  one  that  has  proved  highly  satis- 
factorily if  all  details  of  technique  are  strictly 
adhered  to. 

Although  approximately  50  per  cent  of  pos- 
terior positions  will  rotate  anterior  spontaneously 
if  left  long  enough,  I believe  too  much  stress  has 
been  placed  on  this  point  in  arguments  against 
the  advisability  of  interference  or  assistance  on 
the  part  of  the  obstetrician.  That  this  prolonged 
labor  and  policy  of  watchful  waiting  is  one  of  the 
chief  etiological  factors  in  such  conditions  as 
uterine  inertia,  contraction  ring,  postpartum 
hemorrhage  and  lowered  maternal  resistance  can- 
not be  denied.  Certainly  if  an  abnormal  position 
can  by  a simple  maneuver  be  converted  to  a nor- 
mal position,  such  a procedure  is  well  worth  con- 
sidering. 

In  the  management  of  these  cases,  diagnosis  is 
of  the  greatest  importance.  By  means  of  careful 
abdominal  palpation  and  auscultation,  in  con- 
junction with  rectal  examinations  in  the  first  and 
early  second  stages  of  labor,  accurate  diagnosis  of 
position  can  be  made  in  practically  every  case. 
Resorting  to  vaginal  examinations  to  determine 
position  is  very  rarely  necessary. 


On  abdominal  palpation  the  fetal  back  is  in  the 
mother’s  flank  and  the  anterior  shoulder  is  well 
back  from  the  midline.  A very  helpful  maneuver 
in  diagnosing  positions  is  to  place  the  thumb  and 
middle  finger  equidistant  from  the  symphysis 
pubis  over  the  rami  and  exert  inward  pressure. 
A firm  mass  will  be  encountered,  which  is  the 
forehead,  and  it  will  be  on  the  side  opposite  the 
back.  There  will  be  a depression  on  the  side 
coresponding  to  the  back.  On  auscultation  the 
heart  sounds  are  distant  and  heard  best  usually 
deep  in  the  flank.  Abdominal  palpation  must  be 
relied  upon  until  the  cervix  has  dilated  4 to  5 
cms.,  and  then  the  saggital  suture  with  one  or 
both  fontanelles  may  be  palpated  as  an  additional 
aid  in  diagnosis.  It  is  well  to  remember  that  in 
posterior  positions  the  head  is  somewhat  extended 
so  that  the  posterior  fontanelle,  upon  which  one 
depends  to  a large  extent  in  determining  the 
position  of  the  head,  lies  so  far  back  and  so  high 
it  is  sometimes  very  difficult  to  reach. 

One  frequently  gets  valuable  information  by 
following  the  clinical  course  of  labor.  The  labor 
is  usually  prolonged,  dilatation  slower,  the  cervix 
may  be  pulled  toward  the  side  of  the  presenting 
part,  and  complete  dilatation  may  not  be  reached 
due  to  deflection  of  the  head  which  causes  un- 
equalized pressure  on  the  cervix.  Also  the  bag  of 
waters  frequently  ruptures  early — another  factor 
in  the  slower  cervical  dilatation. 

Postural  treatment  in  the  latter  days  of  preg- 
nancy and  early  labor  before  the  head  has  en- 
gaged or  the  membranes  ruptured  may  be  tried  as 
an  aid  in  bringing  about  rotation.  The  knee  chest 
position  tends  to  throw  the  child’s  back  toward 
the  median  line  of  the  anterior  abdominal  wall 
and  favors  rotation  of  the  head  more  readily  than 
does  the  lateral  position.  Neither  of  these  man- 
euvers, however,  have  proved  very  effectual  in 
bringing  about  rotation.  The  administration  of 
drugs  in  the  first  stage  of  labor  to  stimulate 
uterine  contractions,  such  as  pituitary  prepara- 
tions, or  the  application  of  an  extremely  tight 


August,  1933  Management  of  Occipito-Posterior  Positions — Palmer 


497 


abdominal  binder,  only  add  insult  to  injury  and 
makes  dangerous  pressure  upon  the  child’s  head 
which  may  be  already  distressed.  The  judicious 
use  of  analgesia  and  anesthesia  to  relieve  pain  in 
this  prolonged  labor  is  to  be  encouraged.  Without 
this,  the  physician  is  apt  to  yield  to  the  demands 
of  the  patient  or  her  relatives  and  attempt  de- 
livery when  the  cervix  is  not  fully  dilated. 

The  frequency  and  regularity  of  the  fetal  heart 
should  be  determined  at  regular  intervals  through- 
out the  entire  course  of  labor.  The  character  of 
the  fetal  heart  tones  serves  as  one  of  the  direct 
guides  in  making  a decision  as  to  how  rapidly 
labor  should  be  terminated.  The  patient’s  bowels 
and  bladder  should  be  emptied  as  required,  and 
moderate  amounts  of  fluid  in  the  form  of  water 
and  fruit  juices  should  be  administered  during  the 
long  first  stage  of  labor. 

When  progress  ceases  during  the  first  stage  of 
labor,  the  introduction  of  a Vorhees  bag  will  bring 
about  dilatation  of  the  os  very  quickly  and  at  the 
same  time  stimulate  the  uterus  to  stronger  con- 
tractions. This  method  replaces  artificially  some- 
thing which  is  missing — the  bag  of  forewaters. 
By  this  method  the  patient’s  mental  and  physical 
strength  is  conserved  so  that  frequently  she  may 
be  able  by  her  own  strength  to  accomplish  rota- 
tion of  the  head  and  make  possible  spontaneous 
delivery  of  the  child.  The  point  here  to  be  stressed 
is,  that  delivery  should  not  be  attempted  through 
an  undilated  and  resistant  cervix.  It  is  possible 
to  tell  within  one  or  two  hours  after  the  beginning 
of  the  second  stage  whether  the  head  will  rotate 
spontaneously.  Therefore,  a decision  should  be 
made  and  labor  terminated  in  approximately  two 
hours. 

The  method  of  choice  of  delivery  depends  on  a 
number  of  different  factors.  When  the  greatest 
diameter  of  the  head  has  not  descended  through 
the  pelvic  brim  and  when  there  is  no  apparent 
disproportion,  internal  podalic  version  is  the 
method  of  choice.  In  those  cases  in  which  there 
has  been  an  early  rupture  of  the  membranes  with 
a resultant  dry  and  tonic  uterus  making  version 
impossible,  and  in  those  cases  with  normal  meas- 
urements, yet  the  head  remains  high  and  will  not 
engage  due  tc  a relative  disproportion,  low 
Cesarean  section  is  the  elective  method.  By  far 
the  largest  number  of  fetal  heads  in  this  group  of 
persistent  occipito-posterior  positions  will  become 
arrested  below  the  pelvic  brim  but  not  below  the 
ischial  spines.  In  these  cases  the  method  of  choice 
is  the  modified  Scanzoni  maneuver  of  Bill.  By 
this  method  the  malposition  is  corrected  by  rotat- 
ing the  head  with  forceps  to  the  anterior  position 
without  traction,  then  removing  and  reapplying 
the  forceps  to  complete  the  delivery  by  extraction. 

As  was  stated  before,  strict  adherence  to  the 
proper  technique  is  absolutely  necessary  to  obtain 
satisfactory  results.  Failures  or  unsatisfactory 
results  can  be  attributed  to  the  following: 

1.  Attempts  at  forceps  delivery  of  the  posterior 


head  without  rotation. 

2.  Pulling  a high  head  down  to  a lower  plane 
in  a posterior  position  and  then  rotating. 

3.  Attempting  traction  and  rotation  simul- 
taneously. 

4.  Rotating  the  head  through  a small  arc  at  a 
time  by  continually  reapplying  the  forceps  until 
the  head  is  eventually  in  the  anterior  position. 
The  natural  results  of  these  procedures  are — - 

a.  Slipping  of  the  blades. 

b.  Damage  to  the  child’s  head. 

c.  Damage  to  the  vaginal  wall. 

For  the  sake  of  clarity,  the  procedure  will  be 
outlined  in  stages.  The  best  position  for  the 
patient  to  be  in  is  with  the  thighs  horizontal  and 
the  knees  as  close  together  as  is  compatable  with 
asepsis  and  convenience  in  working.  This  position 
produces  a relaxation  of  the  perineum  and  lessens 
the  danger  of  laceration. 

1.  The  maternal  soft  parts  should  be  manually 
dilated. 

2.  A cephalic  application  of  the  blades  should 
be  made — that  is,  the  blades  should  lie  upon  the 
sides  of  the  head  diametrically  opposite  to  each 
other.  In  making  the  first  application,  the  con- 
cavity of  the  pelvic  curve  of  the  blades  should 
look  toward  the  child’s  face.  Therefore,  in  the 
case  of  an  R.O.P.  the  forceps  should  be  applied  as 
if  one  were  dealing  with  an  L.O.A.  and  vice  versa. 
In  applying  the  blade  it  is  held  perpendicularly  in 
one  hand  while  two  or  more  fingers  of  the  other 
hand  are  passed  into  the  pelvis  to  the  side  on 
which  the  blade  is  to  lie.  The  tip  passes  along  the 
palmar  surface  of  the  fingers  between  the  head 
and  the  cervix  and  comes  to  lie  fiat  against  the 
child’s  head.  While  inserting  the  blades  the  per- 
pendicular position  can  be  maintained  by  the 
thumb  of  the  guiding  hand.  The  anterior  blade  is 
started  in  exactly  the  same  way  as  the  posterior 
but  in  addition  there  is  a slight  rotary  movement, 
using  the  junction  of  the  blade  and  the  shaft  as 
the  pivot.  The  best  test  for  the  accuracy  of  the 
application  is  the  relative  position  of  the  blades 
to  the  lambdoid  sutures.  The  anterior  edge  of  the 
blades  should  lie  parellel  to  the  lambdoid  sutures 
and  equidistant  from  them. 

3.  The  handles  of  the  blades  should  be  depressed 
before  locking  in  an  attempt  to  bring  the  blades  in 
the  long  diameter  of  the  fetal  head. 

4.  The  forceps  are  then  locked  and  the  handles 
raised  toward  the  opposite  groin  and  carried 
around  in  a large  sweeping  circle  in  such  a man- 
ner as  to  keep  the  blades  constantly  in  the  same 
axis  of  the  pelvis.  At  the  end  of  rotation  the 
handles  point  almost  directly  downward.  The 
head  is  rotated  until  the  occiput  lies  directly 
under  the  symphysis.  Absolutely  no  traction 
should  be  made  upon  the  head  during  rotation. 
If  the  head  seems  impacted  it  may  be  loosened  by 
slight  upward  pressure.  During  rotation  the  for- 
ceps should  be  held  with  one  hand  while  the  fin- 
gers of  the  other  hand  are  kept  on  the  posterior 
fontanelle  to  detect  any  slipping  of  the  blades. 
Usually  very  little  force  is  required  to  rotate  the 
head.  It  should  be  remembered  that  manipulation 
rather  than  force  gives  success. 

5.  After  rotation  is  complete  and  before  the 
blades  are  removed,  slight  downward  traction 
should  be  made  sufficient  to  fix  the  head  and  pre- 
vent it  fi-om  rotating  to  its  original  position  after 


498 


The  Ohio  State  Medical  Journal 


August,  1933 


removal  of  the  blades. 

6.  The  forceps  should  then  be  removed  and  re- 
applied as  in  any  occipito-anterior  position.  When 
the  blades  are  reapplied,  the  posterior  blades 
should  be  applied  first  to  support  the  occiput  and 
prevent  the  head  slipping  back  to  the  posterior 
position.  Completion  of  the  delivery  by  extraction 
should  immediately  follow  the  rotation.  This  is 
best  accomplished  by  means  of  axis  traction.  By 
using  axis  traction  a greater  accuracy  in  the 
direction  of  traction  can  be  obtained  and  there- 
fore a lesser  amount  of  force  is  required  to  de- 
liver the  head.  The  anesthesia  should  be  lightened 
after  rotation  is  completed  in  order  to  reestablish 
the  uterine  contractions.  These  contractions  serve 
as  an  additional  aid  in  holding  the  head  in  the 
anterior  position  and  also  aid  subsequent  de- 
livery. Traction  should  be  made  only  simul- 
taneously wtih  contractions.  The  forceps  should 
be  removed  when  the  bi-parietal  eminences  are 
fixed  in  the  vulvar  orifice.  The  rest  of  the  de- 
livery may  best  be  accomplished  manually  by 
means  of  Ritgen’s  maneuver.  Solid  blade  forceps 
are  preferable  to  fenestrated  blades  because — 

a.  Application  and  removal  is  more  easily 
made 

b.  Rotation  of  the  head  is  more  easily  ac- 
complished due  to  the  smoothness  of  the 
blades. 

There  are  some  cases  of  posterior  positions 
which  in  the  process  of  spontaneous  rotation  are 
arrested  in  the  transverse  diameter  of  the  ma- 
ternal pelvis.  These  cases  can  be  satisfactorily 
rotated  and  subsequently  extracted  by  a single 
cephalic  application  of  the  forceps. 

I do  not  believe  in  manual  rotation  of  the  head 
because  of  the  complications  that  may  attend  dis- 
placement and  manipulation  of  the  head,  such  as 
prolapse  of  the  cord  or  one  of  the  arms.  Also 
there  is  a greater  likelihood  of  the  head  slipping 
back  to  the  posterior  position  before  the  forceps 
are  applied.  The  application  of  a vosellum  forcep 
to  the  child’s  scalp  to  prevent  the  backward  rota- 
tion following  manual  rotation  is  not  scientific 
and  is  an  unnecessary  procedure. 

Lacerations  of  the  cervix,  vaginal  wall,  or  peri- 
neum do  not  occur  as  the  result  of  rotation,  but  if 
they  do  occur,  are  the  result  of  subsequent  ex- 
traction and  would  have  occurred  had  the  position 
of  the  head  been  normal  from  the  onset. 

SUMMARY  AND  CONCLUSIONS 

1.  The  vertex  occipito-posterior  position  is  a 
frequent  and  important  complication  in  obstetrics. 

2.  Accurate  diagnosis  is  of  the  greatest  im- 
portance in  the  management  of  these  cases. 

3.  Posterior  positions  should  be  corrected  early 
in  the  second  stage  of  labor. 

4.  In  those  cases  in  which  the  greatest  diameter 
of  the  head  has  not  descended  through  the  pelvic 
brim,  and  when  there  is  no  disproportion,  internal 
podalic  version  is  the  method  of  choice  of  de- 
livery. 

5.  In  those  cases  with  normal  measurements  in 
which  there  has  been  an  early  rupture  of  the 
membranes,  yet  the  head  remains  high  and  will 


not  engage,  due  to  a relative  disproportion,  low 
Cesarean  section  is  the  elective  method  of  de- 
livery. 

6.  By  far  the  greatest  number  of  fetal  heads  in 
the  vertex  occipito-posterior  position  will  become 
arrested  below  the  pelvic  brim.  The  modified 
Scanzoni  maneuver  of  Bill  is  a highly  satisfactory 
method  for  correcting  this  malposition. 

7.  When  the  fetal  head,  in  the  process  of 
spontaneous  rotation,  becomes  arrested  in  the 
transverse  diameter  of  the  maternal  pelvis,  a sin- 
gle cephalic  application  of  the  forceps  will  suffice 
for  rotation  and  subsequent  extraction. 

8.  Success  in  forceps  rotation  depends  entirely 
on  strict  adherence  to  the  technique  in  every  de- 
tail. 

9.  Manual  rotation  is  not  advocated  because  of 
the  complications  that  may  attend  displacement 
and  manipulation  of  the  head. 

10.  Lacerations,  if  they  occur,  are  the  result  of 
delivery  subsequent  to  rotation. 

First-Central  Trust  Bldg. 


New  Books  Received 

Diet  in  Sinus  Infections  and  Colds,  by  Egon 
V.  Ullmann,  M.  D.,  formerly  special  lecturer  for 
biology  at  Oregon  State  College  and  instructor 
at  the  first  medical  clinic,  University  of  Vienna; 
The  MacMillan  Company,  60  Fifth  Avenue,  New 
York;  price  $2.00. 

Report  on  the  Sixth  International  Congress  of 
Military  Medicine  and  Pharmacy;  publication  of 
the  U.  S.  Department  of  State  concerning  the 
transactions  of  the  international  conference  held 
at  The  Hague,  in  June,  1931. 

Transactions  of  the  College  of  Physicians  of 
Philadelphia;  a compilation  of  the  papers  read 
before  the  Philadelphia  college  during  the  year 
1932. 


Sixth  Annual  Graduate  Fortnight  of  the  New 
York  Academy  of  Medicine  will  be  held  at  the 
Academy  Building,  2 East  103rd  Street,  New 
York  City,  October  23  to  November  3,  1933. 
The  program  will  be  devoted  to  “Disorders  of 
Metabolism”.  Meetings  will  be  held  every  after- 
noon and  evening.  A scientific  exhibit  will  be 
held  in  connection  with  the  demonstrations. 
Complete  information  and  a registration  blank 
may  be  obtained  by  writing  to  the  Academy  at  the 
above  address. 


The  American  Congress  of  Physical  Therapy 
will  hold  its  12th  annual  scientific  and  clinical 
session,  September  11  to  15,  1933,  at  the  Palmer 
House,  Chicago.  Programs  and  information  re- 
garding the  meeting  may  be  obtained  from  the 
Executive  Secretary,  30  North  Michigan  Avenue, 
Chicago. 


EIGHTY-SEVENTH  ANNUAL  MEETING 

Akron,  September  7 and  8,  1933 
OHIO  STATE  MEDICAL  ASSOCIATION 
MAYFLOWER  HOTEL 


GENERAL  SESSIONS 


Opening  Session 

Thursday,  September  7,  10:00  A.  M. 

Meeting  Place — Parlor  E,  northeast  corner, 
third  floor,  Mayflower  Hotel. 


This  session  is  combined  with  the  first  session 
of  the  House  of  Delegates.  See  page  500. 


Second  Session 

Thursday,  September  7,  6:30  P.  M. 
BANQUET 

Meeting  Place — Ballroom,  Mayflower  Hotel. 
Details  under  direction  of  Entertainment  Com- 
mittee, Dr.  J.  S.  Millard,  chairman,  and  Banquet 
Committee,  Dr.  J.  H.  Weber,  chairman. 

1.  Annual  address  of  the  President-Elect,  C.  L. 
Cummer,  Cleveland. 

2.  Annual  address  of  the  retiring  President,  H. 
M.  Platter,  Columbus. 

3.  Presentation  of  Past-President’s  gavel  to  re- 
tiring president — D.  C.  Houser  to  H.  M.  Plat- 
ter. 

4.  Address  by  Dr  Olin  West,  Secretary  and  Gen- 
eral Manager,  American  Medical  Association, 
on  “The  Need  for  Unity  in  the  Medical  Pro- 
fession in  Facing  the  Economic  and  Social 
Problems  of  the  Day”. 

5.  Informal  reception  in  honor  of  President  and 
President-Elect.  Entertainment  Features, 
Music,  Dancing. 


Third  Session 

Friday,  Sept.  8,  8:30  A.M. 

Meeting  Place— Ballroom,  second  floor, 
Mayflower  Hotel. 

Paper  No.  1 — 8:30  to  8:50 

The  Status  of  Peptic  Ulcer  in  1933 — by  John 
Dudley  Dunham,  Columbus. 

Etiology : — There  are  many  theories  of  causation. 
Discussion  of  the  most  plausible  theories.  A generally 
accepted  etiologic  factor  has  not  been  proven  for 
chronic  peptic  ulcer. 

Diagnosis : — No  pathognomonic  sign  or  symptom  has 
been  found.  Roentgenologic  findings  are  far  from 
conclusive  in  all  cases.  Diagnosis  must  be  made  from 
the  composite  picture — clinical  and  laboratory. 

Medical  Treatment : — A disease  in  which  causative 
agents  have  not  been  discovered  has  many  methods 
suggested  for  cure,  all  of  which  may  have  some  merit. 
Caution  should  therefore  be  observed  in  criticism. 
Evaluation  of  Sippy  Method,  ventriculin,  gastric 
mucin,  etc.  The  author’s  method:  (1)  ambulatory, 

(2)  hospitalization.  Consideration  of  indications  for 
surgery. 

Paper  No.  2 — 8:50  to  9:10 

Throat  and  Ear  Problems  From  a Pediatric 
Standpoint — by  C.  W.  Wyckoff,  Cleveland. 

The  essayist  desires  to  emphasize  that  more  sincere 
attention  be  given  to  this  very  troublesome  part  of 
the  child”s  anatomy,  believing  that  only  too  often  we 


fail  to  consider  thoroughly  the  problem  in  hand  in 
regard  to  nose,  ear  and  throat  conditions  in  children, 
especially  with  regard  to  the  permanent  welfare  of  the 
patient  in  advising  for  or  against  a tonsil  or  adenoid 
operation  and  sinus  and  ear  treatment. 

Tonsils  and  adenoids  should  not  be  removed  simply 
because  we  can  see  them  or  on  general  principles. 
They  function  like  lymph  glands,  and  are  decided 
barriers  against  further  invasion  of  the  body  by  micro- 
organisms. One  should  make  sure  the  function  has 
been  destroyed  by  over-work,  before  giving  advice. 

We  should  remember  that  a reddened  ear  drum  is 
a common  occurrence  in  the  very  young,  and  in  most 
instances  is  not  an  invitation  for  intervention.  Sur- 
gical mastoiditis  results  only  too  frequently  because 
of  too  early  and  too  much  unnecessary  treatment. 

Paper  No.  3 — 9:10  to  9:30 
The  Eye  in  Relation  to  Industry — by  Walter 
H.  Snyder,  Toledo 

The  eye  is  the  only  organ  in  the  body  not  benefited 
by  the  development  of  modern  industry.  The  number 
of  eyes  lost  in  modern  industry  is  greater  than  before 
the  development  of  later  methods.  High  speed  tool 
steel,  faster  revolving  lathes,  and  abrasive  wheels 
have  all  taken  a large  toll. 

Workmen  are  careless  in  wearing  the  aides  fur- 
nished by  most  of  the  employers  and  the  accumula- 
tion of  small  opacities  on  the  cornea  due  to  repeated 
foreign  bodies  ultimately  reduces  the  vision.  . The  use 
of  dangerous  hammers,  punches,  and  chisels,  has  been 
greatly  reduced  through  a campaign  instituted  against 
these  tools  some  years  ago. 

Electric  welding  now  extensively  used  in  industry, 
has  produced  many  blind  eyes,  not  only  in  the 
operator  but  in  the  bystander  who  watches  the  pro- 
cess. The  Industrial  Commissions  should  forbid  the 
removal  of  a foreign  body  except  by  those  especially 
qualified.  The  neglect  of  this  rule  has  caused  a large 
number  of  these  simple  cases  to  become  large  factors 
in  loss  of  vision. 

Paper  No.  4 — 9:30  to  9:50 
Newer  Aspects  of  the  Management  of  Hyper- 
thyroidism— by  Geo.  M.  Curtis,  Columbus. 

Investigation  of  the  iodine  metabolism  in  toxic 
goiter  has  yielded  results  of  significance  in  this  phase 
of  the  management  of  hyperthyroidism.  The  form 
in  which  iodine  is  administered,  the  amount  given,  the 
associated  storage  of  iodine  in  the  goitrous  gland,  the 
urinary  excretion  of  iodine,  the  blood  and  tissue 
iodine,  will  be  considered  in  their  relation  to  the  de- 
velopment of  a rational  rather  than  an  empiric  pro- 
cedure for  iodine  administration.  The  effects  of 
thyroidectomy  upon  the  iodine  metabolism  will  be 
considered.  Lantern  slides. 

Paper  No.  5 — 9:50  to  10:10 
Some  Essential  Factors  in  the  Differentia- 
tion of  Functional  and  Organic  Disorders 
of  the  Central  Nervous  System — by  H. 
H.  Drysdale,  Cleveland. 

It  has  been  and  still  is  the  custom  of  many  to 
classify  disorders  of  the  central  nervous  system  as 
organic  and  functional  as  if  there  were  some  essen- 
tial difference  between  them  but  science  does  not 
recognize  any  such  distinction,  the  difference  being 
only  temporary  and  one  of  convenience.  Gross  organic 
lesions  are  of  course  well  established  clinically  and 
adequately  understood.  In  the  realm  of  so-called 
functional  disturbances  a dependable  appraisal  is  in- 
variably a complex  problem.  A conservative  physician 
therefore  exhausts  every  recognized  means  of  diag- 
nosis before  pronouncing  a disorder  functional  and 
then  does  so  only  provisionally,  in  the  meantime 
keeping  his  patient  under  close  observation.  In  other 
words  what  today  might  be  regarded  functional  may 
at  some  subsequent  date  prove  to  be  actual  disease. 
This  thesis  deals  with  several  situations  that  are  apt 
to  arise  in  differentiating  functional  from  organic 
diseases  of  the  central  nervous  system. 

Paper  No.  6—10:10  to  10:30 
Sciatica  in  General  Practice — by  Albert  H. 
Freiberg,  Cincinnati. 

It  is  surprising  to  find  how  frequently  sciatica  is 
still  regarded  as  a disease  in  general  practice.  It  has 


499 


500 


The  Ohio  State  Medical  Journal 


August,  1933 


long  been  taught  that  sciatica  is  almost  always  a 
symptom  whose  cause  may  be  discovered  and  treated 
with  success.  In  a very  small  percentage  of  cases, 
possibly  10  per  cent,  it  does  represent  disease  of  the 
nerve  sheath  itself.  By  far  the  greatest  number  of 
cases  must  be  ascribed  to  lesions  involving  the  sacro- 
iliac and  lower  lumbar  or  sacro-lumbar  joints  singly 
or  in  combination.  Spinal  tumors  offer  a confusing 
picture  to  be  borne  in  mind.  The  results  of  treat- 
ment depend  directly  upon  exactness  of  diagnosis,  the 
elements  of  which  are  to  be  discussed.  Lantern  slide 
illustrations. 

Paper  No.  7—10:30  to  10:50 
Diagnosis  and  Prognosis  of  Tuberculosis  in 
Children — by  A.  Graeme  Mitchell,  Cincin- 
nati. 

Evaluation  of  the  important  symptoms  and  methods 
of  examination  in  the  diagnosis  of  tuberculosis  in 
childhood.  Analysis  of  the  tuberculin  reaction  and  its 
significance.  Nonspecific  factors  affecting  skin  re- 
actions. Various  considerations  in  the  prognosis  of 
tuberculosis  in  childhood.  The  importance  of  differ- 
entiating between  tuberculous  disease  and  tuberculous 
infection.  Should  the  disease  tuberculosis  be  treated, 
or  should  the  patient  with  tuberculosis  be  treated  ? 
Lantern  slides. 

Closing  discussions  by  Essayists  (5  minutes  each) 
—10:50  to  11:25 


Fourth  Session 

Friday,  Sept.  8,  1:30  P.M. 

Meeting  Place — Ballroom,  second  floor, 
Mayflower  Hotel. 

Program,  Presentation  by  Members  of  the 
Teaching  Staff  of 

Western  Reserve  University,  Cleveland. 

INTESTINAL  OBSTRUCTION 

Paper  No.  1 — 1:30  to  1:45 

Embryogenetic  Basis  of  Congenital  Obstruc- 
tion— by  Alan  Richards  Moritz,  Assistant 
Professor  of  Pathology. 

A discussion  of  intestinal  obstruction  due  to 
anomalous  embryonal  development  will  include  a con- 
sideration of  segmented  agenesia,  aplasia  and  hypo- 
plasia, stenosis  and  malrotation  of  the  intestine,  as 
well  as  obstructions  predisposed  to  by  anomalous 
mesenteric  or  peritoneal  development.  The  types  of 
obstruction  amenable  to  surgical  relief  will  be  stressed. 
The  genesis  of  such  anomalies  will  be  discussed  and 
the  pathogenesis  will  be  illustrated  with  photographic 
and  diagramatic  lantern  slides. 

Paper  No.  2 — 1:45  to  2:05 

Pathology  of  Organic  Obstructions — by  Harry 
Goldblatt,  Assoc.  Professor  of  Pathology. 

Brief  comments  on  intussusception,  volvulus,  and 
hernial  strangulation  will  be  followed  by  lantern 
demonstration  of  obstruction  due  to  tumors.  Tumors 
may  occur  in  any  part  of  the  intestine  but  the  most 
frequent  site  of  these  is  in  the  large  intestine. 
Graphs  will  indicate  age  and  sex  incidence,  site  of 
occurrence  and  frequency  of  signs  of  obstruction  in 
relation  to  carcinoma  of  the  large  intestine.  Photo- 
graphic lantern  slides  and  large  sections  of  the  tumors 
will  be  projected,  and  reference  will  be  made  to  the 
significance  of  polyps  of  the  colon  and  grading  of 
the  cancers.  Lantern  slides. 

Paper  No.  3 — 2:05  to  2:30 

Pathological  Physiology  and  Symptomatology 
— by  M.  A.  Blankenhorn,  Professor  of  Clini- 
cal Medicine. 

The  changes  brought  about  in  normal  movements  of 
the  intestine  by  obstruction,  the  pathological  physi- 
ology of  reversed  peristalsis,  the  accumulation  of  gas 
and  other  signs  and  symptoms  of  intestinal  obstruc- 
tion will  be  discussed.  The  clinical  handling  of  these 
conditions  and  the  medical  treatment  preparatory  to 
operation  will  also  be  considered. 

Paper  No.  4 — 2:30  to  3:00 

Surgical  Management — by  Carl  H.  Lenhart, 
Professor  of  Surgery. 

Ileus  is  a highly  important  subject  for  consideration 
both  because  of  its  frequency  and  its  high  mortality 
rate.  The  effect  of  delay  in  operating  will  be  con- 


sidered with  emphasis  on  the  importance  of  early 
diagnosis. 

Under  diagnosis,  the  following  will  be  considered: 
methods  of  examination : the  frequency  of  various 

types  of  ileus ; conditions  simulating  ileus. 

The  causes  of  death  in  operative  cases  will  be 
analyzed. 

Therapy  will  be  discussed  under  the  following 
headings : direct  and  immediate  removal  of  cause ; 

slow  removal  of  cause ; salt  and  water  therapy  to 
relieve  alkalosis  and  water  loss ; circumvention  of 
lesion  by  enter-anastomosis  and  fistula  formation ; 
emptying  the  afferent  loop  of  toxic  material ; use  of 
antitoxins  and  vaccines. 


Fifth  Session 

Final  Session  of  the  House  of  Delegates — 
Annual  Election 

(See  detailed  program  and  order  of  business). 


HOUSE  OF  DELEGATES 


First  Session 

Thursday,  September  17,  10:00  A.M. 

Meeting  Place — Parlor  E,  third  floor, 
Mayflower  Hotel. 


In  the  chair,  John  H.  Selby,  President  of  the 
Summit  County  Medical  Society. 

Presentation  of  the  President,  H.  M.  Platter. 


House  of  Delegates  Order  of  Procedure: 

1.  Cull  to  order  by  the  President. 

2.  Roll  Call. 

3.  Consideration  of  Minutes  of  Previous  Meet- 
ing. (Published  in  The  Journal,  June,  1932). 
(Reports  submitted  below,  published  in  full 
in  the  September,  1933,  Journal). 

4.  Reports  of  Standing  Committees: 

(a)  Public  Policy — John  B.  Alcorn,  Columbus, 
Chafrman. 

(b)  Medical  Economics — J.  Craig  Bowman,  Upper 
Sandusky,  Chairman. 

(c)  Publication — Andrews  Rogers,  Columbus,  Chair- 
man. 

(d)  Medical  Defense — J.  E.  Tuckerman,  Cleveland,. 

Chairman.  _ 

(e)  Medical  Education  and  Hospitals — Ben  R.  Mc- 
Clellan, Xenia,  Chairman. 

(f)  Auditing  and  Appropriations — S.  J.  Goodman* 
Columbus,  Chairman. 

5.  Reports  of  Special  Committees: 

(a)  Preventive  Medicine  and  Periodic  Health  Ex- 
aminations— V.  C.  Rowland,  Cleveland,  Chairman. 

(b)  Military  and  Veterans’  Affairs — C.  W.  Stone, 
Cleveland,  Chairman. 


6. 


7. 


8. 


9. 


Report  of  Officers: 

(a)  Treasurer’s  Report  combined  with  report  of 
Committee  on  Auditing  and  Appropriations. 

(b)  Reports  of  Councilors  as  to  the  condition  of 
the  societies  in  their  respective  districts. 


Appointment  of  Committees: 

(a)  A Committee  on  the  Addresses  of  the  Presi- 
dent and  President-Elect. 

(b)  A Committee  on  Resolutions. 

(c)  A Committee  on  Annual  Reports. 

(d)  A Committee  on  Credentials  of  Delegates. 

(e)  A Committee  of  Tellers  and  Judges  of  Election. 

Nomination  and  Election  of  Nominating 


Committees : 

(Nominations  from  the  floor  with  one  representative 
on  the  committee  to  be  elected  from  each  councilor 
district.  This  committee  shall  report  to  the  second 
session  on  Wednesday  afternoon,  its  recommendations 
in  the  form  of  a ticket,  containing  nominees  for 
constitutional  offices  as  required  under  the  Constitu- 
tion. The  President  will  issue  instructions  to  the 
committee  on  the  constitutional  requirements). 


itroduetion  of  Resolutions. 

It  is  necessary  that  all  resolutions  introduced  in  the 
ouse  of  Delegates  be  referred  to  the  Reference  Com- 
itte  on  Resolutions  and  reported  back  to  the  House 
.fore  action  can  be  taken.  All  resolutions  for  con- 


August,  1933 


Program 


501 


sideration  at  this  annual  meeting  must  be  introduced 
at  this  session  and  reported  back  to  the  House  by  the 
Reference  Committee  at  the  Wednesday  afternoon 
session.  All  resolutions  must  be  typewritten  and 
submitted  in  duplicate. 

10.  Miscellaneous  Business. 

Second  Session 

Friday,  September  8,  3:30  P.M. 

Meeting  Place — Parlor  E,  third  floor,  north- 
east corner,  Mayflower  Hotel. 


1.  Roll  Call. 

2.  Continuance  of  unfinished  business  from 
Tuesday’s  session  of  the  House  of  Delegates. 

3.  Annual  Election. 

President-Elect.  (One  year).  Nominations  from  the 
floor. 

4.  Report  of  Nominating  Committee. 

(a)  Election  of  Members  of  Council. 

Members  of  Council  are  elected  for  two-year  terms, 
those  representing  even  numbered  districts  expiring 
in  odd  numbered  years.  To  be  elected: 

Councilor,  Second  District — Present  incumbent,  E. 
M.  Huston,  Dayton. 

Councilor,  Fourth  District — Present  incumbent,  B. 
J.  Hein,  Toledo. 

Councilor,  Sixth  District — Present  incumbent,  H.  S. 
Davidson,  Akron. 

Councilor,  Eighth  District — Present  incumbent,  E. 
R.  Brush,  Zanesville. 

Councilor,  Tenth  District — Present  incumbent,  S.  J. 
Goodman,  Columbus. 

(b)  Election  of  Delegates  and  Alternates  to  the 

American  Medical  Association. 

Three  delegates  ^nd  their  respective  alternates. 
(Two  years  each). 

Those  whose  terms  expire  at  this  time  are: 

J.  P.  DeWitt,  Canton. 

G.  F.  Zinninger,  Canton.  (Alternate). 

C.  E.  Kiely,  Cincinnati. 

L.  H.  Schriver,  Cincinnati.  (Alternate). 

C.  W.  Waggoner,  Toledo. 

John  Sprague,  Athens.  (Alternate). 

(The  By-Laws  of  the  American  Medical  Association 
provide:  A member  of  the  House  of  Delegates  must 
have  been  a member  of  the  American  Medical  Associa- 
tion and  a Fellow  of  the  Scientific  Assembly  for  at 
least  two  years  next  preceding  the  session  of  the 
House  of  Delegates  at  which  he  is  to  serve.  Delegates 
and  Alternates  from  constituent  associations  entitled 
to  more  than  one  representative  shall  elect  them  so 
that  one-half  as  near  as  may  be,  shall  be  elected  each 
year) . 

5.  Reports  of  Reference  Committees. 

(a)  Committee  on  Addresses  of  President  and 
President-Elect. 

(b)  Committee  on  Annual  Reports. 

(c)  Committee  on  Resolutions. 

6.  Selection  of  Place  for  Annual  Meeting  in 
1934. 

7.  Miscellaneous  Business. 

8.  Installation  of  Officers  for  1933-1934. 

9.  Confirmation  by  House  of  Delegates  of  Com- 
mittee Appointments  announced  by  the 
neioly -installed  President,  C.  L.  Cummer. 

(a)  One  member  of  the  Committee  on  Public 
Policy.  (Three  years).  (Member  whose  term  expires, 
John  B.  Alcorn,  Columbus). 

(b)  One  member  of  the  Publication  Committee. 
(Three  years).  (Member  whose  term  expires,  A.  B. 
Denison,  Cleveland). 

(c)  One  member  of  the  Committee  on  Medical  De- 
fense. (Three  years).  (Member  whose  term  expires, 
W.  H.  Snyder,  Toledo). 

(d)  One  member  of  the  Committee  on  Medical  Edu- 
cation and  Hospitals.  (Three  years).  (Member  whose 
term  expires,  John  F.  Wright,  Toledo). 

(e)  One  member  of  the  Committee  on  Medical 

Economics.  ( Three  years ) . ( Member  whose  term 

expires,  J.  Craig  Bowman,  Upper  Sandusky). 

10.  Unfinished  Business. 

11.  Final  Adjournment  of  House  of  Delegates. 


Immediately  following  adjournment  of  the 
House  of  Delegates,  Council  meets  for  re- 
organization. The  newly-installed  President 
becomes  Chairman  of  Council  and  Council 
selects  a Secretary. 


MEDICAL  SECTION 


Carll  S.  Mundy,  Toledo Chairman 

Cecil  Striker,  Cincinnati Secretary 


Thursday,  Sept.  7,  2:00  P.M. 
Meeting  Place- — Ballroom,  second  floor, 
Mayflower  Hotel. 


Paper  No.  1 — 2:00  to  2:15 

The  Chronic  Irritable  Colon — by  W.  S.  Hen- 
derson, Akron. 

The  essayist  feels  that  chronic  irritable  colon  is 
mainly  of  neurogenic  origin,  an  unstable  nervous 
condition  being  the  prominent  etiologic  factor.  He 
has  not  observed  a secondary  inflammatory  change, 
which  may  finally  result  in  an  ulcerative  colitis.  This 
condition  may  continue  for  some  time  with  exacer- 
bations and  remissions.  A careful  history  usually 
warrants  the  conclusion  that  exacerbations  and 
severity  of  symptoms  always  follow  some  nervous  dis- 
turbance ....  This  affliction  is  predominately  a 
disease  of  middle  life  ....  The  most  common  symp- 
tom is  lower  abdominal  bloating  and  flatulence,  the 
chief  complaint  being  of  shifting  pain  in  the  lower 
abdomen.  With  these  symptoms  associated  with  a 
history  of  long  standing  constipation  and  the  use  of 
cathartics  or  enemas  and  temporary  relief  by  the  pas- 
sage of  flatus  or  a bowel  movement,  an  irritable 
colon  must  be  suspected.  X-ray  examination  is  essen- 
tial as  it  gives  much  information  regarding  the  tone 
and  degree  of  irritability  of  the  colon  and  tends  to 
rule  out  any  other  organic  disturbance. 

The  diet,  important  in  all  cases  of  colon  dysfunc- 
tion, is  particularly  so  in  cases  of  chronic  irritable 
colon. 

Discussion — 2:15  to  2:20 — Harland  Howe, 
Toledo. 

General  Discussion — 2:20  to  2:30. 

Paper  No.  2 — 2:30  to  2:45 

Analgesia — by  D.  E.  Jackson,  Cincinnati. 

This  paper  deals  with  the  general  principles  in- 
volved in  the  relief  of  pain  without  loss  of  con- 
sciousness, borderline  states,  and  drug  reactions  in 
the  general  field  of  analgesia  and  anesthesia.  New 
methods  and  new  drugs,  their  availability  and  the 
feasibility  of  their  use  under  varying  conditions  and 
for  various  purposes. 

Discussion — 2:45  to  2:50 — Cecil  Striker, 

Cincinnati. 

General  Discussion — 2:50  to  3:00. 

Paper  No.  3 — 3:00  to  3:15 
Vagaries  of  Venous  Thrombosis — Wm.  H.  Bunn, 
Youngstown. 

A common  error  in  diagnosis  is  mistaking  pul- 
monary infarction  for  pneumonia.  Frequently  venous 
thrombosis  does  not  manifest  itself  locally.  Such  con- 
ditions remain  hidden  until  a circulatory  accident, 
due  to  a piece  of  the  clot  breaking  away  from  a 
thrombosed  vessel,  occurs.  The  differential  diagnosis 
of  post-operative  massive  collapse  of  the  lung,  pul- 
monary embolism,  and  circulatory  collapse  is  im- 
portant to  the  medical  man,  who  is  often  called  upon 
by  the  surgeon  for  his  opinion  in  these  frequent  post- 
operative complications.  Cases  illustrating  some  un- 
usual features  of  venous  thrombosis  are  presented, 
with  slides  showing  X-ray  studies,  post-mortem  find- 
ings and  photographs.  Lantern  slides. 

Discussion— 3 : 15  to  3:20 — R.  W.  Scott, 
Cleveland. 

General  Discussion — 3:20  to  3:30. 

Paper  No.  4 — 3:30  to  3:45 

Chronic  Encephalitis  Associated  with  Gall- 
Bladder  Infection — by  S.  R.  Salzman,  To- 
ledo. 

Chronic  encephalitis  is  not  a rare  endemic  disease, 
as  about  fifty  cases  have  been  seen  during  the  last 
ten  years. 

It  occurs  in  all  grades  of  severity,  from  the  very 
mild  types  to  the  very  severe  cases  having  all  the 
characteristic  changes  of  the  reflexes,  rigid  neck, 
stupor,  glosso-pharyngeal  paralysis,  ptosis,  diplopia, 
and  even  aphasia. 

It  is  associated  with,  and  directly  due  to,  chronic 


502 


The  Ohio  State  Medical  Journal 


August,  1933 


infection  in  the  gallbladder  and  biliary  tract  and  is 
invariably  completely  and  promptly  cured  by  relief 
of  the  biliary  tract  infection. 

A few  typical  cases  are  reported.  The  possibility  of 
the  cerebral  manifestations  being  due  to  sensitization 
as  the  result  of  the  development  of  a secondary 
allergy,  the  result  of  the  active  hepatitis  is  discussed, 
and  pjoof  of  the  sensitivity  of  these  patients  to 
proteoses  isolated  from  the  urine  during  the  attack 
is  presented. 

Discussion — 3:45  to  3:50 — L.  A.  Levison, 
Toledo. 

General  Discussion — 3:50  to  4:00. 

Paper  No.  5 — 4:00  to  4:15 

The  Role  of  Hypoglycemia  in  the  Fatigue 
State — A.  Blaine  Brower,  Dayton. 

The  factors  producing  low  blood  sugar  and  the 
clinical  significance  of  hypoglycemia  will  be  discussed. 

The  discussion  will  embrace  the  factors  of  primary 
depression  of  hepatic  glycogenolysis,  exhaustion  of 
liver  and  muscle  glycogen,  increased  tissue  utilization 
of  glucose,  and  decreased  ingestion  of  carbohydrates, 
especially  in  relationship  to  reduction  diets  in  obesity. 
Case  reports  demonstrating  the  value  of  recognition 
of  hypoglycemia  and  its  proper  management  will  be 
presented.  Lantern  slides. 

Discussion — -4:15  to  4:20 — C.  D.  Fife,  Day- 
ton. 

General  Discussion — 4:20  to  4:30. 

Paper  No.  6 — 4:30  to  4:45 
Studies  in  Congenital  Hemolytic  Jaundice — 
by  C.  A.  Doan,  B.  K.  Wiseman  and  L.  A. 
Erf,  Columbus. 

Two  families  in  which  congenital  hemolytic  jaundice 
appears  have  been  thoroughly  studied.  New  data  with 
reference  to  the  role  of  the  spleen  in  the  control  of 
both  red  and  white  blood  cell  levels  have  been  ob- 
tained. The  justification  of  splenectomy  in  selected 
cases  is  emphasized.  The  importance  of  recognizing 
this  condition  and  the  differential  diagnostic  features 
will  be  presented.  A new  technique  for  the  determina- 
tion of  the  erythrocyte  fragility,  which  is  an  im- 
portant finding  in  this  disease,  has  been  developed. 
Lantern  slides. 

Discussion — 4:45  to  4:50 — Geo.  M.  Curtis, 
Columbus. 

General  Discussion — 4:50  to  5:00. 


SURGICAL  SECTION 


Carl  R.  Steinke,  Akron Chairman 

Norris  Gillette,  Toledo Secretary 

Thursday,  Sept.  7,  2:00  P.M. 

Meeting  Place — Polsky’s  Auditorium,  State  St., 
directly  opposite  side  lobby  entrance  of 
Mayflower  Hotel. 


Paper  No.  1 — 2:00  to  2:15 

Sub-Total  Gastrectomy'  for  the  Cure  of  Peptic 
Ulcer — by  M.  E.  Blahd,  Cleveland. 

An  attempt  will  be  made  to  correlate  the  various 
theories  pertaining  to  the  causation  of  peptic  ulcer. 
At  present  there  is  no  causal  therapy.  However  sub- 
total gastrectomy  offers  the  best  chance  for  a com- 
plete cure.  It  will  be  proven  that  the  mortality  from 
sub-total  gastrectomy  is  no  greater  than  that  of  the 
indirect  operations  which  are  being  used  for  the  cure 
of  this  condition.  It  will  also  be  shown  that  there  is 
a definite  mortality  with  the  medical  treatment  and 
in  the  opinion  of  some,  this  mortality  is  as  great,  if 
not  »reater,  than  that  accompanying  the  surgical 
treatment.  The  results  with  sub-total  gastrectomy 
are  better  in  every  way  than  with  any  other  form  of 
treatment.  Lantern  slides. 

Discussion — 2:15  to  2:20 — L.  G.  Bowers, 
Dayton. 

General  Discussion — 2:20  to  2:30. 

Paper  No.  2 — 2:30  to  2:45. 

Indications  for  Surgical  Intervention  in 
Peripheral  Vascular  Disease — by  Verne 
A.  Dodd,  Columbus. 

Interest  in  peripheral  vascular  disease  has  been 
greatly  stimulated  in  the  past  decade.  Surgical  treat- 


ment is  diversified.  The  present  trend  is  toward  the 
development  of  differential  diagnostic  methods.  The 
primary  differentiation  into  two  major  groups,  the 
functional  and  the  organic,  is  of  distinct  importance 
for  surgical  approach.  The  diagnostic  and  pathologi- 
cal features  of  the  most  common  examples  of  the  sub 
groups  are  summarized.  All  modern  aids  to  assist  in 
the  proper  selection  of  appropriate  surgical  pro- 
cedures are  necessary.  An  attempt  is  made  to 
evaluate  such  aids  as  posture,  color  changes,  derma- 
thermic  alterations,  and  vasographic  findings.  Lan- 
tern slides. 

Discussion — 2:45  to  2:50 — H.  H.  Heath, 
Toledo. 

General  Discussion — 2:50  to  3:00. 

Paper  No.  3 — 3:00  to  3:15 

Tuberculosis  of  the  Kidney — by  E.  B.  Gillette, 
Toledo. 

Outline  of  classification,  origin,  and  mode  of  in- 
fection. Initial  lesions.  The  question  of  unilateral 
and  bilateral  involvement.  The  gross  appearance  of 
the  kidney,  tubercles,  and  the  usefulness  of  pyelo- 
grams.  The  mode  of  extension  of  tubercles  and  their 
significance  will  be  discussed  as  well  as  bladder 
symptoms,  the  significance  of  hematuria,  the  pos- 
sibility of  ascending  infection  and  the  value  of  sedi- 
ment examination.  Appropriate  treatment  outlined. 

Discussion — 3:15  to  3:20 — A.  B.  Johnson, 
Toledo. 

General  Discussion — 3:20  to  3:30. 

Paper  No.  4 — 3:30  to  3:45. 

Treatment  of  Osteomyelitis  with  a Special 
Reference  to  the  Use  of  Maggots  as  an 
After-Treatment — by  Edward  Harlan  Wil- 
son, Columbus. 

In  an  historical  review  the  essayist  states  that  the 
antiseptic  methods  of  treatment  reached  a culmination 
in  the  World  War  being  followed  by  the  discontinuance 
of  strong  chemicals  with  the  substitution  of  vaseline 
packs,  thorough  surgery,  and  infrequent  dressings. 
This  developed  into  the  so-called  Orr  method  in  which 
nature  was  allowed  to  take  care  of  its  own.  Orr-Baer 
originally  introduced  the  use  of  maggots  to  follow 
surgery.  Like  all  new  forms  of  treatment  it  has 
enthusiastic  adherents  and  severe  critics.  The  chief 
drawback  is  the  elaborate  set-up  required  to  cultivate 
maggots.  From  a review  of  a series  of  cases  the 
conclusion  is  drawn  that  surgery  is  two-thirds  of  the 
battle,  and  that  while  the  maggot  treatment  is  useful 
in  after-care,  it  cannot  be  said  to  be  vastly  superior 
to  any  other  form  of  treatment. 

Discussion — 3:45  to  3:50 — J.  A.  Freiberg, 
Cincinnati. 

General  Discussion — 3:50  to  4:00. 

Paper  No.  5 — -4:00  to  4:15 

Pre-Operative  Pathology  in  Its  Relation  to 
Post-Operative  Gallbladder  Deaths — by 
Dudley  W.  Palmer,  Cincinnati. 

Gallbladder  surgery  of  today  should  be  in  the  same 
position  as  appendix  surgery,  namely,  all  other  things 
being  equal,  the  diagnosis  of  gallbladder  disease 
should  call  for  a surgical  procedure  as  soon  as  con- 
venient after  the  diagnosis  has  been  made.  The  proof 
of  this  statement  is  demonstrated  by  the  perusal  of 
the  pathological  conditions  present  in  the  fatal  post- 
operative gallbladder  cases.  Aside  from  the  sur- 
gical accidents  that  might  occur  in  any  major  surgical 
procedure,  the  deaths  following  gall  bladder  operations 
are  almost  always  associated  with  some  type  of  path- 
ology directly  or  indirectly  connected  with  the  biliary 
disease.  These  deaths  probably  would  not  have  oc- 
curred had  the  operations  been  accomplished  before 
complications  had  developed.  Uncomplicated  cases  of 
gallbladder  surgery  carry  a very  small  mortality  risk. 

Medical  treatment  of  established  gallbladder  disease, 
directed  toward  a cure  of  that  disease,  is  misdirected. 
Medical  treatment  of  gallbladder  disease  directed 
toward  the  placing  of  a patient  in  the  best  possible 
condition  to  withstand  surgical  intervention,  has  not 
been  sufficiently  appreciated. 

Discussion — 4:15  to  4:20 — Harry  S.  Noble, 
St.  Marys. 

General  Discussion — 4:20  to  4:30. 

Paper  No.  6 — 4:30  to  4:45. 

Critical  Renal  Surgery — by  Frederick  C.  Her- 
rick, Cleveland. 

This  will  include  a consideration  of  the  pathology  and 
combinations  of  pathology  presenting  serious  renal 
problems  for  treatment.  It  embraces  a discussion  of 
the  congenital  conditions  of  polycystic  kidney  and 
bilateral  pyelectasis ; infections  such  as  bilateral 


August,  1933 


Program 


503 


“carbuncle”  of  the  kidney  and  pyonephrosis  ; cases  of 
bilateral  stones  with  complications ; and  cases  of 
complicated  tuberculosis.  (Illustrated). 

The  extent  of  destruction  of  renal  tissue  will  be 
considered.  Methods  will  be  given  to  estimate  the 
patient’s  ability  to  withstand  operation.  Choice  of 
operation  will  be  considered.  The  associated  toxemias 
with  their  nature  and  relief  will  be  presented.  Con- 
sideration will  be  given  to : dangerous  cases  to  cysto- 
scope ; pre-operative  preparation  ; anesthesia ; and 
finally,  surgical  methods  and  results.  Lantern  slides. 

Discussion — 4:45  to  4:50 — Janies  J.  Joelson, 
Cleveland. 

General  Discussion — 4:50  to  5:00. 


OBSTETRICS  AND  PEDIATRICS 


B.  H.  Carroll,  Toledo Chairman 

Edward  A.  Wagner,  Cincinnati Secretary 


Thursday,  Sept.  7,  2:00  P.M. 

Meeting  Place — O’Neil’s  Auditorium,  Main  Street, 
diagonally  across  from  the  Mayflower  Hotel. 

Paper  No.  1 — 2:00  to  2:15 

Gastro-Enteritis  with  Special  Reference  to 
Continuous  Intravenous  Therapy  — by 
Robert  A.  Lyon,  Cincinnati. 

A brief  review  of  the  clinical  aspects  of  gastro- 
enteritis in  children  is  given  together  with  morbidity 
and  mortality  statistics  of  the  disease  for  the  last  few 
years.  In  regard  to  treatment,  the  method  of  fasten- 
ing a needle  into  the  vein  and  allowing  a normal 
saline  or  a glucose  solution  to  flow  in  slowly  over  a 
period  of  twenty-four  hours  or  longer  has  been  em- 
ployed during  the  last  year  in  a small  group  of  in- 
fants. It  has  seemed  to  be  the  most  effective  method 
in  combating  dehydration  and  is  usually  followed  by 
a marked  clinical  improvement  of  the  patient.  Lanern 
slides. 

Discussion — 2:15  to  2:20 — Leo  Friedman, 
Cincinnati. 

General  Discussion — 2:20  to  2:30. 

Paper  No.  2 — 2:30  to  2:45 

Pyloric  Stenosis — by  Robert  D.  Hostetter.  Day- 
ton. 

A review  of  case  histories  presenting  the  symptoms, 
diagnosis  and  treatment  of  various  degrees  of  pyloric 
stenosis,  from  a slight  pylorospasm  to  complete 
stenosis. 

Discussion — 2:45  to  2:50 — J.  V.  Greene- 
baum,  Cincinnati. 

General  Discussion — 2:50  to  3:00. 

Paper  No.  3 — 3:00  to  3:15 

Peptic  Ulcer  of  Meckel’s  Diverticulum — by 

George  Renner,  Jr.,  Cincinnati. 

Perhaps  one  of  every  five  hundred  persons  is  liable 
to  this  condition,  because  in  approximately  this  frac- 
tion of  the  race  is  found  a Meckel’s  diverticulum  with 
gastric  type  of  acid  secreting  mucosa.  We  present 
two  cases,  a girl  of  fifteen  months  with  recurrent 
massive  intestinal  hemorrhage,  and  a boy  of  eighteen 
months  with  an  acute  abdomen  resulting  from  per- 
foration of  such  an  ulcer.  Preoperative  diagnosis  in  a 
case  where  perforation  has  not  occurred  rests  chiefly 
on  the  history  of  massive  intestinal  hemorrhage. 
Except  for  a secondary  anemia,  physical  examination 
may  be  negative  and  serve  only  to  rule  out  other 
possible  causes  of  such  hemorrhage.  A review  of 
more  than  fifty  cases  in  the  literature  reveals  that 
prompt  surgical  treatment  is  almost  always  success- 
ful ; that  perforation  is  likely  to  occur  if  operation  is 
not  performed  ; and  that  the  mortality  is  high  in  the 
cases  not  operated.  Lantern  slides. 

Discussion — 3:15  to  3:20 — Lloyd  B.  Johns- 
ton, Cincinnati. 

General  Discussion — 3:20  to  3:30. 

Paper  No.  4 — 3:30  to  3:45 

Mortality  Rates  of  Obstetrical  Departments 
in  General  Hospitals — by  A.  J.  Skeel, 
Cleveland. 

The  questions  presented  are  well  defined  : 1st : What 
percentage  of  women,  who  go  to  the  hospital  for 


delivery,  die?  2nd:  Is  there  any  noteworthy  differ- 

ence, as  to  delivery  death-rate,  between  well-con- 
ducted maternity  hospitals  and  similarly  well-regu- 
lated maternity  departments  in  general  hospitals  ? 
3rd : How  many  of  these  deaths  are  due  to  septic 

infection  or  other  preventable  cause?  4th:  How 

many  of  those  dying  in  the  hospital  from  infection, 
acquired  that  infection  before,  and  how  many  after, 
admission  to  the  hospital?  5th:  Is  delivery  safer  at 

home  than  in  a good  hospital  ? 

Tables  will  be  given  with  the  conclusions  arrived  at 
from  their  study.  The  essayist  will  present  the 
Cleveland  plan  for  study  of  hospital  obstetric  mor- 
talities and  their  causes.  Statement  of  requirements 
for  protection  of  obstetric  patients  in  the  hospital. 

Discussion — 3:45  to  3:50 — Scott  C.  Runnels, 
Cleveland. 

General  Discussion — 3:50  to  4:00. 

Paper  No.  5 — 4:00  to  4:15 

Post  Partum  Hemorrhage — by  Sylvester  J. 

Goodman,  Columbus. 

There  is  no  obstetric  emergency  that  so  seriously 
jeopardizes  life.  It  is  so  sudden  that  all  the  courage, 
resource  and  skill  of  the  obstetrician  is  put  to  the 
test.  Some  say  that  it  is  preventable.  Post  partum 
hemorrhage,  in  the  intent  of  this  paper,  is  that  ter- 
rible deluge  of  blood,  following  delivery,  which  shakes 
the  accoucheur’s  nerve  to  its  foundation,  and  which 
in  a few  minutes  drains  the  circulatory  system  of  the 
mother,  at  times,  to  the  last  drop.  There  is  no  warn- 
ing. Most  of  the  statistics  are  gathered  in  hospitals. 
Preparation  for  treatment  in  homes  ; hospital.  Treat- 
ment by  packing  the  uterus  ; fallacies  and  objections. 
Treatment  at  Grant  Hospital  and  other  hospitals ; 
technic ; results.  Other  methods  of  treatment. 

Discussion — 4:15  to  4:20— J.  F.  Baldwin, 
Columbus. 

General  Discussion — 4:20  to  4:30. 

Paper  No.  6 — 4:30  to  4:45 

Breech  Presentations — by  W.  R.  Barney,  Cleve- 
land. 

The  percentage  found  generally  in  practice.  Aver- 
age mortality  rate  reported  is  about  10  per  cent. 
Cause  for  this  large  mortality  rate.  Cranial  injuries 
encountered  in  this  complication. 

Comparison  with  some  conditions  found  in  vertex 
presentations.  Reason  for  the  great  incidence  in 
breech  presentations.  Reports  of  various  authors. 
Comparison  with  oui  series.  Method  advocated  and 
technic  used  by  writer  to  obviate  complications.  Lan- 
tern slides. 

Discussion — 4:45  to  4:50 — Roy  Krigbaum, 
Columbus. 

General  Discussion — 4:50  to  5:00. 


EYE,  EAR,  NOSE  AND  THROAT 


W.  V.  Mullin,  Cleveland  ...  Chairman 

Ivor  G.  Clark,  Columbus Secretary 


Thursday,  Sept.  7,  2:00  P.M. 

Meeting  Place — Parlor  E,  northeast  comer, 
third  floor,  Mayflower  Hotel. 


Paper  No.  1—2:00  to  2:15 

Angiomata  of  the  Face  and  Mouth — by  Charles 
M.  Clark,  Akron. 

Angiomata  are  vascular  neoplasms  occurring  either 
before  or  soon  after  birth  and  in  some  cases  as  late 
as  the  age  of  fifteen  years. 

There  are  two  main  divisions — (1)  Hemangiomata, 
(2)  Lymphangiomata,  depending  on  the  type  of 
vascular  tissue  predominating.  The  appearance  varies 
from  smooth  red  discolorations  of  the  skin  and 
mucosa  to  extensive,  deep,  cavernous  masses  composed 
of  large  blood  or  lymph  spaces,  often  causing  hideous 
deformities  and  interfering  with  the  normal  develop- 
ment and  function. 

These  conditions  should  be  recognized  early  and  the 
proper  treatment  instituted,  because  of  occasional 
rapid  development. 

Early  treatment  with  radium  offers  the  best  chance 
for  a cure,  although  surgical  diathermy  in  the  ex- 
tremely bad  cavernous  types  is  preferred. 

Different  cells  react  differently  to  radium  rays,  so 
the  treatment  should  be  carried  out  carefully  to  pre- 
vent systemic  reactions  and  sloughing  of  the  normal 
parts. 


504 


The  Ohio  State  Medical  Journal 


August,  1933 


In  many  of  the  severe  types  with  deformity,  after 
the  vascular  growth  has  been  cleared  up,  plastic 
operations  are  necessary  to  remove  the  scar  tissue 
and  correct  deformity.  Lantern  slides. 

Discussion— 2:15  to  2:20 — Thomas  E.  Jones, 
Cleveland. 

General  Discussion — 2:20  to  2:30. 

Paper  No.  2 — 2:30  to  2:45 

Mastoiditis  and  Its  Bone  and  Joint  Complica- 
tions— by  Samuel  S.  Quittner  and  Rudolph 
S.  Reich,  Cleveland. 

Bone  and  joint  complications  of  mastoiditis  are 
common  enough  to  warrant  more  than  passing 
thought.  They  may  be  toxic  or  septic  processes  in 
the  bone  or  joint.  The  complications  may  occur  be- 
fore mastoiditis  but  usually  follow  mastoidectomy. 
They  seem  to  be  connected  with  a very  characteristic 
type  of  mastoiditis.  The  complications  favor  the 
joints  and  are  rather  selective,  but  if  in  the  bones 
usually  involve  the  long  ones. 

Early  diagnosis  is  imperative,  for  on  early  treat- 
ment of  the  joint  and  bone  depends  the  favorable  end 
results.  The  responsibility  rests  on  the  otologist  to 
recognize  these  conditions  because  time  is  an  im- 
portant element. 

Discussion — 2:45  to  2:50 — B.  G.  Chollett, 
Toledo. 

General  Discussion — 2:50  to  3:00. 

Motion  Picture — No.  3 — 3:00  to  3:20. 

Bronchoscopy  and  Esophagoscopy  on  the 
Cadaver  and  the  Living — presented  by 
Samuel  Ig'lauer,  Cincinnati.  (Photography 
by  Joseph  Homan). 

Bronchoscopy  and  esophagoscopy  may  be  performed 
with  the  patient  either  in  the  recumbent  or  sitting 
position.  The  sitting  posture  is  used  in  this  film  to 
better  illustrate)  the  technic.  Local  or  general  anes- 
thesia may  be  employed.  Children  may  be  restrained 
and  operated  without  any  anesthetic.  The  use  of  both 

proximally  and  distally  lighted  tubes  is  demonstrated. 

1.  Specially  designed  chair  which  induces  proper 

position  of  patient. 

2.  Bronchoscopy  on  cadaver  with  removal  of  for- 
eign body. 

3.  Bronchoscopy  for  observation  of  bronchial 
tumor. 

4.  Tracing  the  trachea  and  bronchi  on  chest  wall. 

_ 5.  Esophagoscopy  on  cadaver  with  removal  of  for- 
eign body.  Esophagoscopy  on  patients. 

_ Method  of  dilating  lye  stricture  of  esophagus  in  pa- 
tients with  a gastrostomy. 

General  Discussion — 3:20  to  3:30. 

Paper  No.  4 — 3:30  to  3:45 

Ocular  Allergy — by  A.  D.  Ruedemann,  Cleve- 
land. 

Allergy  offers  an  explanation  for  most  cases  of  so- 
called  follicular  conjunctivitis.  Many  cases  present 
difficulties  in  diagnosis  and  must  be  studied  by  his- 
tory, physical  examination,  question  of  contacts,  and 
sensitization  tests.  Instances  are  more  common  than 
supposed.  They  are  not  necessarily  associated  with 
nasal  or  general  reactions.  The  condition  affects  any 
portion  of  eye,  most  commonly  the  palpebral  con- 
junctiva, secondly  the  ocular  conjunctiva.  Treatment 
must  be  local  as  well  as  general  and  gives  immediate 
relief.  Cases  of  vernal  catarrh  with  purely  local  re- 
action. Lantern  slides. 

Discussion — 3:45  to  3:50 — A.  D.  Frost,  Co- 
lumbus. 

General  Discussion — 3:50  to  4:00. 

Paper  No.  5 — 4:00  to  4:15 
The  Hypermature  Cataract,  Its  Prognosis  and 
Treatment — by  Derrick  T.  Vail,  Jr.,  Cin- 
cinnati. 

Evolution  of  the  hypermature  cataract  into  two 
forms  (a)  Shrunken  hard  cataract;  (b)  Intumescent 
soapy  Morgagnian  cataract.  The  first  may  become 
loose  and  dislocated  leading  to  glaucoma,  the  second 
by  mechanical  pressure  also  results  in  glaucoma.  The 
toxic  products  produced  by  cellular  breakdown  within 
the  capsule  leads  to  iritis  and  iridocyclitis.  Con- 
troversy regarding  this  point.  Treatment  is  surgical 
and  the  best  is  intracapsular  removal  even  in  the 
presence  of  acute  glaucoma.  The  Smith  operation  the 
•one  of  choice  because  of  the  danger  of  the  easily 
ruptured  capsule  and  release  of  toxic  substances 


within  the  globe.  It  is  not  difficult  in  either  type  of 
the  hypermature  cataract.  The  technic  of  Smith 
operation  briefly  described.  It  is  better  to  operate 
before  stage  of  hypermaturity  is  reached  even  if  the 
cataract  is  uniocular.  Case  reports.  Lantern  slides. 

Discussion — 4:15  to  4:20 — Wm.  E.  Borden, 
Delaware. 

General  Discussion — 4:20  to  4:30. 

Paper  No.  6 — 4:30  to  4:45 
Lesions  in  Neural  Ectodermal  Structures  of 
the  Eye — by  Donald  J.  Lyle,  Cincinnati. 

Embryological  development  of  the  neural  ectodermal 
structures  of  the  eye.  Neurone  divisions  of  the  nerve 
elements  of  the  eye.  Blood  supply  to  the  neurones. 
Pathological  outline  of  neural  degeneration.  Degener- 
ation of  visual  neurones.  Lesions  involving  the  pig- 
ment epithelium.  Lantern  slides. 

Discussion — 4:45  to  4:50 — Mary  K.  Asbury, 
Cincinnati. 

General  Discussion — 4:50  to  5:00. 


NERVOUS  AND  MENTAL  DISEASES 


J.  Fremont  Bateman,  Cincinnati Chairman 

Henry  C.  Schumacher,  Cleveland Secretary 

Thursday,  Sept.  7,  2:00  P.M. 

Meeting-  Place — Parlor  A,  southeast  corner, 
third  floor,  Mayflower  Hotel. 

Paper  No.  1 — 2:00  to  2:15 
Psychoanalytic  Treatment  of  Neuroses  Simu- 
lating Medical  Conditions — by  Alan  D. 
Finlayson,  Cleveland. 

It  is  a well  recognized  fact  that  it  is  difficult  or 
impossible  to  make  a differential  diagnosis  between  a 
neurosis  and  a medical  condition  especially  if  the 
symptoms  are  predominantly  physical  in  character. 

Two  cases  are  presented  which  were  treated  over  a 
period  of  several  years  by  medical  and  surgical 
methods. 

Analysis  of  the  cases  and  results  of  analytic  therapy. 

Discussion — 2:15  to  2:20  — Carl  Ulrich, 
Cleveland. 

General  Discussion — 2':20  to  2:30. 

Paper  No.  2—2:30  to  2:45. 

Spinal  Cord  Changes  in  Pernicious  Anemia — 

by  C.  E.  Kiely,  Cincinnati. 

In  30  per  cent  of  cases  pernicious  anemia  is  accom- 
panied by  neuritis,  and  in  50  per  cent  by  cord  lesions. 
The  degeneration  of  lateral  and  pyramidal  tracts  is 
almost  pathognomonic  and  occasionally  justifies  a 
diagnosis  without  a typical  blood  picture.  Loss  of 
vibration  sense  is  a common  symptom  and  of  con- 
siderable diagnostic  value. 

Cord  lesions  do  not  regularly  disappear  with  the 
anemia  or  even  get  worse  in  the  face  of  it  or  first 
appear  after  remission  of  the  blood  picture.  Ap- 
parently, a common  toxin  causes  both  blood  and  cord 
changes.  On  this  hypothesis  one  would  explain  cord 
symptoms  without  anemia  as  resulting  _ from  an  un- 
usually susceptible  nervous  system  showing  symptoms 
before  a more  hardy  liver  and  the  failure  of  the  cord 
changes  to  remit  with  the  blood  from  dosage  sufficient 
to  change  the  latter  but  not  the  former. 

Discussion — 2:45  to  2:50 — C.  W.  Stone, 
Cleveland. 

General  Discussion — 2:50  to  3:00. 

Paper  No.  3 — 3:00  to  3:15 

Syringomyelia — by  Ernest  Scott,  H.  E.  LeFever 
and  Mary  H.  Oliver,  Columbus. 

Syringomyelia  with  clinical  history,  neurological  ex- 
amination, and  autopsy  findings.  Hydrocephalus  and 
extreme  cavitation  of  cervical  and  dorsal  cord,  appar- 
ently arising  in  the  region  of  the  posterior  horn.  Dis- 
cussion of  various  histological  methods  employed  to 
demonstrate  the  gliosis  and  degeneration  of  the  grey 
and  white  matter.  Review  of  the  literature.  Lantern 
slides. 

Discussion — 3:15  to  3:20 — H.  E.  LeFever, 
Columbus. 

General  Discussion — -3:20  to  3:30. 


August,  1933 


Program 


505 


Paper  No.  4 — 3:30  to  3:45 

The  Defective  Delinquent — by  C.  C.  Kirk  and 
A.  T.  Hopwood,  Orient. 

This  paper  is  based  upon  a study  of  150  cases  of 
delinquency  in  feeble-minded  institutions  This  in- 
cludes a study  of  the  chief  mental  and  physical 
characteristics  with  a study  of  the  social  and  psych- 
ological factors  involved.  Difficulties  encountered  in 
the  management  and  training  of  these  patients  are 
also  discussed.  A plea  is  made  for  a more  careful 
examination  and  classification  of  these  cases  before 
mitment  to  feeble-minded  institutions.  The  factors 
involved  in  the  care  and  training  of  the  feeble- 
minded in  general  are  not  applicable  to  the  delinquent 
group. 

Discussion — 3:45  to  3:50 — F.  L.  Keiser,  Co- 
lumbus. 

General  Discussion — 3:50  to  4:00. 

Paper  No.  5 — 4:00  to  4:15 

The  End  Results  in  Dementia  Praecox — by 

Carl  W.  Sawyer,  Marion. 

Cases  will  be  taken  and  studied  over  a period  of 
twenty-seven  years,  so  far  as  they  can  be  followed 
and  the  various  situations  which  may  have  developed 
with  them,  during  the  time  that  they  have  been 
under  our  observation,  will  be  recorded  and  classified. 
Graphs  will  be  used  to  illustrate  the  findings,  stereop- 
ticon  slides  will  be  displayed  and  if  possible,  moving 
pictures. 

Discussion — 4:15  to  4:20 — T.  T.  Zuck,  Cleve- 
land. 

General  Discussion — 4:20  to  4:30. 

Paper  No.  6 — 4:30  to  4:45 

Auditory  Hallucinations  in  Problem  Chil- 
dren— by  A.  T.  Childers,  Cincinnati. 

Observations  have  been  made  on  auditory  hallucina- 
tions occurring  in  a number  of  ‘‘problem’’  children 
between  the  ages  of  10  and  18  years.  All  were  cases 
without  evidences  of  former  organic  brain  disease  or 
injury.  Some  attempt  has  been  made  to  interpret  the 
meaning  and  content  of  the  hallucinations.  There  is  a 
brief  discussion  of  the  technique  used  in  eliciting 
such  experiences,  and  the  value  to  the  psychiatrist  of 
a knowledge  of  their  presence  in  the  child  is  pointed 
out. 

Discussion — 4:45  to  4:50 — -E.  A.  North,  Cin- 
cinnati. 

General  Discussion — 4:50  to  5:00. 


PUBLIC  HEALTH  AND  PREVENTIVE 
MEDICINE 


R.  H.  Markwith,  Akron Chairman 

P.  A.  Davis,  Akron Secretary 


Thursday,  Sept.  7,  2:00  P.M. 

Meeting  Place — Parlor  B,  east  side, 
third  floor,  Mayflower  Hotel. 

Paper  No.  1—2:00  to  2:15 
Lead  Poisoning  Followed  by  Diffuse  Vascular 
Disease — by  Z.  T.  Wirtschafter,  Cleveland. 

A painter,  aged  42  years,  previously  in  good  health, 
developed  acute  plumbism.  At  this  time  there  was  no 
evidence  of  any  cardio-vascular  or  renal  damage.  He 
died  five  years  later,  following  a cerebral  accident. 
Autopsy  findings  revealed  a generalized  arterial  and 
arteriolarsclerosis.  In  view  of  the  patient’s  age  and 
the  lack  of  cardio-vascular  disease  at  the  time  of  the 
inception  of  his  plumbism,  this  case  suggests  that 
severe  lead  poisoning  may  lead  to  generalized  arterial 
and  arteriolarsclerosis. 

Discussion — 2:15  to  2:20 — A.  G.  Cranch, 
Cleveland. 

General  Discussion — 2:20  to  2:30 
Paper  No.  2 — 2:30  to  2:45 
A County  Plan  for  the  Control  of  Tuber- 
culosis— C.  L.  Hyde,  East  Akron. 

A united  effort  is  needed  to  control  tuberculosis  in  a 
community.  A county-wide  program  having  all  tuber- 


culosis agencies  guided  by  one  head  meets  the  needs 
of  most  communities.  The  director  should  be  a 
physician  especially  trained  in  tuberculosis  work.  The 
Summit  County  plan  is  described. 

Discussion — 2:45  to  2:50 — V.  C.  Rowland, 
Cleveland. 

General  Discussion— 2:50  to  3:00. 

Paper  No.  3 — 3:00  to  3. 15 
The  Economic  Status  of  Public  Health  Ad- 
ministration— by  H.  G.  Southard,  Colum- 
bus. 

A careful  study  of  the  economics  of  public  health 
administration  in  Ohio  indicates  a periodic  cycle,  in- 
fluencing appropriating  bodies  in  financing  public 
health  service.  Responsibility  of  health  departments 
is  rapidly  increasing  as  a by-product  of  the  economic 
depression.  The  service  is  further  handicapped  by  a 
retrenchment  program  through  curtailment  in  ap- 
propriations and  reduction  of  experienced  personnel. 
A suggested  remedy  is  more  energetic,  conscientious 
service  in  conservation  and  promotion  of  public 
health  in  proportion  to  public  health  expenditures, 
providing  general  health  educational  service  through 
all  agencies  responsible  for  protection  of  the  in- 
dividual and  community  health,  urging  fullest  co- 
operation of  medical  profession  and  establishing  a 
better  understanding  on  the  part  of  the  public  re- 
garding public  health  and  preventive  medicine. 

Discussion — 3:15  to  3:20 — A.  O.  Peters, 
Dayton. 

General  Discussion — 3:20  to  3:30. 

Paper  No.  4 — 3:30  to  3:45 

The  Value  of  Vital  Facts — by  I.  C.  Plummer, 
Columbus. 

In  the  introduction,  the  history  and  the  reasons 
given  for  the  registration  of  births  and  deaths  will 
be  outlined.  The  information  available  on  birth 
records  and  their  immediate  uses  will  be  discussed 
with  a consideration  of  the  data  compiled  from 
records  of  death.  Their  value  to  the  general  public, 
medical  practitioner,  public  health,  and  preventive 
medicine  will  be  emphasized. 

Discussion — -3:45  to  3:50 — 0.  M.  Craven, 
Springfield. 

General  Discussion — 3:50  to  4:00. 

Paper  No.  5 — 4:00  to  4:15 

Public  Health  Within  the  Hospital — by  H.  L. 
Rockwood,  Cleveland. 

Application  of  community  protection  against  disease 
in  public  hospitals  will  be  discussed.  The  occurrence 
of  acute  and  chronic  communicable  disease  among  hos- 
pital personnel  will  be  analyzed.  Protective  methods, 
including  use  of  biologicals,  laboratory  aids,  physical 
examination  of  personnel,  will  be  outlined. 

The  requirements  as  regards  protection  against 
undiagnosed  cases  of  communicable  disease ; the  pre- 
vailing lack  of  adequate  equipment ; the  importance 
of  establishing  prophylactic  technique  against  in- 
fections ; tuberculosis  among  nurses,  will  be  given 
consideration. 

Loss  of  efficiency  in  operation  resulting  from  quaran- 
tine will  be  evaluated  with  ways  and  means  of 
shortening  quarantine  periods.  Protection  of  patients 
and  personnel  following  exposure  to  communicable 
disease  will  be  described. 

Discussion — 4:15  to  4:20 — W.  H.  Peters, 
Cincinnati. 

General  Discussion — 4:20  to  4:30. 

Paper  No.  6 — 4:30  to  4:45 
The  Role  of  Streptococci  in  Infectious  Dis- 
eases— by  J.  A.  Toomey,  Cleveland. 

Investigators  have  claimed  that  scarlet  fever  and 
erysipelas  are  caused  by  specific  strains  of  streptoc- 
occi. They  also  assert  that  such  conditions  as  strep- 
tococcic sore  throat,  puerperal  sepsis,  rheumatic  fever 
and  even  measles  are  due  to  one  or  another  of  specific 
streptococci. 

Agglutination,  absorption  and  neutralization  ex- 
periments are  quoted  and  something  like  the  diseases 
in  question  have  been  produced  experimentally  in  man 
and  animals.  Specific  tests  were  used  and  benefits  fol- 
lowing the  use  of  antitoxins  have  been  described. 

The  value,  however,  of  agglutination  and  absorption- 
agglutination  experiments  with  streptococcic  organ- 
isms is  nil  since  differentiation  with  these  tests  is 
not  clear-cut,  and  the  results  attributed  to  various 
therapeutic  procedures  are  questionable. 

We  have  not  discovered  whether  diseases  of  strep- 
tococcic origin  are  actually  separate  disease  entities. 


506 


The  Ohio  State  Medical  Journal 


August,  1933 


but  we  know  that  a strain  of  streptococci  may  cause 
erysipelas  in  one  individual,  a sore  throat  in  a second 
and  scarlet  fever  in  a third.  It  behooves  us  to  be 
cautious  in  accepting  the  late  work  on  the  specificity 
of  streptococci. 

Discussion — 4:45  to  4:50 — J.  H.  J.  Upham, 
Columbus. 

General  Discussion — 4:50  to  5:00. 


EASTERN  STANDARD  TIME 

The  time  indicated  on  this  program  is  Eastern 
Standard  Time. 

ESSAYISTS— DISCUSSANTS 

“All  papers  read  before  this  Association  shall 
be  its  property.  Each  paper  shall  be  deposited 
with  the  Section  Secretary  when  read.  Authors 
shall  not  cause  papers  read  before  this  Associa- 
tion to  be  published  as  original  elsewhere,  nor 
until  after  they  have  been  published  in  the  official 
Join-rial  of  this  Association.” — Chapter  IV,  Sec- 
tion 3,  By-Laws. 

Discussants  of  papers  are  requested  to  forward 
typewritten  copies  of  their  remarks  to  the  Ohio 
State  Medical  Journal,  131  East  State  Street, 
Columbus,  Ohio,  not  later  than  two  weeks  after 
the  Annual  Meeting  in  order  that  they  may  be 
published  with  the  papers. 

REGISTRATION 

General  registration  for  all  members  and 
guests  will  be  conducted  at  the  registration  head- 
quarters which  will  be  located  in  the  southwest 
corner  of  the  second  floor  of  the  Mayflower 
Hotel,  immediately  adjoining  the  ballroom,  where 
the  general  sessions  will  be  held,  and  the  exhibit 
hall  which  will  house  the  commercial  exhibits. 

Admission  to  all  Sections  and  general  meetings 
and  to  the  special  entertainments  in  connection 
with  the  meeting  will  be  by  badge  only.  Everyone 
in  attendance  must  register  to  obtain  a badge  and 
therefore  gain  admission  to  the  various  sessions 
of  the  meeting. 

Chapter  I,  Sections  1,  2 and  3,  of  the  By-Laws 
restricts  registration  and  attendance  at  the  An- 
nual Meeting  and  its  various  sessions  to  members 
of  the  State  Association  in  good  standing.  Phy- 
sicians from  outside  Ohio,  medical  students  and 
eminent  members  of  scientific  professions  not 
medical  but  allied  thereto,  may  be  admitted  as 
guests  at  the  Annual  Meeting. 

Be  sure  to  take  your  1933  membership  card  to 
Akron  with  you  as  its  presentation  at  the  Regis- 
tration Headquarters  will  greatly  facilitate  the 
registering  of  members. 

ORGANIZATION  LUNCHEON 
Tuesday,  September  7,  1933 
Mayflower  Hotel 

On  Thursday  noon,  September  7,  in  the  ball- 
room of  the  Mayflower  Hotel,  will  be  held  the 
annual  Organization  Luncheon,  at  which  the 
presidents,  secretaries,  treasurers,  legislative  and 
medical  defense  committeemen  as  well  as  the 


members  of  the  House  of  Delegates  from  the  com- 
ponent county  societies  and  academies  of  medicine, 
and  the  state  officers,  councilors,  State  Associa- 
tion committees,  and  section  officers  will  be  the 
guests  of  the  State  Association. 

On  account  of  the  important  economic,  social, 
governmental  and  organization  problems  confront- 
ing the  profession  at  the  present  time,  this  meet- 
ing will  be  devoted  to  an  address  on  problems  of 
professional  relations,  economics,  contract  prac- 
tice, hospital  problems,  and  similar  timely  mat- 
ters, by  Dr.  Geo.  Edw.  Follansbee,  Cleveland, 
chairman  of  the  Judicial  Council  of  the  American 
Medical  Association  and  former  president  of  the 
Ohio  State  Medical  Association. 

This  meeting  will  convene  promptly  at  12 
o’clock  noon  in  order  that  the  luncheon  and  the 
program  will  be  finished  in  sufficient  time  to  have 
the  ballroom  reset  and  arranged  for  the  Medical 
Section  starting  at  2:00  P.  M.  This  luncheon 
meeting  will  immediately  follow  the  first  session 
of  the  House  of  Delegates  which  starts  at  10:00 
A.  M. 

Dr.  Platter,  the  President,  will  call  this  meet- 
ing to  order,  and  Dr.  Cummer,  the  President- 
Elect,  will  preside.  The  chairmen  of  the  standing 
and  special  committees  of  the  State  Association 
will  be  introduced,  but  at  this  meeting  the  usual 
addresses  by  those  officers  will  be  eliminated.  Ad- 
mission by  special  card. 


Have  You  Made  Hotel  Reservations  For 
Akron  Meeting?  If  Not,  Please  Do 
So  Immediately 

For  the  information  of  members  of  the  State 
Association  who  have  not  as  yet  made  their  hotel 
reservations  for  the  87th  Annual  Meeting  of  the 
State  Association  to  be  held  in  Akron,  Thursday 
and  Friday,  September  7 and  8,  and  the  golf 
tournament  on  Wednesday,  September  6,  the  fol- 
lowing list  of  Akron  hotels,  their  rates  and  con- 
veniences is  again  published.  Requests  for  rooms 
should  be  made  direct  to  the  management  of  the 
hotel  selected,  accompanied  by  a request  for  vei’i- 
fication  of  the  reservation. 

THE  MAYFLOWER 
Headquarters  Hotel 
Main  and  State  Streets 

450  rooms,  all  with  bath;  single  room,  $2.50  to 
$4.50;  room  with  double  bed,  $3.50  to  $6.00;  room 
with  twin  beds,  $5.50  to  $6.50;  suites  $10.00, 
$12.00  to  $21.00. 

THE  PORTAGE 
Main  and  Market  Streets 

320  rooms;  59  rooms  with  lavatory  and  toilet, 
$1.50  single;  $2.50  double;  35  rooms  with  lavatory 
and  toilet,  single,  $2.00,  double,  $3.00;  30  rooms 

with  bath,  $2.00  single,  $3.00  double;  65  rooms 

with  bath,  $2.50  single,  $3.50  double;  49  rooms 

with  bath,  $3.00  single,  $4.00  double;  12  rooms 


August,  1933 


Program 


507 


with  bath  and  twin  beds,  $4.00;  14  rooms  with 
bath  and  twin  beds,  $4.50. 

THE  ANTHONY  WAYNE 
314  South  Main  Street 

150  rooms;  single  room  with  bath,  $2.00  to 
$2.50;  double,  $3.00  to  $3.50. 

THE  AKRON 

East  Market  Street  and  Broadway 

200  rooms;  single  room  with  bath,  $2.50  to 
$3.00;  double  room  with  bath,  $3.50  and  $4.00; 
room  with  bath  and  twin  beds,  $4.00;  two-room 
suites  with  connecting  bath,  $2.00  per  room. 

THE  HOWE 
11  South  Main  Street 

175  rooms;  single  room  with  bath,  $1.50  to 


$2.50;  double  room  with  bath,  $3.00  to  $3.50; 
single  room  without  bath,  $1.00  to  $1.25;  double 
room  without  bath,  $2.00. 

THE  MARNE 

South  Main  Street  near  State  Street 

175  rooms;  single  room  with  connecting  shower, 
$1.50;  double  room  with  connecting  shower,  $2.00; 
single  room  with  tub  bath,  $2.50;  double  room 
with  tub  bath,  $3.00. 

THE  TAYLOR 
85  East  Market  Street 

185  rooms;  35  rooms  with  bath,  $1.50;  35  rooms 
with  bath  and  radio,  $2.00;  15  rooms  with  twin 
beds  and  bath,  $3.50  to  $4.00;  100  rooms  with 
running  water,  $1.00  to  $2.00. 


Special  and  Attractive  Features  Are  Being  Planned  For 
Opening  Day  of  87th.  Annual  Meeting  at  Akron 


Preliminary  arrangements  are  rapidly  being 
completed  for  two  special  features  of  the  87th 
Annual  Meeting  of  the  State  Association,  at 
Akron,  Thursday  and  Friday,  September  7 and  8, 
which  promise  to  be  of  exceptional  interest  and 
importance  this  year. 

One  is  the  Annual  Banquet  which  will  be  held 
in  the  Ballroom  of  the  Mayflower  Hotel  on  the 
evening  of  Thursday,  September  7,  starting  at 
6:30  o’clock. 

The  other  is  the  Organization  Luncheon  to  be 
held  in  the  Mayflower  Ballroom  Thursday,  Sep- 
tember 7,  at  12  o’clock  noon. 

The  program  to  be  presented  at  the  Annual 
Banquet  will  be  featured  by  the  Presidential 
Address  of  the  retiring  president,  Dr.  H.  M. 
Platter,  Columbus;  the  Inaugural  Address  of  the 
president-elect,  Dr.  C.  L.  Cummer,  Cleveland,  and 
an  address  by  Dr.  Olin  West,  Chicago,  secretary 
of  the  American  Medical  Association. 

Following  these  addresses,  special  entertain- 
ment, to  be  concluded  with  a dance  and  informal 
reception  for  the  retiring  and  incoming  presi- 
dents, will  be  provided  for  the  banquet  guests, 
arrangements  for  which  are  being  made  by  the 
Entertainment  and  Banquet  Committees  of  the 
Summit  County  Medical  Society. 

These  committees  of  the  Akron  profession  will 
have  charge  of  the  sale  of  tickets  for  the  banquet 
and  other  arrangements  for  the  evening’s  enter- 
tainment. Arrangements  will  be  made  for  the 
seating  of  members  who  are  unable  to  attend 
the  banquet  but  who  may  arrive  later  to  hear  the 
presidential  addresses  and  the  address  of  Dr. 
West. 

The  program  to  be  presented  at  the  Organiza- 
tion Luncheon  this  year  will  be  an  innovation  and 
it  is  believed  will  be  unusually  informative  and 
interesting  to  those  who  will  attend  as  guests  of 
the  State  Association. 

Instead  of  having  addresses  by  the  officers  and 


chairmen,  of  the  various  standing  State  Associa- 
tion committees,  the  Council  Program  Committee 
has  arranged  for  one  address,  to  be  given  follow- 
ing an  introduction  of  the  officers  and  committee 
chairmen. 

Dr.  Geo.  Edw.  Follansbee,  Cleveland,  chairman  of 
the  Judicial  Council  of  the  American  Medical 
Asociation  and  former  president  of  the  State  As- 
sociation, has  been  invited  to  address  the  lunch- 
eon gathering  on  present-day  economic  and  social 
problems  affecting  medical  practice,  including 
problems  of  professional  relationship,  contract 
practice,  hospital  group  insurance  programs, 
questions  of  the  costs  of  medical  care,  and  similar 
matters  of  vital  importance  to  every  physician. 

Due  to  his  long  experience  as  a leader  in  medi- 
cal organization  and  his  exceptional  knowledge  of 
social  and  economic  questions  confronting  the 
medical  profession,  Dr.  Follansbee  is  unusually 
well  qualified  to  discuss  these  questions  and  to 
offer  advice  and  suggestions  as  to  how  the  pro- 
fession should  proceed  to  meet  them,  locally,  on  a 
state-wide  basis,  and  nationally. 

Because  of  the  interest  and  importance  of  the 
message  which  Dr.  Follansbee  will  present,  the 
Council  of  the  State  Association  has  authorized 
that  members  of  the  House  of  Delegates,  and 
officers  of  the  various  scientific  sections  be  in- 
vited to  attend  the  Organization  Luncheon,  in  ad- 
dition to  the  officers,  councilors  and  committee- 
men of  the  State  Association,  presidents,  secre- 
taries and  legislative  and  medical  defense  com- 
mitteemen of  the  component  county  societies,  who 
are  the  customary  guests  of  the  State  Association 
on  this  annual  occasion. 

The  Council  Program  Committee  is  anxious 
that  there  be  a large  attendance  at  the  Organiza- 
tion Luncheon  and  that  the  luncheon  be  started 
promptly,  since  it  must  be  concluded  in  time  to 
permit  the  members  to  attend  the  sessions  of  the 
Scientific  Sections,  starting  Thursday  at  2 p.  m. 


The  President’s  Poqe 


A Personal  Communication  to  the  Membership  from 

H.  M.  Platter,  M.D.,  Columbus,  Ohio 


WITH  this  issue  my  reportorial  duties  cease.  The  President-elect  will  preside 
over  this  page  in  the  September  Journal.  His  thorough  knowledge  of  medical 
organization  and  his  enthusiasm  are  well  known.  That  his  messages  from 
month  to  month  will  prove  worth  while  to  us  all,  I have  no  doubt. 

You  have  been  most  cooperative  to  the  efforts  we  have  put  forth  during  the  past 
year.  May  the  Association  continue  to  grow  in  usefulness  to  the  membership,  and  may 
the  members,  in  turn,  study  their  problems  and  by  close  organization  impress  their 
viewpoints  in  their  several  communities. 

Mencken  quite  aptly  remarks  that  the  great  majority  of  us  might  be  described  with 
perfect  accuracy  as  easy  marks,  and  he  expresses  the  hope  that  the  report  of  the 
Committee  on  the  Costs  of  Medical  Care  will  awaken  us  to  the  fact  that  we  owe  some 
duties  to  ourselves. 

While  my  service  as  President  is  a transitory  incident  in  the  progress  and  move- 
ment of  medical  organization,  I feel  with  modest  pride  that  through  your  help  and  that 
of  the  officers  and  committees,  we  have  contributed  to  worthy  accomplishments  on  be- 
half of  our  beloved  profession. 

Further  efforts  are  necessary  to  meet  and  solve  new  and  renewed  problems.  Your 
leader  and  spokesman,  our  President-Elect,  Dr.  C.  L.  Cummer,  with  his  energy,  training 
and  organization  ability,  can  be  depended  upon  to  preserve  and  advance  those  principles 
and  activities  so  necessary  to  our  safety  and  integrity  as  an  independent,  self-respect- 
ing, scientific  profession.  May  I ask  that  you  give  to  him  the  same  measui’e  of  en- 
thusiastic support  which  you  accorded  to  me? 

The  program  for  the  Akron  meeting  appearing  in  this  issue  should  appeal  to  the 
entire  membership.  Arrange  your  affairs  to  join  with  us  in  making  the  meeting  one 
of  the  best  in  the  history  of  the  Association.  The  Akron  profession  has  made  every 
arrangement  for  our  comfort  and  entertainment.  Do  not  disappoint  them. 


508 


Annual  Meeting  Details  Completed  and  Consideration 
Given  to  Other  Important  Subjects  at  July 
Council  Meeting 


The  Council  of  the  Ohio  State  Medical  Associa- 
tion met  in  the  headquarters  office,  Columbus,  at 
1:00  P.  M.  on  Sunday,  July  9,  1933. 

The  Officers  and  Councilors  present  were: 
President,  Dr.  Platter;  President-Elect,  Dr.  Cum- 
mer; Ex-President,  Dr.  Houser;  Treasurer,  Dr. 
Beer;  Councilors,  Drs.  Caldwell,  Huston,  Klotz, 
Paryzek,  Davidson,  Shanley,  Brush,  Seiler  and 
Goodman;  Dr.  Alcom,  chairman,  and  Dr.  Upham, 
member  of  the  Policy  Committee;  Dr.  Southard, 
State  Director  of  Health;  Dr.  Bigelow,  chairman 
of  the  special  committee  on  hospital  problems; 
Executive  Secretary  Martin  and  Assistant  Ex- 
ecutive Secretary  Nelson. 

The  minutes  of  the  Council  meeting  held  on 
May  7,  1933  (published  on  pages  374  to  376,  in- 
clusive, of  the  June,  1933,  issue  of  The  Journal), 
were  read,  and  on  motion  by  Dr.  Caldwell,  sec- 
onded by  Dr.  Klotz  and  carried,  were  approved. 

ANNUAL  MEETING  PLANS  COMPLETED 

Dr.  Cummer,  President-Elect  and  chairman  of 
the  Council  Program  Committee,  reported  in  de- 
tail on  changes  and  modifications  made  in  the  pro- 
gram for  the  annual  meeting  to  be  held  in  Akron 
on  Thursday  and  Friday,  September  7 and  8, 
1933.  He  explained  that  instead  of  the  usual  type 
of  program  at  the  Organization  Luncheon  on 
Thursday  noon  that  arrangements  had  been  made 
to  have  Dr.  Geo.  Edw.  Follansbee,  chairman  of 
the  Judicial  Council  of  the  American  Medical 
Association,  discuss  present-day’  economic  and 
social  problems  affecting  medical  practice,  includ- 
ing problems  of  professional  relationship,  con- 
tract practice,  hospital  group  payment  plans,  in- 
surance features,  questions  of  the  cost  of  medical 
care,  and  similar  matters. 

Changes  and  substitutions  in  the  scientific  pro- 
gram were  submitted  by  Dr.  Cummer.  He  also 
reported  that  arrangements  had  been  made  to 
secure  Dr.  Olin  West  of  the  American  Medical 
Association  to  present  an  address,  following  the 
addresses  of  the  retiring  and  incoming  presidents, 
on  Thursday  evening  following  the  banquet.  This 
detail  had  been  worked  out  in  conjunction  with 
the  local  committees  to  harmonize  with  the  enter- 
tainment features  following  the  addresses  for 
that  occasion. 

Dr.  Davidson,  chairman  of  the  Council  Com- 
mittee on  Arrangements,  reported  on  a recent 
confei’ence  held  in  Akron,  at  which  verification 
was  made  of  the  meeting  places  for  the  General 
Sessions  and  scientific  Sections.  He  stated  that 
all  local  committees  were  functioning  efficiently 
and  harmoniously.  He  discussed  the  possibility  of 
securing  gratis  souvenir  badges  for  the  meeting. 


Dr.  Cummer  pointed  out  the  desirability  of  pro- 
viding a badge  for  each  member  and  guest  in  at- 
tendance, and  emphasized  the  importance  of  mak- 
ing admission  to  the  various  sessions  during  the 
annual  meeting  contingent  upon  registration  and 
the  wearing  of  the  official  badge.  He  recommended 
that  arrangements  be  made  to  exclude  from  at- 
tendance all  those  who  did  not  have  a badge. 
Upon  motion  by  Dr.  Cummer,  seconded  by  Dr. 
Seiler  and  carried,  the  Council  instructed  that  an 
official  badge  be  provided  as  a prerequisite  to  ad- 
mission to  the  meetings.  Dr.  Davidson  explained 
the  prospect  for  a prize  to  be  presented  at  the 
banquet. 

Upon  motion  by  Dr.  Huston,  seconded  by  Dr. 
Caldwell  and  carried,  the  Council  approved  the 
report  and  recommendations  made  by  Dr.  Cum- 
mer and  Dr.  Davidson. 

workmen’s  compensation  developments 

Dr.  Caldwell,  a member  of  the  Special  Work- 
men’s Compensation  Committee  of  the  State 
Medical  Association,  called  attention  to  the  recent 
report  of  that  committee  published  on  pages  441 
to  444,  inclusive,  of  the  July,  1933,  issue  of  The 
Journal.  He  explained  the  problems  confronting 
that  committee,  its  deliberations  and  contacts  with 
the  Industrial  Commission  and  with  other  groups 
interested  in  workmen’s  compensation  administra- 
tion. He  called  attention  to  the  excerpts  in  that 
report  from  the  recommendations  made  by  the 
Ohio  Manufacturers’  Association  for  improvement 
in  administrative  procedure  by  the  Industrial 
Commission. 

Attention  was  also  called  to  the  creation  by 
resolution  of  a special  committee  of  the  State 
Senate  to  investigate  workmen’s  compensation— 
its  administration,  etc. — and  recommended  that 
the  committee  of  the  State  Medical  Association  co- 
operate with  other  interested  groups  in  a con- 
structive effort  to  solve  the  various  problems  of 
workmen’s  compensation,  especially  as  they  affect 
the  medical  profession.  Other  members  of  Council 
also  discussed  this  matter  and  recommended  that 
the  Special  Workmen’s  Compensation  Committee 
be  continued. 

Dr.  Bigelow,  chairman  of  the  special  committee 
of  the  Ohio  State  Medical  Association  to  confer 
with  a committee  of  the  Ohio  Hospital  Association 
on  annual  contracts  by  hospitals  with  the  State 
Industrial  Commission  in  workmen’s  compensa- 
tion cases,  reported  on  a series  of  correspondence 
culminating  in  a joint  conference  held  in  Cleve- 
land on  July  5,  attended  by  members  of  his  com- 
mittee (himself,  Dr.  John  T.  Murphy  and  Dr.  H. 
V.  Paryzek),  in  addition  to  Dr.  Platter,  Dr.  Cum- 
mer, Dr.  Follansbee  and  Executive  Secretary 


509 


510 


The  Ohio  State  Medical  Journal 


August,  1933 


Martin;  and  the  committee  and  officers  of  the 
Ohio  Hospital  Association. 

Dr.  Bigelow  submitted  for  the  consideration  cf 
the  Council  a suggested  draft  of  a joint  report 
and  communication  from  the  committees  of  the 
State  Medical  Association  and  the  Ohio  Hospital 
Association  to  the  State  Industrial  Commission. 

On  motion  by  Dr.  Caldwell,  seconded  by  Dr. 
Goodman  and  carried,  this  preliminary  suggested 
report  by  the  special  committee  was  approved , 
and  the  committee  was  continued. 

LEGISLATION  AND  POLICY 
Dr.  Alcorn,  chairman  of  the  Policy  Committee, 
summarized  the  high  points  in  the  prolonged,  com- 
plicated and  difficult  legislative  session  recently 
ended.  He  called  attention  to  the  problems  that 
had  arisen  affecting  medical  practice,  and  public 
health  administration.  He  expressed  appreciation 
to  the  legislative  committeemen  for  their  coopera- 
tion in  securing  desired  results.  He  recommended 
that  the  Councilors  urge  the  local  legislative  com- 
mitteemen to  re-establish  contacts  and  express 
appreciation  to  the  members  of  the  Legislature 
who  had  indicated  an  understanding  of  and  proper 
attitude  toward  problems  of  scientific  medicine 
and  public  health.  He  called  attention  to  the  re- 
cent legislative  bulletins,  especially  the  one  issued 
the  past  week,  and  stated  that  a more  detailed 
analysis  and  summary  would  be  contained  in  the 
forthcoming  annual  report  of  his  committee. 

Dr.  Southard  discussed  some  of  the  legislative 
problems  which  had  confronted  the  State  Depart- 
ment of  Health  and  expressed  his  gratitude  for 
the  cooperation  of  the  medical  profession  and  the 
Policy  Committee  of  the  State  Medical  Associa- 
tion. 

CONSTITUTIONAL  QUESTIONS 
Dr.  Cummer  reported  on  a communication  from 
the  Academy  of  Medicine  of  Cincinnati,  accom- 
panied by  an  amendment  to  Section  1,  Article  III 
of  the  Constitution  of  that  component  society, 
dealing  with  classification  of  membership. 

On  motion  by  Dr.  Cummer,  seconded  by  Dr. 
Caldwell  and  carried,  the  Council  approved  the 
amendment  as  submitted. 

A report  was  also  submitted  by  Dr.  Cummer  on 
correspondence  with  the  Secretary  of  the  Auglaize 
County  Medical  Society,  relative  to  a proposed 
amendment  requiring  applicants  for  membership 
in  that  society  to  be  a resident  of  that  county  for 
at  least  a period  of  one  year  before  being  voted 
into  membership.  Dr.  Cummer  pointed  out  that 
it  is  not  the  function  of  the  Council  to  require 
component  county  societies  to  incorporate  specific 
provisions  in  their  by-laws  as  long  as  local  con- 
stitutional provisions  are  not  in  conflict  with  the 
Constitution  and  By-Laws  of  the  State  Associa- 
tion. He  stated,  however,  that  the  opinion  ex- 
pressed in  a communication  from  the  headquar- 
ters office  of  the  State  Medical  Association  advis- 
ing against  such  a specific  requirement  for  delay 


in  action  by  a society  on  membership  application, 
embodied  correct  advice,  and  that  each  society  may 
properly,  under  its  present  provisions,  delay  ac- 
tion on  membership  applications  awaiting  thor- 
ough investigation  of  the  professional  attitude  of 
such  applicants.  Other  members  of  Council 
pointed  out  that  too  hasty  action  by  county  so- 
cieties in  voting  applicants  into  membership  oc- 
casionally creates  later  embarrassment.  Dr.  Hus- 
ton made  the  recommendation  that  rather  than 
incorporating  in  by-laws  provisions  for  a year’s 
delay  in  the  action  on  applications  for  member- 
ship, that  by  a standing  resolution,  societies 
might  cover  the  situation  and  establish  sufficient 
safeguards  by  providing  that  action  on  applica- 
tions for  membership  from  those  physicians  who 
had  not  been  members  of  medical  organization 
elsewhere  at  the  time  application  for  membership 
was  made,  should  be  delayed  for  a definite  period, 
or  as  long  as  one  year  in  case  the  society  so  de- 
sires. 

OHIO’S  PARTICIPATION  IN  A.  M.  A.  .MEETING 

Dr.  Cummer  reported  at  some  length  on  the 
conspicuous  part  taken  by  Ohio  physicians  in  the 
recent  annual  meeting  of  the  American  Medical 
Association  in  Milwaukee,  June  12  to  16.  He 
pointed  out  that  Dr.  Upham  had  been  elevated  to 
the  chairmanship  of  the  Board  of  Trustees,  that 
Dr.  Follansbee  had  taken  a prominent  part  in  the 
proceedings  as  chairman  of  the  Judicial  Council, 
that  among  the  official  delegates  in  the  House  cf 
Delegates,  Dr.  Teachnor,  Dr.  Waggoner  and  Dr. 
McClellan  had  served  on  important  reference  com- 
mittees, and  that  a number  of  Ohio  physicians  had 
taken  a prominent  part  in  the  scientific  program 
and  the  scientific  exhibits.  He  discussed  the  action 
of  the  House  of  Delegates  in  voting  to  hold  the 
1934  annual  meeting  of  the  American  Medical 
Association  in  Cleveland,  and  outlined  preliminary 
plans  for  the  entertainment  of  that  convention. 

Dr.  Upham  also  discussed  some  of  the  high 
points  in  the  A.  M.  A.  annual  meeting,  including 
some  of  the  resolutions  and  official  action  by  the 
House  of  Delegates,  and  referred  to  the  splendid 
address  of  invitation  issued  by  Dr.  Stone  on  be- 
half of  Cleveland  for  next  year’s  annual  meeting. 

PROBLEMS  OF  MEDICAL  AND  HOSPITAL  CARE  OF  THE 
INDIGENT  SICK 

Dr.  Platter  and  Dr.  Southard  reported  at  length 
on  the  series  of  correspondence  and  conferences 
with  the  State  Relief  Commission  on  the  inter- 
pretation of  laws  and  regulations  having  to  do 
with  poor  relief,  including  medical  care  to  the 
indigents.  Reference  was  also  made  to  an  analysis 
in  the  new  federal  act  on  emergency  relief  dis- 
cussed in  an  editorial  in  the  July  1 issue  of  the 
Journal  of  the  American  Medical  Association. 
Recommendations  were  made  that  if  possible  Dr. 
Southard  delegate  from  his  staff  a physician  to 
maintain  constant  contact  with  the  State  Relief 
Commission,  to  whom  problems  should  be  submit- 


August,  1933 


State  News 


511 


ted  arising  in  the  county  medical  societies  and 
otherwise,  in  relation  to  compensation  for  medical 
care  to  the  indigents.  It  was  further  pointed  out 
that  through  a number  of  separate  funds  ad- 
ministered and  ordered  under  authority  of  the 
State  Relief  Commission,  most  of  the  local  com- 
munities in  Ohio  had  funds  available  for  the  pay- 
ment for  medical  service  for  the  needy  sick  with- 
out diverting  any  of  the  federal  funds  made  avail- 
able on  a contingent  basis  to  the  states  for  relief ; 
such  local  funds  furnished  by  the  Relief  Com- 
mission being  available  in  some  instances  through 
authorized  bond  issues,  community  funds,  diver- 
sions from  the  genei'al  revenue  funds,  local  ap- 
portionments of  the  diversion  from  gasoline  tax 
funds,  and  other  special  funds. 

The  Council  requested  the  State  Director  of 
Health  and  the  headquarters  office  of  the  State 
Medical  Association  to  maintain  constant  contact 
with  the  State  Relief  Commission  in  an  effort  to 
assist  county  medical  societies  in  a solution  of 
the  separate  and  distinct  problems  peculiar  to 
each  community  in  this  matter. 

MEMBERSHIP  FIGURES 

A report  submitted  to  the  Council  indicated  that 
there  are  paid  to  date  for  1933,  4,857  members  in 
the  State  Medical  Association,  as  compared  with 
5,164  on  the  same  date  last  year  and  as  compared 
with  a total  at  the  end  of  1932  of  5,352.  The 
Council  discussed  prospects  for  new  members,  as 
well  as  effective  means  to  re-enlist  delinquent 
members  through  emphasis  on  the  necessity  of 
maintaining,  with  highest  possible  efficiency,  or- 
ganization machinery  to  represent  physicians  in 
these  critical  times  in  the  solution  of  economic, 
social  and  governmental  problems. 

By  official  action,  the  Council  authorized  the 
acceptance  of  pro  rata  dues  for  new  members 
only  from  July  1,  and  intermediate  dates  to 
October  1,  to  the  end  of  the  calendar  year  on  the 
basis  of  $3.00  per  member. 

DISCUSSION  ON  LOCAL  AND  COUNCILOR  PROBLEMS 

Each  member  of  Council  reported  in  some  detail 
on  the  conditions  and  problems  in  their  respective 
districts  on  matters  of  organization,  professional 
relations,  membership  status,  financial  questions, 
etc.  During  this  discussion  a number  of  Coun- 
cilors told  of  local  activities  tending  to  further 
socialize  medical  practice  through  various  hospital 
schemes  for  the  payment  of  hospitalization  and 
similar  projects.  It  was  the  consensus  of  opinion 
that  in  view  of  the  peculiar  local  angles  to  many 
of  these  movements,  that  each  academy  of  medi- 
cine and  county  medical  society  should  be  en- 
couraged and  stimulated  to  have  appropriate  com- 
mittees alert  and  in  touch  with  local  develop- 
ments. In  this  connection,  Dr.  Huston  again  em- 
phasized the  importance  of  Councilors’  encourag- 
ing each  county  society  to  create  and  maintain,  at 
maximum  efficiency,  committees  on  public  rela- 
tions, the  duties  of  which  should  be  to  study  and 


be  fully  informed  on  the  various  movements  and 
activities  affecting  medical  practice,  and  to  be  in 
position  to  explain  effectively  the  organized  view- 
point of  the  medical  profession  on  this  matter. 

Detailed  analysis  was  made  by  several  Coun- 
cilors of  movements  for  group  hospital  payment 
plans  on  an  insurance  basis  being  agitated  in  a 
number  of  communities,  and  various  suggestions 
were  made  for  activities  by  county  medical  so- 
cieties on  this  and  similar  problems. 

MISCELLANEOUS 

Attention  was  called  to  and  analysis  made  of 
the  recent  opinion  and  interpretation  by  the  At- 
torney General  of  the  Ohio  law  making  effective 
in  this  state  the  federal  statutes  and  regulations 
on  the  prescribing  of  medicinal  liquor.  (Analysis 
of  this  situation  in  detail  elsewhere  in  this  issue 
of  The  Journal). 

There  was  also  submitted  for  the  information 
of  the  Council,  an  analysis  of  the  National  In- 
dustrial Recovery  Act  and  the  recently  enacted 
state  laws  to  extend  the  application  of  the  prin- 
ciples and  provisions  in  the  national  act  to  intra- 
state industry  and  business.  There  was  a'lso  a 
discussion  on  the  possible  effect  on  medical  prac- 
tice and  medical  organization,  of  relationship  and 
cooperation  with  allied  groups  as  well  as  with 
business  and  industrial  groups  on  questions  of 
competition,  contract  practice,  etc. 

There  was  submitted  to  the  Council  a com- 
munication from  the  Columbus  Academy  of  Medi- 
cine incorporating  a resolution  pertaining  to  the 
medical  profession  in  Germany.  It  was  pointed 
out  by  several  members  of  Council  that  in  view  of 
official  action  on  this  matter  by  the  House  of 
Delegates  of  the  American  Medical  Association, 
since  the  date  of  the  communication  from  the  Co- 
lumbus Academy  of  Medicine,  that  no  official 
action  by  the  Council  of  the  State  Association  is 
necessary  at  this  time. 

Dr.  Cummer,  Dr.  Paryzek,  Dr.  Upham  and  Dr. 
Platter  discussed  recent  conferences  with  Dr. 
Denison  and  Dr.  Finley  of  Cleveland,  in  regard  to 
the  publication  of  a manual  to  provide  for  lectures 
and  clinics  on  the  subject  of  diabetes.  It  was 
further  pointed  out  that  in  view  of  the  national 
character  of  this  problem,  that  any  action  by  the 
Council  of  the  State  Association  was  unnecessary 
at  this  time  and  should  await  action,  if  any,  by 
the  American  Medical  Association. 

The  Council  adjourned  to  meet  in  Akron  on 
Wednesday  evening,  September  6,  immediately 
preceding  the  annual  meeting,  or  upon  call  by  the 
President  at  an  earlier  date. 

S.  J.  Goodman, 
Secretary  of  Council. 


— October  19-20  have  been  set  as  the  tenta- 
tive dates  for  the  14th  Annual  Conference  of 
Health  Commissioners  of  Ohio  with  the  State 
Department  of  Health  in  Columbus. 


OMo  Profession  Had  a Prominent  and  Important  Part  in  the 
Recent  A,  M.  A.  Annual  Meeting 


Ohio  carried  off  many  of  the  high  honors  and 
played  its  usually  prominent  part  in  the  recent 
84th  Annual  Session  of  the  American  Medical 
Association,  held  in  Milwaukee,  June  12  to  16, 
inclusive. 

Total  registration  at  the  Milwaukee  meeting 
was  4601,  of  whom  216  were  Ohio  physicians  and 
guests.  The  Ohio  registration  was  exceeded  by 
only  two  states — -Wisconsin  and  Illinois. 

Recognition  of  Ohio’s  prominence  in  medicine 
and  Cleveland’s  well-founded  claim  as  one  of  the 
world’s  foremost  medical  centers  was  manifest  by 
the  House  of  Delegates  at  its  closing  session  in 
the  selection  of  Cleveland  as  the  meeting  place 
for  the  1934  Annual  Session  of  the  Association, 
following  an  able  and  forceful  presentation  of 
Cleveland’s  invitation  by  Dr.  C.  W.  Stone. 

Ohio  was  ably  and  actively  represented  in  the 
House  of  Delegates  by  Drs.  Wells  Teachnor,  Sr., 
Columbus;  Ben  R.  McClellan,  Xenia;  C.  L.  Cum- 
mer and  C.  W.  Stone,  Cleveland;  John  P DeWitt, 
Canton;  C.  W.  Waggoner,  Toledo,  and  George  F. 
Zinninger,  Canton. 

Dr.  Teachnor  served  as  a member  of  the  im- 
portant Reference  Committee  on  Legislation  and 
Public  Relations  and  Dr.  Waggoner  as  a member 
of  the  equally  important  Reference  Committee  on 
Medical  Economics.  To  these  two  committees 
were  referred  the  vital  economic,  social  and  legis- 
lative questions  presented  to  the  House  of  Dele- 
gates for  consideration.  Dr.  McClellan  served  on 
the  Reference  Committee  on  Amendments  to  the 
Constitution  and  By-Laws  to  which  were  re- 
ferred a number  of  important  organization  prob- 
lems. 

Dr.  J.  H.  J.  Upham,  Columbus,  and  Dr.  Geo. 
Edw.  Follansbee,  Cleveland,  took  an  active  and 
prominent  part  in  the  business  transactions  of  the 
House  of  Delegates.  Dr.  Upham,  as  chairman  of 
the  Board  of  Trustees  of  the  A.M.A.,  presided  at 
the  various  meetings  of  the  trustees  held  during 
the  four-days  session  and  presented  the  reports 
of  the  board  to  the  House  of  Delegates.  Dr. 
Follansbee,  as  chairman  of  the  A.M.A.  Judicial 
Council,  presented  the  report  of  that  board  to  the 
House  of  Delegates  and  assisted  the  various  ref- 
erence committees  considering  questions  involving 
problems  of  ethics,  organization  procedure  and 
policy. 

At  the  final  meeting  of  the  House  of  Delegates, 
the  following  officers  were  elected:  President- 

elect, Dr.  Walter  L.  Bierring,  Des  Moines,  Iowa; 
vice  president,  Dr.  John  H.  Musser,  New  Orleans; 
secretary,  Dr.  Olin  West,  Chicago;  treasurer,  Dr. 
Herman  L.  Kretschmer,  Chicago;  speaker  of  the 
House  of  Delegates,  Dr.  Frederick  C.  Wamshuis, 
Grand  Rapids,  Michigan;  vice  speaker,  Dr. 
Nathan  B.  Van  Etten,  New  York  City;  trustees, 


Dr.  Austin  A.  Hayden,  Chicago,  and  Dr.  Charles 
B.  Wright,  Minneapolis;  member  of  Judicial 
Council,  Dr.  John  O’Shea,  Spokane,  Washington; 
member  of  Council  on  Medical  Education  and  Hos- 
pitals, Dr.  James  S.  McLester,  Birmingham,  Ala- 
bama; member  of  Council  on  Scientific  Exhibit, 
Dr.  James  G.  Paullin,  Atlanta,  Georgia. 

About  60  Ohio  physicians  took  part  in  the 
scientific  programs  presented  during  the  meeting. 
Among  those  who  participated  in  the  program  as 
essayists,  discussants  or  scientific  exhibitors  were : 

Drs.  Alfred  Friedlander,  Cincinnati;  John  P. 
Anderson,  Cleveland;  Henry  J.  John,  Cleveland; 
T.  D.  Spies,  Cleveland;  Robert  S.  Dinsmore, 
Cleveland;  George  W.  Crile,  Cleveland;  W.  James 
Gardner,  Cleveland;  John  P.  Gardiner,  Toledo; 
W.  W.  Brand,  Toledo;  Derrick  T.  Vail,  Jr.,  Cin- 
cinnati; A.  D.  Ruedemann,  Cleveland;  William  V. 
Mullin,  Cleveland;  H.  M.  Goodyear,  Cincinnati; 
Samuel  Iglauer,  Cincinnati;  Edward  D.  King, 
Cincinnati;  Harris  H.  Vail,  Cincinnati;  Henry  J. 
Gerstenberger,  Cleveland;  Arthur  J.  Horesh, 
Cleveland;  G.  Richard  Russell,  Cleveland;  Edna 
E.  Chapman,  Cleveland;  R.  A.  Kehoe,  Cincinnati; 
J.  Victor  Greenebaum,  Cincinnati;  A.  Graeme 
Mitchell,  Cincinnati;  Lee  Foshay,  Cincinnati; 
George  M.  Curtis,  Columbus;  Francis  J.  Phillips, 
Columbus;  Louis  J.  Karnosh,  Cleveland;  Howard 
D.  McIntyre,  Cincinnati;  J.  R.  Driver,  Cleveland; 
Henry  C.  Shaw,  Cleveland;  Emery  R.  Hayhurst, 
Columbus;  P.  A.  Davis,  Akron;  D.  M.  McDonald, 
Akron;  W.  E.  Lower,  Cleveland;  W.  J.  Engel, 
Cleveland;  Burt  G.  Chollett,  Toledo;  Robert  Ca- 
rothers,  Cincinnati;  James  A.  Dickson,  Cleveland; 
Marion  N.  Gibbons,  Cleveland;  Joseph  A.  Frei- 
berg, Cincinnati;  E.  H.  Wilson,  Columbus;  Wal- 
lace S.  Duncan,  Cleveland;  H.  K.  Dunham,  Cin- 
cinnati; David  Steel,  Cleveland;  Samuel  Brown, 
Cincinnati;  U.  V.  Portmann,  Cleveland;  Herbert 
A.  Wildman,  Wooster;  Carl  R.  Steinke,  Akron;  C. 
L.  Hyde,  Akron;  H.  F.  DeWolf,  Cleveland;  J.  V. 
VanCleve,  Cleveland;  Elmore  B.  Tauber,  Cincin- 
nati; Russell  L.  Haden,  Cleveland;  John  T.  Mur- 
phy, Toledo;  H.  N.  Cole,  Cleveland. 

A number  of  Ohio  physicians  were  honored  by 
being  elected  officers  of  several  of  the  scientific 
sections  for  the  ensuing  year.  Dr.  C.  W.  Burhans, 
Cleveland,  was  elected  vice  chairman  of  the  Sec- 
tion on  Pediatrics  and  Dr.  A.  Graeme  Mitchell, 
Cincinnati,  was  selected  alternate  delegate  from 
that  section  to  the  House  of  Delegates.  Dr.  Rus- 
sell L.  Haden,  Cleveland,  was  chosen  secretary  of 
the  Section  on  Pharmacology  and  Therapeutics. 
The  Section  on  Urology  elected  Dr.  Henry  L.  San- 
ford, Cleveland,  as  alternate  delegate  to  the  House 
of  Delegates.  Dr.  John  T.  Murphy,  Toledo,  was 
honored  by  being  re-elected  secretary  of  the  Sec- 
tion on  Radiology. 


512 


August,  1933 


State  News 


513 


Dr.  John  T.  Murphy,  Toledo,  upheld  Ohio’s 
golfing  honors  in  the  annual  tournament  of  the 
American  Medical  Golfing  Association,  held  at  the 
Blue  Mound  Country  Club.  Dr.  Murphy  tied  for 
fourth  place  in  the  association  handicap  event, 
with  a net  score  of  141  for  the  36-hole  contest. 

Among  those  from  Ohio  registered  for  one  or 
more  days  of  the  Milwaukee  session  were: 

Cleveland — (56) — Donald  G.  Allen,  John  P.  Anderson, 
Herman  S.  Applebaum,  A.  L.  Brooks,  Wm.  M.  Champion, 
Milton  B.  Cohen,  H.  N.  Cole,  Samuel  B.  Cowen,  George 
Crile,  Clyde  L.  Cummer,  H.  F.  DeWolf,  James  A.  Dickson, 
R.  S.  Dinsmore,  Josephine  K.  Dirion,  James  R.  Driver,  Wm. 

J.  Engel,  Harold  Feil,  J.  E.  Fisher,  Geo.  Edw.  Follansbee, 
Ed  Gauly,  Henry  J.  Gerstenberger,  Frank  S.  Gibson,  A.  B. 
Grossman,  Russell  L.  Haden,  Henry  J.  John,  Louis  J.  Kar- 
nosr,  Benjamin  S.  Kline,  Lester  W.  Krauss,  Herbert  G. 
Mahrer,  C.  L.  McDonald,  Wm.  V.  Mullin,  D.  A.  Prendergast, 
W.  J.  Quigley,  J L.  Reycraft,  Jack  A.  Rudolph,  Albert  D. 
Ruedemann,  A.  G.  Schlink,  H.  A.  Schlink,  R.  W.  Scott, 
Alvin  O.  Sibila,  T.  D.  Spies,  David  Steel,  Richard  E.  Stifel, 
C.  W.  Stone,  Richard  E.  Stout,  E.  V.  Thiehoff,  J.  J.  Thomas, 
John  A.  Toomey,  Z.  T.  Wirtschafter ; Cleveland  Heights — 
W.  James  Gardner,  Marion  N.  Gibbons  ; Lakewood — Elmore 
R.  Bailey,  C.  Lee  Graber,  Forrest  Mercia,  Robert  M. 
Stecher;  Shaker  Heights — Sarah  Marcus. 

Cincinnati — (39) — Ira  A.  Abrahamson,  Floyd  P.  Allen, 
Julien  E.  Benjamin,  W.  L.  Brodberger,  Samuel  Brown,  A. 
Gerson  Carmel,  Ralph  G.  Carothers,  Robert  Carothers,  Max 
Dreyfoos,  Kennon  Dunham,  Lee  Foshay,  Jos.  A.  Freiberg, 
Eliz.  B.  Gillespie,  Samuel  Goldblatt,  Ralph  Wm.  Good,  Henry 
M.  Goodyear,  J.  Victor  Greenebaum,  Louis  J.  Hendricks, 
Chas.  E.  Howard,  Samuel  Iglauer,  Robert  L.  Johnston, 
Chas.  C.  Jones,  Robert  A.  Kehoe,  Arthur  L.  Knight,  Robert 
A.  Lyon,  H.  D.  McIntyre,  Roger  S.  Morris,  Helena  T.  Rat- 
terman,  Robert  C.  Rothenberg,  Moses  Salzer,  Bernard  A. 
Schwartz,  Louis  Sommer,  K.  L.  Stoll,  Elmore  B.  Tauber, 
Derrick  T.  Vail,  Jr.,  Edward  A.  Wagner,  Arthur  W.  Wen- 
del,  Charlotte  Wiedemer,  Mendel  Zeligs. 

Columbus — (17) — A.  A.  Ahn,  Shirley  Armstrong,  Isabel 
A.  Bradley,  Jonathan  Forman,  Milton  L.  Goodman,  G.  T. 
Harding,  III,  Emery  R.  Hayhurst,  Arthur  G.  Helmick,  Chas. 
W.  McGavran,  G.  B.  Nessley,  Ernest  Scott,  Wells  Teachnor, 
Sr.,  Erwin  W.  Troutman,  J.  H.  J.  Upham,  Thos.  A.  Vogel, 
John  W.  Wilce;  Worthington — G.  T.  Harding,  Jr. 

Toledo — (25) — A.  S.  Avery,  Edward  Binzer,  Ralph  E. 
Boice,  Arthur  A.  Brindley,  B.  G.  Chollett,  Lawrence  I. 
Clark,  C.  J.  Czarnecki,  Fred  M.  Douglas,  Karl  D.  Figley, 
John  Gardiner,  Stanley  D.  Giffin,  W.  W.  Green,  Kenneth  R. 
Howard,  Henry  R.  Lesser,  L.  A.  Levison,  Martin  R.  Lor- 
enzen,  Chares  Lukens,  John  T.  Murphy,  Howard  J.  Park- 
hurst,  Samuel  R.  Salzman,  Herbert  E.  Smead,  Lewis  F. 
Smead,  Bernhard  Steinberg,  Reynold  A.  Tank,  C.  W.  Wag- 
goner. 

Dayton — Sterling  H.  Ashmun,  Homer  D.  Cassell,  A.  D. 
Cook,  Arthur  M.  Culler,  H.  V.  Dutrow,  H.  C.  Hanning,  J. 

K.  Hoerner,  Perley  H Kilbourne,  John  W Millette,  Benedict 
Olch,  Lydia  L Poage,  Walter  M.  Simpson,  Henry  Snow, 
Wallace  B.  Taggart.  Ashland — W.  F.  Emery.  Ashtabula — 
Wm.  F.  Gessler  Avon  Lake — Russell  M Arnold.  Bucyrus — 
Daniel  G.  Arnold,  Robert  L.  Solt. 

Akron — D C Arbuckle,  L.  P.  Harsh,  C.  L.  Hyde,  Dallas 
Pond,  Carl  R.  Steinke,  Elizabeth  M.  Weaver,  Louis  A.  Witze- 
man  ; Cuyahoga  Falls — Roy  Barnwell.  Canton — John  P.  De- 
Witt,  Emerson  Gillespie,  Anna  R.  Hendrickson,  E.  O.  Mor- 
row, Homer  V.  Weaver,  Geo.  F.  Zinninger.  Corning — R.  D. 
Book.  East  Liver-pool — Edward  W.  Miskall.  Findlay — John 
V.  Hartman,  Frank  M.  Wiseley.  Fremont — J.  L.  Curtin. 
Kenton — Mildred  R.  Merkle.  Leetonia — Paul  H.  Beaver. 
Mansfield — Wilmer  D.  Abrams,  C.  H.  Bell,  Carl  R.  Damron, 
Stanley  C.  Schiller,  J.  L.  Stevens,  Ralph  C.  Wise.  Marion — 
J.  W.  Bull,  Maud  L.  Bull,  H.  S.  Rhu.  Mentor — Robert  E. 
Gardner.  Mt.  Vernon — James  F.  Lee.  Oberlin — R.  W.  Brad- 
shaw. Portsmouth — Herbert  M.  Keil.  Salem — R.  E.  Smucker. 
West  Lafayette — M.  T.  Morehead.  West  Union — Ray  Vaugh- 
en.  Willard — J.  C.  Steiner.  Wilmington — Robert  Conrad. 
Woodsfield — H.  P.  Gillespie.  Wooster — Philip  C.  McDowell, 
Alonzo  C.  Smith,  H.  A.  Wildman..  Xenia — Ben  R.  McClellan, 
H.  C.  Messenger.  Youngstown — Edgar  C.  Baker,  Edward  C. 
Goldcamp,  Gabriel  Kramer,  John  S.  Lewis,  Henry  Eugene 
McClenahan,  Ralph  R.  Morrall,  Dean  Nesbit,  O.  J.  Walker. 


The  Leslie  Dana  Gold  Medal,  awarded  annu- 
ally by  the  National  Society  for  the  Prevention 
of  Blindness  for  the  most  outstanding  achieve- 
ments in  the  prevention  of  blindness  and  the  con- 
servation of  vision,  has  been  presented  to  Dr. 
William  H.  Luedde,  director  of  the  department  of 
ophthalmology,  St.  Louis  University  School  of 
Medicine. 


Record-Making  Legislative  Session  Contes 
to  an  End 

Regular  session  of  the  90th  Ohio  General  As- 
sembly was  officially  closed  on  July  10  with  sine 
die  adjournment,  ending  one  of  the  most  strenu- 
ous and  momentous  gatherings  of  the  State  Leg- 
islature held  in  many  years. 

As  the  legislators  left  Columbus  for  their 
homes,  there  were  predictions  from  both  official 
and  non-official  sources  that  the  General  Assembly 
would  be  back  in  special  session  by  Fall  to  con- 
tinue its  deliberations  on  some  of  the  critical  eco- 
nomic questions  which  had  made  its  six-months 
regular  session  one  of  the  most  turbulent  in  Ohio’s 
history. 

Before  adjourning,  the  Legislature  passed  the 
biennial  budget  bill  appropriating  in  excess  of 
$80,000,000  for  the  expenses  of  the  state  govern- 
ment, not  including  funds  for  poor  relief  and 
schools.  The  appropriations  bill,  as  finally 
enacted,  included  a provision  for  $300,000  to  be 
distributed  by  the  State  Department  of  Health  to 
local  health  districts  in  need  of  financial  assistance 
and  which  would  be  seriously  crippled,  or  even  de- 
stroyed, unless  assisted  financially  by  the  state. 

Funds  for  poor  relief  and  schools  were  provided 
in  a “stop-gap”  taxation  program,  enacted  in  the 
closing  days  of  the  session  and  which  was  the 
center  of  much  controversy.  The  Governor’s  pro- 
gram for  a 2 per  cent  general  sales  tax  and  a state 
income  tax  was  discarded  and  the  General  As- 
sembly finally  agreed  on  a taxation  program,  esti- 
mated to  raise  $30,000,000,  which  included  a one 
cent  per  gallon  sales  tax  without  exemptions  in 
gasoline,  kerosene  and  other  liquid  fuels;  enact- 
ment of  the  2 cent  cigaret  tax;  a tax  on  vending 
and  slot  machines;  a 10  per  cent  tax  on  amuse- 
ment admissions  of  more  than  40  cents;  a 2 cent 
cap  tax  on  bottled  beer,  and  a 10  per  cent  tax  on 
cosmetics. 

Since  the  deadline  on  consideration  of  general 
legislation  was  three  weeks  before  adjournment 
(see  July  Journal,  pages  447-450),  few  measures 
having  a bearing  on  medical  practice  and  public 
health,  except  the  appropriations  bill,  were  con- 
sidered in  the  final  days  of  the  session. 

A final  analysis  of  the  legislative  session  is  now 
being  prepared  by  the  Committee  on  Public  Pol- 
icy of  the  State  Association  and  will  be  published 
in  the  September  issue  of  The  Journal,  along  with 
the  annual  reports  of  the  other  standing  and 
special  committees. 

All  members  of  the  State  Association  should 
make  it  a point  to  read  the  forthcoming  report  of 
the  Policy  Committee  carefully  in  order  that  they 
may  obtain  an  accurate  and  complete  picture  of 
the  history-making  record  which  the  90th  General 
Assembly  established. 


Findlay — Dr.  Walter  F.  Galbreath,  until  re- 
cently resident  physician  at  the  Lucas  County 
Hospital,  has  opened  offices  here. 


Federal  Laws  and  Regulations  on  Medicinal  Liquor  Now 
Apply  in  Ohio  * * $ Attorney  General  Holds  Ohio 
Law  Removed  Quantitative  Limitation 


Medicinal  liquor  may  be  prescribed  by  Ohio 
physicians  in  conformity  with  the  provisions  of 
the  Federal  Act  approved  March  31,  1933,  and 
Federal  regulations  which  became  effective  May 
15,  1933,  both  of  which  remove  specific  quantity 
limitation  upon  the  amount  of  liquor  which  may 
be  prescribed  at  any  one  time  and  permit  the  pre- 
scribing physician  to  designate  any  amount  which 
in  his  opinion  is  required  to  meet  the  medicinal 
needs  of  the  patient. 

Confusion  over  the  status  of  the  medicinal 
liquor  question  in  Ohio  was  l’emoved  on  June  26 
when  Attorney  General  John  W.  Bricker  handed 
down  an  opinion  holding  that  the  Smolka-Mc- 
Namee  Act,  enacted  by  the  90th  General  Assembly 
and  effective  June  14,  1933,  brought  the  Ohio 
statutes  relative  to  the  prescribing  of  medicinal 
liquor  into  conformity  with  the  new  Federal 
statutes  and  regulations. 

As  pointed  out  in  previous  issues  of  The  Jour- 
nal, the  Smolka-McNamee  Act,  enacted  March  9 
by  the  General  Assembly  and  signed  by  the  Gover- 
nor on  March  15,  eliminated  the  one-half  pint 
limitation  on  the  amount  of  medicinal  liquor 
which  could  be  prescribed  in  Ohio  and  provided 
that  medicinal  liquor  might  be  prescribed  in  an 
amount  “now  permitted  by  federal  statutes  and 
regulations”.  The  Federal  law  at  that  time 
placed  a one-pint  limitation  on  the  quantity  that 
could  be  prescribed. 

However,  on  March  31  Congress  eliminated 
from  the  Federal  law  any  reference  to  quantity 
limitation  and  on  May  15  new  Federal  rules  and 
regulations  governing  medicinal  liquor  were  put 
into  effect  in  conformity  with  the  provisions  of 
the  Federal  act  of  March  31. 

Immediately  considerable  controversy  arose  as 
to  whether  after  June  14,  when  the  Smolka-Mc- 
Namee Act  went  into  effect,  the  Ohio  law  would 
limit  to  one  pint  the  amount  of  medicinal  liquor 
which  could  be  prescribed  to  any  one  person  in 
any  period  of  10  days  or  whether  the  Ohio  law 
would  be  in  conformity  with  the  new  Federal 
statute  and  regulations  which  removed  any 
specific  quantity  limitation. 

In  order  to  clear  up  this  point,  a bill  was  in- 
troduced into  the  General  Assembly  on  May  25, 
1933,  amending  the  previously  enacted  Smolka- 
McNamee  Act  in  such  a way  that  all  doubt  on  the 
matter  would  be  dispelled.  This  second  measure 
on  the  question  was  passed  by  the  Senate  and 
was  reported  out  of  committee  in  the  House. 
However,  it  was  caught  in  the  legislative  jam  in 
the  closing  hours  before  the  deadline  on  the  con- 
sideration of  general  legislation  and  failed  to  get 


on  the  preferred  calendar  for  consideration  by  the 
House. 

With  the  exact  status  of  the  medicinal  liquor 
situation  in  Ohio  uncertain  for  more  than  a month 
after  the  new  Federal  regulations  became  ef- 
fective, R.  E.  Joyce,  Cincinnati,  Federal  super- 
visor of  permits  for  the  district  which  includes 
Ohio,  asked  Attorney  General  Bricker  for  an 
opinion  to  clarify  the  provisions  of  the  Smolka- 
McNamee  Act  so  that  he  might  know  how  to  pro- 
ceed in  issuing  liquor  permits  in  Ohio. 

On  June  26,  Mr.  Bricker  rendered  the  opinion 
referred  to  previously,  in  which  he  held  that  the 
words  “now  permitted  by  federal  statutes  and 
regulations”  in  the  Smolka-McNamee  Act  refer 
to  Federal  statutes  and  regulations  in  force  at  the 
time  such  act  becomes  effective  (90  days  after 
the  act  is  filed  with  the  Secretary  of  State)  and 
not  at  the  time  the  bill  was  enacted  by  the  Legis- 
lature. 

The  attorney  general  stated  that  he  found  no 
justification  for  departing  from  the  well-estab- 
lished principle  of  law  that  a statute  speaks  as 
of  the  date  it  becomes  effective  in  the  absence  of 
any  language  clearly  disclosing  a contrary  intent 
and  cited  decisions  laid  down  by  the  higher  courts 
of  eight  states,  including  Ohio,  to  support  his 
contention. 

Pursuant  to  the  issuance  of  this  opinion  by 
Attorney  General  Bricker,  Supervisor  Joyce  under 
date  of  June  28  issued  a form  letter  to  all  Ohio 
holders  of  permits  to  prescribe  medicinal  liquor, 
officially  notifying  them  that  after  that  date 
medicinal  liquor  could  be  prescribed  in  Ohio  in 
accordance  with  the  new  Federal  law  and  regu- 
lations. 

The  new  Federal  regulations  governing  the  pre- 
scribing of  medicinal  liquor  and  which  now  apply 
to  Ohio  physicians  are  in  part  as  follows: 
GENERAL  PROVISIONS 

Section  1.  These  regulations  shall  take  effect  and  be  in 
force  on  and  after  May  15,  1933. 

Section  2.  Such  provisions  of  Regulations  2,  Bureau  of 
Industrial  Alcohol,  approved  March  24,  1931,  as  relate  to  the 
manufacture  of  and  traffic  in  intoxicating  liquor  for  medici- 
nal purposes,  including  Article  16  and  17  thereof,  shall  be 
deemed  to  be  a part  of  these  regulations,  except  wherein 
such  provisions  are  in  direct  conflict  with  these  regulations. 

KINDS  OF  LIQUOR  THAT  MAY  BE  PRESCRIBED 

Section  3.  Only  spiritous  and  vinous  liquor  may  be  pre- 
scribed for  medicinal  purposes.  The  term  “spiritous  liquor” 
shall  be  construed  to  mean  alcohol,  whisky,  brandy,  rum,  gin, 
and  such  like  liquor  produced  by  distillation.  The  term 
“vinous  liquor”  shall  be  construed  as  wine  containing  more 
than  3.2  per  centum  of  alcohol  by  weight,  including  the 
fermented  juice  of  the  grape  and  of  such  berries  as  are 
commonly  used  in  the  production  of  wine. 

(Note — Vinous  and  malt  liquors,  and  fruit  juices  con- 
taining not  exceeding  3.2  per  centum  of  alcohol  by  weight 
do  not  come  within  the  purview  of  the  National  Prohibition 
Act,  as  amended.) 

Section  4.  Prescriptions  for  any  liquor  other  than 
spiritous  and  vinous  liquor  for  medicinal  purposes  shall  be 
void  The  following  preparations  listed  in  the  United  States 
Pharmacopeia  and  National  Formulary  classed  as  fit  for 
beverage  purposes  are  held  to  be  spiritous  liquors  and  must 


514 


August,  1933 


State  News 


515 


be  prescribed  in  the  same  manner  and  under  the  same  con- 
ditions as  spiritous  liquors : 

Elixir  aromaticum  (alixir  aromatic) 

Elixir  anisi  (alixir  of  anis) 

Elixir  aromaticum  rubrum  (red  aromatic  elixir) 

Elixir  aurantii  amari  (elixir  of  bitter  orange) 

Elixir  cardamoni  compositum  (compound  elixir  of  car- 
damon) 

Elixir  glycyrrhizae  (elixir  of  licorice) 

Elixir  glycyrrhizae  aromaticum  (aromatic  elixir  of 
glycyrrhiza) 

Elixir  taraxaci  compositum  (compound  elixir  taraxacum) 
Elixir  terpini  hydratis  (elixir  of  terpin  hydrate) 
Spiritus  aetheris  (spirit  of  ether  or  Hoffmann’s  drops) 
Spiritus  myrciae  compositus  (compound  spirits  of  myrcia) 
Tinctura  amara  (bitter  tincture) 

Tinctura  aromatica  (aromatic  tincture) 

Tinctura  aurantii  dulcis  (tincture  of  sweet  orange  peel) 
Tinctura  limonis  corticis  (tincture  of  lemon  peel) 
Tinctura  zingiberis  (tincture  of  ginger) 

Section  5.  Nothing  in  these  regulations  shall  be  con- 
strued as  authorizing  the  prescribing  by  physicians  of  any 
liquor,  or  compounds  thereof,  including  spiritous  and  vinous 
liquors,  in  any  manner  or  in  any  quantity  in  any  state  or 
territory  the  laws  of  which  prohibit  such  prescribing. 

QUANTITIES  OF  LIQUOR  THAT  MAY  BE  PRESCRIBED 
Section  6.  A physician  shall  not  prescribe  for  a patient 
at  any  one  time  a quantity  of  spiritous  or  vinous  liquor  in 
excess  of  what  he  in  good  faith  believes  is  required  to  meet 
the  medicinal  needs  of  the  patient  as  shown  by  the  patient’s 
condition  at  the  time  of  prescribing. 

Section  7.  No  prescription  shall  be  issued  for  a quantity 
that  in  the  judgment  of  the  physician  will  last,  when  used 
as  prescribed,  more  than  thirty  days ; except  that  if  a 
patient’s  medicinal  needs  will  with  reasonable  certainty  con- 
tinue for  a period  longer  than  thirty  days,  a physician  may 
prescribe  for  that  patient  at  one  time  a quantity  of  spiritous 
or  ■'vinous  liquor  sufficient  to  meet  such  needs,  in  which  case 
the  physician  shall  endorse  on  the  prescription  the  word 
“special”  and  within  twenty-four  hours  after  its  issue  shall 
notify  the  Supervisor  of  Permits  in  writing  of  the  issuance 
thereof,  giving  all  the  information  required  to  be  written  on 
prescriptions  by  Section  11,  without  disclosing  the  nature 
of  the  patient’s  ailment.  In  no  case  shall  a physician  issue 
a prescription  for  a quantity  of  spiritous  or  vinous  liquor  in 
excess  of  that  required  to  meet  the  medicinal  needs  of  his 
patient  for  a period  of  ninety  days. 

Section  8.  No  person  shall  by  any  statement  or  repre- 
sentation that  he  knows  is  false,  or  could  by  reasonable 
diligence  ascertain  to  be  false,  induce  any  physician  to  pre- 
scribe liquor  for  medicinal  use  ( 1 ) when  there  is  no  medi- 
cinal need  for  such  liquor  or  (2)  in  excess  of  the  amount  of 
medicinal  liquor  needed. 

ISSUANCE  OF  PRESCRIPTIONS 
Section  9.  Only  a physician  holding  a permit  to  prescribe 
liquor  may  issue  a prescription  therefor.  No  physician  shall 
prescribe  liquor  unless  after  a careful  physical  examination 
of  the  person  for  whose  use  such  prescription  is  sought,  or 
if  such  examination  is  found  impracticable,  then  upon  the 
best  information  obtainable,  he  in  good  faith  believes  that 
the  use  of  spiritous  or  vinous  liquor  as  a medicine  by  such 
person  is  necessary  and  will  afford  relief  to  him  from  some 
known  ailment.  It  is  suggested  that  in  determining  the 
quantity  to  be  prescribed,  the  physician  inquire  of  the 
patient  concerning  the  quantity  of  liquor,  if  any,  recently 
prescribed  for  the  patient  by  other  physicians. 

THE  FORM  OF  THE  PRESCRIPTION  BLANK 
AUTHORIZED  FOR  USE 

Section  10.  Until  such  time,  not  earlier  than  January  1, 
1934,  as  the  stamps  mentioned  in  Section  2 of  the  Act  of 
March  31,  1933,  are  printed  and  furnished  to  physicians,  all 
duly  qualified  physicians  holding  permits  and  authorized  to 
prescribe  liquor  will  be  furnished  a sufficient  number  of 
prescription  blanks.  Form  1403,  in  serially  numbered  books 
of  10  original  and  100  duplicate  blanks  each,  to  meet  their 
requirements.  These  blanks  may  be  procured  free  of  cost 
by  the  physician  from  the  Supervisor  of  Permits. 

Section  11.  The  physician  may  issue  prescriptions,  as 
herein  provided,  using  each  blank  in  the  book,  those  on  which 
the  word  “Duplicate”  is  printed  as  well  as  those  marked 
“Original,”  as  an  original  prescription.  This  will  enable  the 
physician  to  write  200  original  prescriptions  from  each  such 
book  of  blanks.  Attached  stubs  must  be  filled  in  by  the 
physician  at  time  the  prescription  is  written.  Such  stubs 
shall  be  immediately  forwarded  by  the  physician  to  the 
Supervisor  of  Permits  when  the  prescription  blanks  have  been 
exhausted.  The  physician  shall  write  on  each  prescription, 
including  emergency  prescriptions  under  Section  12,  the  kind 
of  liquor  prescribed,  the  quantity  of  liquor  prescribed,  the 
frequency  of  dose,  the  period  of  time  for  which  prescribed, 
the  full  name  of  the  patient,  the  date  prescribed,  the  patient’s 
address,  the  physician’s  signature  and  his  permit  number 
and  address.  The  issuance  in  duplicate  of  prescriptions  on 
Form  1403  shall  be  discontinued. 

Section  12.  In  case  of  loss,  theft  or  other  condition  neces- 
sitating the  use  of  a blank  form  of  prescription  other  than 
Form  1403,  the  physician  may  write  an  emergency  prescrip- 
tion on  an  unofficial  blank.  When  writing  such  a prescrip- 
tion, the  physician  shall  endorse  thereon  the  word  “emerg- 


ency,” together  with  the  other  data  required  by  these 
regulations.  (See  Sections  7 and  11.)  Such  emergency 
prescription  must  be  written  in  duplicate,  the  duplicate  being 
in  lieu  of  the  stub  record  of  the  prescription  that  would 
have  been  written  on  Form  1403.  Such  duplicate  emergency 
prescription  must  be  immediately  forwarded  by  the  physician 
to  the  Supervisor  of  Permits. 

Section  13.  Before  completely  exhausting  the  prescription 
Forms  1403  in  the  book  on  hand,  the  physician  may  apply 
to  the  Supervisor  of  Permits  for  a new  book.  The  cover 
on  the  back  of  the  prescription  book  must  be  detached  and 
used  in  applying  for  a new  book  of  Form  1403  prescription 
blanks. 

Section  14.  All  printed  instructions  and  notices  appear- 
ing on  the  cover  of  the  prescription  book  and  on  the  reverse 
sides  of  all  prescription  blanks,  Form  1403,  may  be  ignored 
wherever  in  conflict  with  these  regulations. 

RECORDS  TO  BE  KEPT  BY  THE  PHYSICIAN 

Section  15.  A record  shall  be  kept  by  every  physician 
who  issues  a prescription  for  spirituous  or  vinous  liquor,  in 
a bound  book  alphabetically  arranged  according  to  surnames 
of  patients,  showing  the  date  of  issue,  the  amount  of  spiritu- 
ous or  vinous  liquor  prescribed,  to  whom  prescribed,  the 
period  for  which  prescribed,  the  purpose  or  ailment  for 
which  it  is  to  be  used,  and  directions  for  use,  stating  the 
amount  and  frequency  of  the  dose.  The  record  book  herein 
required  to  be  kept  shall  be  produced  by  the  physician 
through  commercial  channels,  and  will  not  be  printed  or 
furnished  by  the  Government. 

Section  16.  No  physician  shall  be  called  upon  to  file 
any  statement  of  the  ailment  for  which  spirituous  or  vinous 
liquor  is  prescribed,  in  the  Department  of  Justice  or  Depart- 
ment of  the  Treasury,  or  any  other  office  of  the  Government, 
or  to  keep  his  records  in  such  a way  as  to  lead  to  the  dis- 
closure of  any  such  ailment  except  when  lawfully  required 
in  the  following  manner:  Where  disclosure  of  the  ailment 

may  be  required  in  any  court  of  equity  reviewing  the  action 
of  the  Commissioner  or  the  Supervisor  of  Permits,  of  the 
Bureau  of  Industrial  Alcohol,  in  the  revocation  of  a physi- 
cian’s permit ; or  where  disclosure  as  to  the  ailment  of  the 
patient  is  required  by  any  duly  qualified  person  engaged  in 
the  execution  or  enforcement  of  the  National  Prohibition 
Act,  or  any  Act  supplementary  thereto  ; but  no  such  person 
shall  require  the  physician  to  disclose  the  ailment  except 
where  he  shall  first  obtain  written  specific  authorization  so 
to  do  from  his  superior  officer. 


PRESCRIPTIONS,  BY  WHOM  FILLED  ; CANCELING, 
FILING,  AND  REPORTS 

Section  17.  A pharmacist  employed  by  any  person  other 
than  a retail  druggist  may  not  fill  a prescription  for  spiritu- 
ous or  vinous  liquor.  A prescription  for  spirituous  or  vin- 
ous liquor  written  in  accordance  with  these  regulations  may 
not  be  filled  after  midnight  of  the  seventh  day  following 
the  date  of  its  issuance.  A pharmacist  filling  a prescription 
for  spirituous  or  vinous  liquor  shall  at  the  time  endorse 
upon  said  prescription  over  his  own  signature  in  ink  or  in- 
delible pencil  the  word  “Canceled”  together  with  the  date 
when  the  liquor  is  delivered.  The  canceled  prescriptions 
must  be  kept  in  a separate  file  as  a permanent  record  avail- 
able for  inspection  by  properly  qualified  officers  of  the 
Bureau  of  Industrial  Alcohol,  or  the  Bureau  of  Prohibition 
at  any  reasonable  hour.  No  such  prescription  shall  be  re- 


illed. 

Section  18.  A retail  druggist,  holding  a permit  authoriz- 
ng  the  sale  and  dispensing  of  spirituous  or  vinous  liquor 
>n  physicians’  prescriptions  through  a pharmacist  named  in 
iis  permit  is  required  to  prepare  each  month  a report,  in 
luplieate,  on  Form  1421,  giving  all  the  information  called 
’or  on  such  form,  and  in  addition  thereto,  he  must  indicate 
>n  line  21  of  the  report  form  the  total  number  of  all  pre- 
icriptions  filled  for  spirituous  and  vinous  liquor;  and,  in 
iddition  as  item  21a,  only  the  number  of  prescriptions  which 
le  has  filled  for  spirituous  liquor  in  excess  of  one  quart  and 
he  number  of  prescriptions  which  he  has  filled  for  vinous 
iquor  in  excess  of  one  gallon.  He  shah  forward  one  copy 
►f  this  report  to  the  Supervisor  of  Permits  on  or  before  the 
enth  day  of  the  month  succeeding  the  month  for  which 
he  report  is  prepared,  and  shall  retain  the  other  copy 
is  a permanent  record.  . — 

Section  19.  In  addition  to  the  report  required  in  Section 
.8  the  druggist  shall  notify  in  writing  the  Supervisor  of 
Arndts  within  twenty-four  hours  of  the  filling  of  each 
description  which  calls  for  a quantity  in  excess  of  that 
described  for  a period  of  more  than  thirty  days,  stating 
he  name  and  address  of  the  patient,  the  name  and  Permit 
lumber  of  the  physician,  the  kind  and  quantity  prescribed, 
he  period  of  time  for  which  prescribed,  and  the  name, 
iddress,  and  permit  number  of  the  retail  druggist. 

Section  20.  Liquor  lawfully  obtained  on  prescription  and 
doperly  labeled  may  be  possessed  and  transported  by  the 
lerson  for  whom  prescribed,  by  another  member  of  the 
latient’s  household  (including  a nurse  or  servant)  for  ad- 
niinstering  to  the  patient,  by  the  druggist  filling  the  pre- 
cription  or  his  regular  employee,  or  by  the  physician  who 
ibp  nrescription . 


Dr.  J.  H.  Norris  has  been  named  chief  of 

staff  of  the  Fostoria  City  Hospital.  Dr.  H.  E. 
Fruth  was  re-elected  secretary. 


Problems  of  ^'Kelief^  to  the  Indigent  and  Unemployed 
Including  Local  Phases  of  Medical  Care 


Financing  of  medical  care  for  the  unemployed 
and  indigent  continues  to  be  a serious  problem 
in  many  parts  of  Ohio  and  one  in  which  physi- 
cians in  practically  every  community  are  virtually 
concerned. 

Recent  reports  from  several  sections  of  the 
state  indicate  that  inadequate  funds  have  been 
provided  to  meet  the  costs  of  necessary  medical 
service  to  the  poor  and  temporarily  destitute. 

Physicians  in  some  cities  and  counties  are  not 
being  paid  even  nominal  amounts  for  services 
rendered  to  city,  township  and  county  charges, 
adding  greatly  to  the  charity  load  which  all 
physicians  carry,  even  in  normal  times. 

Conferences  held  recently  by  officers  of  the 
Ohio  State  Medical  Association  and  representa- 
tives of  the  State  Relief  Commission  in  Colum- 
bus, directing  agency  for  relief  activities  through- 
out the  state,  reveal  that  with  one  or  two  excep- 
tions, every  community  in  Ohio  has,  or  is  able  to 
obtain,  sufficient  funds  to  compensate  physicians 
for  services  to  the  unemployed  and  indigent  if 
proper  steps  are  taken  by  the  local  public  officials 
in  charge  of  poor  relief  activities. 

As  pointed  out  in  the  April,  1933,  issue  of  The 
Journal,  Pages  257-258,  political  subdivisions 
should  have  little  difficulty  finding  money  to  pay 
physicians  for  services  to  indigents  if  local  offi- 
cials make  use  of  funds  available  under  existing 
emergency  relief  statutes. 

POUR  SOURCES  FOR  LOCAL  FUNDS 

Four  avenues  of  revenue  for  medical  relief 
activities  are  open  to  city,  township  and  county 
officials,  namely:  (1)  That  part  of  the  general 
revenue  fund  of  the  subdivision  set  aside  for  poor 
relief  work;  (2)  issuance  of  special  poor  relief 
bonds;  (3)  the  excise  tax  on  public  utilities;  (4) 
diversion  of  the  subdivision’s  portion  of  the  gaso- 
line tax.  In  addition  many  communities  have 
funds  available  from  Community  Chests,  etc. 

Some  confusion  and  misunderstandings  have 
arisen  relative  to  the  use  of  Federal  and  state 
relief  funds,  especially  as  to  whether  such  funds 
may  be  used  for  medical  relief. 

Under  the  provisions  of  the  Emergency  Relief 
and  Construction  Act  of  1932,  the  Federal  funds 
made  available  to  states  for  distribution  to  the 
various  subdivisions  could  be  used  only  for  “work 
relief”  and  “direct  relief”. 

This  phraseology  was  interpreted  by  Federal 
and  state  authorities  to  mean  that  no  Federal 
funds  could  be  used  for  financing  medical  care 
to  indigents  but  must  be  used  to  furnish  food, 
clothing,  fuel  and  shelter,  or  provide  work  for 
the  poor. 

As  a result  of  this  interpretation,  no  Federal 
funds  made  available  to  Ohio  were  used  to  pay 


physicians.  The  same  procedure  was  followed  in 
distribution  of  state  funds  to  the  various  sub- 
divisions of  Ohio. 

NEW  FEDERAL  ACT  BROADER  IN  SCOPE 

On  May  12,  the  Federal  Emergency  Relief  Act 
of  1933  became  effective,  amending  various  pro- 
visions of  the  1932  Act.  The  new  act  authorizes 
grants  to  states  “to  aid  in  meeting  the  costs  of 
furnishing  relief  and  work  relief  and  in  relieving 
the  hardship  and  suffering  caused  by  unemploy- 
ment in  the  form  of  money,  service,  materials, 
and/or  commodities  to  provide  the  necessities  of 
life  to  persons  in  need  as  a result  of  the  present 
emergency,  and/or  to  their  dependents,  whether 
resident,  transient  or  homeless”. 

The  Federal  Act  of  1933  provides  for  a fund 
of  $500,000,000  to  be  apportioned  among  the  var- 
ious states.  One  half  of  this  amount  ($250,000,- 
000)  is  to  be  distributed  on  the  basis  of  $1  of 
Federal  money  for  every  $3  expended  by  a state 
and  its  political  subdivisions  out  of  public  moneys 
from  all  sources  for  relief  purposes  during  the 
preceding  quarter  of  the  year.  The  remaining 
$250,000,000  is  available  for  distribution  to  the 
various  states  in  which  the  combined  sources  of 
money  available  for  relief  fall  below  the  esti- 
mated needs  of  the  individual  state.  No  state 
may  obtain  more  than  15  per  cent  of  the  $500,- 
000,000  provided  for  in  the  Act. 

Ohio  at  the  present  time  is  in  an  unfavorable 
position  with  regard  to  obtaining  Federal  assist- 
ance for  relief  work  due  to  the  failure  of  the  state 
to  raise  what  the  Federal  Relief  Administrator 
considers  sufficient  relief  money  from  state  and 
local  sources. 

MORE  STATE  FUNDS  NEEDED 

At  the  beginning  of  the  year,  the  state  com- 
mitted itself  to  raise  about  $12,000,000,  exclusive 
of  local  funds,  for  relief  work.  By  doing  so  it  was 
anticipated  that  an  additional  $12,000,000  could 
be  obtained  from  the  Federal  Government  in 
matched  money  and  outright  grants.  This  $24,- 
000,000,  plus  funds  raised  by  local  subdivisions,  it 
was  believed,  would  provide  sufficient  money  to 
meet  the  relief  needs  of  the  state  during  1933. 

However,  up  to  the  middle  of  July,  the  state 
had  provided  means  of  raising  but  approximately 
$5,000,000  of  the  $12,000,000  to  which  the  state 
committed  itself,  the  State  Relief  Commission 
estimated,  leaving  about  $7,000,000  which  must 
be  raised  by  the  state  before  it  can  obtain  ad- 
ditional Federal  funds. 

Recent  conferences  between  state  and  Federal 
relief  officials  revealed  that  Federal  authorities 
are  unwilling  to  help  Ohio,  beyond  matching  funds, 
until  the  state  takes  more  adequate  steps  to  take 
care  of  its  own  needs. 


516 


August,  1933 


State  News 


517 


The  Ohio  Relief  Commission  has  announced  that 
the  state’s  relief  fund  will  be  exhausted  by 
August  15.  What  steps  will  be  taken  to  meet  this 
situation  are  now  uncertain  but  it  is  reported 
that  the  Governor  is  seriously  contemplating 
calling  the  Legislature  into  special  session  to  con- 
sider the  enactment  of  additional  revenue-pro- 
ducing measures  to  provide  the  state  with  more 
relief  moneys,  and,  therefore,  improve  its  chance 
of  obtaining  additional  Federal  aid. 

While  the  State  Relief  Commission  anticipates 
that  the  state  will  eventually  be  in  a position  to 
obtain  more  Federal  funds,  it  is  doubtful  that 
much,  if  any,  of  the  Federal  moneys  will  be  au- 
thorized for  use  locally  to  finance  medical  relief 
to  the  indigent  at  least  for  the  present. 

RESPONSIBILITY  OF  LOCAL  COMMUNITIES 

The  State  Relief  Commission  points  out  that  it 
is  unwilling  to  authorize  the  use  of  Federal  funds 
for  medical  relief  in  any  political  subdivision 
where  local  funds  are  available  or  can  be  raised 
for  such  purpose.  It  was  pointed  out  by  the  Com- 
mission that  the  fui’nishing  of  medical  care  for 
the  indigent  is  an  obligation  and  function  of  town- 
ships, counties  and  cities  at  all  times,  even  in 
normal  periods,  and  that  adequate  local  provision 
must  be  made  first  for  poor  relief  of  this  nature. 
The  Commission  is  fearful  if  it  authorized  the 
use  of  Federal  or  state  funds  for  all  activities 
coming  under  the  general  heading  of  poor  relief, 
that  many  communities  would  depend  entirely  on 
Federal  or  state  money  for  their  poor  relief  work 
and  use  local  funds,  which  should  be  used  for  such 
functions,  for  unnecessary  activities  or  to  meet 
general  operating  expenses  which  should  be  cur- 
tailed at  this  time. 

Moreover,  the  Commission  is  of  the  opinion 
that  more  effective  use  will  be  made  of  funds 
raised  locally  through  some  sacrifice  on  the  part 
of  local  governments,  than  of  funds  received  from 
the  Federal  or  state  government,  which  may  be 
accepted  under  the  misapprehension  that  they  are 
a “gift”  and  will  not  have  to  be  paid  back. 

In  addition,  it  is  pointed  out  that  local  com- 
munities should  not  be  encouraged  to  forego  their 
responsibilities  in  providing  funds  for  poor  relief 
work  which  is  necessary  at  all  times  for  the 
reason  that  after  the  present  emergency  they 
might  be  inclined  to  consider  this  a permanent 
responsibility  of  the  state  or  Federal  govern- 
ments. 

DETERMINED  DOCTORS  SHALL  BE  PAID 

However,  the  Commission  is  sympathetic  with 
the  serious  situation  confronting  the  medical  pro- 
fession and  is  agreed  that  physicians  should  re- 
ceive just  compensation  for  services  to  the  in- 
digent. 

In  communities  where  local  funds  are  not  avail- 
able to  finance  medical  relief,  the  Commission  has 
indicated  it  may  later  authorize  the  use  of  Fed- 
eral or  state  funds  for  such  purposes.  In  order  to 


obtain  such  authorization,  however,  the  sub- 
division must  submit  to  the  Commission  a com- 
prehensive financial  report,  showing  that  local 
funds  have  been  exhausted,  additional  local  funds 
are  not  available,  and  for  what  purposes  the  Fed- 
eral and  state  funds  are  to  be  used. 

As  a matter  of  fact,  the  State  Relief  Commis- 
sion is  constantly  checking  and  re-checking  the 
relief  activities  of  all  subdivisions.  Those  which 
have  not  made  full  use  of  their  authority  to  pro- 
vide local  funds  for  poor  relief  are  expected  to  do 
so.  Local  officials  are  advised  by  the  Commission 
as  to  how  they  can  make  transfers  of  various 
local  funds  to  provide  additional  revenue  for  re- 
lief work.  An  effort  is  made  by  the  Commission 
to  see  that  adequate  provision  from  local  funds  is 
made  for  regular  poor  relief  activities,  including 
medical  service,  before  other  activities  for  tem- 
porary and  emergency  relief  are  undertaken  and 
ways  of  financing  them  proposed. 

As  pointed  out  by  the  Commission,  the  question 
of  providing  adequate  money  for  medical  relief  is 
largely  a local  one.  The  Commission  has  sug- 
gested that  county  medical  societies  confe,r  with 
local  officials  in  charge  of  poor  relief  activities  and 
attempt  to  work  out  with  them  a satisfactory  pro- 
gram for  handling  the  question  of  financing  medi- 
cal service  to  indigents. 

That  the  Federal  government  takes  the  same 
view  as  the  State  Relief  Commission  relative  to 
local  initiative  and  responsibility  in  meeting  the 
poor  relief  problem  is  indicated  in  a recent  dis- 
cussion of  the  relief  question  by  Langdon  W. 
Post,  assistant  Federal  emergency  relief  ad- 
ministrator. 

FEDERAL  ADMINISTRATOR’S  VIEW 

In  answer  to  several  questions  relative  to  the 
responsibilities  of  local,  state  and  Federal  govern- 
mental units  in  relief  work,  Mr.  Post  said: 

“The  local  relief  agencies  are  expected  to  pay 
the  first  share  of  the  cost  of  unemployment  relief 
in  their  own  communities.  It  is  their  duty,  under 
the . supervision  of  their  state  emergency  relief 
administrators,  to  make  the  major  part  of  the 
expenditures  and  apportion  the  money  provided. 
***  The  local  community  is  expected  to  supply  a 
fair  proportion  of  the  total  expenditures.  After 
the  local  community  has  contributed,  if  there  is  a 
need  for  additional  money,  the  State  should  pro- 
vide funds  for  relief  purposes.  If  there  is  still 
need  for  additional  expenditures  after  the  state 
funds  are  utilized,  the  state  may  apply  to  the 
Federal  Emergency  Relief  Administrator.” 

The  Ohio  Relief  Commission,  as  pointed  out 
previously,  is  anxious  to  assist  the  medical  pro- 
fession in  every  way  it  can  through  its  control 
over  local  relief  activities.  If  informed  of  in- 
stances where  local  officials  are  uncooperative 
with  the  medical  society  and  are  unwilling  to  pro- 
vide funds  for  medical  relief,  the  Commission  has 
indicated  that  it  will  make  a check  of  such  com- 


518 


The  Ohio  State  Medical  Journal 


August,  1933 


plaints  and  take  steps  when  possible  to  relieve 
such  situations. 

There  is  no  desire  on  its  part,  the  Commission 
has  stated,  to  let  the  medical  profession  “hold  the 
bag”  and  it  will  continue  to  insist  that  adequate 
provision  for  medical  care  to  the  poor  be  made  in 
every  community.  It  solicits  the  assistance  of 
physicians  in  the  matter  and  indicates  that  it  will 
willingly  cooperate  with  the  profession  in  bring- 
ing to  the  attention  of  public  officials  their  legal 
and  moral  obligation  in  seeing  that  physicians  re- 


ceive just  compensation  for  their  part  in  meeting 
the  present  emergency. 

All  physicians  should  keep  themselves  fully  in- 
formed on  the  statutory  provisions  for  local  medi- 
cal service  to  the  poor  so  that  they  can  confer  in- 
telligently with  local  officials  in  charge  of  relief 
work.  Statutes  and  regulations  for  local  medical 
relief  were  construed  and  quoted  at  some  length 
in  the  March,  1932,  issue  of  The  Journal,  pages 
203  to  207. 


Licenses  to  Practice  Medicine  and  Surgery  in  Ohio  Issued  to 
237  At  July  Meeting  of  State  Medical  Board 


At  the  regular  summer  meeting  of  the  State 
Medical  Board  in  Columbus,  July  11,  licenses  to 
practice  medicine  and  surgery  in  Ohio  were  issued 
to  237  medical  school  graduates. 

In  addition  the  Board  issued  certificates  en- 
titling them  to  practice  their  special  branches,  to 
eight  osteopaths,  five  chiropractors,  five  mechano- 
therapists,  one  cosmetictherapist,  seven  masseurs, 
and  57  chiropodists. 

After  consideration  of  evidence  submitted  and 
testimony  taken  at  previous  hearings,  the  Board 
revoked  the  license  to  practice  medicine  and  sur- 
gery in  Ohio  of  A.  C.  Christopher,  Cincinnati,  on 
charges  of  grossly  unprofessional  and  dishonest 
conduct.  The  charges  were  based  on  advertising 
done  by  Dr.  Christopher  in  connection  with  the 
operation  of  the  Cincinnati  Facial  Studio. 

First  place  in  the  examinations  conducted  by 
the  Board  in  June  was  taken  by  L.  C.  Gerlinger, 
graduate  of  the  College  of  Medicine,  Ohio  State 
University,  who  had  a point  average  of  89.2. 
Second  place  was  won  by  Richard  Hotz,  of  Medi- 
cine, University  of  Cincinnati,  with  an  average 
of  89.1;  third,  H.  A.  Burstein,  College  of  Medi- 
cine, Ohio  State  University  88.7 ; fourth,  J.  F. 
Smyth,  Jefferson  Medical  College,  87.8,  and  fifth, 
Y.  A.  Venar,  School  of  Medicine,  Western  Reserve 
University,  87.6. 

Those  granted  medical  and  surgical  licenses 
were : 

Ohio  State  University — Louis  Adelman,  Cleve- 
land; Theodore  C.  Allenbach,  Columbus;  Donald 
J.  Alspaugh,  Columbus;  Abraham  Arons,  Cleve- 
land; J.  Herbert  Bain,  New  Concord;  Morris  H. 
Belinky,  Youngstown;  Darrel  D.  Bibler,  Colum- 
bus; Charles  S.  Bishop,  Columbus;  James  A. 
Black,  Madeira;  Clara  G.  Bonner,  Columbus; 
Donald  R.  Brumley,  Columbus;  Henry  A.  Bur- 
stein, Cleveland;  Ovid  0.  Burt,  Londonderry; 
William  W.  Cardoza,  Cleveland;  Herbert  D. 
Chamberlain,  McArthur;  Ben  Chapsky,  Cleve- 
land; John  L.  Clifton,  Jr.,  Columbus;  Manning  E. 
Cohn,  Cleveland;  George  F.  Collins,  New  Phila- 
delphia; Kenneth  W.  Cook,  Sandusky;  Alfred  R. 
Cukerbaum,  Youngstown;  Amato  D’Amore, 
Youngstown;  Theodore  P.  Day,  Westerville; 
Arthur  Dobkin,  Akron;  Corine  T.  Dryer,  Colum- 
bus; Alexander  S.  Fisher,  East  Liverpool;  Pauline 
L.  Fi’eeman,  Danville;  Edward  B.  Gall,  Cleve- 


land; John  J.  Gallen,  Columbus;  Lawton  C.  Ger- 
linger, Columbus;  Guy  A.  Ginn,  Wilberforce;  Mil- 
ton  M.  Gottlieb,  Cincinnati;  Anita  V.  Green, 
Wapakoneta;  Francis  R.  Grogan,  Columbus;  Clyde 
W.  Hall,  Youngstown;  James  J.  Hamill,  Colum- 
bus; John  A.  C.  Hamill,  Cleveland;  Jack  H. 
Hudelman,  Cleveland;  Malcolm  M.  Hargraves,  Co- 
lumbus; Adrian  J.  Hartzler,  Wooster;  David  W. 
James,  Youngstown;  Maurice  M.  Kane,  Toledo; 
Benjamin  M.  Kohrman,  Cleveland;  Albert  Kos- 
toff,  Columbus;  Donald  F.  Kyle,  Cedarville;  Kent 
G.  Latham,  Toledo;  Louis  B.  Lee,  Pomeroy; 
Arthur  D.  Lewis,  Columbus;  Sanford  A.  Luria, 
Cleveland;  James  E.  McCormick,  Zanesville; 
Robert  H.  McKelvey,  Key;  Wm.  L.  Mahaffey,  Mt. 
Vernon;  Paul  J.  Mahar,  Youngstown;  James  R. 
Matson,  Uhrichsville;  Thomas  S.  Miller,  Toledo; 
Wallace  D.  Miller,  Fostoria;  Warren  F.  Mills, 
Columbus;  Leo  Moskowitz,  Cleveland;  Clarence 
E.  Northrup,  Columbus;  Theodore  W.  Novak, 
Cleveland;  Ray  C.  Novatney,  Cleveland;  Gwyn 
A.  Party,  Jackson;  Sam  J.  Pastorelle,  Cleveland; 
Arnold  D.  Piatt,  Columbus;  William  L.  Pritchard, 
Columbus;  Willis  L.  Pugh,  Belief ontaine ; George 
E.  Rice,  Dover;  Maurice  B.  Rusoff,  Columbus; 
Thomas  A.  Shehan,  Shaker  Heights;  Martin  L. 
Sherman,  Columbus;  Paul  R.  Siegel,  Cleveland; 
Howard  C.  Sparks,  Willard;  Douglas  G.  Sroufe, 
Cincinnati;  Byron  L.  Steger,  Bucyrus;  Wilbur 
Stoughton,  Westerville;  John  R.  Swan,  Cam- 
bridge; Roger  L.  Tecklenberg,  Lima;  Francis  M. 
Wadsworth,  Lindsey;  Russell  R.  Wahl,  Napoleon; 
William  L.  Wead,  Xenia;  Marlin  R.  Wedemeyer, 
Columbus;  Lawrence  M.  Weinberger,  Cleveland; 
Robert  J.  Weinrich,  Massillon;  Ralph  E.  Wetzel, 
Akron;  Plinny  S.  Whiteleather,  Moultrie;  La- 
Verne  C.  Ziegler,  Toledo; 

University  of  Cincinnati — Nathan  R.  Abrams, 
Cincinnati;  Archibald  M.  Adams,  Lima;  Charles 
Allison,  Cincinnati;  William  A.  Altemeier,  Jr., 
Cincinnati;  James  J.  Arbaugh,  Martins  Ferry; 
Frederick  P.  Baurichter,  Cincinnati;  Bessie  Mae 
Beach,  Cincinnati;  Edward  J.  Bender,  Cincinnati; 
John  R.  Bierley,  Cincinnati;  Roy  C.  A.  Bock,  Cin- 
cinnati; Herbert  C.  Boehner,  Glendale;  Lester 
Bossert,  Cincinnati;  Andre  A.  Cueto,  Cincinnati; 
Ralph  B.  Cunningham,  Cincinnati;  Charles  D. 
Deeds,  Granville;  Nicholas  E.  Dobos,  Cincinnati; 
Clyde  M.  Dummer,  Cincinnati;  Ford  E.  Eddy, 
Marietta;  Dorothy  L.  Ferris,  Blue  Ash;  Joseph 
N.  Freiden,  Cincinnati;  Jesse  E.  Groff,  Cincin- 
nati; Francis  C.  Haberman,  Cincinnati;  John  S. 
Hagen,  Jr.,  Cincinnati;  William  J.  Hartlage, 
Sciotoville ; Archelaus  D.  Harvey,  Dayton;  Her- 
bert R.  Hathaway,  Springfield;  Richard  Hotz, 
Toledo;  Aloysius  J.  Huesman,  Cincinnati;  Charles 


August,  1933 


State  News 


519 


W.  Hunsche,  Cincinnati ; Emory  R.  Irvin,  Hamil- 
ton; Louis  C.  Jack,  Cincinnati;  Helen  L.  Jackson, 
Cincinnati;  Joseph  H.  Jansen,  Jr.,  Cincinnati; 
Kermit  T.  Johnstone,  Cincinnati;  Aaron  J.  Ran- 
ter, Cincinnati;  Samuel  R.  Kates,  Cleveland; 
Henry  P.  Koehler,  Cincinnati;  Karl  J.  Kraus,  Cin- 
cinnati; Paul  G.  Lenhert,  Cincinnati;  Arthur  Mc- 
Donald, Jr.,  Cincinnati;  Philip  Magrish,  Cincin- 
nati; Charles  W.  Monroe,  Cincinnati;  Charles  E. 
Mumma,  Lewisburg;  Burton  G.  Must,  Cincinnati; 
Howard  J.  Osterman,  Norwood;  Charles  L. 
Pfeiffer,  Cincinnati;  Frank  W.  Prather,  Dayton; 
Huston  H.  Rinehart,  Cincinnati;  Ervin  S.  Ross, 
Cincinnati;  Carl  E.  Roush,  Cincinnati;  Louis  A. 
Safer,  Cincinnati;  James  A.  D.  Schaal,  Logan; 
Wm.  C.  Schmidter,  Jr.,  Cincinnati;  Louis  W.  Sey- 
ler,  Cincinnati;  Houston  W.  Shaw,  Cincinnati; 
Louis  E.  Snyder,  Loveland;  Clyde  I.  Stafford, 
Cincinnati;  Louis  B.  Sternberg,  Cincinnati;  Louis 
P.  Stickley,  Cincinnati;  Frederick  P.  Swing,  Cin- 
cinnati; Bemyce  Tavel,  Cincinnati;  James  A. 
Lewis  Toland,  Rayland;  William  F.  Vinnedge, 
Hamilton;  Marvin  F.  Weissman,  Cincinnati;  Leo- 
pold C.  Wertheimer,  Cincinnati;  Albert  E.  Wyss, 
Cincinnati;  Wilbur  B.  Zinn,  Cincinnati; 

Western  Reserve  University — Victor  A.  Bad- 
ertscher,  Cleveland;  William  S.  Banfield,  Cleve- 
land; Charles  L.  Barrett,  Lakeview;  Garry  G. 
Bassett,  Cleveland;  Frederick  P.  Berlin,  Cleve- 
land; Ernest  R.  Blondis,  Cleveland;  Lilian  A. 
Boker,  Cleveland;  Mary  Broadbent,  Cleveland; 
Kenneth  B.  Browne,  Cleveland;  Guy  W.  Brugler, 
Cleveland;  Eugene  C.  Chamberlain,  Cleveland; 
Frederick  S.  Coombs,  Jr.,  Youngstown;  Roger  P. 
Daniels,  Cleveland;  James  T.  Duncan,  Cleveland; 
Ben  C.  Eisenberg,  Cleveland;  Carl  Ellenberger, 
Lakewood;  Walter  L.  Evans,  Jackson;  Janet  S. 
Forbes,  Cleveland;  Samuel  B.  Frank,  Cleveland; 
Paul  W.  Gebauer,  East  Cleveland;  William  0. 
Harris,  Cleveland;  Albert  J.  Hart,  Cleveland; 
Robert  M.  Hosier,  Cleveland;  Elmer  L.  Jackson, 
Cleveland;  Morris  M.  Kessler,  Cleveland;  John  H. 
King,  Steubenville;  Donald  E.  Leonard,  Cleve- 
land; Santino  J.  Lerro,  Cleveland;  Frederick  P. 
Maibauer,  Cleveland;  Joseph  E.  Martin,  Jr., 
Cleveland;  Frederick  R.  Mautz,  Cleveland;  John 
D.  Morley,  Cleveland;  John  M.  Painter,  Cleve- 
land; Peter  P.  Palsis,  Cleveland;  Rose  Marie 
Petti,  Cleveland;  Ralph  E.  Pickett,  Cleveland; 
William  L.  Potts,  Cleveland;  Joseph  L.  Ptacek, 
Cleveland;  Lewis  K.  Reed,  Cleveland;  John  R. 
Rohrbaugh,  Cleveland;  Mary  E.  Rowland,  Cadiz; 
Clifford  F.  Ryder,  Garrettsville ; Dudley  J.  Shaw, 
Cleveland;  James  V.  Stewart,  Cleveland;  Mar- 
garet H.  Tilden,  Cleveland;  Alvyn  W.  Tramer, 
Cleveland;  Ralph  K.  Updegraff,  Jr.,  Cleveland; 
Yasha  A.  Venar,  Cleveland;  Perry  P.  Volpitto, 
Cleveland;  Clayton  P.  Wangeman,  Cleveland; 
Ralph  T.  Warburton,  North  Canton;  Frank  B. 
Webster,  Cleveland;  Ralph  E.  Wharton,  Cleve- 
land; Woodward  A.  Wickham,  East  Cleveland; 
George  M.  Wyatt,  Cleveland; 

Medical  Schools  outside  Ohio  — Richard  M. 
Free,  Dayton,  Hahnemann  Medical  College;  Fred- 
erick C.  Witwer,  Akron,  Hahnemann  Medical  Col- 
lege; Herbert  E.  Christman,  Lakewood,  Harvard 
Medical  School;  Jay  C.  Day,  Cleveland,  Harvard 
Medical  School;  John  M.  Tomasch,  Cleveland, 
Harvard  Medical  School;  Robert  R.  Blondis, 
Cleveland,  Indiana  University;  John  T.  Martin, 
Akron,  Jefferson  Medical  College;  Morton  J. 
Crow,  Youngstown,  Jefferson  Medical  College; 
Anthony  Ruppersberg,  Jr.,  Columbus,  Jefferson 
Medical  College;  Jack  F.  Smyth,  Lyons,  Jefferson 
Medical  College;  Frank  M.  Rogers,  Cleveland 
Heights,  Marquette  University;  Edward  J. 
Michalenko,  Cleveland,  Northwestern  University; 


Henry  M.  Young,  Cleveland,  Northwestern  Uni- 
versity; Jacob  P.  Freedman,  Cincinnati,  Tufts 
College  Medical  School;  Herman  B.  Kaufman, 
Youngstown,  University  of  Louisville;  Maurice  S. 
Klein,  Cleveland,  University  of  Louisville;  Thomas 
A.  Owens,  Toledo,  University  of.  Michigan;  Har- 
old J.  Theisen,  Cleveland,  University  of  Pennsyl- 
vania; Richard  S.  Knowlton,  Mantua,  University 
of  Rochester;  Robert  C.  Manchester,  Alliance, 
University  of  Rochester;  Willie  M.  Clifton,  Cin- 
cinnati, Woman’s  Medical  College  of  Pa.;  Hazel 
M.  Nichols,  Cincinnati,  Woman’s  Medical  College 
of  Pa.;  Payson  B.  Ayres,  Toronto,  Canada,  Uni- 
versity of  Toronto;  Richard  H.  Dyble,  Canton, 
University  of  Toronto;  Barnet  Sakler,  Cincinnati, 
University  of  Toronto;  Henry  Packer,  Cleveland, 
McGill  University;  Thomas  F.  Ross,  Johnstown, 
University  of  Edinburgh;  Antonio  Pirrone,  Cleve- 
land, University  of  Palmero;  Morton  A.  Roth, 
Dayton,  University  of  Innsbruck. 


Archibald  C.  Adams,  M.D.,  Lima;  Cleveland 
College  of  Physicians  and  Surgeons,  1900;  aged 
58 ; member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died  June 
15  of  heart  disease.  Dr.  Adams  was  a native  of 
Springfield,  Pa.  After  practicing  in  LaFayette 
for  13  years,  Dr.  Adams  moved  to  Lima  where  he 
practiced  for  the  past  20  years.  He  was  coroner 
of  Allen  County  for  two  terms.  Dr.  Adams  be- 
longed to  the  Masonic  Lodge,  Baptist  Church  and 
the  Kiwanis  Club.  Surviving  are  his  widow,  one 
daughter,  two  sons,  one  of  whom  is  Dr.  Archibald 
M.  Adams,  Lima,  two  sisters  and  two  brothers. 

Howard  G.  Barton,  M.D.,  Adelphi;  Ohio  Medi- 
cal University,  Columbus,  1893;  aged  69;  died 
June  8 of  heart  disease.  Dr.  Barton  was  a native 
of  Hocking  County  and  had  practiced  in  Adelphi 
for  many  years.  He  was  a member  of  the  Masonic, 
Knights  of  Pythias  and  Redmen  lodges  and  the 
Methodist  Episcopal  Church.  Surviving  are  his 
widow,  three  sons,  four  daughters,  and  three 
sisters. 

Byron  S.  Cranston,  M.D.,  New  London;  Balti- 
more Medical  College,  Baltimore,  Md.,  1893;  aged 
64;  died  June  13  of  Bright’s  Disease.  Dr.  Cran- 
ston practiced  at  Rudolph  until  1915  when  he 
moved  to  New  London.  He  leaves  his  widow,  one 
son,  Dr.  Clyde  J.  Cranston,  Wakeman,  and  one 
daughter.  Dr.  Cranston  was  a member  of  various 
Masonic  bodies  and  the  Methodist  Episcopal 
Church. 

Raymond  D.  Kahle,  M.D.,  Lima;  New  York 
University  Medical  College,  1884 ; aged  73 ; former 
member  of  the  Ohio  State  Medical  Association  and 
the  American  Medical  Association;  died  June  16 
of  acute  indigestion.  Dr.  Kahle  located  in  Lima 
in  1886.  He  was  appointed  a member  of  the  state 


520 


The  Ohio  State  Medical  Journal 


August,  1933 


board  of  health  by  Governor  McKinley  and  served 
as  a member  of  the  board  for  nine  years,  part  of 
the  time  as  president.  Surviving  are  his  widow, 
one  son,  three  daughters  and  six  brothers. 

William  Edwin  Kneale,  M.D.,  Akron;  Cleveland 
Pulte  Medical  College,  1902;  aged  68;  former 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died  June 
21  of  a sunstroke.  Dr.  Kneale  had  practiced  in 
Akron  for  the  past  26  years.  During  the  World 
War,  he  served  as  a lieutenant  in  the  medical 
corps.  He  was  a native  of  Rochester,  N.  Y.  Sur- 
viving are  his  widow,  two  daughters  and  one  son. 

Frank  Warren  Langdon,  M.D.,  Cincinnati; 
Miami  Medical  College,  Cincinnati,  1881;  aged  81; 
former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  June  8 following  an  extended  illness.  Dr. 
Langdon  was  professor  emeritus  of  neurology  and 
psychiatry  at  the  University  of  Cincinnati,  Col- 
lege of  Medicine.  Dr.  Langdon  was  internationally 
known  in  his  specialty.  At  one  time  he  was  a 
member  of  the  Royal  Society  of  Medicine,  Eng- 
land; American  Neurological  Association;  Lin- 
nean  Society  of  New  York;  Boston  Zoological  So- 
ciety, and  the  Brooklyn  Neurology  Society. 

Francis  Marion  Laughlin,  M.D.,  retired,  East 
Liverpool;  Western  Reserve  University  School  of 
Medicine,  1881 ; aged  77 ; former  member  of  the 
Ohio  State  Medical  Association  and  the  American 
Medical  Association;  died  July  6 after  a lingering 
illness.  Dr.  Laughlin  practiced  in  East  Liverpool 
for  many  years  until  he  retired  from  active  prac- 
tice five  years  ago.  He  was  a member  of  the 
Methodist  Episcopal  Church  and  the  Masonic 
Lodge.  Surviving  are  his  daughter  and  two  sis- 
ters. 

William  H.  Parker,  M.D.,  Wellston;  Starling 
Medical  College,  Columbus,  1898;  aged  61;  mem- 
ber of  the  Ohio  State  Medical  Association  and  a 
Fellow  of  the  American  Medical  Association;  died 
June  24  of  coronary  thrombosis.  Dr.  Parker  was 
a native  of  Providence,  Rhode  Island.  He  located 
in  Wellston  in  1901.  During  the  World  War  he 
served  as  a captain  in  the  medical  corps.  Dr. 
Parker  was  first  commander  of  Wellston  Post, 
American  Legion  and  was  a member  of  various 
Masonic  orders.  Surviving  are  his  widow,  one  son 
and  one  daughter. 

Vernon  Roberts,  M.D.,  Dayton;  State  Univer- 
sity of  Iowa,  College  of  Medicine,  1907;  aged  49; 
died  June  29  of  wounds  inflicted  by  an  assassin  at 
the  National  Military  Home  of  which  Colonel 
Roberts  was  chief  medical  officer.  Dr.  Roberts 
was  murdered  at  the  door  of  his  home  by  a 
Spanish- American  and  World  War  veteran  and 
former  inmate  at  the  Home  who  was  disgruntled 
at  having  been  removed  from  the  pension  rolls. 
Dr.  Roberts  joined  the  staff  of  the  National  Mili- 
tary Home  in  1913.  He  served  in  the  World  War 


and  in  1925  again  joined  the  staff  of  the  military 
home  as  chief  surgeon.  He  was  a member  of  the 
Masonic  Lodge  and  Phi  Rho  Sigma,  medical  fra- 
ternity. Surviving  are  his  widow,  his  mother  and 
one  sister. 

Henry  L.  Wenner,  M.D.,  Tiffin;  Western  Re- 
serve University,  School  of  Medicine,  1882;  aged 
72;  member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  June  26  of  injuries  sustained  in  an 
automobile  accident.  Dr.  Wenner  was  a native  of 
Tiffin.  He  practiced  in  McCutchenville  and  Ar- 
cadia for  a short  time  before  opening  offices  at 
Tiffin.  He  had  served  on  the  Tiffin  board  of  edu- 
cation and  was  a candidate  for  Congress  in  1898. 
Dr.  Wenner  was  an  officer  of  the  Junior  Order 
and  a trustee  of  the  Junior  Order  home  at  Tiffin. 
He  also  was  a member  of  the  Odd  Fellow,  Knights 
of  Pythias  and  Masonic  lodges.  Surviving  are  his 
widow  and  two  children,  one  of  whom  is  Dr. 
Henry  L.  Wenner,  Jr.,  of  Toledo. 

Samuel  B.  Woodward,  M.D.,  Dayton;  Tulane 
University,  School  of  Medicine,  1920;  aged  37; 
died  June  18  at  Asheville,  N.  C.  Dr.  Woodward, 
director  of  surgery  at  the  National  Military  Home, 
Dayton,  was  on  leave  of  absence  in  an  effort  to 
regain  his  health  at  the  time  of  his  death.  He  is 
survived  by  his  widow.  He  was  a native  of  Ox- 
ford, Mass. 

Reuben  D.  Whisler,  M.D.,  Findlay;  Baltimore 
Medical  College,  Baltimore,  Md.,  1892;  aged  67; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  June  14.  Dr.  Whisler  was  born  on  a 
farm  near  Bluffton.  He  practiced  for  30  years  at 
Benton  Ridge,  moving  to  Findlay  ten  years  ago. 
He  served  as  coroner  of  Hancock  County  from 
1920  to  1924.  He  was  a member  of  the  Methodist 
Episcopal  Church.  Surviving  are  his  widow  and 
three  sons,  two  of  whom  are  physicians.  Dr.  S.  F. 
Whisler,  Findlay,  Hancock  County  health  commis- 
sioner, and  Dr.  Lehr  Whisler,  Willard. 


Cleveland — At  the  recent  meeting  of  the  Amer- 
ican Dermatological  Association  in  Chicago,  Dr. 
Harold  N.  Cole  of  Cleveland  was  elected  presi- 
dent for  the  ensuing  year.  Dr.  Cole  also  is  a 
member  of  the  Council  on  Pharmacy  and  Chem- 
istry of  the  American  Medical  Association  and 
a member  of  the  National  Board  of  Examiners 
for  Dermatology  and  Syphilology. 


Akron — On  July  24,  Dr.  Samuel  St.  John, 
Wright,  veteran  Akron  practitioner,  celebrated 
his  81st  birthday.  Dr.  Wright  has  been  a mem- 
ber of  the  Summit  County  Medical  Society  and 
the  Ohio  State  Medical  Association  for  57  years. 
He  was  president  of  the  former  society  in  1905. 


St.  Marys — Offices  have  been  opened  here  by 
Dr.  Robert  E.  Boswell,  formerly  of  Dayton. 


August,  1933 


State  News 


521 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

(The  Pioneer  Post-Graduate  Medical  Institution  in  America) 


Eye,  Ear,  Nose  and  Throat 


For  Information  Address 

Medical  Executive  Officer,  345  West  50th  Street,  New  York  City 


COOK  COUNTY  GRADUATE  SCHOOL  OF  MEDICINE 

(In  affiliation  with  Cook  County  Hospital) 

ANNOUNCES  CONTINUOUS  COURSES— JUNE  1ST  TO  NOVEMBER  1ST 

MEDICINE — General  and  Intensive  Courses,  all  branches  (Intensive  One  Week  Course,  Tuition  $30.00) 
PEDIATRICS — Informal  Course 

OBSTETRICS — Informal  Course — Two  Weeks  Intensive  Course 

GYNECOLOGY — Three  Months  Course — Two  Weeks  Course 

FRACTURES  AND  TRAUMATIC  SURGERY— General  Course— Intensive  Course 
UROLOGY — Two  Months  Course — Two  Weeks  Course 

CYSTOSCOPY — Intensive  Two  Weeks  Course 

SURGERY — Three  Months  General  Course — Two  Weeks  Intensive  Course  Surgical  Technique  (Laboratory).  General, 
Intensive  or  Special  Courses,  Tuberculosis,  Orthopaedic  Surgery,  Roentgenology,  Dermatology  and  Syphilis, 
Ophthalmology,  Ear,  Nose  and  Throat,  Anatomy,  Pathology,  Nervous  and  Mental  Diseases. 

Teaching  Faculty — Attending  Staff  of  Cook  County  Hospital 

Address:  Registrar,  427  South  Honore  Street,  CHICAGO,  ILLINOIS 


CURDOLAC  FOODS 

FULFILL  THE  A.  B.  C.’s  OF  THE 
DIABETIC  DIET  PERFECTLY  — 

Curdolac  Breakfast  Cereal 

Curdolac  Soya  Flour 

Curdolac  Wheat-Soya  Flour 

Curdolac  Soya  Cereal  Johnny  Cake  Flour 

Curdolac  Soya-Bran  Breakfast  Food 

Curdolac  Soya-Bran  Flour 

Adequate  in  nourishment 
Beautiful  to  the  sight 
Correct  in  food  value 

Samples  and  Literature  on  request 

CURDOLAC  FOOD  COMPANY 

Box  299  Waukesha,  Wis. 


LAUB'S 

QUALITY 

BREAD 


. . Tested  and  ac- 

cepted by  your  own 
official  body. 


The  Jacob  Laub  Bak- 
ing Co.,  Cleveland,  O. 


522 


The  Ohio  State  Medical  Journal 


August,  1933 


POSTGRADUATE  COURSE 


LABORATORY  COURSE 


For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

A house  doctor  is  appointed  July  1st  and 
January  1st 


For  Nurses  and  Graduates  of  High  School 
CLASSES  LIMITED  TO  SIX 
X-ray,  Basal  Metabolism,  Electre-cardiography  and 
Physical  Therapy 


150  clinical  patients  daily  provide  material  for  classes. 

Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 


For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


Naif's  Fvrom 

■ties  dd&  Academies 


First  District 

Adams  County  Medical  Society  met  in  regular 
session  June  21  at  West  Union.  Two  papers  were 
presented,  one  by  Dr.  O.  S.  Roebuck,  Gomer,  on 
“Blood  Pressure  Findings  in  General  Practice” 
and  one  by  Dr.  J.  R.  Hilling-,  Mt.  Orab,  on  “An- 
esthesia.” The  August  meeting  of  the  society 
will  be  held  at  Blue  Creek  at  the  home  of  Dr. 
0.  E.  McHenry. — News  Clipping. 

Highland  County  Medical  Society  was  ad- 
dressed by  Dr.  Robert  Conard,  Wilmington,  at 
its  meeting  June  7 at  Hotel  Parker,  Hillsboro. 
Dr.  Conard  spoke  on  “The  History  of  Medicine.” 
Dinner  was  served  before  the  program. — News 
Clipping. 

Second  District 

Montgomery  County  Medical  Society  held  its 
annual  picnic  Wednesday,  June  28,  at  the  home 
of  Dr.  W.  H.  Delseamp,  Bellbrook. — News  Clip- 
ping. 

Third  District 

Hardin  County  Medical  Society  held  its  annual 
banquet  June  29  at  the  Spring  Grove  Golf  Club, 
near  Kenton.  Dr.  L.  L.  Ely,  associated  with  the 
Eli  Lilly  & Company,  Indianapolis,  was  the  prin- 
cipal speaker. — News  Clipping. 

Marion  Academy  of  Medicine  met  June  6 in 
regular  session  at  the  Marion  City  Hospital.  The 
guest  speaker  was  Dr.  Claude  B.  Norris,  Youngs- 
town, who  addressed  the  society  on  “Syphilis.” — 
Bulletin. 

Van  Wert  County  Medical  Society  at  its  meet- 
ing June  6 was  addressed  by  C.  V.  Hoke,  Van 
Wert  attorney,  on  “Medical  Jurisprudence.”  The 
program  was  arranged  by  Dr.  C.  R.  Keyser,  Dr. 
W.  P.  Clay  and  Dr.  W.  E.  Beach. — News  Clip- 
ping. 

Fourth  District 

Four  County  Medical  Society  met  Friday,  June 
16  at  the  Wauseon  Memorial  Hospital.  The  pro- 
gram was  presented  by  Dr.  Charles  Mayo,  Jr., 
and  Dr.  Howard  Hartman,  tooth  of  Rochester, 
Minn.,  and  Dr.  J.  Howard  Brown,  Johns  Hopkins 


University.  Dr.  Mayo  discussed  “Chronic  and 
Acute  Intussusception”;  Dr.  Hartman,  “Treat- 
ment of  Duodenal  Ulcer”,  and  Dr.  Brown,  “Re- 
lation of  Milk  to  Disease”.  Dinner  was  served 
following  the  program. — News  Clipping. 

Wood  County  Medical  Society  held  its  last  meet- 
ing until  Fall  on  June  15  at  the  Women’s  Club, 
Bowling  Green.  A business  session  was  followed 
by  a roundtable  discussion  of  business,  organiza- 
tion and  scientific  questions.— News  Clipping. 

Fifth  District 

Ashtabula  County  Medical  Society  met  in  regu- 
lar session  June  13  at  Hotel  Ashtabula.  A paper 
on  “Pericarditis,  Acute  and  Chronic”  was  pre- 
sented by  Dr.  Richard  Dexter,  Cleveland.  A com- 
mittee composed  of  Drs.  Collander,  Wynkoop, 
Fleek  and  Park  was  named  to  arrange  for  the 
annual  picnic  of  the  society  in  August. — A.  M. 
Mills,  M.  D.,  Secretary. 

Geauga  County  Medical  Society  met  on  June 
28  at  the  home  of  Dr.  W.  C.  Cory,  Chardon. 
The  guest  speaker  was  Dr.  W.  C.  McCalley,  Cleve- 
land.— News  Clipping. 

Sixth  Ristrict 

Stark  County  Medical  Society  held  its  annual 
outing  June  28  at  the  Congress  Lake  Country 
Club.  Golf,  fishing,  horse  shoes  and  bridge  af- 
forded the  entertainment  during  the  afternoon. 
Following  a banquet  in  the  evening,  attended  by 
243  members  and  guests,  Dr.  Harvey  Bartle, 
Philadelphia,  addressed  the  society.  A musical 
program  climaxed  the  program. — F.  S.  VanDyke, 
M.  D.,  Secretary. 

Wayne  County  Medical  Society  held  a brief 
meeting  June  13  at  Wooster  at  which  routine 
business  was  transacted  and  a roundtable  dis- 
cussion held. — News  Clipping. 

Seventh  District 

Columbiana  County  Medical  Society  met  in  Lis- 
bon on  July  11.  The  principal  paper  was  pre- 
sented by  Dr.  Fred  R.  Crowley,  Salem,  on  “Cor- 
relation of  Surgery  With  Medicine.”  The  paper 


August,  1933 


State  News 


52£ 


Edward  Reinert 


PK.G.,  M.D. 


247  East  State  Street 


Columbus,  Ohio 


Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 


FRANK  GALLEN,  M.D., 

Dermatology 

Tel.  Main  1537 


LEE  A.  HAYS,  M.D., 

Roentgenology 
University  5842 


W.  H.  MILLER,  M.  D. 


328  East  State  St. 

Office  Telephone,  MAin  3743 


Columbus,  Ohio 
Residence,  EVergreen  5644 


Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

<L 

Prompt  and  Full  Report 


524 


The  Ohio  State  Medical  Journal 


August,  1933 


was  discussed  by  Dr.  L.  W.  King-  and  Dr.  A.  J. 
Michels. — Bulletin. 

Tuscarawas  County  Medical  Society  was  ad- 
dressed by  Dr.  James  A.  Dickson  and  Dr.  E.  P. 
McCullagh,  both  of  Cleveland,  at  its  meeting 
June  8 at  New  Philadelphia. — News  Clipping. 

Eighth  District 

Athens  County  Medical  Society  held  a well- 
attended  meeting  June  5 at  the  Athens  State 
Hospital,  Athens.  A motion  picture  demonstrat- 
ing the  use  of  serum  in  snake  bites  was  shown, 
after  which  Dr.  C.  H.  Creed,  superintendent  of 
the  hospital,  discussed  two  cases  of  multiple  scle- 
rosis. Refreshments  were  served  following  the 
meeting.  The  next  meeting  of  the  society  will  be 
held  on  Labor  Day  at  the  home  of  Dr.  T.  A. 
Copeland,  Rome  Township,  when  members  of  the 
Meigs  and  Hocking  County  medical  societies  will 
be  guests. — T.  A.  Copeland,  M.D.,  Secretary. 

Perry  County  Medical  Society  met  in  regular 
session  June  19  at  the  Park  Hotel,  New  Lex- 
ington. Dr.  Harry  L.  Hite,  Thornville,  addressed 
the  society  on  “Cod  Liver  Oil — Its  Preparation 
and  Usage.” — News  Clipping. 

Ninth  District 

Scioto  County — At  the  June  19  meeting  of  the 
Hempstead  Academy  of  Medicine  at  Portsmouth, 
the  academy  was  addressed  by  Dr.  Jonathan  For- 
man, Columbus,  on  “Allergy  As  Encountered  by 
the  General  Practitioner.” 

The  Academy  was  addressed  by  Dr.  G.  I.  Nel- 
son, Columbus,  on  Monday  evening,  July  10.  Dr. 
Nelson  discussed  “Certain  Aspects  of  Cardio- 
vascular Disease”. — Bulletin. 

Tenth  District 

Crawford  County  Medical  Society  held  a social 
and  dinner  meeting  June  21  at  the  Gabon  Country 
Club.  A golf  tournament  was  held  in  the  after- 
noon, followed  by  a dinner  and  musical  program 
in  the  evening. — News  Clipping. 

Madisoji  County  Medical  Society  at  a meeting 
June  21  at  the  London  Country  Club  was  ad- 
dressed by  Dr.  I.  B.  Harris,  Columbus,  on  “Acute 
Appendicitis”. — News  Clipping. 


The  following  licenses  through  reciprocity  have 
been  approved  by  the  Ohio  State  Medical  Board: 
Harold  G.  Beeson,  Wooster,  McGill  University; 
Charles  H.  Edwards,  Stockport,  Memphis  Hos- 
pital Medical  College;  Roy  C.  Ernest,  Cleveland, 
University  of  Maryland;  John  H.  Hayes,  Colum- 
bus, University  of  Arkansas;  Louis  E.  Kamin, 
Cincinnati,  Detroit  College  of  Medicine  and  Sur- 
gery; Valerian  J.  Mastny,  Cleveland,  St.  Louis 
University;  Selma  C.  Mueller,  Dayton,  Uni- 
vrsity  of  Michigan;  Jaffray  J.  Vega,  Celina,  Uni 
versity  of  Louisville;  Mell  B.  Welbom,  Cincinnati, 
Emory  University;  Albert  R.  Zoss,  Cincinnati, 
University  of  Michigan,  and  Rudolph  J.  Schork, 
Cleveland,  Johns  Hopkins  University. 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 

LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Association. 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey.  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Conp,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


August,  1933 


State  News 


525 


Your  Baby  Patients— 

Wherever  they  go  this  Summer, 
let  KLIM  go  with  them 


WITH  six  to  eight  weeks  re- 
maining before  the  summer  is 
really  over,  thousands  of  people  will 
yet  be  going  away  on  vacation. 
Among  these,  some  will  be  baby 
patients  of  yours,  whose  parents 
will  face  the  perennial  problem  of  a 
new,  untried  and  therefore  uncer- 
tain milk  supply.  Anxious  mothers 
will  consult  you.  You  can  solve  that 
problem  for  them  and  so  relieve 
their  minds — through  Klim. 

Klim  has  long  been  widely  known 
to  the  medical  profession  as  an  easi- 
ly-digested and  never-varying  pas- 
teurized whole  milk  for  infant  and 
child  feeding.  And  it  also  serves  as 
a dependable  milk  for  adults — as 
a beverage  and  for  cooking. 


For  this  reason  more  and  more 
doctors  are  counselling  parents, 
naturally  worried  over  the  “vaca- 
tion milk”  problem,  to  take  along 
Klim — the  powdered  whole  milk — 
for  safety,  convenience  and  assured 
uniformity.  Klim,  as  you  know,  is 
in  no  sense  a prepared  baby  food. 
It  is  simply,  pure,  whole  cow’s  milk, 
with  all  the  vital  properties  retained 
and  only  the  readily-restored  water 
content  removed.  Thus  it  also  keeps 
without  refrigeration  and  so  solves 
still  another  pressing  vacation 
problem. 

® Note:  Merrell-Soule  Powdered 
Whole  Lactic  Acid  and  Protein 
Milks  are  also  available  for  infant 
feedingduringthesehot  summer  months . 


Literature  a,nd  samples  sent  on  request. 


The  Borden  Company,  Dept.  KM  70,  350  Madison  Avenue,  New  Tork.  N.  Y. 


526 


The  Ohio  State  Medical  Journal 


August,  1933 


Ohio  Senate  Committee  to  Investigate 
Workmen’s  Compensation  Administration 

A legislative  investigation  and  inquiry  into  the 
operation  and  administration  of  the  Ohio  Work- 
men’s Compensation  Law  with  a view  to  deter- 
mining what,  if  any,  changes  or  modifications  in 
the  compensation  law  should  be  recommended  to 
the  General  Assembly  will  get  under  way  soon  as 
a result  of  the  adoption  by  the  Ohio  Senate  on 
June  29  of  a resolution  offered  by  Senator  Marvin 

C.  Harrison,  Cleveland,  authorizing  such  investi- 
gation. 

The  committee  named  in  the  resolution  to  make 
the  investigation  is  composed  of  Senator  Har- 
rison, chairman,  and  Senator  B.  R.  Donovan,  To- 
ledo; Senator  Paul  Yoder,  Dayton;  Senator  Carl 

D.  Sheppard,  Akron;  Senator  John  A.  Lloyd, 
Portsmouth;  and  Senator  William  E.  Handley, 
Cincinnati.  The  committee  is  instructed  to  report 
its  findings  and  recommendations  to  any  ad- 
journed session  of  the  90th  General  Assembly  or 
the  regular  session  of  the  91st  General  Assembly 
which  convenes  in  January,  1935. 

In  listing  the  reasons  for  such  investigation, 
the  resolution  declared  that  there  has  been  re- 
ported “a  great  deal  of  dissatisfaction  and  com- 
plaint upon  the  part  of  injured  employes  and  the 
dependents  of  killed  employes  in  relation  to  their 
inability  to  have  their  claims  passed  upon  and 
decided  in  a reasonable  time  by  the  industrial  com- 
mission” and  that  “there  is  reported  to  be  a con- 
siderable dissatisfaction  among  those  members  of 
the  medical  profession  treating  injured  workmen 
because  of  undue  delay  in  having  their  bills  for 
such  service  acted  upon  and  paid  by  the  depart- 
ment of  industrial  relations”. 

The  resolution  declared  it  is  reported  “the  con- 
ditions asserted  above  have  been  created  by  the 
release  from  the  department  of  industrial  rela- 
tions of  100  employes  in  the  division  of  work- 
men’s compensation,  thereby  reducing  the  person- 
nel of  the  division  to  such  an  extent  that  the 
business  of  the  division  cannot  be  efficiently  and 
expeditiously  disposed  of”.  The  resolution  also 
calls  attention  to  the  report  that  employes  of  the 
department  are  being  compelled  to  work  more 
hours  per  week  at  reduced  salaries  and  to  the  re- 
port “that  in  the  administration  of  the  work- 
men’s compensation  law  a system  of  legalism  has 
developed,  injurious  to  those  coming  under  the 
provisions  of  the  law”. 

To  recommend  legislation  which  will  remedy  the 
above  conditions,  if  true,  and  to  supply  the  Gen- 
eral Assembly  with  information  in  order  that 
adequate  appropriations  for  the  department  may 
be  made  are  the  purposes  for  which  the  investi- 
gating committee  is  created,  the  resolution  points 
out.  The  committee  is  given  the  power  to  sum- 
mon witnesses,  to  compel  their  attendance,  to  ad- 
minister oaths,  to  make  examinations  and  to 
compel  the  production  of  whatever  books,  records 
and  other  documents  that  may  be  necessary  “for 
a full  and  complete  investigation”. 


New  Member  of  State  Industrial 
Commission 

John  W.  Beall,  Lima,  has  been  appointed  by 
Governor  White  and  confirmed  by  the  State  Sen- 
ate as  a member  of  the  State  Industrial  Com- 
mission for  the  term  ending  June  30,  1939.  Mr. 
Beall,  previously  associated  with  the  Ohio  Steel 
Foundries  Co.,  Lima,  and  former  secretary  of 
the  Democratic  State  Executive  Committee,  suc- 
ceeds Wellington  T.  Leonard  as  a representative 
of  employers  on  the  Commission. 


The  Wendt-Bristol 
Company 

Two  complete  ethical  stores  in 
Columbus 

51  E.  State  St.  721  No.  High  St. 

for  the  convenience  of  the  Physicians  and 
Surgeons — and  the  many  people  they  serve 

Two  Prescription  Departments 

maintained  in  a high  class  manner  with 
eight  registered  Pharmacists 
Other  Complete  Departments 
OFFICE  EQUIPMENT 

PHYSIO  THERAPY  APPARATUS 
HOSPITAL  SUPPLIES 

HEALTH  FOODS 

G'+~3 

W-B  Pharmaceutical  Supplies 
JOBBING  STOCKS  ALL  LEADING 
MANUFACTURERS 

Antitoxins  and  Vaccines  in  Special 
Refrigeration  Plants 

<T*0 

Prompt  Service  on  Phone  Ordera 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  advertisements  under  this  heading  are  60  cents 
per  line,  payable  in  advance.  Minimum  charge  of  $1.00 
for  each  insertion.  Price  covers  the  cost  of  remailing 
answers.  Forms  close  16th  of  the  month  preceding 
publication. 


Assistance  to  Medical  Writers — Abstracts,,  Translations, 
Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  Place,  Chicago, 
Illinois. 


For  Sale — Excellent  location,  northwestern  Ohio.  Owner 
deceased.  Address  B.  M.,  care  Ohio  State  Medical  Journal. 


For  Sale — Office  equipment,  drugs  and  library,  deceased 
physician.  Address  Mrs.  W.  D.  Moccabee,  Cardington,  Ohio. 


For  Sale — Established  practice  of  deceased  physician  in 
town  of  900,  including  a large  country  radius.  Complete 
office  equipment,  drugs,  and  library.  Cash  or  terms.  Office 
may  be  rented  if  desired.  Write  Mrs.  Grace  W.  Tucker, 
Rradner,  Ohio 


August,  1933 


State  News 


527 


Exclusively  Engaged 
in  providing 


Thirty 'four  Years 


Tsjffo  Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

Wheaton,  111. 


528 


The  Ohio  State  Medical  Journal 


August,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

John  B.  Alcorn,  Chairman,  (1933) 

Columbus 

J.  H.  J.  Upham  (1934) Columbus 

C.  W.  Stone  (1935) Cleveland 

H.  M.  Platter,  (ex-officio) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

D.  C.  Houser,  (special) Urbana 

C.  W.  Waggoner,  (special) Toledo 

A.  H.  Freiberg,  (special) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

A.  B.  Denison,  (1933) Cleveland 

Gilbert  Micklethwaite,  (1935)  ....Portsmouth 
MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

W.  H.  Snyder,  (1933) Toledo 

F.  P.  Anzinger,  (1935) Springfield 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) Toledo 

R.  H.  Birge,  (1935) . Cleveland 

MEDICAL  ECONOMICS 
J.  Craig  Bowman,  Chairmai),  (1933) 

Upper  Sandusky 
A.  B.  Brower,  (1934) Dayton 

E.  0.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 

V.  C.  Rowland,  Chairman Cleveland 

Jonathan  Forman . Columbus 

Beatrice  T.  Hagen __ Zanesville 

R.  R.  Hendershott Tiffin 

C.  I.  Stephen Ansonia 

MILITARY  AND  VETERANS’  AFFAIRS 

C.  W.  Stone,  Chairman Cleveland 

Fred  K.  Kislig  (deceased). Dayton 

A.  E.  Brant Youngstown 

COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

S.  J.  Goodman,  Chairman Columbus 

John  A.  Caldwell Cincinnati 

I.  P.  Seiler Piketon 

ARRANGEMENTS  1933  ANNUAL  MEETING 

H.  S.  Davidson,  Chairman Akron 

E.  M.  Huston . _.Dayton 

E.  B.  Shanley New  Philadelphia 

PROGRAM  1933  ANNUAL  MEETING 

C.  L.  Cummer,  Chairman Cleveland 

B.  J.  Hein __ Toledo 

E.  R.  Brush Zanesville 


SECTION  OFFICERS  FOR  1932-1933 


MEDICINE 

Carll  S.  Mundy Chairman 

125  15th  St.,  Toledo 

Cecil  Striker Secretary 

700  Provident  Bank  Bldg.,  Cincinnati 

SURGERY 

Carl  R.  Steinke  Chairman 

1027  Second  Natl.  Bldg.,  Akron 

Norris  Gillette Secretary 

320  Michigan  St.,  Toledo 

OBSTETRICS  AND  PEDIATRICS 

B.  H.  Carroll Chairman 

240  Michigan  St.,  Toledo 

Edward  A.  Wagner Secretary 

2560  Grandin  Rd.,  Cincinnati 


EYE,  EAR.  NOSE  AND  THROAT 


W.  V.  Mullin Chairman 

Euclid  at  93rd  St.,  Cleveland 

Ivor  G.  Clark Secretary 

188  E.  State  St.,  Columbus 
NERVOUS  AND  MENTAL  DISEASES 

J.  Fremont  Bateman Chairman 

Box  36,  Elmwood  Place 

Henry  C.  Schumacher Secretary 

2525  Euclid  Ave.,  Cleveland 

PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 
R.  H.  Markwith Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 

J.  P.  DeWitt,  (1933) Canton 

C.  E.  Kiely,  (1933) Cincinnati 

C.  W.  Waggoner,  (1933) . Toledo 

Wells  Teachnor,  Sr.,  (1934) Columbus 

Ben  R.  McClellan,  (1934) Xenia 

E.  R.  Brush,  (1934) Zanesville 

C.  W.  Stone,  (1934) . Cleveland 


ALTERNATES 


G.  F.  Zinninger,  (1933) Canton 

L.  H.  Schriver,  (1933) Cincinnati 

John  Sprague,  (1933) Athens 

D.  H.  Morgan,  (1934) Akron 

A.  C.  Messenger,  (1934) Xenia 

A.  Howard  Smith,  (1934) Marietta 

C.  L.  Cummer,  (1934) Cleveland 


EIGHTY- SEVENTH  ANNUAL  MEETING, 
AKRON,  SEPTEMBER  7th  and  8th,  193  3 


September,  1933 


Advertisements 


529 


THE  SAWYER  SANATORIUM 

White  Oaks  Farm,  Marion,  Ohio 

TREATS  NERVOUS  and  MENTAL  DISEASES 


Science  and 
sympathy  join  to 
prevent  and  to  repair  Mental 
Ills  at  the  Sawyer  Sanatorium 

SEND  FOR  HOUSE  BOOK 
A ddress 

SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 


The  Ohio  State  Medical  Association 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year;  single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 


Andrews  Rogers,  M.D.,  Chairman 

A.  B.  Denison,  M.D.  (1933) 

Gilbert  Micklethwaite,  M.D.  (1935) 


(1934) Columbus 

Cleveland 

Portsmouth 


EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager 


Officers  1932-1933 


PRESIDENT 

H.  M.  Platter,  M.D Columbus 

PRESIDENT-ELECT 

C.  L.  Cummer,  M.D Cleveland 

TREASURER 

James  A.  Beer,  M.D Columbus 

EXECUTIVE  SECRETARY 
Don  K.  Martin Columbus 


State  Council 

First  District 

John  A.  Caldwell,  M.D Cincinnati 

Second  District 

E.  M.  Huston,  M.D. Dayton 

Third  District 

0.  P.  Klotz,  M.D Findlay 

Fourth  District 

B.  J.  Hein,  M.D Toledo 

Fifth  District 

H.  V.  Paryzek,  M.D.  : Cleveland 

Sixth  District 

H.  S.  Davidson,  M.D Akron 

Seventh  District 

E.  B.  Shanley,  M.D. New  Philadelphia 

Eighth  District 

E.  R.  Brush,  M.D Zanesville 

Ninth  District 

1.  P.  Seiler,  M.D Piketon 

Tenth  District 

S.  J.  Goodman,  M.D. ...Columbus 

Ex-Officio,  The  Ex-President 
D.  C.  Houser,  M.D. Urbana 


530 


The  Ohio  State  Medical  Journal 


September,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies 


President 


Secretary 


First  District 


Adams L.  H.  Leonard,  Manchester O.  T.  Sproull,  West  Union 

Brown . R.  B.  Hannah,  Georgetown Geo.  P.  Tyler,  Jr.,  Ripley 

Butler _.H.  O.  Lund,  Middletown — Walter  Roehl,  Middletown 

Clermont J.  K.  Ashburn,  Batavia Allan  B.  Rapp,  Owensville 

Clinton F.  A.  Peele,  Wilmington Wm.  L.  Regan,  Wilmington 

Fayetta S.  E.  Boggs,  Washington  C.  H J.  F.  Wilson,  Washington  C.  H... 

Hamilton Parke  G.  Smith,  Cincinnati Geo.  B.  Topmoeller,  Cincinnati — 

Highland _C.  C.  Cropper,  Lynchburg  W.  B.  Roads,  Hillsboro 

Warren J.  E.  Witham,  Waynesville James  Arnold,  Lebanon 

Second  District  Cyril  Hussey,  Sidney H.  R.  Huston,  Dayton 

Champaign N.  M.  Rhodes,  Urbana L.  A.  Woodburn,  Urbana 

Clark C.  W.  Evans,  Springfield Roger  Marquart,  Springfield 

Darke W.  T.  Fitzgerald,  Greenville ...W.  D.  Bishop,  Greenville.. 

Greena L.  L.  Taylor,  Yellow  Springs H.  C.  Schick,  Xenia 

Miami F.  D.  Kiser,  Tippecanoe  City G.  A.  Woodhouse,  Pleasant  Hill — 


Montgomery A.  F.  Kuhl,  Dayton_ . Miss  M.  E.  Jeffrey,  Dayton 

Prebla C.  M.  Treffinger,  Eaton C.  J.  Brian,  Eaton 

Shalby R.  E.  Paul,  Botkins A.  B.  Lippert,  Sidney 


3d  Wednesday  in  April,  Juna,  A us 
Oct. 

4th  Wednesday  in  Feb.,  May  and 
Nov. 

2d  Wednesday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Monday  evening  of  each  waak 
1st  Wednesday,  monthly. 

1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 


2d  Thursday,  monthly. 

2d  and  4th  Wednesday  noon 
2nd  Friday,  monthly. 

1st  Thursday,  monthly. 

1st  Friday,  monthly,  except  Jnir 
and  August. 

1st  and  3d  Friday  each  month 
3d  Thursday,  monthly. 

1st  Friday,  monthly. 


Third  District  V.  H.  Hay,  Lima C.  E.  Hufford,  Toledo 


Alien 

E.  C.  Yingling,  Lima  - 

Auglaize 

Hancock  - 

A.  E.  King,  Mb.  Cory 

Hardin  . 

F.  M.  Elliott,  Ada. 

Logan 

Marion 

Mercer  . 

Seneca 

Van  Wert 

Wyandot 

B.  A.  Moloney,  Upper  Sandusky 

_W.  L.  Naus,  Upper  Sandusky 

Fourth  District — (With  Third  District  in  Northwestern  Ohio  District) 


Defiance S.  E.  DeMuth,  Hicksville D.  J.  Slosser,  Defiance^ 


Fulton 

Henry 

Lucas . 

Ottawa 

Paulding 

Putnam 

Bandusky  _ 
Williams  _ 
Wood 


P.  S.  Bishop,  Delta 

_T.  P.  Delventhal,  Napoleon- 

L.  R.  Effler,  Toledo. 

_ R.  A.  Willett,  Elmore 


- C.  E.  Houston,  Paulding 

E.  Blackburn,  Kalida 

D.  W.  Philo,  Fremont 

B.  C.  Bly,  Bryan 

F.  L.  Sterling,  Bowling  Green 


— Geo.  McGuffin,  Pettisville 

F.  M.  Harrison,  Napoleon 

A.  P.  Hancuff,  Toledo 

Cyrus  R.  Wood,  Port  Clinton 

Gaile  L.  Doster,  Paulding 

W.  B.  Light,  Ottawa 

J.  C.  Boyce,  Fremont 

H.  R.  Mayberry,  Bryan 

R.  N.  Whitehead,  Bowling  Green- 


Fifth  District — . — H.  V.  Paryzek,  Councilor Chrm.  Com.  on  Arrangements 

Ashtabula J.  F.  Docherty,  Conneaut A.  M.  Mills,  Ashtabula 

Cuyahoga H.  V.  Paryzek,  Cleveland Clarence  H.  Heyman,  Cleveland 

Erie J.  C.  Kramer,  Sandusky G.  A.  Stimson,  Sandusky 

Geauga H.  E.  Shafer,  Middlefield Isa  Teed-Cramton,  Burton 

Huron W.  W.  Lawrence,  Norwalk Geo.  F.  Linn,  Norwalk 


Lake G.  O.  Hedlund,  Painesville 

Lorain Herman  Campbell,  Elyria 

Madina Harry  Streett,  Litchfield— 

Trumbull E.  P.  Adams,  Warren 


B.  T.  Church,  Painesville 

,W.  E.  Hart,  Elyria 

— — J.  K.  Durling,  Wadsworth 

R.  H.  McCaughtry,  Warren 


Tiffin,  Oct.  3,  1933 
3d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 
1st  Thursday,  monthly. 
17th  of  each  month. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Thursday,  monthly. 

3rd  Thursday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


3d  Thursday,  monthly,  except 
July,  August,  December. 

2nd  Thursday  monthly. 

1st  Wednesday,  monthly. 

Friday,  each  week. 

2d  Thursday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Thursday,  monthly. 

3d  Thursday,  monthly. 

Cleveland. 

2nd  Tuesday,  monthly. 

3d  Fri.  Feb.,  March,  May,  Sept., 
Nov.,  Dec. 

Last  Wednesday,  monthly,  except 
July,  Aug.,  Sept. 

Last  Wednesday,  Apr.  to  Oct. 

3d  Tuesday,  Feb..  May, 

August,  Nov. 

4th  Tuesday,  monthly. 

2d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  monthly,  except 
June,  July,  August. 


September,  1933 


The  Ohio  State  Medical  Journal 


531 


Societies 


President 


Secretary 


Sixth  District A.  E.  Brant,  Youngstown J.  H.  Seiler,  Akron 2d  Wed.,  Jan.,  April  & Oct. 


Ashland H.  M.  Gunn,  Ashland  ; Paul  E.  Kellogg,  Ashland 2nd  Friday,  Sept,  to  May. 

Holmes L.  E.  Anderson,  Mt.  Hope C.  T.  Bahler,  Walnut  Creek 1st  Tuesday,  quarterly,  Jan.,  April, 

July,  October. 

Mahoning J.  P.  Harvey,  Youngstown _W.  M.  Skipp,  Youngstown 3d  Tuesday,  monthly. 

Portage S.  U.  Sivon,  Ravenna E.  J.  Widdecombe,  Kent 1st  Thursday,  monthly. 

Richland C.  H.  Bell,  Mansfield Mabel  Emery,  Mansfield Last  Thursday,  monthly. 

Stark — _H.  Welland,  Canton F.  S.  VanDyke,  Canton 2d  Tuesday,  monthly. 

Summit J.  H.  Selby,  Akron . A.  S.  McCormick,  Akron 1st  Tuesday,  monthly. 

Wayne W.  A.  Morton,  Wooster R.  C.  Paul,  Wooster 2d  Tuesday,  monthly. 


Seventh  District  — 

Belmont . G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire 1st  Thurs.,  monthly,  4 p.  m.. 

except  July  and  August. 

Carroll (With  Stark  Co.  Society) 

Columbiana J.  W.  Robinson,  Lisbon 1 John  Fraser,  East  Liverpool 2d  Tuesday,  monthly. 

CoBhocton Floyd  Craig,  Coshocton J.  D.  Lower,  Coshocton Last  Thursday,  monthly 

Harrison A.  C.  Grove,  Jewett W.  C.  Wallace,  Hopedale 3d  Wednesday,  monthly. 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville Last  Thursday,  monthly. 

Monroe G.  W.  Steward,  Woodsfield _A.  R.  Burkhart,  Woodsfield 2d  Wednesday,  monthly. 

Tuscarawas  F.  B.  Larimore,  New  Phila G.  L.  Sackett,  New  Phila 2d  Thursday,  monthly. 


Eighth  District 


Athens C.  E.  Welch,  Nelsonville T.  A.  Copeland,  Athens 1st  Monday,  monthly. 

Fairfield E.  B.  Roller,  Lithopolis C.  W.  Brown,  Lancaster 2d  Tuesday,  monthly. 

Guernsey C.  C.  Headley,  Cambridge E.  F.  Hunter,  Cambridge 1st  and  3rd  Thursday  each  month 

Licking Geo.  W.  Sapp,  Newark G.  A.  Gressle,  Newark Last  Friday,  monthly. 

Morgan D.  G.  Ralston,  MeConnelsville C.  E.  Northrup,  McConnelsville 3d  Wednesday,  monthly. 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 1st  Wednesday,  monthly. 

Noble 


Perry James  Miller,  Corning F.  J.  Crosbie,  New  Lexington 3d  Monday,  monthly. 

Washington  W.  W.  Sauer,  Marietta G.  M.  James,  Marietta 2d  Wednesday,  monthly 


Ninth  District 


Gallia O.  A.  Vornholt,  Gallipolis Milo  Wilson,  Gallipolis 1st  Wed.,  Feb.,  May,  Sept,  and  Dec 

Hocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan Quarterly. 

Jackson J.  S.  Hunter,  Jackson J.  J.  MeClung,  Jackson I 2nd  Tuesday,  monthly. 

Lawrence Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 1st  Thursday,  monthly. 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 3d  Thursday,  bi-monthly. 

Pike L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly 1st  Monday,  monthly. 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 2d  Monday,  monthly. 

Vinton O.  S.  Cox,  McArthur H.  S.  James.  McArthur 3d  Wednesday,  monthly 


Tenth  District 


Crawford E.  C.  Brandt,  Crestline R.  L.  Solt,  Bucyrus 1st  Monday,  monthly. 

Delaware Geo.  D.  Lowry,  Delaware J.  G.  Parker,  Delaware 1st  Tuesday,  monthly. 

Franklin . Jonathan  Forman,  Columbus John  H.  Mitchell,  Columbus Every  Monday,  8:30  p.  m. 

Knox S.  O.  Gantt,  Centerburg R.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly 

Madison R.  S.  Postle,  London G.  C.  Seheetz,  West  Jeffersom 4th  Wednesday,  monthly. 

Morrow F.  M.  Hartsook,  Cardington T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly 

Pickaway C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville 1st  Friday,  monthly. 

Rosb Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 1st  Thursday,  monthly. 

Union E.  J.  Marsh.  Broadway Angus  Maclvor.  Marysville 2d  Tuesday,  monthly. 


532 


Advertisements 


September,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 

This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL,  M.D. 

Medical  Directors. 

Dayton,  Ohio 

MRS.  GEORGE  V.  SHERIDAN, 
President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

NAOMI  VOGE,  R.  N. 

Resident  Superintendent 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


A MODERN  ETHICAL  HOSPITAL 

Rates:  $25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alcohol,  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  Not  limited  as  to  the  quantity 
used  but  can  give  the  patient  as  much  whiskey  as  his  condition  requires. 

NERVOUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoscine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  that  their  own 
home  affords. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 

tal. Female  attendants  only ; absolute  privacy ; com- 
fortable, well-appointed  ladies’  lounge. 

Cherokee  Road  (Long  Distance  Phone  East  1488) 

THE  STOKES  SANATORIUM 

Louisville,  Ky.  27  Years  Treating  Nervous  Patients. 


THE  OXFORD  RETREAT 

Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 


R.  HARVEY  COOK,  Physician-in-Chief 


FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


WHITING  MINERAL  SPRINGS 

SANITARIUM  AND  BATHS 

L.  A.  WHITING,  Owner 

Hydrotherapy  scientifically  applied  for  the  treatment  of  rheumatism  and  allied  diseases, 
together  with  cases  for  elimination  and  rest  cure. 

0Medical  department  thoroughly  proficient  and  STRICTLY  ethical. 

First  class  and  modern  in  every  department  with  moderate  rates. 

WHITING  SANITARIUM  »>  »»  MARTINSVILLE,  IND 

VAN  W.  WHITING,  Manager 


THE  MERCER  SANITARIUM  • MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristown,  Pa.) 


PtUBLI©  MSABTInl  - SOCIAL  "WBJLFAK 
MEMCAIL  ECONOMICS 
"m-md  OM.CAN1EATHON  PROB1LI 

‘UJiih  Editorial  Comment  by  D.K.M. ^===s%( 


Im  TMs 


Coming-  as  a climax  to  a most  difficult  year  in 
the  history  of  medical  org-anization,  this  year’s 
annual  meeting  at  Akron,  September  7 and  8, 

takes  on  added  signifi- 
cance and  importance. 

In  addition  to  pre- 
senting one  of  the 
Issue  finest  scientific  pro- 

grams ever  arranged 
for  a state  meeting,  giving  to  each  person  in  at- 
tendance an  unusual  opportunity  to  improve  his 
knowledge  so  that  he  can  render  more  efficient 
service,  the  Akron  meeting  will  offer  an  oppor- 
tune time  for  studious  consideration  of  many  of 
the  important  problems  confronting  the  medical 
profession. 


As  the  editor  of  the  Michigan  State  Medical 
Journal  pointed  out  to  his  readers  recently: 
“One  function  of  medical  organization  is  to  im- 
prove the  mental  equipment  of  its  membership; 
the  other  is  to  insure  each  physician  as  much 
economic  security  as  possible  so  that  he  may  live 
well  as  a citizen  and  perform  his  duties  efficiently 
to  the  public.” 


Experiences  of  the  past  year  have  shown  that 
economic  security  is  a fickle  thing.  All  physicians 
have  felt  the  evil  effects  of  the  financial  collapse 
and  world-wide  social  unrest.  Although  not  now 
as  acute  as  it  has  been,  the  period  of  uncertainty 
is  by  no  means  over.  Many  unsolved  problems 
still  confront  us. 


One  guess  is  as  good  as  another  as  to  what  the 
present  status  of  the  individual  physician  would 
have  been  had  he  not  had  strong  and  active  medi- 
cal organization  to  look  to  for  aid  and  protection 
during  the  troubled  days  of  the  recent  past. 

The  87th  Annual  Meeting  at  Akron  will  give 
the  membership  as  a whole  the  opportunity  to  re- 
view the  accomplishments  of  medical  organization 
and  to  prepare  for  the  future. 

All  things  considered,  we  believe  medical  or- 
ganization has  made  a remarkable  record  of 
achievement  during  the  past  year.  The  reports  of 
the  standing  and  special  committees  of  the  State 
Association,  published  in  this  issue  of  The  Jour- 
nal, reflect  the  untiring  efforts  of  those  manning 
the  machinery  of  the  state  organization  in  the 
interests  of  the  profession.  In  those  communities 
where  medical  organization  has  functioned  prop- 


erly, many  important  questions  have  been  satis- 
factorily handled,  attesting  to  what  may  be  ac- 
complished through  teamwork  and  enterprise. 

As  a whole,  medical  organization  in  Ohio,  state 
and  local,  has  functioned  effectively  during  this 
troublesome  period,  due  to  wise  leadership  and 
the  loyalty  and  cooperation  of  the  majority  of  the 
membership. 

But  what  of  the  future?  Medical  organization 
must  not  make  the  fatal  mistake  of  assuming  an 
attitude  of  indifference,  believing  that  the  storm 
has  blown  over  and  that  all  its  problems  have 
been  solved. 

During  the  sessions  of  the  Akron  meeting  this 
point  should  be  emphasized  and  reemphasized. 
Those  given  the  opportunity  of  taking  part  in 
the  proceedings  of  the  annual  gathering  should 
consider  it  their  solemn  duty  to  arouse  the  mem- 
bership to  a realization  that  innumerable  acute 
situations  still  face  every  practitioner  of  medicine 
and  that  a virile  organization  is  more  necessary 
now  than  ever  before  if  these  issues  are  to  be 
satisfactorily  met. 

Every  physician  in  attendance  should  leave  with 
an  increased  desire  to  give  still  more  of  his  in- 
terest, time  and  energy  to  the  activities  of  medi- 
cal organization.  This  message  should  be  carried 
home  to  members  unable  to  attend  the  Akron 
meeting,  and  to  those  eligible  physicians  who 
should  be,  but  are  not,  members  of  organized 
medicine.  We  can  think  of  no  better  time  for 
every  member  of  the  State  Association  to  take 
the  first  step  in  carrying  out  the  admonition  at- 
tributed to  Charles  E.  Dawes: 

“If  you  work  in  a profession,  in  Heaven’s  name 
work  for  it.  If  you  live  by  a profession,  live  for 
it.  Help  advance  your  co-worker.  Respect  the 
great  power  that  protects  you,  that  surrounds 
you  with  the  advantages  of  organization,  and  that 
makes  it  possible  for  you  to  achieve  results. 
Speak  well  for  it.  Stand  for  it.  Stand  for  its 
profesisonal  supremacy.  If  you  must  obstruct  or 
decry  those  who  strive  to  help,  why — quit  the 
profession.  But  as  long  as  you  are  a part  of  a 
profession  do  not  belittle  it.  If  you  do  you  are 
loosening  the  tendrils  that  hold  you  to  it,  and 
with  the  first  high  wind  that  comes  along  you 
will  be  uprooted  and  blown  away,  and  probably 
you  will  never  know  why.” 


545 


546 


The  Ohio  State  Medical  Journal 


September,  1933 


The  medical  profession  has  been  watching  with 
considerable  interest  the  nation-wide  activity 
which  has  taken  place  pursuant  to  enactment  of 
the  National  Recovery  Act, 
especially  developments  re- 
lating to  the  drafting  and 
submission  of  codes  gov- 
erning the  conduct  of  var- 
ious business  and  indus- 


Code  of 
C onduct  Still 
Fundamental 


trial  groups. 


For  centuries  the  medical  profession  has  been 
governed  by  a code  of  ethics  setting  forth  the  re- 
sponsibility and  obligations  of  physicians  to  their 
patients  and  to  each  other.  Frequently,  the  prin- 
ciples of  medical  ethics  have  been  ridiculed  by 
those  who  failed  to  understand  their  purpose  or 
to  realize  the  necessity  for  them. 


Now  amid  social  and  economic  disorder,  busi- 
ness and  industrial  groups  have  begun  to  realize 
that  certain  principles  of  fair  practices  to  govern 
the  relationship  between  them  and  the  public  and 
between  them  as  competing  groups  may  in  the 
end  be  their  salvation. 


All  of  which  should  impress  every  physician 
with  the  fact  that  the  principles  of  medical  ethics, 
conceived  centuries  ago  by  the  profession  itself, 
today  are  of  greater  significance  than  ever  before, 
and  if  carefully  observed  by  all  members  of  the 
profession  will  eventually  play  a major  role  in 
alleviating  the  chaotic  condition  which  now  con- 
fronts the  medical  profession. 

Many  physicians  are  confronted  with  an 
economic  crisis.  All  manner  of  inducements,  some 
good,  some  bad,  have  been  offered  to  tide  them 
over  this  crisis.  Some  have  offered  their  profes- 
sional services  to  new  and  untried  schemes. 
Others  have  refused  to  have  a part  in  question- 
able programs.  The  temptations  have  been  many. 
Fortunately,  a comparatively  few  members  of  the 
profession  have  yielded.  The  principles  of  medical 
ethics  have  proven  again  their  value  and  have 
been  a powerful  factor  in  guiding  the  profession 
through  these  troublesome  times. 


Although  the  crisis  still  exists  and  the  danger 
point  has  not  been  passed,  it  seems  certain  that 
the  medical  profession  has  weathered  the  gale 
with  the  esteem  and  respect  of  the  public  for  it 
intact.  For,  as  one  observer  has  declared: 


“It  is  difficult  to  believe  that  for  the  sake  of 
improving  their  present  financial  status,  doctors 
will  knowingly  exchange  their  birth-right  for 
questionable  relief  from  a pressing  but  tempor- 
ary need.  Rather  is  it  the  conviction  that  they 
will  not  permit  themselves  to  be  herded  onto  the 


wrong  road,  but  will  bend  to  their  individual 
tasks  with  earnestness  and  vigor,  certain  in  their 
belief  that  in  this  course  lies  their  only  hope  of 
salvation.” 


In  a recent  issue  of  The  Survey  Graphic,  C.  E. 
A.  Winslow,  professor  of  public  health,  Yale  Uni- 
versity, discussed  public  health  financing  and 
warned  against  the 


Concerning 
Public  Health 
Administration 


adoption  of  a penny- 
wise, pound-foolish  at- 
titude in  the  matter  of 
public  health  budget 
slashing. 

Professor  Winslow  severely  criticizes  the  al- 
leged activities  of  the  medical  profession  in  some 
communities  where  difficulties  have  arisen  be- 
tween public  health  officials  and  private  prac- 
titioners. 

‘The  medical  profession  inherits  an  almost 
priestly  social  tradition  and  the  vast  majority  of 
its  members  still  practice  a ministry  of  healing 
and  not  a business  inspired  by  the  profit  motive”, 
he  declared. 

“No  group,  however,  can  be  made  up  entirely  of 
unselfish  and  devoted  individuals.  A certain 
small  but  active  section  of  the  profession  has  long 
viewed  with  disapproval  the  opportunities  offered 
to  certain  of  its  members  by  salaried  positions  in 
the  public  health  service  and  has  considered  that 
such  services  constitute  unfair  competition  with 
individualistic  private  practice,  forgetting  that 
the  full-tme  and  part-time  medical  employes  of 
health  departments  who  are  rendering  good  medi- 
cal service  to  the  public  have  their  own  rights  and 
privileges  as  members  of  the  medical  profession. 
This  group  has  seen  in  the  present  crisis  an  op- 
portunity to  eliminate  such  competition  and  in 
certain  communities  apparently  has  made  a con- 
certed effort  to  cripple  public  health  service  by 
allying  itself  with  economic  groups  bent  on  in- 
discriminate tax  reduction.  In  Indiana  such  an 
alliance  has  wrecked  the  state  health  organization. 
In  Tennessee  it  tried  to  do  so  and  failed. 


“Such  activities  have  been  described  somewhat 
severely  but  with  some  justice,  as  medical  sabot- 
age. They  may  take  various  forms,  but  in  gen- 
eral they  involve  the  reorganization  of  health 
boards  so  as  to  give  control  to  the  organized 
medical  profession  and  the  replacement  of  ex- 
perienced full-time  public  health  experts  by  part- 
time  men  closely  associated  with  the  reactionary 
group  of  physicians.  The  medical  profession 
should  be  well  represented  on  health  boards;  but 
no  single  profession  can  fairly  represent  the  pub- 
lic interest  as  a whole.  To  turn  over  the  public 
health  service,  or  any  part  of  it,  to  physicians  un- 
trained in  public  health  and  pledged  to  the  idea 
of  eliminating  so-called  ‘unfair  competition’  is 
like  entrusting  the  police  force  of  a city  to  the 
representative  of  a private  detective  agency  or  its 
water  supply  to  the  representative  of  a spring 
water  company  with  the  aim  of  so  conducting  the 
public  business  that  it  shall  not  compete  with  the 
respective  private  vested  interests  concerned.” 

It  is  difficult  to  believe  that  the  organized 
medical  profession  in  any  community  has  de- 


September,  1933 


Editorial 


547 


liberately  plotted,  as  Professor  Winslow  implies, 
to  “wreck”  the  public  health  department  of  the 
community  or  has  been  actuated  by  selfish  motives 
in  whatever  controversy  has  taken  place. 

On  the  other  hand,  it  is  not  difficult  to  imagine 
an  intolerable  situation  for  the  physicians  in  some 
communities  arising  from  improper  management 
on  the  part  of  the  health  officer  or  an  unfortunate 
selection  of  personnel  to  administer  the  public 
health  laws,  and  calling  for  concerted,  vigorous 
action  on  the  part  of  the  medical  profession  to 
protect  its  own  rights  and  the  best  interests  of 
the  public.  It  is  possible  that  such  a situation  may 
have  existed  in  the  communities  mentioned  by 
Professor  Winslow. 

The  vulnerable  part  of  Professor  Winslow’s 
criticism  seems  to  us  to  be  his  fear  of  any  move 
to  give  organized  medicine  a leading  part  in  local 
public  health  activities.  We  fail  to  see  how  this 
would  be  dangerous  or  result  in  a breakdown  of 
public  health  administration.  In  fact,  we  know  of 
no  other  group  so  informed,  unselfish  and  so  well 
qualified  to  play  a directing  role  in  all  medical 
and  health  activities  as  the  medical  profession  or 
which  can  command  greater  confidence  from  the 
public  generally. 

Experience  in  Ohio  has  shown  that  the  most 
efficient  public  health  departments  are  those 
which  have  the  active  support  of  the  medical  pro- 
fession and  are  headed  by  a health  officer  who 
works  in  close  cooperation  with  the  organized 
medical  profession  of  his  community ; looks  to  his 
colleagues  in  private  practice  for  advice  and  sug- 
gestions, and  who  is  himself  an  active  member  of 
his  county  medical  society. 

Naturally,  it  is  desirable  that  a health  officer 
have  a fundamental  understanding  of  the  essen- 
tials of  public  health  work,  much  of  which  is  ob- 
tainable from  practical  experience.  On  the  other 
hand,  a health  administrator  may  be  impotent  and 
a failure  unless  he  understands  the  medical  view- 
point, realizes  the  proper  limitations  of  public 
health  work,  and  has  the  personal  attributes 
which  win  for  him  the  confidence  and  good  will 
of  his  medical  colleagues  as  well  as  the  public. 

Professor  Winslow’s  intimation  that  medical 
organization  should  assume  more  of  a hands-off 
attitude  in  public  health  administration  should 
not  be  taken  seriously.  If  anything,  groups  of 
physicians  in  many  communities  have  been  lax, 
rather  than  over-active,  in  their  relationships 
with  public  health  officials.  We  believe  that  those 
health  officers  who  are  sincerely  interested  in 
making  their  departments  effective  gladly  wel- 
come greater  cooperation  on  the  part  of  the 
physicians  of  their  districts. 

Incidentally  but  almost  axiomatically  it  may  be 
added  that  practically  all  of  the  difficulties  and 
misunderstanding  on  this  matter  are  caused  by 
self-opinionated  lay  “experts”  who  are  neither 
health  commissioners  nor  practicing  physicians. 

For  the  good  of  all  concerned,  medical  organiza- 


tion should  not  play  second  fiddle  in  public  health 
activities.  Greater  interest  on  the  part  of  the 
medical  profession  in  all  communities  in  public 
health  work  is  certain  to  insure  greater  benefits 
for  the  community  as  a whole. 


“The  medical  profession  is  slowly  but  surely 
becoming  convinced  that  the  quickest  and  surest 
way  to  protect  the  public  health  and  safeguard 
the  principles  and  stand- 
ards of  medical  practice  is 
for  doctors  to  enter  the 
political  arena  and  become 
active  participants  in  the 
business  of  lawmaking.” 

The  editor  of  the  Wayne  County  (Detroit) 
Medical  Bulletin  in  making  this  observation 
touches  on  a subject  which  has  become  of  in- 
creasing importance  in  recent  year's  from  the 
standpoint  of  the  medical  profession  as  a whole 
and  one  which  is  destined  to  grow  in  importance 
in  the  not  distant  future. 

Those  inclined  to  be  a bit  skeptical  as  to  the 
need  for  civic  activity  on  the  part  of  the  medical 
profession  should  peruse  with  a critical  eye  the 
annual  report  of  the  Committee  on  Public  Policy 
of  the  State  Asosciation,  published  in  this  issue 
of  The  Journal. 

A reading  of  that  report  should  impress  every 
physician  with  the  increasing  importance  of  con- 
stant and  close  contact  between  medical  organi- 
zation and  governmental  and  legislative  events 
and  developments.  As  intimated  in  the  report 
of  the  Committee  on  Public  Policy,  each  year 
brings  forth  an  increasing  number  of  important 
governmental  and  legislative  problems  for  the 
medical  profession,  some  more  difficult  and  com- 
plex than  those  of  previous  years  and  all  of  vital 
concern  to  those  interested  in  medical  standards 
and  the  public  health. 

Our  Michigan  contemporary  urges  members  of 
the  medical  profession  to  interest  themselves  in 
governmental  questions  and  obseiwes  that  “the 
opportunity  is  ripe  for  doctors  to  take  a hand  at 
the  wheel  and  do  a little  of  the  steering  them- 
selves”. 

The  same  hope  was  expressed  recently  by  the 
out-spoken  editor  of  Southern  Medicine  and  Sur- 
gery who  declares : 

“Doctors’  reputation  for  peacefulness  and  re- 
serve has  led  some  into  the  belief  that  we  will  not 
fight  for  our  rights,  and  has  kept  us  from  seeking 
the  political  preferment  to  which  we  are  entitled. 
Let  us  show  all  and  sundry  how  erroneous  is  this 
assumption,  and  that  forbearance  means  neither 
simplemindedness  nor  cowai’dice.  Let  us  go  into 
politics.” 

Of  the  same  tenor  is  the  plea  made  in  a legisla- 
tive summary  published  in  the  official  publication 
of  the  medical  society  of  an  eastern  state,  in 
which  the  writer  laments  the  fact  that  there  were 


Participation 
In  Public 
Affairs 


548 


The  Ohio  State  Medical  Journal 


September,  1933 


1934  A.M.A.  Meeting  to  Be  in  Cleve- 
land, June  11-15 

Official  announcement  has  been  made  that 
the  Eighty-Fifth  Annual  Session  of  the 
American  Medical  Association  will  be  held 
in  Cleveland,  June  11  to  15,  1934.  As  Ohio 
physicians  know,  at  the  1933  session  of  the 
American  Medical  Association  in  Milwaukee, 
the  House  of  Delegates  selected  Cleveland 
as  the  convention  city  for  1934  over  Atlantic 
City,  Washington,  and  several  other  cities. 


only  eight  physicians  who  were  members  of  the 
recent  legislative  session  in  that  state. 

These  examples  of  the  awakening  of  political- 
mindedness on  the  part  of  medical  leaders  in 
various  sections  of  the  country  are  signs  that  per- 
haps in  the  near  future  an  increasing  number  of 
physicians  will  assume  an  active  interest  in  the 
public  life  of  their  communities. 

Active  interest  in  civic  affairs  need  not  neces- 
sarily involve  office-seeking  or  office-holding.  One 
can  easily  imagine  the  power  and  influence  of  the 
medical  profession  in  any  community  where  most 
of  the  physicians  keep  themselves  fully  informed 
concerning  candidates  or  prospective  candidates 
for  office,  local  and  state,  and  in  their  contacts 
with  electors  from  all  walks  of  life  drive  home 
the  importance  of  choosing  those  who  have  the 
correct  attitude  toward  medical  and  health  mat- 
ters. There  are  many  activities  in  local  politics  in 
which  physicians  may  participate  but  which  may 
not  necessarly  involve  candidacy  for  office. 

Just  as  the  present  period  of  financial  distress 
has  taught  the  physician  the  lesson  that  he  must 
not  stand  on  the  sidelines  and  watch  someone  else 
solve  his  economic  problems  for  him,  some  of  the 
recent  experiences  the  medical  profession  has  had 
in  governmental  and  legislative  functions  have 
awakened  in  him  a realization  that,  to  use  the 
words  of  one  famous  gridiron  mentor,  the  best  de- 
fense is  a good  offense  and  that  this  offense  should 
lead  him  to  direct  participation  in  the  game  going 
,on  in  the  political  arena 


An  amusing,  but  pertinent,  observation  on  the 
present  state  of  national  affairs  was  made  not 
long  ago  in  the  New  York  World-Telegram,  in 
which  an  object  lesson  is 
drawn  that  merits,  we 
believe,  studied  thought 
on  the  part  of  the  medi- 
cal profession. 

The  editorial  begins 
with  the  story  of  the  two  shipwrecked  men  in  a 
lifeboat.  One  was  rowing.  The  other  was  pray- 
ing. 


Learned  From 


“0  Lord!”  shouted  the  supplicant,  “we  promise 
Thee  everything  if  we  may  only  see  a sail!” 

“Hey!”  cried  the  man  at  the  oars.  “Don’t 
promise  too  much!  I think  I see  a sail.” 

Then  the  W orld-T elegram  warns  how  the  nation 
has  been  quick  to  forget  a lot  of  promises  it  made 
when  the  economic  outlook  was  the  darkest  now 
that  the  upturn  in  business  and  industry  seems  to 
have  been  reached. 

There  is  something  about  the  analogy  drawn  in 
the  editorial  which  should  appeal  to  the  medical 
profession. 

For  the  past  few  years,  physicians  have  been 
forced  to  fight  for  their  existence  and  to  maintain 
their  profession  as  an  independent,  individualistic, 
scientific  vocation.  We  have  achieved  much  and 
placed  ourselves,  perhaps,  on  a sounder  basis  than 
ever  before.  We  have  promised  ourselves  and  our 
colleagues  that  never  again  will  we  be  caught 
napping;  that  we  will  continue  the  militant  cam- 
paign we  have  begun  in  demanding  our  rights  and 
defending  our  policies  and  principles.  Moreover, 
we  have  pledged  ourselves  to  cooperate  and  assist 
in  an  effort  to  work  out  some  of  the  troublesome 
medico-social  problems  that  confront  us  and  con- 
tinue to  prepare  ourselves  to  give  to  the  public 
the  kind  of  service  and  consideration  which  is  due 
it. 

While  it  should  not  be  assumed  by  any  means 
that  our  troubles  are  over  and  our  problems 
solved,  there  is  some  indication  at  present  that 
much  of  the  agitation  which  has  plagued  and 
almost  demoralized  us  has  subsided  and  that  we 
are  going  to  be  given  a fair  opportunity  to  solve 
some  of  these  questions  in  a way  which  we  believe 
to  be  for  the  best  interests  of  the  public,  as  well 
as  the  medical  profession  generally. 

For  this  reason,  now  would  appear  to  be  a 
time  of  supreme  danger  for  us.  Shall  we  continue 
to  expend  time  and  energy  working  out  ways  of 
adjusting  ourselves  to  meet  economic  and  social 
changes,  preserving  the  policies  and  principles 
which  we  know  to  be  correct?  Or,  shall  we  con- 
clude that  the  task  is  done,  our  problems  solved, 
and  that  we  can  drift  back  into  a lackadaisical 
way  of  meeting  questions  of  supreme  importance? 

The  answer,  we  believe,  is  obvious.  Simply  be- 
cause we  think  we  see  a “sail”,  we  dare  not  dis- 
continue “rowing”,  nor  do  we  dare  forget  the 
promises  which  we  have  made  to  ourselves  and 
others  that  from  now  on  we  are  going  to  be  pre- 
pared for  contingencies  as  they  arise. 

For  us  to  forget  the  lessons  of  the  past  few 
years  would  obliterate  the  only  good  which  the 
present  period  of  depression  and  unrest  has  pro- 
duced. 


Littre's  Hernia  * * * A Meckel's  Diverticulum  in  a Hernia  Sac 

with  Meport  of  a Case 


S.  C.  Lind,  M.D., 

MECKEL’S  diverticulum  is  no  longer  a 
surgical  curiosity.  From  time  to  time 
every  surgeon  operates  on  a patient  suf- 
fering from  either  inilammation  of  a Meckel’s 
diverticulum,  or  from  obstruction  caused  by  it. 
Occasionally  the  operator  discovers  a diverticulum 
in  the  course  of  an  abdominal  operation.  Very 
rarely  does  he  find  it  in  a hernia  sac.  The  in- 
cidence of  a Meckel’s  diverticulum  in  a hernia  sac 
is  so  small  that  all  cases  should  be  recorded. 
Perhaps  if  enough  are  described,  it  may  be  pos- 
sible to  make  an  accurate  pre-operative  diagnosis 
in  some  patients. 

Meckel’s  diverticulum  is  said  to  be  present  in 
1.3  per  cent  of  bodies  subjected  to  autopsy. 
Pabst  states  that  in  21,693  autopsies  285  diverti- 
cula were  found,  although  he  remarks  that  Abers 
noted  only  one  in  1,000  cases.  That  Meckel’s 
diverticulum  is  discovered  by  the  operating  sur- 
geon in  the  course  of  routine  laparotomies  with 
much  less  frequency  is  indicated  by  Balfour’s  re- 
port of  fifteen  in  the  course  of  10,000  operations, 
Watson,  in  1923,  collected  147  cases  from  the 
literature  in  which  a Meckel’s  diverticulum  was 
found  either  alone  or  as  part  of  the  contents  of 
a hernia  sac.  Pabst  reports  that  in  86  of  his 
series  of  121,  the  diverticulum  only  was  found  in 
the  sac.  Most  of  the  patients  were  adults  and 
middle-aged  individuals.  The  male  sex  predomi- 
nated 79  to  33.  In  the  balance  the  sex  of  the  in- 
dividuals was  not  given. 


A summary  of  Dr.  Watson’s  report  of  130  cases 
in  which  the  type  of  hernia  was  stated,  is  as  fol- 
lows : 


Sex  not 

Male 

Female 

given 

Inguinal 

69 

12 

15 

Femoral 

10 

21 

3 

The  right  sided  herniae  predominate  over  the 
left  more  than  three  to  one.  Eighty-three  of  the 
collected  cases  occurred  on  the  right  side,  both 
inguinal  and  femoral,  while  only  28  were  on  the 
left.  Perhaps  this  may  be  explained  on  the  ground 
that  the  lower  ileum  is  generally  found  to  the 
right  of  the  median  line. 

Historically,  we  note  that  Pabst  credits 
Lavater,  in  1671,  as  having  observed  the  first 
authentic  case  of  a Meckel’s  diverticulum  in  a 
hernia  sac.  Littre  published  his  classical  paper  in 
1700,  reporting  two  cases.  Exactly  one  hundred 
years  later  Meckel  investigated  and  described  the 
diverticulum  which  bears  his  name.  He  decided 
that  it  was  of  congenital  origin.  One  year  after 
Littre’s  article  appeared,  Mevy  encountered  a 
diverticulum  in  a strangulated  hernia  which  came 


Cleveland,  Ohio 

to  operation.  This  is  the  first  recorded  occurrence 
in  the  living. 

The  types  of  Meckel’s  diverticula  found  in 
hernia  are  as  varied  as  those  remaining  within 
the  abdomen.  Some,  at  the  base,  have  a diameter 
equal  to  that  of  the  gut.  Others  have  a narrow 
lumen  and  terminate  in  a thread-like  strand.  The 
larger  diverticula  are  quite  like  the  small  in- 
testine in  their  histological  structure,  and  their 
mucosa  may  contain  both  Peyer’s  patches  and 
acid  secreting  glands  similar  to  those  of  the  gas- 
tric mucosa.  These  later  glands  frequently 
ulcerate,  and,  at  times,  give  rise  to  obscure  in- 
testinal hemorrhage.  Whether  a mesentery  is 
present  may  be  questioned.  Pabst  states  that 
Meckel’s  diverticula  may  have  a mesentery,  while 
Watson  claims  that  they  do  not  have  a mesentery. 
Personally,  we  have  never  seen  a mesentery,  al- 
though as  in  the  case  here  reported  a distinct  and 
separate  vessel  supplied  the  diverticulum.  Dr.  T. 
Wingate  Todd,  in  a personal  communication,  re- 
plied that  a mesentery  may  or  may  not  be  present. 

The  entrance  of  a diverticulum  into  a hernia 
sac  may  be  regarded  as  an  accident.  Eickhorn 
theorized  that  the  diverticulum  was  drawn  into 
the  sac  by  the  descent  of  the  testes  to  which  it 
was  attached.  This  theory  is  not  accepted,  and 
according  to  Watson  is  less  plausible  as  an  ex- 
planation of  this  hernia  than  of  a hernia  of  the 
appendix  or  cecum.  The  very  fact  that  hernia  is 
so  common,  that  Meckel’s  diverticulum  occurs  in 
at  least  one  person  in  a hundred,  and  that  so  few 
hernias  contain  a Meckel’s  diverticulum  forces 
one  to  the  conclusion  that  it  enters  the  sac  quite 
by  chance. 

Symptoms  produced  by  this  type  of  hernia  when 
the  diverticulum  is  attached  to  the  sac  are  more 
pronounced  than  those  of  the  usual  hernia. 
Naturally  if  the  diverticulum  is  not  adherent, 
and  the  contents  of  the  sac  are  readily  reduced, 
the  true  nature  of  the  hernia  will  be  missed.  In 
almost  all  the  recorded  cases,  the  hernia  was 
either  strangulated  or  the  tip  of  the  diverticulum 
was  adherent.  Thus  the  operator  or  the  path- 
ologist in  fatal  unoperated  cases  was  able  to 
make  the  diagnosis. 

If  the  hernia  is  strangulated,  it  is  said  to 
present  all  the  symptoms  and  physical  findings  of 
the  usual  strangulated  hernia.  Where  a hernia  is 
small,  and  hard  to  find,  if  the  patient  presents 
symptoms  of  obstruction,  one  must  think  of  a 
Littre’s  hernia.  Particularly  is  this  true  of  fat 
women,  in  whom  a femoral  hernia  may  be  over- 
looked. If  the  diverticulum  is  adherent,  and 
slightly  inflammed,  especially  at  the  tip,  the 
hernia  is  not  only  tender,  but  general  abdominal 


549 


550 


The  Ohio  State  Medical  Journal 


September,  1933 


symptoms  are  present.  These  consist  of  nausea, 
at  times  vomiting,  and  pain.  The  pain  is  cramp- 
like, and  may  be  referred  to  the  epigastrium. 
Constipation  is  the  rule.  The  general  picture  is 
that  of  an  incomplete  obstruction.  The  ingestion 
of  food  aggravates  the  symptoms,  while  ab- 
stinence and  an  enema  usually  bring  relief.  If 
the  hernia  is  incompletely  reduced,  a tender  cord- 
like process  in  the  inguinal  canal  is  said  to  be 
palpable.  In  my  patient  the  hernia  was  so  sen- 
sitive to  pressure  that  such  a process,  although  it 
must  have  been  present,  was  over-looked. 

The  treatment  is  operation,  and  prompt  opera- 
tion. A number  of  the  earlier  cases  were  per- 
mitted to  go  on  to  ulceration  of  the  diverticulum 
with  infection  of  the  sac,  and,  in  some,  of  the 
peritoneum.  Infection  is  a very  real  danger,  and 
is  easier  to  prevent  than  treat.  An  adherent 
diverticulum  is  subject  to  trauma.  The  diverti- 
culum should  be  removed,  and  unless  infection  is 
present,  the  hernia  repaired.  In  disposing  of  the 
diverticulum,  care  must  be  observed  lest  the 
lumen  of  the  bowel  be  unduly  constricted.  In  the 
present  case,  the  clamp  was  placed  transversely 
to  the  long  axis  of  the  ileum,  so  as  to  lessen  the 
narrowing  of  intestine.  Had  it  been  placed 
longitudinally,  as  is  usually  recommended  and  de- 
picted in  articles  dealing  with  Meckel’s  diverti- 
culum, the  intestinal  canal  would  have  been  too 
much  constricted. 

The  prognosis,  while  worse  than  in  simple 
hernias,  is  better  than  in  the  ordinary  strangu- 
lated hernia.  Pabst  reports  60  operations  with  13 
deaths;  21  not  opei'ated,  with  two  recoveries. 
His  statistics  extend  from  1800  to  1909,  and  are 
much  less  favorable  than  more  recent  figures. 
Of  twenty-eight  patients  from  1900  to  1910,  only 
one  died.  Watson  reports: 


No.  of 
cases 

Re- 

coveries 

Deaths 

Diverticulum  excised 

- 61 

58 

3 

Operation  and  Drainage.. 

4 

3 

1 

Spontaneous  Fistula  __ 

5 

3 

2 

Operation — Diverticulum 

reduced  to  abdomen 

- 6 

4 

2 

(symptoms 

continued) 

Thus  we  may  conclude 

that  an 

early  operation 

with  removal  of  the  diverticulum  offers  a good 
chance  for  recovery,  and  cure  of  the  hernia. 

CASE  REPORT 

The  patient — male,  aged  39  years — employed  in 
a dairy- — presented  himself  with  the  complaint  of 
pain  in  the  side.  He  entered  the  office,  walking  in 
a stooped  position,  and  holding  his  right  side. 
Two  months  ago  he  first  noticed  a swelling  in  the 
right  groin,  which  seemed  to  follow  the  lifting  of 
milk  cans.  This  caused  him  no  inconvenience,  and 
he  continued  with  his  work.  He  bought  a truss 
one  month  ago,  since  which  time  the  hernia  has 
been  painful.  He  found  that  the  pressure  of  the 
truss  made  him  worse,  and  discontinued  wearing 
it.  During  the  past  week,  he  experienced  pain  in 
the  hernia,  nausea  and  abdominal  cramps.  Yester- 


day all  symptoms  became  more  intense,  and  walk- 
ing caused  severe  pain.  Eating  increased  his  dis- 
comfort. Constipation  developed  a week  ago,  and 
he  has  taken  laxatives.  Defecation  brought  tem- 
porary relief. 

The  past  history  is  irrelevant.  Examination: 
The  patient’s  face  expresses  anxiety  and  shows 
evidence  of  suffering.  He  is  a muscular,  middle- 
aged  man.  The  pharynx  is  injected,  and  an  oc- 
casional coarse  rale  is  heard  over  both  right  and 
left  lung.  The  circulatory  system  was  not  re- 
markable. The  abdomen  seemed  slightly  dis- 
tended, but  was  not  tender  on  pressure.  No  ten- 
derness over  epigastrium  or  gall  bladder  was 
noted.  The  spleen  and  liver  were  not  enlarged  to 
either  percussion  or  palpation. 

Local  findings:  A typical  hernia  mass,  the 

size  of  a hen’s  egg,  was  found  in  the  right  in- 
guinal region.  The  lower  border  entered  the 
scrotum.  Palpation  caused  pain,  and  gentle  pres- 
sure exerted  in  an  attempt  to  replace  the  hernia, 
made  the  patient  cry  out.  A partial  reduction  was 
accomplished.  The  left  inguinal  canal  was  some- 
what relaxed,  but  a definite  hernia  could  not  be 
demonstrated.  Impression:  Incarcerated  inguinal 
hernia,  and  prompt  operation  was  advised. 

The  patient  was  somewhat  relieved  by  the 
partial  reduction  and  refused  to  go  to  the  hospital 
until  the  next  day. 

Operation:  September  19,  1932 — Anesthesia 

local — Gas  added  when  freeing  tip  of  diverticulum. 
The  exposed  sac  appeared  unusually  thick,  was 
isolated  less  easily  than  the  ordinary  hernia  sac, 
and  was  firmly  attached  to  the  scrotum.  The  sac 
was  opened  and  found  to  contain  what  at  first 
sight  appeared  to  be  small  intestine  with  glis- 
tening normal  serosa.  On  passing  the  finger  into 
and  around  this  supposed  loop  of  intestine,  it  was 
found  to  be  large  diverticulum  with  the  tip  firmly 
adherent  to  the  bottom  of  the  sac.  This  was  cut 
free,  and  the  diverticulum  and  ileum  pulled  into 
the  wound.  The  diverticulum  was  three  and  one- 
half  inches  long,  with  a diameter  at  the  base  ap- 
proximately equal  to  that  of  the  intestine  from 
which  it  sprang.  An  artery  about  one-sixteenth 
of  an  inch  in  diameter  furnished  the  main  blood 
supply.  This  was  under-run  with  a ligature  be- 
fore the  .diverticulum  was  resected.  On  account  of 
the  danger  of  constricting  the  intestine  the  base 
was  clamped  transversely  to  the  long  axis  of  the 
bowel.  The  diverticulum  was  cut  away  between 
clamps  with  the  cautery  and  inverted  with  a run- 
ning right  angle  suture.  This  was  reinforced 
with  a second  suture.  ; 

The  diameter  of  the  bowel  was  not  greatly  nar- 
rowed, and  the  operation  was  completed  using  a 
modified  Ferguson  technique  in  repairing  the 
hernia. 

The  post  operative  course  was  not  remarkable. 
Nothing  was  given  by  mouth  for  48  hours. 
Hypodermoclysis  supplied  fluid.  Morphine  was 
used  as  needed.  The  wound  healed  without  in- 
cident, and  the  patient  left  the  hospital  at  the  end 
of  two  weeks. 

PATHOLOGICAL  REPORT — BY  E.  SNEIDERMAN,  M.D. 

OF  LUTHERAN  HOSPITAL 

The  specimen  is  that  of  a hollow  tubular 
diverticulum,  measuring  three  inches  long  by  one 
inch  in  diameter.  The  external  surface  is  dif- 
fusely and  moderately  injected.  The  wall,  on 
cross  section,  consists  of  mucous  membrane  and 
inner  circular  and  outer  longitudinal  muscle 
layer  and  serosal  layer.  On  section  the  mucosa  is 
thrown  into  folds.  The  contents,  a tenacious  and 
greenish  fecal  material.  Section  of  the  mucous 


September,  1933  Gas  Gangrene  Septicemia— Pavey  & Reinhart 


551 


membrane  shows  a characteristic  villous  forma- 
tion and  the  lining  cells  are  of  a cylindrical  type, 
moderate  amount  mucous  cells  interspersed  here 
and  there.  The  lumen  contains  a pink  straining- 
hematogenous  structureless  material.  The  muscle 
wall  is  composed  of  two  layers,  one  that  of  an 
intercircular  and  the  other  that  of  an  outer 
longitudinal  type.  The  muscle  wall  revealed 
slight  infiltration  with  few  small  round  cells. 

The  muscle  wall  is  well  developed  throughout 
its  entire  extent  except  for  one  area  showing  a 
moderate  diminution  in  thickness.  The  serosal 
layer  is  well  defined,  somewhat  thickened,  defi- 
nitely vascularized  and  contains  inflammatory 
cells. 

A non-strangulated  hernia  which  is  producing 
abdominal  distress,  and  which  is  very  sensitive  to 
palpation  may  contain  an  adherent  Meckel’s 
diverticulum. 

Diagnosis:  Meckel’s  diverticulitis. 

1201  Medical  Building. 


REFERENCES 

Pollidori : Hernia  Diverticular,  Strangulated  Hernia  of 

Meckel’s  Diverticulum — Reforma  Med. — May  5,  1930 — Vol.  46, 
P.  682-686. 

Scalone : Hernia  Diverticular — Gelatinous  Pseudocystic 

Degeneration  of  Meckel’s  Diverticulum  Herniated  in  In- 
guinal Region — Policlinio  (Sex  Chir) — October,  1928,  Vol. 
35,  P.  530-556. 

Bianchi,  G. : Hernia  Diverticular,  Study  of  Hernia  of 

Meckel’s  Diverticulum.  Gazz  D Osp.,  July  10,  1927,  Vol.  48, 
P.  651-655. 

Marinacci,  S.  : Hernia  Diverticulum  in  Rare  Form  of 
Littre’s  Hernia — Policlinico  (Sex  Prat) — April  6,  1925. 

Vol.  32,  P.  487-488. 

Pabst,  Fritz : Ein  Meckel’s  ches  Divertikel  in  Einer 

Hernia  Interparietalis  Inguinals  Incarcerata  Dextra  Beitral 
F Klin  Chir.,  1910,  LX.  P.  646. 

Balfour:  J.  Minnesota  M.  A- — 1911,  XXI,  P.  110. 

Watson  : Hernia — C.  V.  Mosey  Co. — 1924,  Chapt.  XXV, 
P.  550. 

Littler,  R.  M.  : Meckel’s  Diverticulum  Strangulated  in  a 
Femoral  Hernia — British  Med.  Jour.,  March  22,  1924. 

Sweet,  Richard  H. : Incarceration  of  a Meckel’s  Diver- 

ticulum in  a Femoral  Hernia — A Report  of  a Case  with  a 
Review  of  the  Literature.  New  England  Jour,  of  Med., 
Vol.  202,  May  22,  1930,  P.  997. 

Lanman,  Thos.  H. : Meckel’s  Diverticulum  in  a Left 

Inguinal  Hernia — Boston  M.  & S.  Jour.,  May  29,  1924,  Vol. 
190,  P.  926. 


Gas  Gangrene  Septicemia  as  a Complication  o£  Pregnancy* * 

Charles  W.  Pavey,  M.D.,  and  H.  L.  Reinhart,  M.D.,  Columbus,  Ohio 


EPTICEMIA  caused  by  the  Clostridium 
Welchii  is  a comparatively  rare  complica- 
tion of  pregnancy  and  parturition.  What 
was  apparently  a case  of  this  condition  was  re- 
ported by  Leduc  in  1597  and  since  then,  beginning 
in  1891  and  continuing  up  to  the  present,  there 
have  been  about  fifty  additional  cases  reported  in 
the  literature.  In  approximately  twenty  thousand 
deliveries  in  the  University  Clinic  we  have  had 
only  one  case  and  it  will  be  the  purpose  of  this 
paper  to  report  that  case  and  describe  the  clinical 
picture  of  which  it  was  a typical  representative. 

CASE  REPORT 

The  patient  was  a white  woman  28  years  of 
age,  admitted  on  the  clinical  service  of  the  Ob- 
stetrical Department  of  University  Hospital  at 
7:15  P.  M.,  February  23,  1933.  She  had  been  sent 
in  for  an  incomplete  abortion  by  a city  physician 
who  had  seen  her  shortly  before  admission. 

According  to  her  history  she  had  menstruated 
last  eighty-one  days  previously.  Three  days  be- 
fore coming  to  the  hospital  she  had  done  a wash- 
ing shortly  after  which  she  noticed  a pain  in  the 
left  lower  quadrant  of  the  abdomen.  The  aching- 
pain  persisted  and  the  next  day  she  suffered 
malaise  and  loss  of  appetite. 

The  second  day  following  the  onset  of  the  pain 
it  became  more  severe  and  began  to  be  intermit- 
tent in  character,  resembling  labor  pain.  About 
this  time  also  she  became  nauseated  and  vomited 
some  and  passed  several  rather  large  clots  of 
blood  from  the  vagina  during  the  night.  The  third 
morning  following  the  onset  of  her  first  symptom 
she  was  somewhat  relieved  and  went  to  the 
divorce  court  where  her  marital  difficulties  were 
being  aired.  Returning  home  at  noon  she  became 
dizzy  and  nauseated  and  suffered  numbness  of 
her  extremities  and  exacerbation  of  the  pain  in 

From  the  Departments  of  Obstetrics  and  Pathology, 
Ohio  State  University,  College  of  Medicine,  Columbus,  Ohio. 

* This  condition  is  not  to  be  confused  with  the  relatively 
common,  seldom  fatal,  localized  gas  bacillus  infection  of  the 
uterus  that  is  more  of  the  nature  of  a sapremia  and  is 
usually  dealt  with  in  a single  paragraph  in  obstetrical  texts. 


her  abdomen.  Arriving  home  she  was  surprised  to 
notice  in  the  mirror  that  her  skin  had  become  a 
deep  copper  color.  Her  temperature  at  this  time 
was  101.  A city  doctor  was  called  and  he  sent  the 
patient  to  the  hospital. 

The  patient  was  a gravida  viii,  para  iv,  and  in- 
sisted that  all  of  her  abortions,  including  this  one, 
were  spontaneous  and  that  the  others  had  been 
entirely  free  of  complications.  She  had  left  her 
husband  eight  months  previously  and  had  been 
living  with  another  man.  Her  past  medical  and 
surgical  histories  and  symptoms  by  systems  were 
negative  so  far  as  concerned  her  present  illness, 
with  the  possible  exception  of  her  statement  that 
twenty-three  days  prior  to  admission  she  had 
noticed  a scant,  foul,  yellow  vaginal  discharge 
that  she  had  never  had  before. 

Physical  examination  revealed  a white  woman 
of  ordinary  development  apparently  forty-five 
years  of  age  but  giving  her  actual  age  as  only 
twenty-eight.  The  most  striking  feature  on  in- 
spection of  the  patient  was  a deep  copper  color 
with  purple  mottling  of  the  skin  of  the  entire 
body.  The  patient  was  lying  in  bed  in  apparent 
distress  with  a gravely  apprehensive  expression 
on  her  face.  The  temperature  was  97.8,  pulse  124 
and  respiration  28.  The  blood  pressure  was 
124/78.  The  pupils  were  equal  and  regular  and 
reacted  normally.  The  sclera  were  pale  yellow  in 
color.  The  teeth  were  carious  and  unhygienic  with 
some  evidence  of  pyorrhea.  The  tongue  was  thick 
and  dry  as  were  also  the  lips  and  buccal  mucous 
membrane.  The  tonsils  were  large  and  cryptic 
but  there  was  no  real  evidence  to  indicate  that 
they  were  diseased.  The  thyroid  and  cervical 
glands  were  negative. 

The  chest  was  symmetrical  and  the  expansion 
equal.  There  was  some  moisture  and  diminution 
of  breath  sounds  at  both  bases.  The  area  of  car- 
diac dullness  was  apparently  increased  slightly 
and  the  rate  was  quite  rapid  but  the  valve  sounds 
were  all  normal. 

The  abdomen  was  normal  in  contour.  There 
was  marked  tenderness  and  some  rigidity  in  the 
left  lower  quadrant  and  exquisite  tenderness  and 
marked  rigidity  in  the  splenic  region.  The  spleen 
was  not  palpable. 


552 


The  Ohio  State  Medical  Journal 


September,  1933 


Vaginal  examination  was  done  under  light  gas 
anesthesia.  The  introitus  and  vagina  were  nor- 
mally multiparous,  the  cervix  was  softened 
slightly  and  bore  an  old  bilateral  laceration.  There 
was  a positive  Hegar’s  sign  and  the  uterus  was 
enlarged  to  about  the  size  of  a six  weeks  preg- 
nancy. There  was  no  evidence  of  any  free  blood 
in  the  cul-de-sac  and  the  adnexa  were  apparently 
normal.  No  gas  bubbles  were  present  in  the  vag- 
inal secretion. 

The  reflexes  were  normal.  The  extremit;es  were 
negative  except  for  the  coppery  discoloration 
which  faded  out  slightly  as  it  became  more  distal, 
the  nails’  beds  were  purplish  and  the  tempera- 
ture of  the  extremities  was  much  lower  than  that 
of  the  trunk. 

The  blood  count  was  2,120,000  reds — 33,000 
whites — 40  per  cent  hemoglobin — 92  per  cent 
polys  of  which  70  per  cent  were  bands  and  22  per 
cent  segmented  forms  and  8 per  cent  lymphocytes. 
The  urine  was  a deep  purple  resembling  grape 
juice  in  color.  Chemical  examination  revealed  two 
plus  albumen  and  negative  sugar.  There  were  no 
blood  cells,  but  there  was  a large  amount  of 
blood  pigment. 

We  felt  that  this  patient  had  probably  induced 
an  abortion  on  herself  and  in  so  doing  introduced 
a virulent,  fulminating,  hemolytic  organism  into 
the  uterus  and  placental  site  with  resultant  sep- 
ticemia followed  by  spontaneous  rupture  of  the 
spleen  which  we  thought  was  the  cause  of  the 
abdominal  signs.  Surgical  consultation  was  had 
but  the  patient’s  condition  was  such  that  it  was 
not  deemed  advisable  to  interfere. 

Certain  supportive  measures  were  carried  out 
which  included  a hypodermoclysis  and  a fourth  of 
morphine  on  two  occasions.  An  hour  and  a half 
after  she  was  first  seen  she  said  “I  think  I’m  a 
goner”,  an  opinion  in  which  we  all  privately  con- 
curred. Within  a very  few  minutes  of  the  time 
she  made  this  remark,  she  lapsed  into  a coma, 
her  pulse  became  progressively  weaker  and  in 
thirty  minutes  she  was  dead. 

The  body  was  embalmed  and  preserved  under 
refrigeration  until  twelve  hours  later,  when  per- 
mission was  given  for  an  autopsy.  On  entering 
the  autopsy  room  we  were  immediately  struck  by 
the  fact  that  the  patient  we  had  observed  the 
night  before  as  of  ordinary  development  and  size 
now  appeared  definitely  obese.  The  coppery  dis- 
coloration of  the  skin  and  the  purplish  areas  of 
ecchymosis  were  unchanged,  but  there  was  now 
in  addition  a generalized  edema  and  subcutaneous 
emphysema. 

On  opening  the  abdomen,  the  peritoneal  cavity 
was  found  to  contain  free  gas  and  blood.  The 
liver  margin  extended  somewhat  below  the  costal 
margin  and  the  gall  bladder  slightly  beyond  the 
liver.  The  stomach  was  distended  out  of  pro- 
portion to  the  intestines.  All  of  the  viscera  were 
discolored  in  the  same  manner  as  the  surface  of 
the  body.  In  the  left  retro-peritoneal  region,  there 
was  a considerable  amount  of  clotted  blood  ex- 
tending from  the  lower  pole  of  the  kidney  down 
into  the  left  inguinal  region.  The  tissues  in  this 
region  were  infiltrated  with  blood  but  there  was 


no  evidence  of  rupture  of  any  of  the  large  vessels. 
The  noteworthy  findings  on  examination  of  the 
abdominal  organs  were  as  follows: 

The  kidneys  were  enlarged,  edematous  and  on 
cut  section  presented  a “foamy”  appearance  re- 
sembling the  so-called  “foamy  liver.”  The  medulla 
was  quite  congested  and  the  cortex  was  marked 
by  numerous  punctate  areas,  cystic  in  character 
and  containing  hemolysed  blood. 

The  ovaries  and  tubes  were  apparently  normal 
and  in  the  left  ovary  there  was  a corpus  luteum 
approximately  two  and  one  half  centimetres  in 
diameter.  The  uterus  was  slightly  enlarged  and 
both  endometrium  and  myometrium  were  em- 
physematous. There  was  no  evidence  of  perfora- 
tion. The  cervix  was  soft  and  bore  an  old  bila- 
teral laceration.  On  opening  the  uterus  some  dis- 
integrated material  resembling  placenta  was 
found.  Sections  through  the  uterine  wall  re- 
vealed no  evidence  of  any  suppurative  process, 
but  the  emphysematous  character  noted  above 
was  striking. 

The  liver  was  normal  in  size  and  weighed  1250 
grams.  The  capsule  was  red  and  contained  some 
small  cystic  areas  but  was  not  the  typical  “foamy 
liver”  of  gas  bacillus  infection.  On  cut  section, 
the  substance  of  the  liver  was  firm,  fatty  in 
character,  and  had  a yellow  pasty  color  sugges- 
tive of  yellow  atrophy. 

The  gastro-intestinal  .tract,  except  for  the  dis- 
proportionate distention  of  the  stomach  and  the 
abnormal  color  and  friability  of  the  mesenteric 
attachment  throughout  its  length,  was  not  re- 
markable. 

The  spleen  weighed  150  grams;  was  unusually 
dark  in  color;  and  showed  some  increase  in 
amount  and  softness  of  the  pulp. 

The  bone  marrow  of  the  femur  was  hyperplastic 
throughout. 

There  was  bloody  fluid  in  both  sides  of  the 
thoracic  cavity  and  the  lungs  were  emphysema- 
tous with  hypostatic  congestion  at  the  bases.  The 
mucous  membrane  of  the  bronchi  was  stained 
with  blood  and  presented  some  petechial  hemor- 
rhages. 

The  per'cardial  cavity  contained  considerable 
hemolysed  blood  but  no  clot.  The  heart  was 
moderately  enlarged  and  contained  a chicken-fat 
clot  in  the  right  ventricle,  but  was  otherwise  not 
remarkable. 

Throughout  the  body  a marked  friability  of 
tissue  was  noted,  particularly  of  the  veins.  This 
was  so  pronounced  that  the  pedunculated  organs 
could  be  lifted  free  of  their  pedicles  with  com- 
parative ease. 

Microscopic  examination  of  the  section  served 
to  confirm  the  impression  of  Bacillus  Welchii 
septicemia.  Colon’es  of  bacilli  and  severe  exten- 
sive hemolysis  were  found  in  heart,  lungs,  spleen, 
kidneys,  liver,  adrenal,  thyroid,  breast,  uterus, 
ovaries,  vaginal  mucosa  and  skin.  Using  Wright 
Giemsa  stain,  the  bone  marrow  showed  a diffuse 


September,  1933  Intravenous  Liver  Extract — Payne  & Brittingham 


553 


infiltration  of  blunt  ended  encapsulated  bacilli  of 
the  morphology  of  Clostridium  Welchii. 

There  was  emphysema  and  acute  necrosis  of 
uterus,  ovaries,  liver  and  kidneys.  The  kidney 
lesion  was  an  acute  diffuse  hemorrhagic  necrosis 
similar  to  that  seen  in  bicholoride  poisoning. 

In  view  of  the  history  of  the  case  and  the 
characteristic  autopsy  findings,  we  believe  this  to 
be  a case  of  Clostridium  Welchii  septicemia  in 
which  the  primary  focus  was  the  uterus  following 
an  abortion. 

CONCLUSIONS 

(1)  Bacillus  Welchii  septicemia  is  coming  to 
be  recognized  with  increasing  frequency  as  a 
cause  of  death  in  puerperal  infections. 

(2)  The  infection  is  probably  a mixed  one, 
with  progressive  tissue  destruction  providing  an 
excellent  medium  for  growth  of  Bacillus  Welchii 


and  the  elaboration  of  a powerful  hemolytic  toxin 
with  the  septicemia  following  extensive  involve- 
ment of  the  uterus. 

(3)  The  disease  is  characterized  by  severe 
hemolysis  manifesting  itself  clinically  in  diffuse 
bronzing  of  the  skin  and  purplish  discoloration  of 
the  urine  and  pathologically  by  acute  necrosis  and 
emphysema  of  most  of  the  body  tissues. 

BIBLIOGRAPHY 

Puerperal  Sepsis,  B.  Welchii,  Fatal  Types — A.  F.  Lask, 
M.D.  Am.  J.  Obst.  & Gyn.  V.  XXV,  No.  2,  p.  288. 

Clostridium  Welchii  Septicemia — P.  W.  Tombs,  M.D.  and 
J.  D.  Michelson,  M.D.— Am.  J.  Obst.  & Gyn.  V.  XV,  p.  379, 

Gas  Gangrene  Complicating  Obstructed  Labor — J.  E. 
Church  MRCS  British  Med.  J.  Jan.  30,  1932 — p.  189. 

Generalized  Gas  Gangrene,  J.  E.  P.  Adams  MRCS.  British 
Med.  J.,  Dec.  26,  1931— p.  1179. 

A Case  of  Puerperal  Gas  Gangrene  Cured  by  Early 
Operation — M.  Gutman — Zentralblatt  f.  Gynaekologie,  55  : 
1406,  April  18,  1931. 

Gas  Gangrene  of  the  Uterus,  H.  Kanniker — Zentralblatt 
fuer  Gynaekologie,  11  :2341-2349,  March  9,  1927. 

Gas  Gangrene  Sepsis,  H.  Dobbek — Deutsche  Med.  Wchn- 
schr,  57 :1664  September  25,  1931. 


Intravenous  Liver  Extract  Therapy  In  Pernicious  Anemia 

Warren  Payne,  M.D.,  and  H.  H.  Brittingham,  M.D.,  Cleveland,  Ohio 


STIMULATED  by  a publication  of  Castle  and 
Taylor*,  intravenous  liver  extract  therapy 
was  instituted  as  a possible  life-saving 
measure  in  a very  uncooperative,  deaf  and  dumb 
case  of  pernicious  anemia  present  on  a medical 
division  of  Cleveland  City  Hospital.  The  method 
of  preparation  of  the  extract  was  so  simple,  the 
transient  symptoms  accompanying  the  injection 
so  mild,  and  the  results  so  impressive  that  this 
form  of  treatment  was  adopted  for  all  cases  of 
pernicious  anemia  in  a relapse.  For  economic 
reasons  as  well  as  for  scientific  interest,  we  began 
to  treat  all  ambulatory  cases  found  in  the  out- 
patient department  by  the  same  method.  This  re- 
port deals  with  the  results  obtained  in  a series  of 
two  hundred  and  fifty  such  treatments. 

Preparation  of  Product:  Our  preparation  of 

the  liver  extract  for  intravenous  injection  was 
practically  identical  with  the  method  suggested 
by  Castle  and  Taylor*.  Four  and  a half  grams  of 
any  commercial  liver  extract  (Fraction  G.)  suit- 
able for  oral  administration,  equivalent  to  one 
hundred  grams  of  whole  liver,  was  dissolved  in 
fifteen  cubic  centimeters  of  warm  normal  saline 
solution.  Th's  was  filtered,  allowed  to  cool  and 
then  refiltered.  The  total  quantity  of  fluid  was 
made  to  equal  twenty  cubic  centimeters  and  then 
sterilized  by  placing  in  a boiling  water  bath  for 
five  minutes. 

Administration  and  Dosage:  The  liver  extract 
solution  was  first  given  intravenously  at  a uni- 
form rate  of  administration  not  to  exceed  two 
cubic  centimeters  per  minute.  In  the  last  half  of 
this  series  the  rate  of  administration  of  one  cubic 

From  the  Medical  Clinic  of  Western  Reserve  University 
at  Cleveland  City  Hospital. 

♦Castle.  W.  B.  and  Taylor,  F.  H.  L. : Intravenous  Use 

of  Extract  of  Liver,  J.  A.  M.  A.  96:  1198  (April  11),  1931. 


centimeter  per  minute  was  used.  The  latter  rate 
is  advised  because  the  transient  symptoms  which 
occurred  during  the  injection  were  reduced  to  a 
minimum  and  in  certain  individuals  were  avoided. 
The  dosage  administered  was  constant,  always 
the  equivalent  of  one  hundred  grams  of  whole 
liver.  This  was  given  every  ten  to  fourteen  days 
to  patients  in  a relapse,  every  twenty-eight  days 
to  those  in  a remission. 

Clinical  Material:  The  twenty-five  individuals 
used  in  this  series  of  treatments  were  clinically 
proved  cases  of  pernicious  anemia  seen  in  one  or 
more  relapse  of  the  disease.  During  the  relapse 
each  patient  showed  an  achlorhydria,  leukopenia, 
high  color  index,  high  icteric  index,  typical  blood 
picture  and  a reticulocyte  response  to  hemopoietic 
substance  administered.  There  were  thirteen 
males  and  twelve  females.  Their  ages  varied  from 
thirty  to  sixty-seven  years  with  an  average  age 
of  fifty-one  years.  The  duration  of  illness  varied 
from  three  months  to  nine  years  with  an  average 
duration  of  a little  less  than  three  years.  Seven 
cases  had  received  no  specific  therapy,  one  case 
had  been  treated  wtih  intramuscular  injections 
and  the  remaining  seventeen  cases  had  received 
either  whole  liver,  desiccated  hog  stomach  or  liver 
extract  by  mouth.  The  highest  blood  pressure 
recorded  was  190/100  in  a case  in  a remission  and 
the  lowest  blood  pressure  was  92/40  found  in  a 
case  suffering  from  a relapse  of  the  disease.  Four 
of  the  group  had  no  objective  neurological  changes, 
five  patients  had  combined  sclerosis  of  the  spinal 
cord  and  the  remaining  sixteen  individuals  had 
varying  grades  of  peripheral  polyneuritis.  The 
complications  were  those  commonly  found  at  this 
period  of  life:  generalized  arteriosclerosis,  pul- 
monary emphysema,  chronic  bronchitis,  chronic 


554 


The  Ohio  State  Medical  Journal 


September,  1933 


arthritis,  chronic  urinary  tract  infections,  vari- 
cose ulcers  and  one  case  of  thyrotoxicosis  who  de- 
veloped a postoperative  myxoedema. 

Symptoms  during  Injections : All  patients  were 
instructed  to  describe  any  unusual  sensation  that 
might  occur  during  or  after  administration  of  the 
liver  extract  solution.  The  most  common  finding 
was  flushing  of  the  face,  often  accompanied  by  a 
sensation  of  pounding  in  the  head.  In  five  of  the 
earlier  treatments  headaches  were  severe  but 
were  avoided  later  by  using  the  slower  rate  of 
injection.  Less  frequent  symptoms  were  restless- 
ness, dizziness,  weakness,  ringing  in  the  ears, 
salty  or  metallic  taste,  desire  to  yawn,  thirst, 
nausea  and  a desire  to  empty  the  bowel.  These 
were  usually  elicited  by  direct  questioning,  dis- 
appeared immediately  after  the  injection  was  over 
and  were  of  so  little  consequence  to  the  patient 
that  they  were  not  considered  by  us  sufficient  to 
constitute  a reaction. 

The  blood  pressure  and  pulse  were  recorded 
after  each  two  cubic  centimeters  of  liver  extract 
injected.  A moderate  lowering  of  the  blood  pres- 
sure occurred  quite  frequently  when  the  more 
rapid  rate  of  administration  was  in  vogue.  At 
such  times  the  fall  in  systolic  pressure  was  ten  to 
fifteen  millimeters  of  mercury,  in  diastolic  pres- 
sure from  five  to  ten  millimeters  of  mercury. 
With  the  slower  rate  of  injection,  that  is,  one 
cubic  centimeter  of  material  given  every  minute, 
the  blood  pressure  changes  were  much  less  promi- 
nent. When  vaso-dilatation  did  occur  the  heart 
rate  was  accelerated  ten  to  twenty  beats  per 
minute. 

Latent  Reactions : An  elevation  of  temperature 
to  less  than  39.5  degrees  centigrade  following  in- 
travenous administration  of  liver  extract  was 
arbitrarily  considered  to  be  a mild  reaction  pro- 
viding there  was  no  vomiting,  the  accompanying 
chill  lasted  no  longer  than  thirty  minutes  and  the 
patient  felt  sufficiently  strong  to  return  home 
within  two  hours.  This  occurred  after  20  per 
cent  of  the  treatments.  The  chill  came  on  within 
one-half  hour  after  the  injection  was  completed 
and  usually  lasted  from  ten  to  fifteen  minutes. 
Rarely  nausea  was  noted  but  the  patients  rapidly 
regained  a normal  condition. 

Elevations  of  temperature  to  39.5  degrees  cen- 
tigrade or  above  and  those  chills  complicated  by 
vomiting  or  prolonged  pyrexia  were  designated  as 
moderate  latent  reactions.  Such  reactions  oc- 
curred following  five  treatments  or  2 per  cent  of 
the  two  hundred  and  fifty  injections  administered. 

The  first  reaction  of  moderate  severity  followed 
an  initial  treatment  given  at  the  faster  rate  of 
two  cubic  centimeters  per  minute  to  a patient 
(Case  13),  in  a relapse.  Minimal  symptoms — 
slight  dizziness,  cardiac  palpitation  and  flushing 
of  the  face  were  noted  during  the  injection.  The 
initial  blood  pressure  was  92/40  and  the  lowest 
blood  pressure  recorded  was  85/35.  The  pulse 
varied  between  ninety  and  ninety-six  beats  per 


minute.  Twenty  minutes  after  completion  of  the 
treatment  the  patient  had  a severe  chill  lasting 
seventy  minutes  and  the  temperature  rose  from 
thirty-eight  to  forty  degrees  centigrade,  returning 
to  normal  after  thirty-six  hours. 

The  second  moderate  reaction  followed  a treat- 
ment given  to  an  ambulatory  patient  (Case  9) 
who  had  a considerable  degree  of  hyperthyroidism. 
There  were  no  symptoms  during  the  injection  of 
the  liver  extract;  the  pulse  remained  at  one  hun- 
dred and  eight  and  the  initial  blood  pressure  of 
150/88  fell  to  120/80.  Twenty  minutes  later  the 
patient  began  to  chill  and  this  lasted  for  thirty 
minutes  and  the  patient  vomited  twice.  The  tem- 
perature rose  to  39.4  degrees  centigrade  but  re- 
turned to  normal  after  six  hours.  The  next  morn- 
ing the  patient  felt  no  ill  effects  and  was  dis- 
charged. 

A third  moderate  reaction  occurred  in  a case 
(Case  4)  treated  in  the  out-patient  department. 
There  was  no  change  in  the  blood  pressure  and 
the  pulse  remained  practically  at  seventy-two.  A 
slight  headache  and  only  a mild  degree  of  flushing 
of  the  face  occurred  during  the  intravenous  in- 
jection of  liver  extract.  The  patient  reported  on 
his  next  visit  that  he  had  chilled  for  over  an  hour 
and  was  confined  to  bed  for  two  days.  He  stated 
that  he  did  not  really  recover  for  about  a week. 

Two  treatments  given  to  an  elderly  female 
(Case  21)  in  a relapse  of  the  disease  caused  little 
or  no  transient  symptoms  during  the  actual  in- 
jection of  the  intravenous  liver  extract.  Both 
treatments,  however,  were  followed  by  chills,  tem- 
perature elevations  to  39.8  and  39.4  degrees  cen- 
tigrade and  by  a mild  degree  of  shock.  The  blood 
pressure  dropped  from  102/50  to  80/20  and  the 
peripheral  pulse  became  weak  and  thready.  The 
patient  was  at  no  time  unconscious  but  complained 
of  extreme  weakness  and  a sensation  of  extreme 
coldness.  This  condition  lasted  two  and  three 
hours  respectively  under  ordinary  shock  therapy. 

In  all  five  of  these  reactions  there  was  no 
apparent  correlation  between  the  immediate  phe- 
nomena accompanying  the  injection  and  the  sub- 
sequent reactions.  The  immediate  signs  and 
symptoms  were  minimal  yet  the  latent  reactions 
were  moderately  severe.  A similar  disparity  was 
also  noted  in  those  patients  who  developed  mild 
latent  reactions. 

Results:  The  patients  treated  during  a re- 

lapse responded  to  the  initial  injection  with  a 
prompt  reticulocyte  rise,  symptomatic  improve- 
ment and  increase  in  red  blood  cells  and  per- 
centage of  hemoglobin.  Patients  having  an  in- 
itial red  blood  cell  count  of  one  million  gained  a 
million  red  blood  cells  in  the  first  ten  days  and 
another  million  in  the  following  eighteen  days. 
Those  whose  initial  counts  were  higher  than  one 
million  gained  proportionately  less  rapidly. 

The  reticulocyte  count  showed  its  first  signifi- 
cant increase  in  thirty-six  to  forty-eight  hours  and 
reached  its  maximum  in  three  to  five  days.  Gen- 


September,  1933 


Intravenous  Liver  Extract — Payne  & Brettingham 


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erally,  this  maximum  was  about  20  per  cent 
and  compared,  in  type  and  extent,  to  the  reti- 
culocyte response  expected  from  a much  larger 
amount  of  liver  or  its  extract  given  by  mouth 
and  occurred  somewhat  earlier  than  that  follow- 
ing oral  therapy. 

The  maintenance  dose  for  patients  in  a remis- 
sion was  arbitrarily  set  at  one  injection  every 
four  weeks  and  this  has  proved  satisfactory  to 
date.  As  one  expects,  red  blood  cell  counts  have 
dropped  following  acute  infections  but  they  have 
risen  again  without  more  frequent  liver  therapy. 
There  have  also  been  unexplained  fluctuations  in 
the  red  blood  cell  counts  but  not  more  frequently 
than  usually  occur  in  out-patient-department  pa- 
tients receiving  liver  extract  or  desiccated  hog 
stomach  by  mouth. 

A decrease  in  neurological  symptoms  occurred 
paralleling  the  improvement  in  the  blood.  There 
has  also  been  striking  improvement  in  two  cases 
showing  considerable  involvement  of  the  spinal 
cord.  In  one  instance  (Case  2)  the  neurological 
improvement  paralleled  that  of  the  blood  but  in 
another  case  (Case  5)  the  neurological  improve- 
ment was  equally  striking  although  the  increase 
in  red  blood  cells  was  only  from  three  million 
five  hundred  thousand  to  four  million  five  hun- 
dred thousand. 

Discussion:  The  advantages  of  the  intraven- 

ous route  for  liver  administration  in  cases  of 
pernicious  anemia  outweigh  its  disadvantages 


when  given  under  controlled  conditions  and  when 
particular  attention  is  paid  to  a slow  rate  of  in- 
jection. It  is  of  special  value  in  patients  who  need 
hemopoietic  substance  and  are  unable  to  absorb 
the  material  through  their  gastro-intestinal  tract 
because  of  vomiting  or  a diarrhea.  Also  patients 
who  tire  of  liver  or  its  equivalent  in  a concen- 
trated form  because  of  its  taste  or  because  of  the 
necessity  of  taking  it  frequently  find  relief  by 
intravenous  injections.  The  fact  that  the  pa- 
tients have  a definite  appointment  to  report  to 
the  clinic  only  once  a month  insures  adequate 
therapy  and  relapses  are  less  apt  to  occur.  Cer- 
tain it  is  that  the  majority  of  patients  (72  per 
cent)  in  this  small  series  prefer  the  intravenous 
route  as  compared  with  the  oral  administration 
of  liver  extract. 

The  intravenous  injection  of  liver  extract  has 
the  advantage  of  immediate  and  certain  utiliza- 
tion of  adequate  amounts  of  hemopoietic  substance 
without  the  pain  so  commonly  associated  with 
intramuscular  or  subcutaneous  injections.  No 
fatalities  or  alarming  symptoms  occurred  in  this 
series. 

As  a minor  consideration,  the  cost  per  patient 
for  treating  pernicious  anemia  has  been  consider- 
ably reduced.  It  costs  less  than  one  dollar  to 
bring  a patient  from  one  million  red  blood  cells 
or  less  to  four  and  a half  million  and  less  than 
fifteen  cents  a month  to  maintain  him  at  this 
level. 


556 


The  Ohio  State  Medical  Journal 


September,  1933 


The  disadvantages  of  intravenous  liver  extract 
injections  are  (1)  the  occurrence  of  latent  re- 
actions in  21.6  per  cent  of  the  treatments.  Certain 
patients  have  a particular  tendency  to  develop 
these  latent  reactions  and  because  of  this  fact 
these  cases  should  be  treated  by  other  methods. 

(2)  Another  disadvantage  is  that  veins  become 
inaccessable,  especially  in  females,  because  pa- 
tients gain  weight  in  response  to  adequate 
therapy. 

CONCLUSIONS 

(1)  A total  of  two  hundred  and  fifty  injections 
of  liver  extract  were  given  intravenously  to 


twenty-five  cases  of  pernicious  anemia  over  a 
period  of  from  two  to  thirteen  months. 

(2)  The  treatments  were  given  every  ten  to 
fourteen  days  during  a relapse  and  every  twenty- 
eight  days  during  a remission. 

(3)  A rate  of  one  cubic  centimeter  of  liver  ex- 
tract solution  per  minute  produced  negligible 
symptoms  during  the  treatment. 

(4)  There  were  21.6  per  cent  latent  reactions* 
none  of  which  were  fatal  or  very  alarming. 

(5)  The  clinical  response  to  intravenous  liver 
extract  therapy  is  more  dramatic  than  that  pro- 
duced by  adequate  amounts  of  liver  extract  or 
desiccated  hog  stomach  given  by  mouth. 


Oral  Bismuth  in  the  Treatment  of  Syphilis 

Reed  O.  Brigham,  M.D.,  Toledo,  Ohio 


THE  use  of  bismuth  in  the  treatment  of 
syphilis  has  been  practiced  for  a number 
of  years.  Both  animal  experiments  and 
clinical  results  have  now  definitely  shown  that 
bismuth  is  a good  spirocheticide.  It  is  more 
pronounced  than  mercury,  although  not  as  pow- 
ful  as  the  arsenicals,  although  over  long  periods 
of  time  may  be  equally  effective  and  not  as  dan- 
gerous. It  also  is  of  value  in  conjunction  with 
the  arsenicals. 

One  of  the  great  objections  in  the  use  of  bis- 
muth has  been  the  rather  painful  intramuscular 
injections,  especially  in  oil  and  in  the  soluble  bis- 
muth preparations.  The  author  has  never  found 
any  on  the  market  which  were  entirely  painless. 
Then  there  is  the  objection  that  bismuth  so  in- 
jected is  very  slowly  absorbed.  The  intraven- 
ous injection  of  bismuth  is  too  dangerous  to  be 
recommended. 

Several  years  ago  some  suggestions  were  made 
to  use  an  oral  administration  of  a soluble  bis- 
muth. This  seemed  particularly  of  advantage 
over  the  intravenous  and  intramuscular  routes 
of  medication.  The  author  therefore  asked  his 
druggist  to  cooperate  in  the  preparation  of  a 
soluble  form.  This  form  was  done  in  the  sub- 
stance of  a gylcerite  of  bismuth,  which  is  soluble, 
in  which  preparation  one  fluid  dram  contains 
sixteen  grains  of  bismuth  and  sodium  tartrate. 
Average  dose  is  recommended  in  the  National 
Formulary  as  ten  minims.  After  this  prepara- 
tion was  carefully  prepared,  which  required  some 
time  and  technique,  in  conjunction  with  the  phar- 
macist, it  was  administered  to  a number  of  cases. 
First  two  cases,  which  had  not  become  Wasser- 
man  negative  with  arsphenamine,  became  very 
weak  one  plus  with  the  administration  of  this 
bismuth  solution.  They  were  both  old  eases.  This 
led  to  further  use  of  the  solution  both  alone 
and  in  conjunction  with  arsphenamine  medication. 
In  other  cases  also  the  use  of  iodide  in  conjunc- 


tion with  bismuth  seem  to  be  of  advantage.  A 
number  of  cases  have  been  so  treated  during  the 
past  three  years  and  in  all  cases  there  has  been 
marked  improvement  both  clinically  and  serologic- 
ally in  the  administration  of  bismuth.  The  dosage 
is  often  run  up  to  twenty  minims  three  times  a 
day.  In  weak  and  poorly  nourished  patients  this 
shows  slightly  toxic  results,  manifest  first  in 
soreness  of  the  gums,  similar  to  mercury.  When 
the  dosage  is  reduced,  these  symptoms  quickly 
disappear.  One  of  the  routes  through  which  bis- 
muth is  eliminated  from  the  system  is  through 
the  saliva  and  this  manifests  itself  in  the  marked 
blackening  of  the  tongue  after  medication  has 
continued  for  a week  or  more,  therefore  proving 
we  have  absorption  of  the  glycerite  of  bismuth. 
This  preparation  of  glycerite  of  bismuth  has  long 
been  used  as  a tonic,  and  patients  usually  re- 
mark that  they  feel  much  better  after  taking 
the  bismuth  preparation.  In  no  case  in  which 
it  has  been  used  has  the  preparation  failed  to 
produce  good  clinical  results  and  only  in  one 
or  two  cases  did  it  fail  to  produce  excellent  sero- 
logical results.  The  medication  of  this  form  of 
bismuth  was  frequently  continued  for  a period 
of  three  months  with  a brief  rest  and  then  another 
three  months  period  to  fully  clear  up  old  cases. 

The  oral  administration  of  bismuth  therefore 
has  given  good  clinical  and  serological  results  in 
the  treatment  of  syphilis.  It  has  proved  a very 
palatable  way  of  giving  the  drug  and  is  well  tol- 
erated by  the  patients  and  many  of  them  prefer 
it  to  hypodermic  medication.  It  also  has  the 
advantage  over  the  hypodermic  medication  in  that 
the  patient  is  getting  a continuous  supply  of 
bismuth  every  day  and  not  in  large  doses  at  fre- 
quent intervals.  The  author  therefore  recom- 
mends a more  wide  use  of  oral  administration 
of  bismuth  be  practiced  in  the  treatment  of 
syphilis. 

1320  Monroe  Street. 


Annual  Report  of  tlie  Committee  oai  Public  Policy 


John  B.  Alcorn,  Chairman,  (1933) Columbus 

J.  H.  J.  Urn  am,  (1934) Columbus 

C.  W.  Stone,  (1935) 1 Cleveland 

H.  M.  Platter,  ex-officio Columbus 

C.  L.  Cummer,  ex-officio Cleveland 

D.  C.  Houser,  (special) Urbana 

C.  W.  Waggoner  (special) Toledo 

A.  H.  Freiberg  (special) Cincinnati 

Don  K.  Martin,  Secretary Columbus 

Vital  changes  which  have  been  taking  place  in 
long-established  relationships  between  the  govern- 
ment and  the  public  and  in  economic  and  social 
structures  were  reflected  in  the  activities  of  this 
year’s  session  of  the  90th  Ohio  General  Assembly. 

In  constant  and  direct  contact  with  the  General 
Assembly  during  its  six-months  session,  termed 
by  veteran  observers  one  of  the  most  turbulent 
and  strenuous  legislative  gatherings  in  Ohio’s  his- 
tory, the  Committee  on  Public  Policy  of  the  Ohio 
State  Medical  Association  was  in  an  advantageous 
position  to  observe  at  first-hand  many  of  the 
effects  of  the  economic,  social  and  political  up- 
heaval which  has  been  taking  place,  producing 
fundamental  changes  in  our  heretofore  established 
order  of  things. 

Meeting  at  a time  of  economic  crisis  and  wide- 
spread unrest,  the  90th  General  Assembly  was 
confronted  with  problems  of  unprecedented  im- 
portance and  seriousness;  poor  and  unemployment 
relief,  taxation,  financing  of  schools,  depreciated 
revenues,  and  kindred  questions.  The  situation 
was  complex  and  puzzling,  potent  with  great  pos- 
sibilities for  beneficial  or  detrimental  legislation. 

Before  the  General  Assembly  had  an  oppor- 
tunity to  devote  its  attention  to  many  of  the 
major  questions,  it  was  faced  with  the  grave  re- 
sponsibility of  enacting  emergency  legislation  to 
aid  in  solving  the  banking  crisis  and  to  provide 
means  whereby  the  state  and  its  political  subdi- 
visions could  meet  the  ensuing  financial  emer- 
gency. With  this  question  disposed  of  as  far  as 
legislation  was  concerned,  the  General  Assembly 
embarked  on  an  effort  to  meet  the  financial,  taxa- 
tion and  schools  problems,  only  to  become  mired 
in  a prolonged  deadlock  which  was  broken  only 
after  strenuous  activity,  finally  permitting  the 
members  to  return  to  their  homes  in  July,  battle- 
scarred  and  exhausted. 

RECORD  NUMBER  OF  PROPOSALS 

While  the  90th  General  Assembly  was  estab- 
lishing a near  record  for  holding  the  longest 
regular  session,  it  also  broke  all  l’ecent  marks  for 
the  number  of  bills  introduced.  The  total  number 
of  proposals  was  1125, — 709  in  the  House  and 
416  in  the  Senate.  In  1931,  the  total  number  of 
bills  presented  was  973  and  in  1929  the  total  num- 
ber was  781. 


Included  in  this  mass  of  proposals  was  a record 
number  of  weird,  faddish,  fantastic  and  ultra- 
modern measures,  attesting  to  the  “spirit  of  the 
times”  and  the  crusading  temper,  amounting  in 
some  cases  to  a panacea  complex,  of  some  of  the 
members.  Moreover,  there  was  a liberal  supply 
of  extremely  controversial,  quack  and  destructive 
proposals,  all  of  which  won  some  support  in  the 
Assembly  and  added  fuel  to  the  fire  of  unrest  and 
discontent  which  made  the  session  one  of  the  most 
hectic  in  recent  times. 

After  being  deadlocked  for  weeks  on  the  tax 
program  submitted  by  the  Governor,  the  two 
chief  provisions  of  which  were  a retail  sales  tax 
and  an  earned  income  tax,  during  which  time  bit- 
ter conflict  and  controversy  took  place,  the  As- 
sembly discarded  the  Governor’s  program  and 
enacted  a “stop-gap”  program,  estimated  to  raise 
approximately  $30,000,000  to  meet  present  emer- 
gency, leaving  the  formation  of  a permanent  taxa- 
tion program  for  later  and  a more  normal  period. 

The  taxation  program  finally  decided  upon 
provided  for  repeal  of  1 cent  of  the  present  4 
cents  a gallon  excise  tax  on  gasoline;  a 1 cent 
sales  tax  without  exemptions  on  gasoline,  kero- 
sene and  other  liquid  fuels;  extension  of  the 
present  2 cent  tax  on  cigarets;  a license  tax  on 
vending  and  slot  machines;  a 10  per  cent  amuse- 
ment tax;  a 10  per  cent  sales  tax  on  cosmetics, 
and  a 2 cent  cap  tax  on  bottled  beer. 

With  the  exception  of  the  tax  on  vending  and 
slot  machines,  which  he  vetoed,  the  Governor 
permitted  the  tax  proposals  to  become  laws  with- 
out his  signature.  However,  at  that  time  he 
stated  that  the  revenues  raised  by  them  would  be 
inadequate  to  meet  the  needs  of  the  schools  and 
for  poor  relief  and  that  a special  session  of  the 
Legislature  would  be  necessary  to  enact  ad- 
ditional revenue-producing  measui*es.  As  this 
report  was  being  completed,  Governor  White  an- 
nounced that  the  General  Assembly  would  be  con- 
vened in  special  session  on  August  16  for  the 
purpose  of  considering  additional  tax  proposals, 
including  the  once-defeated  general  sales  tax,  an 
income  tax,  and  sales  taxes  on  several  classes  of 
luxuries  or  non-essentials,  to  meet  the  financial 
emergency  faced  by  the  schools  and  for  poor  re- 
lief purposes. 

The  interest  aroused  in  connection  with  forma- 
tion of  a tax  program  is  reflected  in  the  variety 
of  ideas  found  in  the  numerous  taxation  measures 
introduced — -between  60  and  70  dealing  solely  with 
this  subject,  ranging  from  special  privilege  and 
license  taxes  to  general  sales  and  income  taxes. 

THE  GENERAL  RESULTS 

Summing  up  the  record  of  the  90th  General  As- 
sembly, it  may  be  said  that  in  spite  of  its  delay 


557 


558 


The  Ohio  State  Medical  Journal 


September,  1933 


in  the  enactment  of  a taxation  program,  and  in 
spite  of  its  inclination  to  over-estimate  the  im- 
portance of  various  foolish  and  unnecessary  pro- 
posals, the  90th  General  Assembly  did  accomplish 
things.  As  one  observer  aptly  pointed  out:  “It 

had  to.” 

An  unprecedented  number  of  emergency  laws 
were  enacted,  to  meet  economic  and  relief  con- 
tingencies. An  unusual  number  of  experimental 
proposals,  fostered  and  promoted  by  theorists  and 
those  believing  changes  in  established  methods  of 
procedure  would  solve  any  and  all  problems  were 
presented  and  some  of  them  enacted.  The  senti- 
ment for  centralization,  regulation  and  licensing 
accounted  for  the  creation  of  a half  dozen  or  more 
additional  state  boards  and  commissions.  Some 
of  these  agencies  are  necessary  to  administer  laws 
enacted  to  meet  the  economic  emergency  and  some 
of  them  are  superfluous  and  “just  another  board,” 
created  to  administer  silly  and  unnecessary  laws 
which  slipped  through  during  the  closing  weeks 
of  the  Legislature.  Another  indication  of  the 
urge  for  a change  and  for  experimentation  was 
the  success  attained  by  some  measures  liberalizing 
present  laws  governing  personal  conduct  and  some 
which  places  the  government  in  the  role  of  ai’- 
biter  in  social  and  welfare  activities,  indicating 
again  the  “relief”  complex  which  dominated  much 
of  the  Assembly’s  deliberations.  Additional  evi- 
dence of  new  departures  in  governmental  activity 
is  found  in  the  enactment  of  measures  giving  gov- 
ernment regulatory  power  over  business  and  in- 
dustry and  the  authority,  if  necessary,  to  estab- 
lish regulations  governing  prices,  wages,  hours  of 
labor,  costs,  and  other  factors  entering  into  the 
conduct  of  business  and  industry. 

HEALTH,  WELFARE  AND  MEDICAL  ISSUES 

During  the  1933  session  of  the  Legislature, 
there  were  introduced  no  less  than  150  measures 
which  had  some  bearing  on  public  health,  public 
welfare,  medical  practice,  medical  education, 
statutory  regulations  of  medicine  or  its  branches, 
and  allied  social-economic  questions  in  which  the 
medical  profession  was  directly  interested.  These 
were  in  addition  to  the  various  taxation  proposals 
submitted  in  which  physicians,  as  well  as  all  other 
citizens,  were  vitally  concerned.  All  of  these 
proposals  were  carefully  studied  and  analyzed  by 
the  Committee  on  Public  Policy  in  the  light  of  the 
best  available  medical  thought. 

Cultists  and  anti-health  and  anti-medical  groups 
were  extremely  active  during  the  entire  session. 
Strenuous  efforts  were  made  by  them  to  tear  down 
the  safeguards  established  by  present  sound  medi- 
cal and  health  statutes.  Concerted  attempts  were 
made  to  have  the  Legislature  grant  special  privi- 
leges to  cultists  and  unqualified  practitioners. 

Movements  to  entangle  medical  practice  and 
public  health  administration  with  welfare  activi- 
ties found  scattering  support  and  some  efforts 
were  made  to  modify  the  public  health  laws  of  the 


state  in  such  a way  that  public  health  adminis- 
tration would  have  been  seriously  crippled. 

MEDICAL  AND  HEALTH  SAFEGUARDS  PRESERVED 

In  spite  of  the  fact  that  the  spirit  of  the  times 
encouraged  the  consideration  of  proposals  pro- 
viding for  the  trial  of  new  theories  and  programs, 
concocted  by  socially-minded  individuals,  and  in 
spite  of  the  persistent  activities  of  inimical  in- 
fluences, dangerous  alignment  and  deceptive  vote 
trading,  organized  medicine  was  successful  in 
keeping  the  present  health  and  medical  statutes 
intact.  No  amendments,  exemptions  or  provisions 
granting  special  privileges  to  cultists  and  limited 
practitioners  were  enacted.  Those  hostile  to  sci- 
entific medicine  were  repulsed.  Attacks  on  the 
present  public  health  laws  were  met  successfully. 

In  view  of  the  general  situation  and  other  fac- 
tors which  made  this  the  most  hectic  session  of 
the  State  Legislature  in  recent  times,  your  com- 
mittee believes  this  to  be  a remarkably  fine  re- 
sult, justifying  the  great  amount  of  time  and 
energy  which  your  committee,  ably  assisted  by  the 
legislative  committeemen  of  the  various  compon- 
ent county  societies  and  the  personnel  of  the  As- 
sociation staff,  has  expended  in  meeting  the  nu- 
merous important  issues  which  were  constantly 
before  us. 

In  view  of  these  results,  your  committee  is  more 
convinced  now  than  ever  before  that  our  methods 
and  procedure  in  handling  legislative  problems 
and  in  contacting  the  members  of  the  Legislature, 
are  correct  and  practical. 

In  its  contact  with  legislators  and  in  consider- 
ing proposals  in  which  we  were  interested,  the 
Policy  Committee  endeavored  at  all  times  to  gauge 
its  attitude  and  action  by  the  greatest  public  bene- 
fit and  with  the  idea  always  in  mind  that  what 
is  detrimental  to  the  medical  profession  and  to 
scientific  medicine  is  certain  to  be  detrimental  to 
the  health  and  welfare  of  the  public.  We  con- 
sistently tried  to  represent  the  sound,  concerted, 
conservative  medical  viewpoint  on  matters  per- 
taining to  public  health  and  medical  practice.  In 
our  activities  we  stressed  the  unselfish  motives 
of  the  medical  profession  in  health  and  medical 
matters  and  endeavored  to  guide  ourselves  by 
what  we  considered  of  greatest  benefit  to  the  pub- 
lic and  to  the  majority  of  the  medical  profession. 

Attesting  to  the  correctness  of  our  attitude  on 
these  questions  is  the  friendly  and  cordial  spirit 
shown  by  the  most  of  the  members  of  the  Gen- 
eral Assembly  toward  the  medical  profession ; 
their  willingness  to  preserve  present  medical  and 
health  laws,  and  their  refusal  to  enact  legisla- 
tion which  would  be  destructive  to  scientific  medi- 
cine and  public  health,  or  unjustly  discrimina- 
tory to  the  medical  profession. 

EARNEST  ATTITUDE  OF  LEGISLATORS 

The  great  majority  of  the  members  of  the  90th 
General  Assembly  were  conscientious,  hard-work- 
ing and  unselfish  individuals,  differing  frequently 


September,  1933 


Annual  Reports 


559 


on  major  issues,  to  be  sure,  but  most  of  whom 
sincerely  endeavored  to  serve  the  best  interests 
of  their  constituents,  as  well  as  the  state  as  a 
whole. 

Those  members  of  the  Legislature  who  showed 
the  correct  attitude  toward  medical  and  health 
legislation  and  refused  to  be  influenced  by  de- 
structionists  and  anti-medical  and  anti-health 
groups,  deserve,  and  undoubtedly  would  welcome, 
expressions  of  appreciation  and  approval  from 
their  physician  constituents.  It  is  especially  im- 
portant that  this  be  done  since  in  these  uncertain 
times  it  is  quite  likely  that  the  present  Legisla- 
ture will  be  recalled  a number  of  times  for  special 
sessions,  and  because  undoubtedly  many  members 
of  the  90th  General  Assembly  will  seek  re-elec- 
tion one  year_  hence. 

Your  committee  feels  that  the  major  portion  of 
credit  for  our  remarkable  achievement  in  emerg- 
ing successfully  from  the  strenuous  and  uncer- 
tain legislative  session  just  concluded,  belongs  to 
the  conscientious  and  energetic  legislative  com- 
mitteemen of  the  various  county  medical  societies 
and  those  members  of  the  county  societies  who 
assisted  them  in  contacting  members  of  the  Leg- 
islature from  their  county  and  districts. 

Without  able  and  active  assistance  from  most 
of  the  committeemen,  officers  and  members  of  the 
various  county  societies,  the  Committee  on  Pub- 
lic Policy  would  have  been  severely  handicapped 
in  legislative  activities  in  Columbus  and  in  con- 
tacting members  of  the  General  Assembly  there. 
Naturally,  members  of  the  Legislature  look  to 
the  physicians  in  their  home  communities  for  ad- 
vice and  suggestions — or  should.  Information 
and  advice  usually  proves  to  have  more  effect 
upon  members  of  the  Legislature  when  given  by 
physicians  whom  they  know  intimately,  than  when 
it  is  given  to  them  by  some  member  of  our  com- 
mittee with  whom  they  are  only  slightly  ac- 
quainted. In  most  cases  those  legislators  com- 
ing from  counties  or  districts  where  the  medical 
profession  is  alert  and  active,  well-informed  on 
medical  and  health  questions,  and  interested  in 
civic,  legislative  and  political  matters,  are  the 
ones  who  can  be  depended  upon  to  represent  the 
sound  medical  and  health  viewpoints  in  legislative 
activities. 

SPLENDID  RESULTS  THROUGH  COOPERATION 

The  results  which  we  attained  in  the  recent  ses- 
sion prove  that  much  can  be  accomplished  through 
whole-hearted  and  concerted  activity.  This  is  ab- 
solutely necessary  at  all  times,  not  only  in  legisla- 
tive matters  but  in  all  matters  in  which  the  medi- 
cal profession  is  interested  or  concerned. 

Your  committee  has  tried  through  bulletins  and 
special  communications  to  keep  the  legislative 
committeemen,  and  through  them  the  membership 
generally,  accurately  informed  on  events  and  de- 
velopments at  the  state  Capitol.  We  have  had  the 
cooperation  of  most  of  the  key-men  in  the  county 


societies  to  whom  we  wish  to  express  our  ap- 
preciation and  approval.  Let  us  continue  the  good 
work  which  is  reflected  so  well  in  our  record  for 
the  past  session  of  the  General  Assembly. 

In  conclusion,  we  present  the  following  sum- 
mary of  the  measures,  many  of  which  have  health, 
welfare-medical  angles,  which  were  studied, 
analyzed  and  followed  by  the  Policy  Committee 
during  the  90th  session  of  the  General  Assembly, 
with  their  respective  status  at  the  time  the  Legis- 
lature adjourned.  Measures  relating  to  taxation, 
between  60  and  70  in  number,  are  not  included  in 
the  list  because  of  space  limitations,  but  all  of 
them  were  carefully  perused  by  the  committee  at 
the  time  of  their  introduction  and  were  followed 
closely  during  the  entire  session: 

WELFARE,  POOR  RELIEF,  MENTAL  HYGIENE,  ETC. 

Senate  Bill  60  (DeArmond  of  Butler),  same  as  House  bill 
158  (Goodwin  of  Butler),  providing  for  the  operation  of  the 
State  Emergency  Relief  Commission  until  March  1,  1935. 
Enacted.  Signed  by  the  Governor. 

Senate  Bill  61  (Gunsett  of  Van  Wert),  same  as  House 
Bill  167  (Kaser  of  Shelby),  authorizing  local  subdivisions  to 
continue  to  divert  gasoline  tax  funds  for  poor  relief  pur- 
poses. Enacted.  Signed  by  the  Governor. 

Senate  Bill  63  (Espy  of  Hamilton),  same  as  House  Bill 
152  (Roberts  of  Belmont),  authorizing  cities  to  issue  bonds 
and  levy  a tax  on  public  utilities  to  raise  funds  for  poor 
relief.  Enacted.  Signed  by  the  Governor. 

Senate  Bill  64  (Lowery  of  Muskingum),  same  as  House 
Bill  161  (Niday  of  Gallia),  authorizing  school  boards  to  fur- 
nish relief  for  needy  school  children.  Enacted.  Signed  by 
the  Governor. 

House  Bill  337  (Mrs.  O’Neil  of  Summit),  providing  for 
diversion  of  $2,000,000  of  the  gasoline  tax  funds  for  poor 
relief  purposes.  Enacted.  Signed  by  the  Governor. 

House  Bill  700  (Kaser  of  Shelby),  amending  House  Bill 
337  to  provide  for  the  diversion  of  four  million  dollars  in- 
stead of  two  million  from  the  gasoline  tax  fund  for  poor 
relief  purposes.  Senate  Taxation  Comimttee. 

House  Bill  264  (Lehmann  of  Sandusky),  creating  a State 
Emergency  Relief  Fund  to  consist  of  money  which  may  be 
raised  by  special  taxes  imposed  by  the  Legislature.  En- 
acted. Signed  by  the  Governor. 

Senate  Resolutions  31,  34,  36,  37  and  38  (Ackerman  of 
Cuyahoga),  recommending  administrative  reforms  at  the 
state  penal,  correctional  and  mental  institutions.  Adopted 
by  the  Senate. 

House  Bill  464  (Wilkins  of  Lake),  providing  for  the  ad- 
mission of  wives,  widows  or  dependent  mothers  of  world 
war  veterans  to  the  Madison  Home.  Enacted.  Signed  by  the 
Governor. 

House  Joint  Resolution  No.  6 (Cassidy  and  Harrison  of 
Cuyahoga),  providing  for  ratification  of  the  proposed  child 
labor  amendment  to  the  Constitution  of  the  United  States. 
Adopted  by  both  branches. 

Senate  Bill  324  (Ackerman  of  Cuyahoga),  providing  a 
new  schedule  for  meetings  of  the  State  Parole  Board. 
Enacted.  Signed  by  the  Governor. 

Senate  Bill  8 (Emmons  of  Summit , to  provide  for  the 
sterilization  of  certain  classes  of  feeble-minded  and  epilep- 
tics. Indefinitely  postponed  by  the  Senate  Health  Committee. 

Senate  Bill  153  (Pfeiffer  of  Franklin),  same  as  House 
Bill  157  (William  Pringle  of  Cuyahoga),  to  permit  counties 
so  desiring  to  establish  a county  welfare  department  to 
take  over  the  welfare  duties  now  under  the  control  and 
supervision  of  the  county  commissioners  or  boards  chosen  by 
them.  Indefinitely  postponed  by  the  Senate  Committee  on 
Institutions. 

Senate  Bill  49  (Haynes  of  Coshocton),  to  require  the 
creation  of  county  welfare  departments  in  each  county  to 
take  over  the  functions  of  a number  of  county  officials,  in- 
cluding local  health  administration.  Senate  Committee  on 
Institutions. 

Senate  Bill  24  (Espy  of  Hamilton),  providing  a person 
bringing  an  indigent  child  into  Ohio  for  placement  must 
post  bond  with  the  State  Department  of  Public  Welfare. 
House  Calendar. 

Senate  Bill  25  (Espy  of  Hamilton),  providing  for  control 
of  minors  committed  to  the  Juvenile  Court  by  the  Division 
of  Charities,  State  Department  of  Welfare,  and  regulating 
the  costs  of  caring  for  such  wards.  House  Calendar. 

Senate  Bill  163  (Pfeiffer  of  Franklin),  clarifying  pro- 
visions for  transfer  of  patients  from  a state  hospital  to 
the  State  Hospital  for  Epileptics.  Senate  Committee  on 
Institutions. 

Senate  Bill  164  (Pfeiffer  of  Franklin),  eliminating  ref- 
erence to  former  board  of  administration  in  the  commitment 


560 


The  Ohio  State  Medical  Journal 


September,  1933 


and  admissions  statutes  governing  institutions  for  the  feeble- 
minded. Senate  Committee  on  Institutions. 

Senate  Bill  165  (Pfeiffer  of  Franklin),  placing  the  su- 
perintendent or  chief  officer  of  state  welfare  institutions 
under  civil  service  rules  and  regulations.  Senate  Committee 
on  Institutions. 

Senate  Bills  318,  319,  320,  321,  322,  323,  325,  326,  327, 
328,  329,  330,  331  and  333  (Ackerman  of  Cuyahoga),  having 
to  do  with  administrative,  commitment,  parole,  transfer,  etc. 
in  the  state  penal,  correctional  and  mental  institutions. 
House  Calendar. 

Senate  Resolutions  30,  32,  33,  35,  39,  40  and  41  (Acker- 
man of  Cuyahoga),  recommending  administrative  reforms  at 
the  state  penal,  correctional  and  mental  institutions.  Senate 
Committee  on  Institutions. 

House  Bill  98  (Bostwick  of  Madison),  giving  guardians  of 
insane  persons  the  right  to  institute  divorce  proceedings. 
House  Codes  Committee. 

House  Bill  140  (Dunn  of  Tuscarawas),  providing  the  legal 
residence  of  an  insane  person  shall  be  the  county  in  which 
he  or  she  had  resided  for  12  consecutive  months.  House 
Codes  Committee. 

House  Bill  141  (Dunn  of  Tuscarawas),  to  permit  super- 
intendents of  state  hospitals  to  return  to  the  custody  of  the 
probate  court  in  the  county  of  residence  harmless  insane, 
feeble-minded  and  epileptic  patients  to  be  housed  in  the 
county  home.  House  Health  Committee. 

House  Bill  188  (Hall  of  Guernsey)  increasing  the  penalty 
for  working  a female  more  than  50  hours  per  week.  House 
Labor  Committee. 

House  Bill  231  (Kasch  of  Summit),  providing  for  all 
working  women  an  eight-weeks  vacation  with  pay  before 
and  after  childbirth  and  that  the  employer  shall  pay  her 
medical  and  hospital  bills.  House  Labor  Committee. 

House  Bill  233  (Kasch  of  Summit),  to  require  washrooms 
in  factories,  shops,  etc.  House  Reference  Committee. 

House  Bill  234  (Kasch  of  Summit),  to  prohibit  the  em- 
ployment of  women  and  children  between  the  hours  of  7 
p.m.  and  7 a.m.  House  Labor  Committee. 

House  Bill  235  (Kasch  of  Summit),  to  provide  female 
employes  shall  have  a week’s  vacation  with  pay  in  each 
month.  House  Labor  Committee. 

House  Bill  236  (Kasch  of  Summit),  to  provide  that  per- 
sons intending  to  marry  must  have  a physician’s  certificate 
showing  they  do  not  have  a venereal  disease  before  obtain- 
ing a marriage  license.  House  Calendar. 

House  Bill  274  (Carney  of  Cuyahoga),  to  place  on  the 
defendant  the  burden  of  proof  that  he  has  not  neglected 
his  destitute  parents.  House  Calendar. 

House  Bill  321  (Boyd  of  Cuyahoga),  to  substitute  the 

word  “illegitimate”  for  the  word  “bastard”  fn  sections  of 
the  statutes  referring  to  illegitimate  children.  House  Codes 
Committee. 

House  Bill  410  (Uible  of  Cuyahoga),  to  change  the  names 
of  institutions  for  the  feeble-minded  to  “state  training 
schools”.  Senate  Committee  on  Institutions. 

House  Bill  411  (Uible  of  Cuyahoga),  to  designate  the 

state  institutions  at  Longview  and  Lima  as  “state  hospitals”. 
House  Committee  on  Benevolent  and  Penal  Institutions. 

House  Bill  530  (Dunn  of  Tuscarawas),  to  provide  the 

maximum  rate  to  be  charged  counties  for  the  support  of 
inmates  in  state  mental  institutions  shall  be  $3.50  instead 
of  $5.00  per  week.  House  Committee  on  Benevolent  and 
Penal  Institutions. 

House  Bill  550  (Carney  of  Cuyahoga),  to  authorize  the 
State  Department  of  Welfare  to  inspect  all  public  and 
private  relief  agencies.  Senate  Calendar. 

House  Bill  553  (Hesse  of  Cuyahoga),  creating  a Children’s 
Division  in  the  State  Department  of  Welfare.  Senate  Com- 
mittee on  Institutions. 

House  Bill  555  (Hesse  of  Cuyahoga),  to  provide  that  pro- 
visions of  the  commitment  statutes  shall  apply  in  cases 
where  transfer  of  an  inmate  from  the  Ohio  Soldiers’  and 
Sailors’  Home  to  a state  hospital  is  deemed  advisable. 
House  Committee  on  Soldiers’  and  Sailors’  Orphans’  Home. 

House  Bill  600  (David  Pringle  of  Cuyahoga),  to  give  the 
State  Department  of  Welfare  the  right  to  regulate  admis- 
sions to  and  discharges  from  all  institutions  under  its 
supervision.  House  Calendar. 

PUBLIC  HEALTH,  SANITATION,  HOSPITALS,  ETC. 

House  Bill  80  (Hesse  of  Cuyahoga),  a measure  sponsored 
and  supported  by  the  Ohio  Hospital  Association  providing 
for  reimbursement  until  March  1,  1935,  of  hospitals  from  the 
State  Maintenance  and  Repair  Fund  _(derived  from  a per- 
centage of  the  automobile  license  tag  fees)  for  services  ren- 
dered to  indigent  injured  in  motor  vehicle  accidents.  Only 
hospitals  organized  “not  for  profit”  are  permitted  to  share 
in  the  fund.  Enacted.  Signed  by  the  Governor. 

House  Bill  241  (Addison  of  Franklin),  providing  for  the 
addition  of  “diagnosis  and  preventive  dentistry”  to  the  sub- 
jects required  in  the  examination  for  dental  licenses ; re- 
quiring a biennial  re-registration  of  dentists,  and  making 
more  strict  the  present  statutes  relative  to  fraudulent  ad- 
vertising by  dentists.  Enacted.  Signed  by  the  Governor. 

House  Bill  486  (Agnew  of  Mahoning),  to  regulate  the 
manufacture,  distribution  and  sale  of  ice  cream  and  setting 
up  strict  sanitary  regulations  governing  the  ice  cream  in- 
dustry. Enacted.  Signed  by  the  Governor. 

House  Bill  671  (Burk  of  Huron),  establishing  a State 
Milk  Commission  to  regulate  the  production,  distribution  and 


sale  of  milk  and  to  fix  wholesale  and  retail  milk  prices. 
Enacted.  Signed  by  the  Governor. 

Senate  Bill  19  (Pfeiffer  of  Franklin),  seeking  to  take 
from  the  Governor  the  appointment  of  the  State  Director  of 
Health  and  place  such  appointment,  for  a five-year  term* 
in  the  hands  of  the  Public  Health  Council.  Indefinitely 
postponed  by  the  Senate  Health  Committee. 

Senate  Bill  40  (Annat  of  Cuyahoga),  to  codify  the  pro- 
cedure on  appeal  from  decisions  of  boards,  commissions  and 
departments ; amends  statutes  pertaining  to  appeals  from 
rulings  and  orders  of  the  State  Department  of  Health  on 
sanitary  matters  to  preserve  the  appeal  only  to  the  Supreme 
Court  but  widening  the  appeal  to  include  evidence  and  law 
as  well  as  question  of  error,  thus  permitting  a hearing  of 
an  issue  on  its  merits.  House  Calendar. 

House  Bill  159  (Metcalf  of  Franklin),  to  amend  the 
statutes  pertaining  to  appeals  from  orders  of  the  State  De- 
partment of  Health  on  sanitary  matters  by  permitting  such, 
appeals  to  be  originated  in  the  common  pleas  court  in- 
stead of  in  the  State  Supreme  Court  on  petition  in  error. 
House  Judiciary  Committee. 

House  Bill  225  (Foss  of  Mercer),  to  provide  for  appoint- 
ment of  a county  board  of  health  by  the  county  commission- 
ers instead  of  the  district  advisory  council  and  for  state* 
subsidies  to  those  districts  where  necessary  public  health 
service  cannot  be  provided  within  the  financial  resources  of 
the  district  itself.  House  Committee  on  County  Affairs. 

House  Bill  296  (Kaser  of  Shelby),  to  permit  cities  to» 
abolish  the  boards  of  health  as  now  constituted  and  to  place- 
local  health  administration  under  the  department  of  public 
safety  and  to  permit  villages  to  withdraw  from  general 
health  districts  and  to  set  up  health  administration  under 
the  village  marshal  or  mayor.  Indefinitely  postponed  by  the 
House  Committee  on  Cities. 

House  Bill  137  (Pollock  of  Stark),  to  permit  dentists  to 
sign  death  certificates.  Defeated  by  the  House,  15  to  104. 

House  Bill  164  (Burk  of  Huron),  to  provide  more  flexi- 
bility in  the  disposal  of  unclaimed  and  unidentified  bodies 
for  dissection  and  permitting  schools  of  embalming  to 
secure  such  bodies  for  teaching  purposes.  Defeated  by  the 
House,  50  to  46. 

Senate  Bill  350  (Waldvogel  of  Hamilton),  to  provide  that 
in  counties  of  400,000  or  more  population  there  may  be 
created  the  office  of  Chief  Medical  Examiner  on  the  staff  of 
the  county  prosecutor  to  exercise  the  duties  now  carried  on 
by  the  county  coroner.  House  Judiciary  Committee. 

House  Bill  238  (Hesse  of  Cuyahoga),  to  permit  the 
juvenile  court  to  authorize  medical  and  surgical  emergency 
service  for  its  wards  without  legal  red-tape.  House  Calendar. 

Senate  Bill  238  (McManus  of  Lucas),  to  provide  meats  ira 
shipment  must  be  enclosed  in  sanitary  containers.  Senate 
Health  Committee. 

Senate  Bill  244  (Smolka  of  Cuyahoga),  to  amend  the 
statutes  regulating  artificial  lighting  and  electrical  work  in 
school  buildings.  Senate  Health  Committee. 

Senate  Bill  316  (Smolka  of  Cuyahoga),  to  recodify  and 
amend  the  sanitary  plumbing  code.  Senate  Labor  Committee. 

EFFORTS  TO  CRIPPLE  THE  MEDICAL  PRACTICE 
ACT,  ETC. 

House  Bill  60  (Kesler  of  Highland),  the  usual  type  of 
Christian  Science  proposal  to  exempt  “the  practice  of  re- 
ligious tenets”  from  the  provisions  of  the  Medical  Practice 
Act.  Under  this  deceptive  measure,  anyone  claiming  to 
practice  religious  tenets  could  treat  all  types  of  physicaE 
and  mental  ailments  and  charge  a fee  therefor,  provided  no 
medicines  or  material  means  were  employed.  It  would  permit 
the  commercialization  of  prayer  and  interfere  seriously  with 
the  control  of  communicable  diseases.  House  Health  Com- 
mittee. 

House  Bill  201  (Lauer  of  Marion),  to  create  a separate 
licensing  and  examining  board  for  chiropractors ; to  extend 
the  privileges  of  chiropractors  ; to  permit  them  to  treat  all 
kinds  of  diseases  and  injuries  by  chiropractic  methods,  in- 
cluding contagious,  infectious  and  venereal  diseases  ; to 
permit  chiropractors  to  sign  death  certificates,  and  which 
would  destroy  part  of  the  effectiveness  of  the  responsible* 
centralized  licensing  system  set  up  by  the  Medical  Practice 
Act.  House  Health  Committee. 

House  Bill  227  (Ward  of  Monroe),  to  grant  a license  to 
practice  medicine  and  surgery  in  Ohio  to  one  Carl  M. 
Dyhre,  a graduate  of  a school  not  recognized  by  any  state 
medical  licensing  boards,  undoubtedly  unconstitutional- 
House  Health  Committee. 

WORKMEN’S  COMPENSATION 

Senate  Bill  352  (Haynes  of  Coshocton),  to  permit  the 
State  Industrial  Commission  to  borrow  up  to  $10,000,000  on* 
bonds  in  which  its  money  is  invested  to  pay  claimants  iit 
case  money  from  paid-in  premiums  is  insufficient  to  meet 
such  obligations.  Enacted.  Signed  by  the  Governor. 

House  Bill  377  (Roberts  of  Belmont),  identical  with 
Senate  Bill  186  (Gingher  of  Franklin),  the  “agreed”  work- 
men’s compensation  measure  sponsored  by  a joint  committee 
representing  industry  and  labor  which  simplifies  the  pro- 
cedure in  administering  some  of  the  provisions  of  the  Work- 
men’s Compensation  Law  and  clarifies  the  meaning  of  other 
sect’ons  of  the  law.  Enacted.  Signed  by  the  Governor. 

Senate  Bill  402  (Mosier  of  Cuyahoga),  authorizing  the 
State  Department  of  Industrial  Relations  to  Serve  as  a state 


September,  1933 


Annual  Reports 


561 


agency  under  the  National  Employment  System.  Enacted. 
Signed  by  the  Governor. 

Senate  Resolution  62  (Harrison  of  Cuyahoga),  establish- 
ing a special  Senate  committee  to  inquire  into  and  investigate 
matters  relating  to  wormen’s  compensation  administration 
and  report  back  to  this  or  the  91st  General  Assembly  with 
recommendations  and  suggestions  for  improving  adminis- 
trative procedure.  Adopted.  Comittee  composed  of  Senators 
Harrison,  chairman,  Donovan,  Yoder,  Sheppard,  Lloyd  and 
Handley. 

House  Bill  42  (Byrne  of  Lucas),  to  enact  a “wide  open” 
occupational  disease  provision  in  the  Workmen’s  Compensa- 
tion Law  by  defining  the  term  “injury”  as  used  in  the  law 
bo  mean  any  injury  or  disability  received  in  or  arising  out 
of  employment,  which  would  create  innumerable  medical 
problems  and  difficulties  in  administration.  House  Labor 
Committee. 

Senate  Bill  173  (Waldvogel  of  Hamilton),  to  amend  the 
hearings  and  appeal  sections  of  the  Workmen’s  Compensa- 
tion Law.  Senate  Labor  Committee. 

House  Bill  596  (Carney  of  Cuyahoga),  to  authorize  the 
State  Industrial  Commission  to  appoint  solicitors  to  call  upon 
all  employer's  amenable  to  the  Workmen’s  Compensation 
Law  and  request  them  to  become  contributors  to  the  state 
insurance  fund.  House  Labor  Committee. 

House  Bill  33  (Gillespie),  as  originally  drafted  would 
have  enlarged  the  State  Industrial  Commission  to  six  mem- 
bers, two  of  whom  would  sit  in  Columbus,  two  in  Cleveland, 
and  two  in  Cincinnati.  A substitute  bill  reported  out  by 
the  House  Judiciary  Committee  to  authorize  the  State  In- 
dustrial Commission  to  appoint  12  deputy  commissioners  with 
powers  and  duties  similar  to  those  now  invested  in  claim 
referees  and  to  employ  12  physicians  to  assist  in  reviewing 
claims.  House  Calendar. 

MEDICINAL  LIQUOR,  PROHIBITION,  ETC. 

Senate  Bill  9 (Smolka  and  McNamee  of  Cuyahoga), 
amending  the  state  prohibition  statutes  to  permit  in  Ohio 
the  prescription  of  medicinal  liquor  in  quantities  “now” 
provided  by  Federal  statutes  or  regulations.  Enacted. 
Signed  by  the  Governor. 

After  the  enactment  of  Senate  Bill  9,  the  Federal  law 
was  changed  to  remove  all  quantitative  restrictions  on  the 
amount  of  medicinal  liquor  which  may  be  prescribed.  To 
clarify  the  meaning  of  the  Smolka-McNamee  Act  and  to  re- 
move doubts  that  the  Ohio  statutes  would  conform  to  the 
new  Federal  law  and  regulations  and  not  to  the  old  Federal 
law  which  limited  prescriptions  to  one  pint,  Senate  Bill  389 
(Handley  of  Hamilton)  was  introduced  striking  out  the 
word  “now”  in  the  Smolka-McNamee  Act.  Senate  Bill  389 
passed  the  Senate  and  was  reported  out  by  the  House 
Judiciary  Committee.  However,  it  was  caught  in  the  legisla- 
tive jam  previous  to  the  deadline  on  enactment  of  general 
legislation  and  failed  to  get  on  the  “jitney”  calendar  for 
action  by  the  House.  Subsequently,  the  attorney  general  in 
an  official  opinion  held  that  the  Smolka-McNamee  Act 
brought  the  Ohio  statutes  into  conformity  with  the  new  Fed- 
eral law  and  regulations,  thus  removing  all  quantitative 
limitation  on  the  amount  which  may  be  prescribed  in  Ohio 
and  doing  away  with  the  necessity  for  statutory  clarification 
of  the  Smolka-McNamee  Act. 

Senate  Bill  204  (Mosier  and  Lawrence  of  Cuyahoga),  pro- 
viding for  a convention  to  pass  on  amendments  to  the  Con- 
stitution of  the  United  States  proposed  by  Congress  for 
ratification  by  state  conventions — specifically  to  pass  on 
ratification  of  an  amendment  to  repeal  the  Eighteenth 
Amendment  of  the  Constitution  of  the  United  States. 
Enacted.  Signed  by  the  Governor. 

Senate  Bill  346  (Ackerman  and  Lawrence  of  Cuyahoga), 
creating  a state  commission  to  regulate  the  sale  and  dis- 
tribution of  spirituous,  vinous  and  cereal  beverages  at  whole- 
sale and  retail  (the  so-called  Beer  Commission  Law). 
Enacted.  Signed  by  the  Governor. 

Senate  Bill  380  (Ackerman  of  Cuyahoga),  amending 
Senate  Bill  346  to  clarify  some  of  the  provisions  of  that 
measure  and  change  the  administrative  set  up  for  the  State 
Liquor  Control  Commission.  Enacted.  Signed  by  the 
Governor. 

Senate  Bill  20  (Handley  and  Kane  of  Hamilton),  to  re- 
peal statute  prohibiting  remission  or  suspension  of  a fine  in 
liquor  law  violations.  Enacted.  Signed  by  the  Governor. 

Senate  Bill  404  (Ackerman  of  Cuyahoga),  to  create  a 
bureau  of  enforcement  and  inspection  under  the  State 
Liquor  Control  Commission  to  take  over  the  powers  and 
duties  of  the  State  Prohibition  Department  and  to  abolish 
that  department.  House  Calendar. 

Senate  Joint  Resolution  4 (Smolka  of  Cuyahoga),  identical 
with  House  Joint  Resolution  2 (McCrystal  of  Erie),  sub- 
mitting to  a vote  of  the  electorate  the  question  of  repealing 
the  prohibition  amendment  of  the  Consitution  of  Ohio. 
Adopted  by  both  houses. 

PENSIONS,  INSURANCE,  SOCIAL  LEGISLATION 

House  Bill  681  (O’Neil  of  Summit  and  Wm.  Pringle  of 
Cuyahoga),  providing  for  the  setting  up  of  a minimum  wage 
commission  to  establish  minimum  wages  for  women  and 
children,  to  examine  the  books  of  employers,  and  to  prose- 
cute any  who  fail  to  comply  with  the  rulings  and  regula- 
tions of  the  board.  Enacted.  Signed  by  the  Governor. 

House  Bill  1 (by  initiated  petition),  to  provide  for  a 
state-supported  old  age  pension  system.  Passed  in  different 


form  by  both  branches  but  failed  of  enactment  due  to  lack 
of  agreement  between  the  two  houses.  Conference  Committee. 

House  Bill  1/2  (Keifer  of  Clark),  to  establish  a system 
of  unemployment  insurance  financed  by  employers  and  em- 
ployes. Passed  by  House.  Failed  of  enactment  in  Senate. 

Senate  Bill  281  (Haynes  of  Coshocton),  providing  for  the 
establishment  of  a pension  system  for  superannuated  or  in- 
capacitated state  employes  without  provision  for  appropria- 
tion of  funds  by  the  state.  Enacted.  Signed  by  the  Gov- 
ernor. 

LICENSING  SYSTEMS,  BOARDS,  COMMISSIONS,  ETC. 

Senate  Bill  103  and  Senate  Bill  372  (Emmons  of  Summit), 
providing  for  a commission  to  regulate  and  license  horse 
racing  and  providing  for  the  levy  of  a tax  on  betting  at 
races.  Enacted.  Signed  by  the  Governor. 

House  Bill  318  (Zoul  of  Cuyahoga),  creating  a state 
board  of  cosmetology  to  examine  and  license  persons  en- 
gaged in  or  teaching  cosmetology,  hair  dressing,  manicuring, 
and  regulate  such  businesses.  Amended  to  “cure”  the 
measure  of  medical  and  health  objections.  Enacted.  Signed 
by  the  Governor. 

Senate  Bill  129  (Geo.  Roberts  of  Mahoning),  establishing 
a state  barbers’  licensing  and  examining  board  to  regulate 
the  business  of  barbering.  Amended  to  “cure”  it  of  medical 
and  health  objections.  Enacted.  Signed  by  the  Governor. 

Senate  Bill  66  (Gunsett  of  Van  Wert),  changing  the 
date  for  the  issuance  of  chauffeurs’  licenses  from  January  1 
to  September  1,  effective  September  1,  1934.  Enacted. 

Signed  by  the  Governor. 

Senate  Bill  99  (LeFever  of  Athens),  to  create  a board  to 
examine  and  license  embalmers  and  funeral  directors  and  to 
take  over  the  duties  now  invested  in  the  State  Embalmers* 
Examining  Board.  Enacted.  Signed  by  the  Governor. 

Senate  Bill  174  (Waldvogel  of  Hamilton),  creating  a 
state  board  to  examine  and  license  professional  engineers 
and  surveyors.  Enacted.  Signed  by  the  Governor. 

Senate  Bill  15  (Eugene  Roberts  of  Mahoning),  to  provide 
for  the  licensing  of  automobile  drivers.  House  Calendar. 

House  Bill  189  (Baker  of  Hamilton),  to  provide  *for  the 
licensing  of  automobile  drivers.  Defeated  in  the  House,  32 
to  82. 

Senate  Bill  22  (Mosier  of  Cuyahoga),  to  provide  no  one 
may  drive  an  automobile  unless  he  can  show  proof  of  ability 
to  bear  the  cost  of  damages  incurred  in  a motor  vehicle 
accident,  such  proof  to  be  in  the  form  of  liability  insurance, 
surety  bond,  personal  bond  or  cash  deposit  with  the  Com- 
missioner of  Motor  Vehicles.  Defeated  in  the  House. 

Senate  Bill  48  (Emmons  of  Summit),  to  provide  no  one 
under  21  years  of  age  and  not  a citizen  of  the  United  States 
shall  be  licensed  as  a real  estate  broker.  Defeated  in  Senate. 

Senate  Bill  114  (Ackerman  of  Cuyahoga),  to  establish  a 
state  athletic  commission  to  regulate  and  license  boxing, 
wrestling,  etc.  House  Calendar. 

S-enate  Bill  242  (Gingher  of  Franklin),  to  establish  a 

state  board  of  accountancy  to  examine  and  license  ac- 
countants and  to  regulate  the  practice  of  public  account- 
ancy. Senate  Judiciary  Committee. 

Senate  Bill  247  (Smolka  of  Cuyahoga),  to  establish  a 

state  board  of  registration  of  painting  and  decorating  con- 
tractors to  regulate  the  business  of  painting  and  decorating. 
Senate  Labor  Committee. 

Senate  Bill  252  (Donovan  of  Lucas),  to  regulate  the 

operation,  construction  and  use  of  taxicabs.  Senate  Com- 
mittee on  Highways  and  Automotive. 

Senate  Bill  282  (Geo.  Roberts  of  Mahoning),  to  create  a 
state  board  of  agriculture.  Senate  Committee  on  Agri- 
culture. 

Senate  Bill  293  (McManus  of  Lucas),  to  provide  for  the 
licensing  of  slot  machines.  Enacted.  Vetoed  by  Governor. 

Senate  Bill  306  (DeArmond  of  Butler),  to  create  a state 
highway  commission.  Senate  Committee  on  Highways  and 
Automotive. 

House  Bill  176  (Eirick  of  Cuyahoga),  to  regulate  out- 
door advertising  and  to  provide  for  licenses  and  permits  for 
doing  such  advertising.  House  Taxation  Committee. 

House  Bill  506  (Kalb  of  Ottawa),  to  create  a state  trade 
commission  to  prevent  the  use  of  unfair  methods  of  com- 
petition in  business.  House  Judiciary  Committee. 

House  Bill  511  (Bohnert  of  Pickaway),  to  regulate  the 
manufacture,  sale  and  advertising  of  hamburger,  ground 
beef,  sausage,  etc.  House  Committee  on  Dairy  and  Foods. 

House  Bill  516  (Frick  of  Seneca),  to  authorize  munici- 
palities to  license  dry  cleaning  establishments.  House 
Calendar. 

House  Bill  526  (Pollock  of  Stark),  to  provide  for  the 
licensing  of  coin  operating  devices.  House  Calendar. 

House  Bill  607  (Carey  of  Lucas),  to  regulate  the  opera- 
tion, construction  and  use  of  taxicabs.  House  Labor  Com- 
mittee. 

MISCELLANEOUS 

House  Bill  51  (Spaght  of  Summit  and  Addison  of  Frank- 
lin), recodifying  the  statutes  relative  to  garnishment ; fixing 
the  exemption  from  garnishment  for  single  persons  at  $30 
and  for  heads  of  families  at  a minimum  of  $60  per  month  ; 
making  “work,  labor  and  necessaries”  a ground  for  attach- 
ment ; setting  up  a trusteeship  arrangement  for  debtors 
being  garnisheed ; and  declaring  a moratorium  on  wage  as- 
signments for  two  years  Enacted.  Signed  by  the  Governor. 

House  Bill  699  (Burk  of  Huron),  the  biennial  appropria- 
tions bill  of  approximately  $83,000,000  providing  funds  to 


562 


The  Ohio  State  Medical  Journal 


September,  1933 


operate  the  state  government  and  including  a state  subsidy 
of  $300,000  to  be  distributed  to  local  public  health  districts  in 
need  of  financial  assistance.  Enacted.  Signed  by  the 
Governor. 

House  Bill  705  (Carney  of  Cuyahoga),  granting  to  the  Gov- 
ernor dictatorial  powers  to  regulate  intra-state  business  in 
line  with  the  National  Recovery  Act  affecting  inter-state 
business  and  virtually  suspending  the  provisions  of  the  Val- 
entine Anti-Trust  Law.  Enacted.  Signed  by  the  Governor. 

House  Bill  707  (Addison  of  Franklin),  authorizing  build- 
ing and  loan  associations  to  exchange  mortgages  for  Federal 
Home  Loan  Bank  bonds.  Enacted.  Signed  by  the  Governor. 

Senate  Bill  403  (Waldvogel  of  Hamilton),  permitting  po- 
litical subdivisions  to  vote  bonds  outside  the  15-mill  limita- 
tion to  provide  funds  for  participation  in  the  $3,000,000,000 
Federal  public  works  program.  Enacted.  Signed  by  the 
Governor. 

Senate  Bill  133  (Handley  of  Hamilton),  authorizing  a court 
to  modify  or  remit  sentences  and  fines  in  misdemeanor  cases. 
Enacted.  Signed  by  the  Governor. 

Senate  Bill  412  (Lloyd  of  Scioto),  authorizing  boards  of 
education  to  borrow  money  and  issue  notes  to  pay  teachers’ 
salaries  accruing  since  January  1,  1933.  Enacted.  Signed 
by  the  Governor. 

House  Bill  34  (Addison  of  Franklin),  to  provide  a j'ury 
trial  for  all  persons  charged  with  the  violation  of  any 
statute  or  ordinance  where  the  penalty  involved  is  a fine  of 
more  than  $50.  Enacted.  Signed  by  the  Governor. 

House  Bill  198  (Haeffner  of  Mahoning),  providing  no  in- 
itiative, referendum  and  nominating  petition  shall  be  re- 
jected because  of  invalid  signatures  if  the  required  number 
of  valid  signatures  have  been  secured.  Enacted.  Signed  by 
the  Governor. 

House  Bill  263  (Eikenberry  of  Preble),  providing  ma- 
chinery for  the  dissolution  by  the  state  of  insolvent  build- 
ing and  loan  institutions.  Enacted.  Signed  by  the  Governor. 

House  Bill  270  (McNamee  of  Cuyahoga),  providing  for  a 
system  of  highway  police  for  enforcement  of  the  motor 
vehicle  laws.  Enacted.  Signed  by  the  Governor. 

House  Bill  271  (McNamee  of  Cuyahoga),  providing  for 
the  transfer  of  the  bureau  of  motor  vehicles  from  the 
jurisdiction  of  the  Secretary  of  State  to  that  of  the  State 
Director  of  Highways.  Enacted.  Signed  by  the  Governor. 

House  Bill  656  (Lawrence  of  Cuyahoga),  authorizing 
banks  to  limit  the  payment  of  liabilities  to  depositors  and 
other  creditors.  Enacted.  Signed  by  the  Governor 

House  Bill  657  (Gradison  of  Hamilton),  extending  the 
powers  and  duties  of  the  state  superintendent  of  banks  with 
references  to  liquidation  of  banks  and  to  the  resumption  of 
business  by  banks  after  liquidation.  Enacted.  Signed  by  the 
Governor. 

House  Bill  660  (Lawrence  of  Cuyahoga),  authorizing  the 
state  treasurer  to  issue  certificates  of  indebtedness  (scrip) 
in  payment  of  material  and  services  furnished  to  the  state. 
Enacted.  Signed  by  the  Governor. 

House  Bill  66i  (Baker  of  Hamilton  and  Haynes  of  Co- 
shocton), creating  an  advisory  board  in  the  division  of 
banks  to  assist  in  the  liquidation  and  reorganization  of 
banks.  Enacted.  Signed  by  the  Governor. 

House  Bill  63  (Eikenberry  of  Preble),  providing  owner  or 
operator  of  a motor  vehicle  shall  not  be  liable  in  case  of  in- 
jury to  or  death  of  a guest  passenger  unless  the  owner  or 
operator  is  found  guilty  of  wilful  or  wanton  misconduct  in 
the  operation  of  the  vehicle.  Enacted.  Signed  by  the 
Governor. 

House  Bill  670  (Eikenberry  of  Preble),  providing  for  more 
effective  supervision  and  examination  of  building  and  loan 
associations.  Enacted.  Signed  by  the  Governor. 

House  Bill  219  (Best  of  Franklin),  permitting  the  com- 
mon pleas  court  to  declare  a moratorium  on  the  foreclosure 
of  any  mortgage  until  February  1,  1935.  Enacted.  Signed 
by  the  Governor. 

House  Bill  328  (Pettit  of  Logan),  providing  when  the 
office  of  county  coroner  in  counties  of  less  than  100,000  popu- 
lation becomes  vacant  by  death,  resignation,  expiration  of 
term  of  office,  etc.,  the  county  commissioners  may  appoint  a 
suitable  person  to  the  vacancy,  and  during  the  absence  of 
the  coroner  a justice  of  the  peace  may  be  designated  by  him 
to  serve  as  coroner.  Enacted.  Signed  by  the  Governor. 

House  Bill  108  (Beard  of  Montgomery),  reducing  the  fees 
collected  by  the  probate  judge.  Enacted.  Signed  by  the 
Governor. 

House  Bill  13  (Pollock  of  Stark),  reducing  the  per  diem 
salary  paid  common  pleas  judges  for  holding  court  in  coun- 
ties other  than  residence  to  $10  and  limiting  the  amount 
paid  for  his  expenses  to  $6  per  day.  Enacted.  Signed  by 
the  Governor. 

House  Bill  696  (Douglas  of  Cuyhoga),  providing  for 
separate  reports  of  trust  companies  and  banks  doing  a 


trust  business  and  making  trust  funds  preferred  claims. 
Enacted.  Signed  by  the  Governor. 

House  Bill  691  (Eikenberry  of  Preble),  to  permit  build- 
ing and  loan  associations  to  invest  funds  in  Federal  home 
loan  bonds.  Enacted.  Signed  by  the  Governor. 

House  Bill  675  (Gradison  of  Hamilton),  to  increase  the 
kinds  of  securities  which  may  be  accepted  by  county  com- 
missioners and  boards  of  education  as  security  for  deposits 
of  school  funds.  Enacted.  Signed  by  the  Governor. 

House  Bill  331  (Gilbert  of  Montgomery),  extending  the 
term  of  office  of  the  county  recorder  to  four  years.  Enacted. 
Signed  by  the  Governor. 

House  Bill  697  (Eirick  of  Cuyahoga),  to  repeal  House 
Bill  331  extending  the  term  of  office  of  the  county  recorder. 
House  Committee  on  County  Affairs. 

Senate  Bill  146  (Matthews  of  Clark),  extending  the  term 
of  office  of  the  county  clerk  to  four  years.  Enacted.  Vetoed 
by  the  Governor. 

Senate  Bill  364  (Yoder  of  Montgomery),  extending  the 
terms  of  other  county  elected  officials.  House  Calendar. 

Senate  Bill  135  (Marshall  of  Cuyahoga),  to  prohibit  cor- 
porations from  practicing  optometry  and  to  make  more 
strict  the  statutes  pertaining  to  advertising  by  optometrists. 
Indefinitely  postponed  by  House  Health  Committee. 

Senate  Joint  Resolution  10  (Lowery  of  Muskingum),  to 
provide  a constitutional  amendment  to  extend  to  four  years 
the  terms  of  elected  state  officials.  House  Elections  Com- 
mittee. 

Senate  Joint  Resolution  31  (Yoder  of  Montgomery),  to 
provide  a constitutional  amendment  to  limit  sessions  of  the 
General  Assembly  to  91  days.  Defeated  in  the  Senate. 

Senate  Bill  342  (Lewis  of  Belmont),  to  authorize  the 
Governor  to  reorganize  the  executive  department  of  the 
state  government ; providing  for  a survey  for  the  purpose 
of  eliminating  duplications,  to  reduce  personnel  and  effect 
consolidations,  and  for  the  temporary  dismissal  of  all  em- 
ployes of  the  executive  department  pending  reorganization. 
House  Committee  on  Organization  of  State  Government. 

House  Bill  288  (Armbruster  of  Henry),  to  authorize 

county  commissioners  to  refund  outstanding  county  road 
bonds  as  they  mature  in  the  period  1934  to  1944  by  the 
issuance  of  20-year  serial  bonds  to  be  retired  out  of  gaso- 
line tax  funds.  House  Calendar. 

House  Bill  206  (Eikenberry  of  Preble),  to  authorize 

county  commissioners  to  assume  unpaid  assessments  for 
state  highways  levied  prior  to  July  25,  1929,  and  to  refund 
to  property  owners  assessments  which  have  been  paid. 
House  Calendar. 

House  Bill  390  (David  Pringle  of  Cuyahoga),  to  provide 
that  money  paid  indigents  in  connection  with  poor  relief 
programs  shall  not  be  subject  to  execution,  garnishment, 
attachment,  the  operation  of  the  bankruptcy  or  insolvency 
laws,  and  shall  not  be  assignable.  House  Codes  Com- 
mittee. 

Senate  Bill  23  (Mosier  of  Cuyahoga),  to  provide  for 
division  of  the  state  into  new  congressional  districts  and 
reapportionment  of  Ohio’s  representation  in  the  U.  S.  Con- 
gress. Senate  Committee  on  Elections  and  Federal  Re- 
lations. 

House  Bill  75  (Roberts  of  Belmont),  to  permit  labor 
organizations  to  furnish  legal  aid  and  advice  to  their  mem- 
bers in  all  cases  arising  solely  out  of  their  employment. 
Senate  Calendar. 

Senate  Bill  77  (Eugene  Roberts  of  Mahoning),  to  permit 
courts  to  suspend  the  execution  of  sentence  and  place  de- 
fendants on  probation.  Senate  Judiciary  Committee. 

Senate  Bill  170  (McManus  of  Lucas),  to  prohibit  certain 
acts  which  create  monopolies,  restrain  trade, ; and  limit  or 
destroy  competition  in  the  business  of  selling  household 
commodities.  House  Calendar. 

House  Joint  Resolution  36  (Johnson  of  Fulton)  propos- 
ing to  amend  the  Ohio  Constitution  to  permit  the  con- 
solidation of  common  pleas  courts  into  districts.  House 
Judiciary  Committee. 

House  Joint  Resolution  35  (Roberts  of  Belmont),  to  pro- 
vide for  a joint  legislative  committee  to  investigate  and 
recommend  ways  for  providing  a shorter  work  day  and  a 
shorter  work  week.  House  Calendar. 

House  Joint  Resolution  42  (Foss  of  Mercer),  to  provide 
for  the  appointment  of  a joint  legislative  committee  to 
study  township  and  county  government  and  to  devise  ways 
and  means  of  increasing  their  efficiency  and  lowering  their 
costs.  House  Calendar. 

Senate  Bill  416  (Lewis  of  Belmont),  to  authorize  county 
commissioners  to  refinance  special  road  assessments  falling 
due  in  1933,  34  and  35  by  issuing  20-year  bonds  to  be  retired 
from  gasoline  tax  funds  allocated  to  the  counties.  (Similar 
to  House  Bill  288  (Armbruster)  and  House  Bill  206  (Eik- 
enberry). Senate  Taxation  Committee. 


Annua]  Report  of  the  Committee  on  Medical  Economics 

Including  Activities  of  the  Special  Committee  on  Hospital  Contracts  and  X-ray 
Service  in  Connection  With  Workmen’s  Compensation  Cases 


J.  Craig  Bowman,  Chairman,  (1933) 

Upper  Sandusky 


A.  B.  Brower,  (1934) Dayton 

E.  0.  Smith,  (1935) Cincinnati 

Don  K.  Martin,  Secretary Columbus 


Because  of  their  intimate  relationship  with  pub- 
lic and  community  problems,  it  was  inevitable 
that  physicians  would  be  directly  affected  by  the 
epochal  economic,  social  and  governmental 
changes  which  have  been  taking  place. 

The  results  of  the  prevailing  economic  distress, 
unrest,  uncertainty,  changing  social  conditions, 
unprecedented  extension  of  the  powers  and  ac- 
tivities of  government,  have  brought  about  the 
most  critical  situation  which  has  ever  confronted 
the  medical  profession. 

Physicians  have  been  keenly  aware  during  the 
past  few  years,  especially  during  the  past  12 
months,  that  the  demands  upon  them  have  been 
the  greatest  in  peace-time  history.  The  reward 
from  a material  standpoint  has,  in  many  cases, 
approached  the  negligible. 

With  the  increasing  problems  during  recent 
months  in  providing  medical  and  hospital  care  for 
the  needy  sick  caused  by  unemployment,  this 
committee  has  been  especially  concerned  with  the 
administration  of  the  poor  relief  laws  and  the  re- 
lief funds  in  the  various  local  communities.  In 
some  communities  there  was  a disposition  on  the 
part  of  officials  to  make  little  or  at  least  inade- 
quate provisions  for  the  payment  to  physicians 
for  services  rendered  to  the  increasing  number  of 
needy  sick.  However,  in  other  communities 
through  efforts  of  officers  and  committees  of  the 
county  medical  societies,  various  methods  were 
developed  to  meet  the  situation,  at  least  partially. 

As  pointed  out  in  articles  on  this  question  pub- 
lished from  time  to  time  in  the  Ohio  State  Medical 
Journal,  there  were  several  sources  of  revenue  for 
medical  relief  which  might  be  adopted  by  city, 
township  and  county  officials,  including  (a)  that 
part  of  the  general  revenue  fund  of  the  subdivi- 
sion set  aside  for  poor  relief  work,  (b)  issuance, 
under  emergency  legislation,  of  special  poor  relief 
bonds,  (c)  part  of  the  funds  from  the  excise  tax 
apportioned  locally  raised  by  public  utilities,  (d) 
diversion  of  the  subdivision’s  portion  of  the  gaso- 
line tax  allotted  for  this  purpose,  and  (e)  funds 
made  available  in  some  cities  from  community 
funds. 

The  Federal  Emergency  Relief  Act  of  1933 
broadened  the  intent  of  the  act  of  the  previous 
year,  to  include  “service”  in  relieving  hardship 
and  suffering.  This,  of  course,  could  be  inter- 
preted to  include  payment  to  physicians  for 
medical  services  rendered. 


Through  cooperation  with  the  State  Depart- 
ment of  Health  and  the  Ohio  Relief  Commission, 
officers  of  the  State  Medical  Association  have 
urged  that  in  any  allotment  of  funds  or  formula- 
tion of  budget  for  local  relief,  that  provisions  be 
made  for  payment  for  medical  service.  In  some 
instances  this  has  been  developed  into  a plan  to 
preserve,  as  far  as  possible,  the  free  choice  of 
physicians  by  those  needing  medical  service  from 
among  those  who,  in  this  emergency,  were  willing 
to  accept  such  cases  at  a stipulated  fee  schedule. 
Naturally,  such  fee  schedule  for  this  purpose  was 
lower  than  would  be  expected  to  be  charged  in 
normal  times  or  to  patients  who  are  able  to  pay 
for  medical  attention.  However,  such  a system, 
where  developed,  has  been  considered  more  equi- 
table than  the  too  meagre  salary-contract  system 
which  had  prevailed  in  some  communities.  It  is 
hoped  that  by  the  time  this  is  published,  if  not 
before,  a practical  and  equitable  system  will  have 
been  worked  out  through  the  cooperation  of  the 
Ohio  Relief  Commission,  local  relief  officials,  the 
State  Department  of  Health,  health  departments, 
the  State  Medical  Association,  and  the  county 
medical  societies. 

Obviously,  members  of  the  medical  profession 
should  not  be  imposed  upon  by  their  communities 
or  expected  to  render  medical  service  without 
compensation  to  those  needy  members  of  the 
community  who  are  being  provided  at  public  ex- 
pense with  other  necessities  of  life. 

VITAL  PROBLEMS  CONFRONT  PROFESSION 

During  the  past  period  of  unrest  and  uncer- 
tainty, numerous  efforts  have  been  made  to  over- 
throw completely  the  existing  system  of  medical 
practice.  Unjust  and  unfair  criticism  has  been 
leveled  at  the  profession,  arousing  distrust  on  the 
part  of  some  factions  of  the  public. 

So  far,  medicine  has  withstood,  in  a large 
measure,  the  attacks  which  have  been  launched 
against  it.  But  what  of  the  future?  What  direc- 
tion will  the  tide  take  during  the  period  of  re- 
adjustment and  recovery?  How  will  problems  of 
vital  concern  to  the  medical  profession  be  solved? 

Solutions  for  many  of  the  problems  now  con- 
fronting us  are  not  now  apparent.  However,  it  is 
obvious  that  most  of  them  are  not  isolated  ques- 
tions involving  only  the  physician  and  his  indi- 
vidual clientele,  but  are  for  the  most  part  phases 
of  larger  and  more  comprehensive  economic  and 
social  factors  of  general  interest  and  importance. 
A few  can  and  should  be  solved  by  the  medical 
profession  itself  through  necessary  and  practical 
adjustments  in  existing  methods  to  meet  chang- 
ing conditions. 

Developments  of  the  past  year  or  so  indicate 


563 


564 


The  Ohio  State  Medical  Journal 


September,  1933 


the  nature  of  some  of  the  difficulties  that  the  pro- 
fession will  be  called  upon  to  face  in  the  future. 
Although  significant  changes  in  social  and  eco- 
nomic conditions  have  contributed  many  of  the 
complications  which  have  arisen  to  plague  phy- 
sicians, they  have  not  been  wholly  responsible  for 
all  the  difficulties  and  worries  that  have  har- 
rassed  us.  The  courageous  efforts  which  have 
been  put  forth  by  the  medical  pi’ofession  to  ad- 
just itself  in  a sane  and  orderly  way  to  the  ad- 
verse conditions  of  the  past  few  years  have  been 
thwarted  in  some  instances  by  vicious  and  un- 
called-for attacks  on  the  profession  by  radicals, 
theorists,  so-called  reformers,  social  experts  and 
others  who  believe  in  revolution  as  a means  to 
stabilization. 

Because  of  widespread  publicity  and  propa- 
ganda concerning  the  economic  and  social  aspects 
of  medicine  and  continuous  carping  on  the  part  of 
self-appointed  critics,  public  thinking  regarding 
medical  practice  and  the  medical  practitioner  has 
been  maneuvered  into  an  unfortunate  and  dan- 
gerous position.  Unwisely,  many  persons  have 
been  led  to  believe  that  medical  care  can  be  meas- 
ured solely  in  terms  of  dollars  and  cents.  The 
economic  and  organization  aspects  of  medical  care 
have  been  greatly  overemphasized.  On  the  other 
band,  the  fact  that  quality  and  individual  applica- 
tion is  the  fundamental  element  in  any  system  of 
efficient  medical  care  has  either  been  ignored  or 
treated  with  indifference. 

VARIOUS  ATTEMPTS  TO  “MODERNIZE”  MEDICAL 
SERVICE 

As  a result  of  the  agitation  stirred  up  by  in- 
dividuals and  groups  who  contend  that  medicine 
has  been  reactionary  and  unprogressive,  numerous 
movements  to  revolutionize  the  field  of  medicine 
have  been  launched.  Most  of  these  are  out-and- 
out  attempts  to  socialize  medical  practice  and 
place  medical  care  on  a commercialized,  mass  pro- 
duction basis.  Schemes  of  various  kinds  have 
been  initiated  to  “modernize”  medical  practice, 
ranging  from  so-called  group  practice  projects 
and  sickness  insurance  schemes  to  pernicious 
contract  practice  rackets,  sponsored  by  lay  pro- 
moters with  an  eye  for  quick  monetary  returns. 

The  public’s  confidence  in  the  medical  profes- 
sion has  been  shaken  somewhat  because  of  false 
and  misleading  propaganda  which  has  been  broad- 
cast by  socially-minded  experts  or  by  those  with  a 
financial  stake  in  some  commercial  medical  ven- 
ture. Already  the  intimate,  confidential  and  pro- 
fessional relationship  between  physician  and  pa- 
tient, so  necessary  to  insure  beneficial  and  effec- 
tive medical  care,  has  been  disrupted  in  some 
communities  by  the  inauguration  of  some  new 
form  of  organization  for  the  management  of 
medical  needs. 

Commercialized  schemes  have  been  established 
in  our  own  state,  submerging  the  interests  of  both 
the  patient  and  the  physician,  and  are  nothing 


more  nor  less  than  cut-rate,  basement-store  enter- 
prises, permeated  by  the  evils  of  contract  bar- 
gaining, solicitation  of  business,  misrepresenta- 
tion, underbidding,  elimination  of  free  choice  of 
physician,  inferior  medical  attention,  etc.  Un- 
fortunately, some  physicians  have  winked  at  our 
code  of  ethics  and  against  their  better  judg- 
ment have  attached  themselves  to  undertakings  of 
this  type  which  are  detrimental  to  the  public  and 
degrading  to  the  profession  of  medicine.  Public 
revolt  against  such  forms  of  medical  racketeering 
and  quackery  is  certain  to  come  sooner  or  later. 

During  the  past  12  months  or  so,  we  have  been 
literally  swamped  with  outside  advice  as  to  how  to 
meet  our  problems  and  those  of  the  public.  We 
have  been  urged  to  organize  ourselves  into  large 
groups  for  the  purpose  of  furnishing  the  public 
with  the  benefits  of  curative  and  preventive  medi- 
cine, but  have  been  furnished  no  assurance  that 
such  a program  would  actually  lead  to  a wider 
distribution  of  medical  benefits,  to  an  improve- 
ment in  medical  service,  or  to  the  preservation  of 
the  personal  relationship  between  physician  and 
patient. 

GROUP  AND  INSURANCE  “PLANS” 

It  has  been  suggested  by  some  that  the  costs  of 
medical  care  should  be  placed  on  a group  purchase 
basis  through  the  use  of  insurance,  taxation,  etc., 
but  no  suggestion  has  been  forthcoming  as  to  how 
to  safeguard  such  insurance  programs  against  the 
evils  which  followed  the  establishment  of  such 
schemes  in  some  of  the  larger  European  countries 
and  which  have  lowered  the  standard  of  medical 
practice  in  those  nations. 

Hospitals  have  been  urged  to  convert  them- 
selves into  gigantic  medical  centers  and  to  in- 
augurate periodic  payment  plans  to  enable  pa- 
tients to  meet  the  costs  of  hospitalization,  but 
there  has  been  no  guarantee  that  such  a plan 
would  not  place  the  hospital  in  direct  competition 
with  the  physicians  of  the  community  or  that  the 
insurance  plan  thus  set  up  would  not  ultimately  be 
extended  to  include  both  the  services  of  the  hos- 
pital and  of  the  physicians  on  the  hospital  staff, 
causing  a breakdown  in  the  relationship  between 
physician  and  patient. 

Frequently,  we  hear  the  threat  that  unless  we 
do  something  about  the  question  of  medical  costs, 
the  government  will  step  in  and  that  physicians 
will  be  relegated  to  the  position  of  brass-button 
attendants,  but  how  to  prevent  such  political 
domination  from  destroying  the  professional  as- 
pects of  medical  practice  and  bringing  disaster 
to  the  public  has  not  been  divulged. 

However  undesirable,  harmful  and  impractical 
as  most  of  the  suggestions  which  have  so  far 
been  advanced  for  “modernizing”  medical  practice 
may  be,  we  dare  not  discount  the  trends  and 
movements  which  are  threatening  to  undermine 
that  which  has  stood  the  test  of  time,  remember- 
ing that  in  eras  of  distress  and  unrest  the  public 


September,  1933 


Annual  Reports 


565 


is  ultra-gullible  and,  seeking  a Moses  to  lead  them, 
many  persons  are  easily  influenced  by  false 
prophets. 

As  Dr.  Olin  West  has  expressed  it: 

“The  issue  is  clearly  defined,  though  there  are 
those  who  would  becloud  it  and  are  making  per- 
sistent efforts  to  that  end.  Shall  the  practice  of 
medicine  be  socialized?  Shall  the  age-old  in- 
stitution erected  on  the  basis  of  the  experience  of 
an  observant,  devoted,  efficient  and  constantly 
progressive  profession  be  overthrown?  Shall  the 
professional  aspects  of  medical  practice  be  de- 
stroyed?” 

Every  physician  does,  or  should,  recognize, 
some  defects  in  present  methods  of  medical  prac- 
tice. There  are  some  imbalances,  injustices  and 
weaknesses.  The  profession  constantly  is  seeking 
to  remedy  these  flaws  and  is  taking  proper  steps 
to  meet  new  obligations  and  responsibilities. 
Medical  costs  are  burdensome  in  some  instances 
and  for  some  classes  of  society,  but  the  physician 
knows,  and  his  lay  critics  should  know,  that  the 
costs  of  illness  constitute  an  economy  problem  for 
which  the  medical  profession  is  not  responsible 
and  should  not  be  expected  to  bear  the  sole  bur- 
den. 

ADJUSTMENTS  AND  CORRECTIONS  CAN  BE  MADE 

Quite  properly  the  medical  profession  has 
moved  with  conservatism  in  proposing  changes  in 
established  programs  and  in  accepting  untried 
proposals.  In  fact,  the  profession  is  apprehensive, 
and  justifiably  so,  of  attempts  to  interfere  with 
the  individual  service  of  the  physician  to  the  in- 
dividual patient;  to  inject  mediocrity  into  the  ren- 
dition of  medical  care,  and  to  place  the  financial 
aspects  of  medical  practice  ahead  of  the  profes- 
sional and  scientific.  Close  adherence  to  this  creed 
would  seem  to  be  more  necessary  at  present  than 
ever  before,  for,  as  Dr.  Harvey  Cushing  recently 
declared  in  his  scholarly  essay  on  “Medicine  at 
the  Crossroads”,  now  would  seem  to  be  “a  most 
inopportune  time  to  fly  to  evils  we  know  not  of, 
but  rather  to  stick  firmly  to  what  has  proved  in 
the  long  run  the  great  stabilizer — every  honest 
man  with  faith,  hope  and  a stout  heart  going 
about  his  own  business,  with  swift  punishment 
for  dishonesty  and  crime”. 

A solution  of  the  complex  problems  of  medical 
care,  medical  costs,  etc.,  will  not  be  found  in  any 
scheme  or  system  which  ultimately  would  destroy 
the  entire  present  system.  As  aptly  stated  in  the 
final  report  of  the  Commission  on  Medical  Edu- 
cation : 

“Allowing  for  defects  in  present  methods,  there 
are  fundamental  advantages  in  the  American 
form  of  practice  which  need  to  be  strengthened. 
It  is  not  necessary  to  substitute  for  the  present 
efforts  a paternalistic  plan,  ill-adapted  to  the 
philosophy  of  American  life,  but  rather  to  encour- 
age the  evolution  of  a pattern  which  will  embrace 
the  desirable  features  of  our  present  methods  and 
the  correction  of  its  defects.  Some  efforts  are 
being  made  to  provide  standardized  service  on  a 
mass  production  basis,  reflecting  recent  practices 
in  industry.  It  is  a fundamental  fallacy  to  base 


any  program  upon  the  assumption  that  the  human 
being  who  is  the  unit  of  practice  can  be,  or  is 
likely  in  the  future  to  become,  a uniform,  stand- 
ardized organism.” 

No  single,  all-inclusive,  inelastic  “plan”  will 
meet  all  the  situations  and  conditions  arising  from 
disabling  sickness  or  injury.  Most  of  the  problems 
of  medical  care  are  essentially  local  and  practical; 
not  general  and  theoretical.  No  single  artificial 
program  can  be  made  to  fit  the  conditions  in  all 
communities.  There  are  no  safe  cut-rate,  short- 
cuts to  efficient  and  effective  medical  service. 
Facilities  needed  to  provide  adequate  medical  care 
in  one  community  may  be  unnecessary  in  others. 
Such  facilities  should  be  established  on  the  basis 
of  local  conditions  and  needs. 

LOCAL  ACTIVITY  AND  RESPONSIBILITY 

In  its  consideration  of  medico-social  questions 
during  the  past  year,  the  Committee  on  Medical 
Economics  has  been  greatly  impressed  with  the 
necessity  for  increased  local  activity  and  more  ex- 
tensive study  of  these  questions  on  the  part  of 
the  medical  profession  generally.  Every  physician 
should  have  a keen  realization  of  the  tremendous 
responsibilities  which  rest  upon  the  profession 
and  medical  organization  at  this  time.  We  dare 
not  leave  to  outsiders  the  tasks  which  are  ours. 
Some  adjustments  in  our  present  system  of  medi- 
cal practice  are  needed  and  should  be  made — by 
us,  not  by  those  outside  the  profession.  Serious 
consideration  should  be  given  by  us  to  the  future 
economic  and  ethical  relations  of  the  profession 
to  the  public  in  the  light  of  current  developments. 
One  of  our  primary  responsibilities  is  to  deter- 
mine, if  possible,  the  procedure  and  policies  which 
will  guide  the  future  course  of  medical  practice. 

If  the  medical  profession  is  to  determine  its 
own  destiny  and  be  successful  in  a defense  of  the 
principles  and  policies  which  it  knows  to  be  cor- 
rect and  in  the  best  interest  of  the  public,  strong 
and  active  medical  organization  must  be  main- 
tained, with  special  emphasis  on  the  maintenance 
of  county  society  activities  and  efforts  at  a maxi- 
mum of  efficiency. 

Your  committee  is  of  the  opinion  that  it  is  the 
duty  of  every  county  medical  society  to  see  that 
its  members  are  fully  and  accurately  informed 
about  the  important  medico-social  questions  con- 
fronting the  profession.  Every  society  should 
have  a special  committee  whose  duty  is  to  assist 
the  officers  of  the  society  in  disseminating  such 
information  to  the  membership  and  in  arranging 
programs  for  the  discussion  of  economic  questions. 

Moreover,  it  is  important  that  every  county 
society  have  an  active  committee  on  public  re- 
lations on  economics  or  civic  affairs  to  contact 
and  cooperate  with  official  and  non-official  groups 
and  agencies  in  the  community  interested  or  en- 
gaged in  medical,  hospital  and  public  health  ac- 
tivities. Through  such  a committee  the  member- 
ship of  every  county  society  may  obtain  first-hand 


566 


The  Ohio  State  Medical  Journal 


September,  1933 


information  concerning  community  activities  in 
which  the  medical  profession  is  vitally  interested. 
At  the  same  time,  through  such  a committee  the 
society  may  impress  upon  governmental  officials 
and  lay  groups  the  concerted  and  correct  medical 
viewpoint  on  questions  and  activities  of  mutual 
interest. 

Every  county  medical  society  should  provide 
itself  with  strong  leadership  with  the  courage  to 
face  impending  problems  and  possessing  those  at- 
tributes which  will  command  the  respect  of  the 
community  and  stimulate  interest  and  activity  on 
the  part  of  the  membership.  The  leaders,  in  fact 
the  entire  membership,  of  all  county  societies 
should  realize  that  local  problems  are  best  met  by 
local  action.  Long-established  fundamental  prin- 
ciples have  been  laid  down  for  our  guidance  but 
they  must  be  given  local  application  to  become  of 
practical  value.  It  is  the  duty  of  each  county 
society  to  enforce  the  code  of  medical  ethics.  It 
is  up  to  the  county  society  to  investigate,  analyze 
and  take  such  action  as  it  may  deem  appropriate 
where  questionable  ventures  for  distributing 
medical  services  are  proposed  or  initiated.  Close 
scrutiny  of  hospital  financing  programs  and  hos- 
pital reorganization  plans  is  imperative.  If  prob- 
lems pertaining  to  the  care  of  the  indigent  sick 
arise,  it  is  the  duty  of  the  county  society  through 
its  officers  or  proper  committee  to  confer  with 
city,  township  or  county  officials,  as  the  case  may 
be,  and  with  volunteer  welfare  agencies,  in  order 
that  a mutual  solution  of  the  question  arising 
may  be  worked  out. 

Medical  organization  at  present  is  confronted 
with  its  greatest  opportunity,  as  well  as  a momen- 
tous responsibility.  The  individual  physician  can- 
not hope  to  cope  with  the  vital  problems  we  have 
with  us  now  and  will  have  in  ensuing  months. 
Much  has  been  and  will  continue  to  be  accom- 
plished by  our  state  and  national  organizations, 
but  in  the  final  analysis  the  key  to  a solution  of 
many  of  our  problems  is  in  the  hands  of  the 
various  component  county  units.  Varying  situa- 
tions must  be  met  by  local  activity.  The  challenge 
to  local  initiative,  enterprise  and  keen  appraising 
judgment  by  the  members  of  organized  medicine 
has  never  been  greater.  In  concerted  and  vigorous 
local  activity  and  local  application  of  fundamental 
policies  and  principles  lies  our  salvation. 

The  Committee  on  Medical  Economics,  the  offi- 
cers, and  the  headquarters  office  of  the  State  As- 
sociation are  ready  and  desirous  at  all  times  to 
assist  and  cooperate  with  county  societies  in  a 
solution  of  their  problems.  However,  as  we  have 
tried  to  emphasize  in  this  report,  most  of  the 
complicated  questions  confronting  the  profession 
must  be  decided  through  local  initiative  and  re- 
sponsibility. 

workmen’s  compensation  questions 

During  the  past  year,  as  in  previous  years, 
your  Committee  on  Medical  Economics  has  been  in 


close  and  constant  touch  with  the  State  Industrial 
Commission  and  has  considered  many  of  the  im- 
portant questions  which  have  arisen  pertaining  to 
administration  of  the  Ohio  Workmen’s  Compensa- 
tion Law. 

The  State  Industrial  Commission  has  been  con- 
fronted with  serious  financial  and  administrative 
problems,  resulting  from  the  prolonged  business 
slump,  unemployment,  reduction  in  premium  in- 
come, increase  in  the  average  costs  per  claim,  de- 
preciation in  the  value  of  securities  constituting 
the  “reserve  fund”  and  other  factors  arising  from 
the  general  economic  situation,  and  from  failure 
of  the  administrative  machinery  to  function 
efficiently  at  all  times. 

Seeking  assistance  in  its  effort  to  solve  the 
acute  and  serious  questions  confronting  it,  the 
State  Industrial  Commission  sought  the  counsel 
of  the  Ohio  State  Medical  Association.  A series  of 
conferences  was  held,  attended  by  officials  of  the 
Commission,  officers  of  the  Ohio  State  Medical 
Association  and  members  of  the  Committee  on 
Medical  Economics,  at  which  time  the  Commis- 
sion submitted  a number  of  proposals  for  con- 
sideration, including  a suggested  revised  and  re- 
duced schedule  of  fees  to  be  paid  physicians  for 
treating  disabled  workmen  under  the  Workmen’s 
Compensation  Law. 

Subsequently,  data  and  suggestions  offered  by 
the  Commission  at  these  conferences  were  ana- 
lyzed by  a Special  Workmen’s  Compensation  Com- 
mittee, representing  the  State  Association  and  as- 
sisted in  its  deliberations  by  the  officers  of  the 
State  Association  and  the  members  of  the  Com- 
mittee on  Medical  Economics.  Following  a careful 
study  of  the  situation  and  the  suggestions  made 
by  the  Commission,  the  Special  Workmen’s  Com- 
pensation Committee,  composed  of  Dr.  Geo.  Edw. 
Follansbee,  Cleveland,  chairman;  Dr.  John  A. 
Caldwell,  Cincinnati,  and  Dr.  B.  J.  Hein,  Toledo, 
prepared  a report  which  was  approved  by  the 
Council  of  the  State  Association  and  submitted  to 
the  Industrial  Commission. 

In  that  report  (June,  1933,  issue  of  The  Jour- 
nal, pages  377-380),  it  was  strongly  recommended 
that  no  reductions  be  made  in  the  medical  and 
surgical  fee  schedule,  which  “is  reasonable  and 
fair  for  the  honest,  competent  physician  and  for 
the  Industrial  Commission”.  It  was  pointed  out 
that  reduction  of  the  medical  and  surgical  fee 
schedule  would  not  solve  the  problems  confront- 
ing the  Commission  or  eliminate  obvious  abuses 
that  were  having  a tendency  to  dissipate  the 
workmen’s  compensation  fund.  In  a sincere  effort 
to  assist,  the  Commission  in  solving  its  difficulties, 
the  Special  Workmen’s  Compensation  Committee 
submitted  to  the  Commission,  a number  of  con- 
structive and  practical  suggestions  for  improving 
the  administrative  procedure  which,  it  was  felt, 
would  lead  to  stricter  enforcement  and  closer 
adherence  to  the  rules  and  regulations  of  the  Com- 


September,  1933 


Annual  Reports 


567 


mission  and  would  be  effective  in  saving  the  fund 
from  abuses  and  dissipation. 

However,  the  State  Industrial  Commission, 
while  agreeing  that  the  recommendations  of  the 
State  Medical  Association  for  improvement  in 
administrative  procedure  were  all  “meritorious”, 
felt  that  they  would  not  result  in  the  necessary 
and  immediate  decrease  in  expenditures  for  medi- 
cal services,  which  the  Commisison  believed  was 
imperative.  Consequently,  on  May  24,  1933,  the 
Commission  ordered  a reduction  from  all  bills  for 
medical  services  rendered  on  or  after  April  1, 
1933,  after  they  have  been  approved  on  the  basis 
of  the  general  fee  schedule  as  to  amount  and  the 
necessity  for  the  service,  an  amount  equal  to  20 
per  cent  of  each  bill,  with  several  exceptions. 

Action  of  the  Commission  in  making  a tempor- 
ary 20  per  cent  1’eduction  on  medical  and  surgical 
bills,  together  with  an  explanation  of  the  ex- 
ceptions; and  an  analysis  of  a repoi't  submitted 
to  the  Commission  by  the  Ohio  Manufacturers’ 
Association,  representing  industx*y,  in  which  con- 
structive suggestions  for  improving  the  adminis- 
trative procedure  in  workmen’s  compensation 
cases  were  listed,  were  discussed  in  detail  in  a 
second  repoi’t  of  the  Special  Workmen’s  Com- 
pensation Committee,  published  in  the  July  issue 
of  The  Journal,  pages  441  to  444  inclusive. 

The  Committee  on  Medical  Economics  joins 
with  the  Special  Woi’kmen’s  Compensation  Com- 
mittee in  believing  that  the  temporary  reduction 
in  medical  and  surgical  fees  will  fail  to  solve  the 
impoi’tant  problems  confronting  the  Commission 
and  in  urging  the  Commission  to  place  into  effect 
as  soon  as  possible  some  of  the  practical  and  con- 
structive suggestions  made  by  the  Ohio  State 
Medical  Association  and  the  Ohio  Manufacturers’ 
Association  for  eliminating  abuses  and  impi’oving 
the  administrative  system  in  order  that  a real 
solution  to  the  Commission’s  difficulty  may  result. 

X-RAY  PROBLEMS,  REPORTS  TO  CLAIMANTS,  ETC. 

Many  additional  workmen’s  compensation  ques- 
tions have  arisen  during  the  past  year  and  have 
been  discussed  by  the  Committee  on  Medical 
Economics  and  the  headquarters  office  staff  with 
authorities  at  the  Industrial  Commission. 

At  the  present  time,  the  Committee  on  Medical 
Economics  is  assisting  and  cooperating  with  a 
special  committee  appointed  by  the  Pi’esident  of 
the  State  Association  to  consider  joint  pi’oblems 
between  the  medical  profession  and  hospitals, 
especially  those  pertaining  to  A-ray  service  and 
the  annual  contracts  of  hospitals  with  the  State 
Industrial  Commission. 

The  special  committee,  composed  of  Dr.  L.  L. 
Bigelow,  Columbus,  chairman,  Dr.  John  T.  Mur- 
phy, Toledo,  and  Dr.  H.  V.  Paryzek,  Cleveland, 
has  held  several  conferences  with  representatives 
of  the  Ohio  Hospital  Association  and  officials  of 
the  Industrial  Commission  regarding  A-ray  prob- 
lems arising  in  the  hospitalization  of  beneficiaries 
under  the  workmen’s  compensation  fund. 


At  the  present  time,  and  over  a period  of  years, 
the  contracts  made  annually  between  hospitals 
and  the  State  Industrial  Commission  have  provided 
that  the  hospital  providing  A-ray  sei’vices  may  or 
may  not  include  the  cost  of  the  sei’vice  in  its  per 
diem  rate  for  hospitalizing  woi’kmen’s  compensa- 
tion cases.  The  inclusion  of  A-i’ay  costs  in  the 
per  diem  rate  is  not  at  present  compulsory  and  a 
considerable  number  of  hospitals  exclude  such 
costs.  If  the  hospital  includes  A-ray  service  in  its 
per  diem  rate,  the  Commission  will  not  pay  a fee 
to  the  physician  rendering  the  service  and  he 
must  make  arrangements  with  the  hospital  dii’ect 
for  his  fee.  However,  if  the  hospital  excludes  the 
cost  of  A-ray  fi’om  its  per  diem  rate,  the  physician 
is  paid  by  the  Commission  for  the  A-ray  service 
the  same  as  any  other  physician  rendering  ser- 
vice to  injured  workmen. 

Almost  a year  ago,  it  was  proposed  to  the  In- 
dustrial Commission  by  representatives  of  the 
Ohio  Hospital  Association  that  the  Commission 
require  all  hospitals  owning  A-ray  equipment  to 
include  the  cost  of  A-ray  sei’vice  in  the  per  diem 
contract  rate  for  workmen’s  compensation  cases, 
and  that  the  1933  contract  between  hospitals  and 
the  Commission  be  revised  to  include  this  re- 
quirement. 

Following  a conference  between  representatives 
of  the  State  Medical  Association,  Ohio  Hospital 
Association,  and  the  Industrial  Commission,  it 
was  agreed  that  no  new  ruling  should  be  adopted 
requiring  hospitals  in  their  1933  contracts  to  in- 
clude A-ray  service  as  a part  of  the  per  diem  rate, 
but  that  the  question  be  given  further  considera- 
tion at  joint  conferences  before  such  action  is 
taken. 

Several  fundamental  factors  are  involved  in 
and  have  been  carefully  considered  in  connection 
with  this  question. 

The  modern  hospital  is  expected  to  have  and 
maintain  as  a part  of  its  service  and  equipment 
a modern  A-ray  department,  just  as  it  maintains 
modern  operating  rooms,  with  necessary  equip- 
ment and  technical  personnel.  It  is  logical  and 
proper  that  a hospital  maintaining  an  A-ray  de- 
partment may  include  in  its  legitimate  overhead 
expense  the  costs  of  maintaining  and  operating 
such  department. 

On  the  other  hand,  the  use  of  an  A-ray  de- 
partment of  a hospital  and  the  interpretation  of 
the  work  done  therein  is  a professional  service. 
Such  professional  A-ray  sei’vice  should  be  paid 
for  exactly  as  other  professional  services  rendered 
by  physicians,  without  regard  to  the  overhead  ex- 
pense of  installation  and  maintenance  of  the 
equipment. 

Applying  these  principles  specifically  to  A-ray 
work  in  connection  with  workmen’s  compensa- 
tion cases: 

First,  the  physical  A-ray  equipment  owned  and 
maintained  by  hospitals  under  contract  with  the 


568 


The  Ohio  State  Medical  Journal 


September,  1933 


State  Industrial  Commission  may  be  included  in 
the  per  diem  contract  costs  if  the  individual  hos- 
pital so  desires. 

Second,  all  professional  service  in  connection 
with  X-ray  service  in  workmen’s  compensation 
cases,  meaning-  an  interpretation  by  a qualified 
physician  of  Ar-ray  plates,  should  be  paid  for 
separately  direct  to  physicians  in  accordance 
with  a definite  fee  schedule. 

If  the  foregoing  suggestions  were  to  be  in- 
corporated in  rules  and  regulations  governing 
X-ray  service  in  hospitalized  workmen’s  com- 
pensation cases,  the  hospital  owning  and  main- 
taining an  A'-ray  department  would  receive  com- 


pensation toward  its  legitimate  overhead  expense 
incurred  in  the  maintenance  of  such  department; 
the  physician  performing  the  professional  service 
in  connection  with  X-ray  work  (physicians  being 
the  only  persons  qualified  to  render  such  pro- 
fessional service)  would  be  paid  direct  for  his 
services,  and  the  State  Industrial  Commission 
would  be  protected  against  the  possibility  of 
duplication  of  charges  made  in  X-ray  services. 

It  is  hoped  that  an  agi’eement  along  these 
lines  will  be  reached  by  the  special  X-ray  com- 
mittee of  the  State  Association,  the  representa- 
tives of  the  hospital  association,  and  officials  of 
the  Industrial  Commission. 


Annual  Meport  of  die  Publication  Committee 


Andrews  Rogers,  Chairman,  (1934) Columbus 

Gilbert  Micklethwaite  (1935) Portsmouth 

A.  B.  Denison,  (1933) Cleveland 

Don  K.  Martin,  Secretary Columbus 


During  the  past  year  of  important  social  and 
economic  developments  and  acute  problems,  the 
Committee  on  Publication  has  been  deeply  im- 
pressed with  the  importance  of  the  task  delegated 
to  it — assembling,  editing  and  supervising  the  pub- 
lication of  the  Ohio  State  Medical  Journal,  the 
official  journal  of  the  Ohio  State  Medical  Asso- 
ciation. 

Present-day  trends  and  developments  make  it 
more  necessary  than  ever  before  that  all  phy- 
sicians keep  themselves  accurately  and  thoroughly 
informed  concerning  the  problems  confronting  the 
medical  profession. 

Moreover,  the  rapid  advances  being  made  con- 
stantly in  the  field  of  scientific  medicine  demand 
that  every  physician  make  every  possible  effort  to 
increase  his  scientific  knowledge  in  order  that  he 
may  become  a better  physician  and  provide  his 
clientele  with  all  the  benefits  modern  medicine 
has  to  offer. 

Only  by  constant  reading  and  study  can  the 
modern  physician  hope  to  keep  abreast  of  the 
times  scientifically  and  expect  as  well  to  be  in  a 
position  to  cooperate  with  and  assist  his  fellow 
physicians  in  organized  efforts  to  meet  the  im- 
portant questions  affecting  medical  practice  and 
public  health.  These  problems  cannot  be  solved 
unless  the  entire  profession  is  adequately  and  ac- 
curately informed  concerning  them.  Neither  can 
they  be  solved  unless  we  maintain  strong  and 
united  medical  organization. 

The  Ohio  State  Medical  Journal  plays  an  in- 
dispensable part  in  the  activities  of  medical  or- 
ganizat’on  in  Ohio.  Realizing  this,  the  Committee 
on  Publication  has  tried  diligently  to  make  your 
Journal  a leader  in  its  particular  field.  We  have 
endeavored  to  make  it  function  in  such  a way  that 
the  aims  and  purposes  for  which  it  was  founded 
will  be  fulfilled.  We  have  made  every  effort  to 


have  it  serve  the  entire  membership  of  the  State 
Association,  and  to  voice  the  concerted  medical 
viewpoint  at  all  times. 

Although  The  Journal  itself  is  the  best  and 
most  complete  record  of  its  efforts  during  the 
past  12  months,  your  committee  believes  that  a 
brief  summary  of  some  of  the  details  and  prob- 
lems in  connection  with  the  publication  of  The 
Journal  may  tend  to  stimulate  greater  interest 
among  the  membership  in  this  important  activity 
of  the  Association  and  emphasize  the  committee’s 
responsibilities. 

During  the  past  year,  The  Journal  presented 
approximately  900  pages  of  informative  text,  in- 
cluding about  80  papers  on  scientific  subjects;  ac- 
counts of  medical  society  and  academy  activities 
and  meetings ; news  regarding  physicians;  activi- 
ties in  the  hospital  and  public  health  fields;  legal 
and  court  opinions  of  interest  to  physicians;  leg- 
islative and  governmental  developments;  sum- 
maries of  new  laws  and  regulations  affecting  phy- 
sicians; reviews  of  activities  of  allied  and  re- 
lated groups  and  organizations;  comments  and 
criticisms  on  social  and  economic  questions  affect- 
ing medical  practice  and  scientific  medicine;  re- 
ports on  the  work  carried  on  by  the  officers,  coun- 
cilors and  committees  of  the  State  Association,  and 
other  news  of  interest  to  the  profession  generally. 

The  Journal  is,  and  will  continue  to  be,  a con- 
secutive record  of  many  matters  of  direct  interest 
to  every  physician.  For  that  reason,  we  strongly 
urge  every  member  not  only  to  read  each  copy 
each  month,  but  to  keep  for  ready  reference  a 
complete  file  of  each  year’s  issues. 

HIGH  STANDARDS  MAINTAINED 

The  scientific  papers  published  in  The  Journal 
during  the  past  year  covered  a variety  of  interest- 
ing subjects.  Most  of  them  were  read  at  the 
last  annual  meeting  of  the  State  Association.  A 
few  were  submitted  to  the  committee  direct.  All 
were  judged  by  the  committee  from  the  standpoint 
of  scientific  value,  literary  style  and  general  in- 
terest. To  conscientiously  and  consistently  judge 


September,  1933 


Annual  Reports 


569 


all  papers  solely  on  these  three  requisites  and  in 
an  impersonal  way  so  far  as  the  authors  are  con- 
cerned has  been  the  aim  of  your  committee.  Each 
manuscript  was  scrutinized  carefully  and  thor- 
oughly by  the  committee  which  employs  a system 
of  double  editing  in  order  to  minimize  errors  and 
to  obtain  clarity  and  brevity.  Papers  which  did 
hot  measure  up  to  the  standards  which  have  been 
set  for  articles  appearing  in  The  Journal  were  re- 
jected, as  were  those  which  had  been  published 
previously  in  other  publications  or  in  pamphlet 
form  by  the  authors,  and  those  submitted  by  phy- 
sicians who  were  not  members  of  the  State  Asso- 
ciation. 

All  papers  published  during  the  past  year  have 
been  catalogued  in  the  card  index  on  scientific 
papers  kept  at  the  state  headquarters  office.  This 
index  covers  a period  of  twenty-eight  years  and  is 
maintained  for  the  convenience  of  members  de- 
siring information  regarding  titles,  authors  and 
dates  of  publication  of  scientific  articles  which 
have  appeared  in  The  Journal. 

All  advertising  copy  submitted  for  publication 
in  The  Journal  must  meet  strict  tests.  Every  ad- 
vertisement before  it  is  admitted  to  the  columns 
of  The  Journal  must  have  been  approved  by  the 
Committee  on  Publication,  the  Cooperative  Ad- 
vertising Bureau  of  the  American  Medical  Asso- 
ciation, and  the  A.M.A.  Council  on  Pharmacy  and 
Chemistry.  All  advertising  copy  is  judged  from 
the  standpoint  of  the  quality  and  scientific  value 
of  the  product  or  products  advertised;  the  ac- 
curacy of  the  claims  made  by  the  advertiser;  the 
reputation  of  the  advertiser;  and  the  style  and 
dignity  of  the  advertising  material.  Regular  ad- 
vertising rates  for  various  classes  of  advertising 
have  been  established.  No  advertisements  are  ac- 
cepted on  a contingent  or  percentage  basis.  Your 
committee  urges  every  member  to  read  the  adver- 
tisements presented  in  The  Journal.  Any  con- 
cern which  passes  the  strict  censorship  maintained 
by  The  Journal  deserves  the  cooperation  and  sup- 
port of  the  membership. 

CONTRIBUTIONS  OF  NEWS  SOLICITED 

Your  committee  appeals  to  every  member  of  the 
State  Association  to  take  a personal,  active  inter- 
est in  aiding  the  Committee  on  Publication  in  ob- 
taining and  assembling  material.  Any  material 
deemed  by  any  physician  to  be  of  interest  to  the 
profession  should  be  sent  to  the  state  headquar- 
ters office  at  Columbus  where  the  material  for 
The  Journal  is  assembled.  News  of  county  so- 
ciety and  academy  activities  and  meetings  should 
be  furnished  the  committee  each  month,  either  by 
the  secretary  or  correspondent  of  the  county  so- 
ciety or  academy.  Because  of  the  splendid  co- 
operation of  the  secretaries  or  correspondents  of 
most  of  the  county  societies,  the  section  devoted 


to  county  society  and  academy  news  has  grown 
steadily.  It  is  now  one  of  the  largest,  most  inter- 
esting, and  most  important  departments  of  The 
Journal.  There  still  are  a few  county  societies 
which  have  no  systematic  plan  for  furnishing  news 
for  The  Journal.  It  is  hoped  that  during  the  en- 
suing year  every  society  will  fall  in  line. 

Incidentally,  all  news  submitted  to  The  Journal 
should  reach  the  state  headquarters  office  not  later 
than  the  twelfth  day  of  the  month  preceding  the 
date  of  publication  which  is  always  on  the  first 
day  of  the  month.  The  numerous  details  inci- 
dental to  preparing  copy  for  publication  and  the 
printing,  binding  and  mailing  of  The  Journal  re- 
quire considerable  time,  making  it  necessary  to 
establish  a deadline  for  all  copy.  This  deadline 
must  be  adhered  to  so  that  The  Journal  can  reach 
the  members  on  time  each  month. 

Because  of  the  uncertainty  of  advertising  reve- 
nue to  The  Journal  during  the  current  year,  due 
to  the  continued  unsettled  condition  of  business, 
your  committee  has  arranged  for  the  publication 
of  The  Journal  on  an  economical  basis  comparable 
to  that  maintained  during  the  past  year. 

By  economizing  still  more  on  routine  expenses  in 
connection  with  the  publication  of  The  Journal, 
your  committee  hopes  to  partially  offset  the  losses 
which  may  be  sustained  by  decreased  advertising 
revenues. 

Your  committee  believes  that  close  adherence 
to  the  economy  program  which  it  has  worked  out 
in  cooperation  with  the  Committee  on  Auditing 
and  Appropriations  will  enable  the  Committee  on 
Publication  to  meet  financial  problems  which  may 
arise  and  at  the  same  time  assure  the  maintenance 
or  improvement  of  the  high  standards  which  have 
been  established  for  The  Journal. 

In  conclusion,  your  committee  wishes  to  express 
its  appreciation  to  all  members  of  the  State  Asso- 
ciation who  have  cooperated  with  and  assisted 
it.  Without  the  assistance  of  a large  part  of  the 
membership,  your  committee  would  have  been  se- 
verely handicapped  in  its  work  and  The  Journal 
would  have  suffered. 

Your  committee  desires  to  assure  the  member- 
ship that  it  is  open  at  all  times  to  suggestions  for 
improving  The  Journal.  We  solicit  constructive 
criticism.  We  want  the  advice  and  counsel  of  the 
members;  in  fact,  we  are  entitled  to  them.  We 
are  anxious  to  make  The  Journal  conform  to  the 
wishes  and  will  of  the  majority  of  the  members. 
All  suggestions  as  to  how  to  make  the  Ohio  State 
Medical  Journal  a better  journal  will  be  given 
careful  and  thoughtful  consideration  by  your  com- 
mittee. Keep  in  mind  that  The  Journal  is  your 
journal.  Its  usefulness  and  character  depend 
largely  on  the  degree  of  cooperation  and  as- 
sistance given  by  the  membership  generally  to 
those  whose  duty  it  is  to  edit  and  publish  it. 


Animal  Keport  ©£  the  Committee  on  Medical  Defense 


J.  E.  Tuckerman,  Chairman,  (1934)  ....Cleveland 


W.  H.  Snyder,  (1933) Toledo 

P.  P.  Anzinger,  (1935) Springfield 

Don  K.  Martin,  Secretary Columbus 


“In  recent  years  the  cost  of  medical  defense 
and  the  increase  of  malpractice  suits  have  both 
exacted  enormous  economic  toll  from  the  medical 
profession.  The  handwriting  on  the  wall  plainly 
points  to  the  fact  that  unless  the  medical  profes- 
sion assumes  a more  aggressive  attitude  from 
within  its  own  ranks,  with  the  idea  of  mitigating 
this  increasing  evil,  the  future  will  exact  even  a 
larger  toll.” 

The  foregoing  observation  by  an  authority  on 
medical  jurisprudence  is  of  special  significance  at 
this  time  when  rackets  are  flourishing  and  unset- 
tled economic  conditions  have  stimulated  the  urge 
among  many  individuals  to  acquire  “easy  money” 
at  the  expense  of  others,  including  physicians. 

Data  from  various  sources,  including  the  records 
of  the  Committee  on  Medical  Defense,  show  that 
there  has  been  an  increase  in  Ohio  during  the 
past  few  years  in  the  number  of  threats  and  suits 
against  physicians  for  alleged  malpractice. 

What  can  we  and  what  are  we  going  to  do 
about  this  menace  to  our  professional  standing 
and  our  economic  security? 

There  is  considerable  truth  in  the  foregoing 
statement  to  the  effect  that  the  medical  profes- 
sion itself  can  do  much  to  eliminate  the  “mal- 
practice damage  suit  industry”. 

In  1916,  the  State  Association  established  the 
existing  medical  defense  plan  for  the  purpose  of 
preventing  so  far  as  possible  unjust  suits  for 
alleged  malpractice  and  aiding  in  the  defense  of 
physicians  named  defendants  in  such  actions. 
Despite  the  well-organized  plan  which  has  been 
set-up  and  which  has  operated  smoothly  since  that 
date,  suits  and  threats  of  suits  have  been  increas- 
ing. Why? 

The  answer  is  obvious:  Largely  because  some 
members  of  the  medical  profession  have  failed  to 
give  their  wholehearted  support  and  cooperation 
to  this  important  activity  of  organized  medicine 
and  have  failed  to  realize  the  evils  of  unguarded 
remarks  concerning  their  fellow  practitioners  and 
their  work. 

No  medical  defense  plan  is  capable  of  function- 
ing with  a maximum  of  effectiveness  so  long  as 
this  situation  exists.  Malpractice  suits  and 
threats  cannot  be  kept  at  a minimum  until  all 
physicians  realize  that  they  must  make  a united 
effort  to  solve  this  problem  among  themselves  by 
heeding  the  repeated  warnings  and  advice  given 
by  the  Committee  on  Medical  Defense  and  others 
in  touch  with  the  factors  involved. 

CAUSES  AND  BASIS  OF  SUITS 

An  analysis  of  the  causative  factors  in  mal- 
practice suits  and  threats  indicates  how  we  can 


safeguard  ourselves  to  a large  extent  against  this 
evil. 

In  an  occasional  suit  charging  malpractice 
there  is  fairly  reasonable  evidence  of  carelessness 
and  negligence  on  the  part  of  the  defendant  phys- 
ician. However,  such  suits  are  exceedingly  few 
in  number  compared  to  the  large  number  insti- 
gated to  swindle  physicians  or  filed  in  a spirit  of 
revenge  to  ruin  his  practice.  It  is  true  that  the 
ratio  of  malpractice  actions  in  which  final  judg- 
ment is  rendered  against  the  physician  is  rela- 
tively small  compared  to  the  number  of  actions 
that  are  filed  or  the  number  which  never  go  to 
trial.  However,  the  publicity  attending  the  filing 
of  such  suits  always  is  undesirable  regardless  of 
the  final  outcome  and  the  worry  occasioned  by 
them  is  something  which  all  physicians  desire  to 
avoid.  Such  suits,  although  wholly  without  justi- 
fication, reflect  upon  the  standing  of  the  physician 
sued  and  upon  the  standing  of  the  whole  profes- 
sion. So,  the  importance  of  preventing  the  insti- 
gation of  suits  regardless  of  motive  behind  them 
or  the  final  outcome  is  apparent. 

Strange  as  it  may  seem,  the  majority  of  suits 
and  threats  are  inspired  by  or  receive  some  im- 
petus from  the  thoughtless,  critical  or  disparaging 
remarks  made  by  some  physician  concerning  a 
colleague  or  his  professional  skill. 

If  all  physicians  would  guard  against  making 
imprudent  or  slanderous  comments  concerning 
their  fellow  practitioners,  the  primary  cause  of 
more  than  75  per  cent  of  suits  for  alleged  mal- 
practice would  be  eliminated. 

Until  all  physicians  learn  that  “talk  is  not 
cheap,  silence  is  golden”,  none  of  us  is  immune 
from  the  malpractice  menace.  Suits  quite  often 
are  epidemic  in  nature.  One  suit  may  be  fol- 
lowed by  several  more  in  the  same  locality.  Often 
the  physician  whose  careless  or  malicious  remarks 
may  have  inspired  a suit  against  some  colleague 
is  the  next  victim. 

A study  of  the  records  of  suits  filed  and  threats 
made  against  members  of  the  State  Association 
during  the  past  year  shows  that  the  most  serious 
and  primary  cause  of  suits  and  threats  was  ill- 
advised  and  unjustifiable  talk  by  one  physician 
concerning  another.  Additional  causes  of  threats 
and  suits  were: 

Hope  of  dissatisfied  patients  and  plaintiff  at- 
torneys to  profit. 

Desire  to  injure  the  defendant’s  professional 
standing. 

Criticism  by  relatives  and  friends  of  a patient. 

Carelessness  and  negligence  on  the  part  of  the 
physician ; superficial  examinations  and  service. 

Failure  on  the  part  of  the  physician  to  keep 
adequate  and  accurate  records. 

Negligence  on  the  part  of  assistants  and  at- 
tendants employed  by  the  physician. 

Failure  on  the  part  of  the  patient  or  his  family 


570 


September,  1933 


Annual  Reports 


571 


to  carry  out  the  physician’s  instructions  and  ad- 
vice. 

Approximately  half  of  the  cases  on  which 
threats  or  suits  were  based  were  fracture  or  sus- 
pected fracture  cases.  Moreover,  a large  propor- 
tion of  the  patients  who  sued  or  threatened  to  sue 
were  indigents  or  near-indigents.  This  should 
serve  to  warn  physicians  that  they  must  take  ex- 
treme precautions  when  treating  indigent  pa- 
tients. 

MEDICAI,  EXPERT  TESTIMONY 

An  important  consideration  which  should  not 
be  lost  sight  of  is  that  few,  if  any,  malpractice 
actions  can  be  successfully  prosecuted  without  the 
use  of  medical  expert  testimony. 

Naturally,  every  physician  has  the  inalienable 
right  to  testify  as  a medical  witness  whenever 
and  for  whomsoever  he  pleases.  When  summoned 
to  testify  in  any  litigation,  for  malpractice  or 
otherwise,  the  physician,  of  course,  is  expected  to 
express  his  honest  opinion. 

However,  the  seeming  willingness  of  some  phy- 
sicians to  take  the  witness  stand  for  the  purpose 
of  testifying  against  a fellow  physician  for  com- 
pensation paid  by  the  plaintiff  has  encouraged  the 
filing  of  malpractice  suits. 

One  authority  in  commenting  on  this  point  re- 
cently, stated: 

“There  is  no  use  denying  the  fact  that  honest 
differences  of  opinion  exist  in  many  matters  per- 
taining to  medicine  and  surgery,  and  that  the 
profession’s  legal  rights  to)  be  privileged  to  take 
the  witness  stand  for  the  purpose  of  aiding  jus- 
tice ought  not  to  be  abridged  under  any  circum- 
stances. However,  when  due  consideration  is 
taken  of  the  fact  that  most  malpractice  actions 
against  physicians  and  surgeons  result  in  a judg- 
ment in  favor  of  the  accused  physician,  then  we 
are  not  at  all  far  off  in  alleging  that  even  honest 
differences  of  opinion  existing  among  physicians 
and  surgeons  are  not  sufficiently  wide  in  variation 
to  form  legal  grounds  for  redress. 

“From  the  point  of  view  of  the  trial  lawyer  for 
the  plaintiff,  no  physician’s  or  surgeon’s  testimony 
aids  his  case  unless  it  is  of  distinct  value  as  evi- 
dence which  tends  to  prove  that  the  defendant 
actually  did  something  negligently,  or  omitted 
to  do  something  which  he  ought  to  have  done.  No 
medical  witness  when  giving  expert  testimony 
can  refrain  from  disparaging  his  professional 
brother,  and  at  the  same  time  he  a useful  and  val- 
uable witness  for  the  side  calling  him.  Of  course, 
if  such  disparagement  even  when  based  wholly  on 
differences  of  opinion,  is  justified,  then  all  is  well; 
but  when  viewed  by  the  yardstick  of  measurement 
of  the  decisions  rendered  in  the  majority  of  such 
suits,  it  becomes  evident  that  the  disparagement 
accorded  the  defendant  physician  usually  is  not 
justified.” 

Assuredly,  no  physician  should  perjure  himself 
to  defend  a colleague  or  attempt  to  obstruct  the 
administration  of  justice.  However,  some  mem- 
bers of  the  profession  might  well  curb  their  will- 
ingness to  take  the  stand  for  plaintiffs  in  mal- 
practice suits,  especially  when  it  is  perfectly  ob- 
vious that  the  allegations  are  groundless  or  it  is 
apparent  that  the  suit  was  instigated  in  a spirit 
of  revenge  or  merely  for  profit. 


LEGAL  LIABILITY  OF  PHYSICIANS 

Every  physician  should  have  a thorough  un- 
derstanding of  the  obligations  he  assumed  when 
he  undertakes  to  care  for  a patient.  He  must 
carefully  observe  certain  fundamental  principles 
of  medicine  and  law  in  his  relationship  with  the 
patient.  The  legal  liability  of  the  physician  and 
his  contractual  obligations  may  be  summarized  as 
follows : 

Legally,  a physician  is  not  required  to  take  a 
case  unless  he  so  desires.  If  he  accepts  the  em- 
ployment, he  contracts  to  bring  to  it  the  average 
degree  of  skill,  care  and  diligence  exercised  by  the 
members  of  his  profession  in  the  same  and  similar 
locations  or  localities,  in  the  light  of  the  present 
state  of  medical  science.  He  cannot  abandon  the 
case  without  cause  or  without  proper  notice  to  the 
patient.  He  must  follow  the  approved  methods 
of  treatment,  and  if  there  be  more  than  one  ap- 
proved method,  he  must  use  his  best  judgment  in 
determining  which  method  to  follow.  He  must 
give  the  patient  proper  instructions  as  to  the  care, 
attention  and  caution  toi  be  exercised  by  the  pa- 
tient in  his  absence.  He  must  attend  with  suffi- 
cient frequency  and  it  is  for  the  physician  to  de- 
termine when  no  further  attention  is  required. 
He  must  use  care  in  the  selection  of  his  assistants, 
or  of  another  to  perform  an  operation  which  may 
be  necessary.  He  is  liable  for  the  acts  of  his 
assistants  or  for  another  employed  by  him,  so 
long  as  they  are  jointly  engaged,  and  is  liable  for 
the  acts  of  his  assistant  or  intern  acting  under 
his  direction.  Only  persons  thoroughly  compe- 
tent by  reason  of  education  and  experience  should 
be  employed  by  him  to  assist  him  in  the  care  of 
patients. 

MEDICAL  DEFENSE  REGULATIONS 

Aside  from  providing  machinery  for  emphasiz- 
ing information  to  the  membership  as  to  how  to 
avoid  malpractice  suits  and  threats,  the  medical 
defense  plan  of  the  State  Association  offers  to 
members  of  the  Association  in  good  standing  val- 
uable assistance  in  event  of  litigation,  provided 
the  member  sued  is  eligible  to  defense  under  the 
rules  and  regulations  of  the  defense  plan. 

When  sued  or  threatened  with  suit,  a member 
should  immediately  notify  the  Executive  Secre- 
tary, Ohio  State  Medical  Association,  131  East 
State  Street,  Columbus,  Ohio,  requesting  medical 
defense  blanks.  Upon  receipt  of  the  blanks,  the 
member  should  furnish  the  information  requested 
in  duplicate,  and  send  one  of  the  completed  blanks 
to  the  chairman  of  the  Committee  on  Medical  De- 
fense, Dr.  J.  E.  Tuckerman,  Osborn  Building, 
Cleveland,  Ohio,  and  the  other  to  the  State  Asso- 
ciation offices. 

Under  the  rules  and  regulations  of  the  medical 
defense  plan,  the  State  Association  is  barred  from 
aiding  in  the  defense  of  a physician  if: 

1.  He  is  not  in  good  standing  (dues  fully  paid 
up)  in  his  county  medical  society  and  therefore 
not  in  good  standing  in  the  State  Association ; or, 
if  the  alleged  cause  of  the  suit  occurred  or  the  suit 
was  filed  during  a period  for  which  the  member  is 
or  was  in  arrears  with  his  dues,  or  in  case  the 
alleged  cause  occurred  previous  to  the  defendant’s 
membership  in  the  State  Association.  Annual 


572 


The  Ohio  State  Medical  Journal 


September,  1933 


dues  in  the  State  Association  are  always  due  in 
advance  on  or  before  January  1. 

2.  He  has  failed  to  forward  a medical  defense 
application  blank,  properly  filled  out,  to  the  State 
Association  offices  within  ten  days  after  the  serv- 
ice of  summons. 

3.  He  does  not  take,  or  have  taken  and  keep  on 
file,  or  have  available,  Z-ray  pictures  of  fracture 
cases,  unless  it  can  be  shown  that  at  the  time  and 
place  it  was  impossible  to  secure  an  Z-ray  plate. 

4.  He  has  been  sued  on  “cross  complaint”,  hav- 
ing filed  a suit  to  collect  a bill  within  one  year  of 
the  termination  of  his  services. 

5.  He  is  believed  guilty,  after  careful  investiga- 
tion, of  illegitimate  professional  actions  or  service. 

Although  the  medical  defense  plan  does  not 
permit  the  State  Association  to  contribute  to  the 
cost  of  engaging  legal  counsel  when  the  case  is 
conducted  by  an  insurance  company,  it  permits 
the  Committee  on  Medical  Defense  to  give  all 
other  aid  possible  to  facilitate  the  preparation  of 
the  defense,  arranging  for  corroborative  testi- 
mony, giving  advice  and  suggestions  gained  from 
experience  in  similar  cases,  etc. 

Moreover,  the  medical  defense  plan  is  elastic 
enough  to  permit  the  committee  to  participate 
in  any  suit,  when  principles  of  law  affecting  mal- 
practice actions  are  at  stake  or  where  an  adverse 
decision  would  establish  a precedent  involving  the 
interests  of  the  entire  profession. 

Judgments  and  Insurance 

Under  the  medical  defense  plan,  the  State  As- 
sociation cannot  pay  court  judgments  in  any  case. 
It  should  be  clearly  understood  by  all  members 
that  the  medical  defense  plan  is  not,  avid  should 
not  be  considered  insurance,  as  this  term  is  ap- 
plied to  indemnity.  It  is  entirely  up  to  the  indi- 
vidual physician  whether  or  not  he  wishes  to  carry 
indemnity  insurance  against  malpractice. 

If  a physician  decides  to  insure  himself  in  this 
manner,  he  should  deal  only  with  indemnity  com- 
panies with  a sound  financial  rating  and  a repu- 
tation for  honest  and  fair  dealings.  If  at  any 
time  questions  arise  as  to  a member’s  rights  under 
an  indemnity  policy,  he  can  seek  the  advice  and 
counsel  of  the  Committee  on  Medical  Defense. 
Thus  the  medical  defense  plan  is  of  primary 
value  even  to  those  members  who  carry  indemnity 
insurance,  and  would  be  of  major  benefit  to  all 
members  even  if  all  of  them  carried  insurance. 

The  Committee  on  Medical  Defense  always  has 
insisted  that  all  unjust  suits  be  fought  through 
to  the  last  court,  if  necessary,  to  protect  the  indi- 
vidual physician  and  the  profession  against  un- 
warranted actions  and  accusations.  Due  to  re- 
peated emphasis  of  this  point  by  your  committee 
to  representatives  of  various  indemnity  com- 
panies, most  of  them  have  minimized  their  efforts 
to  compromise  suits  regardless  of  the  facts  or 
effect  on  the  reputation  of  the  physician  defend- 
ant. Frequently  indemnity  companies  have  sought 
the  advice  and  counsel  of  the  Committee  on  Medi- 
cal Defense.  They  realize  the  additional  protec- 


tion and  value  offered  by  the  medical  defense  plan 
of  the  State  Association.  Moreover,  some  of 
these  companies,  realizing  the  importance  of  mem- 
bership in  medical  organization,  are  refusing  to 
issue  a malpractice  indemnity  policy  to  any  physi- 
cian who  is  not  a member  of  his  county  medical 
society  and  the  State  Association. 

If  a physician  sued  is  eligible  to  defense  under 
the  medical  defense  plan,  the  Committee  on  Medi- 
cal Defense  engages  the  necessary  legal  talent  to 
conduct  his  defense.  In  practically  all  cases  in 
which  the  defense  is  conducted  by  the  State  Asso- 
ciation, local  attorneys  are  retained  to  handle  the 
case.  However,  the  designation  of  local  counsel 
and  their  employment  is  entirely  in  the  hands  of 
the  counsel  for  the  committee  which  will  not  con- 
tribute to  the  expense  of  legal  services  unless  the 
attorneys  are  approved  by  thht  counsel. 

Members  of  county  medical  societies  are  urged 
to  give  not  only  their  moral  support  but  also  to 
take  an  active  part  in  the  conduct  of  the  trial 
of  a colleague,  giving  whatever  assistance  they 
can  and  the  circumstances  justify.  When  the  de- 
fense is  conducted  by  the  State  Association  such 
service  should  be  given  without  thought  of  pecu- 
niary return. 

SUMMARY  OF  SUITS 

The  medical  defense  plan  is  vital  and  important 
to  every  physician  and  to  the  profession  at  large. 
It  is  worth  many  times  its  cost.  If  considered 
solely  from  the  economic  factor  involved,  its  dis- 
tinct value  to  the  profession  generally  is  quite 
evident.  Since  the  medical  defense  plan  has  been 
in  operation,  the  following  suits  and  threats  have 
been  filed  with  the  committee: 

Suits  Threats 


1916-1926,  inclusive 141  110 

1927  10  9 

1928  21  7 

1929  23  16 

1930  16  17 

1931  19  20 

1932  13  18 

1933  (January  to  August) 8 9 


If  the  judgment  sought  in  each  suit  filed  against 
members  of  the  State  Association  since  1916  were 
set  at  the  conservative  estimate  of  $10,000,  the 
aggregate  of  damages  sued  for  would  be  approxi- 
mately two  million  and  a half  dollars.  Of  course, 
the  actual  economic  loss  by  the  profession  has 
been  smaller  than  this  amount  due  to  the  efficient 
and  effective  defense  furnished  by  the  State  As- 
sociation. However,  our  aim  should  be  to  reduce 
this  enormous  potential  loss  to  a minimum  through 
application  of  the  means  for  prevention  of  mal- 
practice suits. 

Every  county  medical  society  and  academy  of 
medicine,  as  well  as  every  physician,  should  take 
an  active  interest  in  this  important  activity  of 
the  State  Association.  Frequent  discussions  on 
this  subject  should  be  held  at  county  society  meet- 
ings. Individual  physicians  can  assist  materially 


September,  1933 


Annual  Reports 


573 


by  keeping  in  mind  at  all  times  the  advice  and 
warnings  contained  in  this  and  previous  reports 
of  the  Committee  on  Medical  Defense.  Practice 
of  the  “Golden  Rule”  by  every  physician  and 
earnest  cooperation  on  the  part  of  the  profession 


collectively  in  the  work  of  this  committee  will  go 
far  toward  minimizing  this  menace.  The  key  to 
a solution  for  a large  part  of  the  malpractice 
problem  is  in  the  hands  of  the  profession  itself. 
Let  us  use  it. 


Annual  Keport  ©jf  the  Committee  ©m  Medical  Education 

and  Hospitals 


Ben  R.  McClellan,  Chairman,  (1934) Xenia 

John  F.  Wright,  (1933) Toledo 

R.  H.  Birge,  (1935) Cleveland 

Don  K.  Martin,  Secretary Columbus 

During  the  past  year  there  has  been  much  pub- 
licity and  discussion  regarding  the  economic  and 
social  aspects  of  medical  care.  Elaborate  surveys 
have  been  conducted  and  many  recommendations 
made  in  an  effort  to  solve  some  of  the  problems 
confronting  the  medical  profession  which  are  the 
result  of  social  and  economic  changes. 

The  Committee  on  Medical  Education  and  Hos- 
pitals has  studied  many  of  the  proposals  which 
have  been  advanced,  realizing  that  any  modifica- 
tion which  may  be  made  in  the  relationship  be- 
tween the  public  and  the  medical  profession  would 
influence  existing  and  future  programs  in  the 
field  of  medical  education  and  hospital  adminis- 
tration. 

Frankly,  most  of  the  proposals  made  for  solv- 
ing the  pi’oblems  of  medical  care  have  failed  to 
place  adequate  emphasis  on  the  necessity  for  in- 
suring a high  quality  of  medical  care  in  extending 
the  scope  of  medical  services. 

In  the  Final  Report  of  the  Commission  on 
Medical  Education,  this  point,  which  we  believe 
to  be  of  great  importance,  is  emphasized: 

“Recent  publicity  regarding  the  purely  economic 
aspects  of  the  problem,  has  emphasized  the  pres- 
ent forms  and  costs  rather  than  the  needs  and 
methods  of  procuring  a service  of  high  quality. 
Everyone  familiar  with  the  problems  involved  is 
aware  of  the  necessity  of  securing  a more  effective 
and  wider  application  of  sound  medical  services, 
a better  distribution  of  the  economic  burden  of 
illness,  greater  emphasis  upon  the  prevention  of 
disease,  and  a better  and  more  economical  co- 
ordination of  medical  activities.  It  is  essential, 
however,  to  keep  clearly  in  mind  that  the  most 
important  factor  is  the  quality  of  care,  not  the 
plan  of  organization  nor  the  method  of  financing. 
There  are  features  of  finance,  organization,  and 
public  concern  involved,  but  the  essential  char- 
acteristics are  professional  and  technical. 

“The  quality  of  medical  care,  in  the  last  analy- 
sis, depends  upon  an  intelligent  interpretation  and 
correlation  of  scientific  knowledge  in  its  applica- 
tion to  the  needs  of  the  individual.  This  can  be 
accomplished  only  by  trained  and  experienced  per- 
sonnel who  realize  the  significance  of  that  knowl- 
edge and  have  the  discriminating  judgment  neces- 
sary for  its  proper  use.  Although  many  factors 
enter  into  the  determination  of  the  quality  of 
service,  the  most  vital  considerations  are  the 
qualifications  and  training  of  the  physician.  This 


immediately  indicates  that  the  educational  fea- 
tures are  paramount  in  a sound  program  of  medi- 
cal services.” 

It  is  unmistakably  evident  that  since  the  quality 
of  medical  care  must  be  given  primary  considera- 
tion in  any  system  of  distribution,  grave  mistakes 
are  inevitable  unless  proper  emphasis  is  placed 
on  the  necessity  for  sound  methods  of  training 
physicians  for  active  practice. 

responsibilities  of  medical  educators 

Medical  education  is  concerned  primarily  with 
the  qualifications  and  training  of  students  to  prac- 
tice medicine  and  with  the  activities  which  con- 
tribute new  knowledge  regarding  health  and  dis- 
ease. However,  medical  educators  should  not 
overlook  the  fact  that  changes  in  social  organiza- 
tion and  new  economic  developments  have  brought 
about  changes  in  the  public  aspects  of  medicine 
and  complicated  the  problems  of  medical  services. 
New  responsibilities  have  been  placed  upon  the 
medical  profession  and  some  adjustments  may  be 
necessary  to  meet  these  responsibilities.  Uni- 
versity and  medical  school  leaders  can  contribute 
much  toward  solving  these  questions. 

By  way  of  emphasis,  we  quote  again  from  the 
report  of  the  Commission  on  Medical  Education: 

“Medical  education  should  emphasize  to  stu- 
dents the  influences  of  urbanization,  industrial- 
ization, and  present-day  conditions  of  living  which 
are  important  in  the  causation,  treatment,  and 
prevention  of  disease.  These  factors  must  be  ap- 
preciated if  the  physician  is  to  perform  his  func- 
tion of  advising  patients  in  regard  to  their  health 
problems.  The  unit  of  practice,  regardless  of  how 
medical  services  are  organized  or  how  social  or- 
ganization is  changed,  will  continue  to  be  the  in- 
dividual patient.  If  the  individual  is  to  obtain  the 
most  helpful  counsel,  it  is  important  that  the 
physician  be  acquainted  with  the  social,  economic, 
and  other  environmental  factors  which  have  an 
influence  on  the  individual  and  his  health. 

“The  training  of  students  adequately  to  meet 
the  newer  conditions  and  the  new  philosophy  of 
medical  responsibility  can  only  be  brought  about 
through  a shift  in  the  interests  and  point  of  view 
of  those  in  charge  of  medical  education,  who  must 
be  convinced  of  the  vital  importance  of  these 
newer  influences.  This  can  not  be  brought  about 
merely  by  adding  new  courses  or  supplementing 
existing  efforts  to  call  attention  to  these  prob- 
lems, but  only  by  the  awakening  of  an  interest 
and  the  stimulation  of  a fresh  viewpoint  in  the 
faculties.  Present  methods  of  training  in  some 
places  are  those  of  a generation  ago.  The  present 
curricula  in  some  of  the  schools  are  hampered  by 


574 


The  Ohio  State  Medical  Journal 


September,  19-33 


a largely  useless  burden  of  traditional  subject 
matter  and  ought  to  be  reorganized.  There  should 
be  a diffusion  throughout  the  preparation  of 
physicians,  and  especially  in  the  clinical  depart- 
ments, of  the  social  and  preventive  aspects  of 
modern  medicine. 

“The  sound  conception  of  the  training  for 
medicine  requires  an  understanding  on  the  part 
of  educators  of  the  problems  in  the  community. 
Many  of  the  requirements  of  the  curriculum  and 
of  licensure  have  been  formulated  by  those  fa- 
miliar with  problems  of  practice  in  the  past,  but 
some  of  the  factors  which  are  now  influencing 
the  whole  situation  have  not  been  reflected  in 
teaching.  The  needs  of  the  community  and  the 
responsibilities  and  requirements  of  practice  have 
changed  materially,  not  only  in  regard  to  techni- 
cal matters  but  also  in  the  larger  concept  of 
public  relations. 

“The  medical  graduate  unfamiliar  with  the 
newer  conditions  of  practice  is  at  a great  dis- 
advantage when  he  is  precipitated  into  a com- 
petitive professional  market  with  little  by  which 
he  can  guide  himself  beyond  the  immediate  ex- 
igencies and  necessities  of  making  a living.  It  is 
fully  recognized  that  the  body  of  knowledge  re- 
garding the  economic  and  social  aspects  of  medi- 
cine is  scant  and  that  important  fundamental 
studies  of  the  whole  subject  ought  to  be  made  as 
early  as  possible.  It  is  important  that  the  stu- 
dent be  equipped  with  an  understanding  and 
sympathetic  attitude  toward  the  social  obliga- 
tions of  the  profession,  in  order  that  he  may  be 
prepared  to  undertake  his  responsibilities  in  cur- 
rent community  health  work  and  to  meet  new  and 
shifting  conditions  of  the  future.” 

SUPPLY  AND  DISTRIBUTION 

Among  other  important  questions  confronting 
the  profession  and  one  which  should  be  of  par- 
ticular interest  to  medical  educators,  is  that  con- 
cerning the  supply  and  distribution  of  physicians. 
Well-informed  authorities  have  pointed  out  that 
there  is  at  present  an  over-supply  of  physicians 
in  the  United  States.  This  surplus  is  steadily  in- 
creasing. Of  course,  it  is  important  that  the  num- 
ber of  medical  practitioners  be  sufficient  at  all 
times  to  insure  competent  medical  service  for  all. 
However,  an  over-supply  is  quite  likely  to  result 
eventually  in  excessive  competition,  rendering  of 
unnecessary  services,  increased  costs  of  medical 
care,  and  other  conditions  which  would  tend  to 
lower  the  standards  of  the  profession. 

Moreover,  there  is  evidence  showing  that  the 
present  supply  of  physicians  is  not  well  dis- 
tributed in  relation  to  population  and  medical 
needs. 

The  problem  of  over-supply  is  one  which  de- 
mands the  attention  of  medical  school  adminis- 
trators and  those  in  charge  of  medical  licensure. 
Fewer  admissions  to  medical  schools  must  neces- 
sarily result  in  fewer  physicians.  Stricter  regu- 
lations governing  admission  to  practice,  espe- 
cially among  graduates  of  unapproved  medical 
schools  and  those  from  foreign  countries,  might 
accomplish  the  same  result. 

The  problem  of  distribution,  while  not  as  ser- 
ious as  often  pictured,  is  complicated.  Organized 
efforts  on  the  part  of  medical  school  officials  and 
medical  organization  to  influence  graduates  to 
settle  in  communities  where  the  need  is  greatest 


and  the  opportunities  good  should  be  started. 
Cooperation  between  the  medical  profession  and 
the  public  in  the  development  of  new  oppor- 
tunities and  new  fields  for  medical  practitioners 
would  contribute  toward  a solution  of  this  ques- 
tion. Medical  schools  should  consider  modifying 
their  courses  so  that  the  new  physician  would  not 
be  so  dependent  upon  auxiliary  agencies  in  carry- 
ing on  his  practice  and,  therefore,  be  more  self- 
sufficient  in  assuming  the  responsibilities  of  in- 
dividual practice  in  communities  lacking  these 
outside  agencies. 

However,  it  must  be  admitted  that  economic 
factors  and  local  enterprise  play  a big  part  in  this 
question  of  distribution.  The  development  of 
mediums  of  communication  in  outlying  com- 
munities; the  improvement  of  social  and  edu- 
cational facilities,  and  the  establishment  of  rural 
hospital  centers  and  other  similar  facilities  will 
eventually  have  a tendency  to  attract  more  phy- 
sicians to  rural  sections.  Any  attempt  to  meet 
the  problem  by  providing  short  medical  courses 
for  the  training  of  physicians  especially  for  rural 
practice  should  be  avoided.  Such  a method  would 
not  produce  the  result  sought  nor  provide  such 
communities  with  the  quality  of  medical  service 
to  which  they  are  entitled. 

POST-GRADUATE  TRAINING 

The  part  which  universities  and  medical  schools 
take  in  the  field  of  post-graduate  education  is  ob- 
vious. Furthermore,  the  responsibilities  of  medi- 
cal organization  and  of  hospitals  in  this  line  of 
activity  is  great.  The  quality  of  medical  service 
depends  largely  upon  the  extent  to  which  phy- 
sicians keep  abreast  of  new  knowledge  and 
methods. 

Problems  arising  from  the  rapid  growth  of 
specialization  should  be  recognized.  The  best  in- 
terests of  the  public  and  the  medical  profession 
demand  that  those  who  claim  to  be  specialists  are 
so  in  fact.  How  to  meet  the  problem  is  uncertain. 
Some  societies  of  specialists  have  made  progress 
by  conducting  special  examinations  and  assemb- 
ling certified  lists  of  qualified  specialists.  It  has 
been  suggested  that  some  system  of  state  regis- 
tration of  specialists  should  be  worked  out.  It  has 
been  advocated  that  this  method  should  be  on  a 
nation-wide  scale.  In  some  quarters  it  is  sug- 
gested that  hospitals  try  to  meet  the  problem  by 
excluding  from  their  staffs  all  who  are  unable  to 
prove  that  they  are  adequately  prepared  to  prac- 
tice the  specialty  they  have  selected.  The  ques- 
tion is  one  about  which  medical  educators  should 
be  concerned.  All  medical  students  should  be  im- 
pressed with  the  importance  of  obtaining  adequate 
preparation  before  holding  out  themselves  as 
qualified  experts  in  any  of  the  specialties  and 
urged  to  take  advantage  of  post-graduate  oppor- 
tunities before  limiting  themselves  to  any  special 
phase  of  medical  practice. 

Medical  schools  can  and  should  take  a direct  in- 
terest in  helping  hospitals  to  formulate  sound  pro- 


September,  1933 


Annual  Reports 


575 


grams  for  the  training  of  interns.  Members  of 
hospital  staffs  should  devote  more  attention  and 
assume  greater  responsibility  in  this  field  of 
medical  education. 

These  are  but  a few  of  the  important  questions 
confronting  those  engaged  in  educating  the  phy- 
sicians of  the  future.  All  deserve  serious  con- 
sideration. All  are  complicated  with  problems 
that  demand  solution. 

MEDICAL  EDUCATION  IN  OHIO 

What  is  the  status  of  medical  education  in 
Ohio? 

Ohio  is  making  important  contributions  to  this, 
as  well  as  all  other  phases  of  medical  activity. 

Ohio’s  three  Class  A medical  schools  rank 
among  the  leaders  in  undergraduates  medical 
training.  They  have  placed  into  operation  post- 
graduate training  programs.  They  have  main- 
tained for  years  the  highest  of  standards  and  are 
turning  out  competent  and  well-trained  physi- 
cians. Their  efforts  deserve  the  united  support 
and  cooperation  of  the  entire  medical  profession 
of  Ohio. 

A detailed  review  of  the  work  and  activities  of 
the  three  Ohio  Medical  schools  was  published  in 
the  October,  1932,  issue  of  The  Journal,  at  the  be- 
gining  of  the  1932-33  school  year.  That  article 
should  be  considered  a supplement  to  this  report. 

Ohio  is  meeting  satisfactorily  its  obligations  in 
the  field  of  intern  training.  The  last  report  of 
the  Council  on  Medical  Education  and  Hospitals 
of  the  American  Medical  Asso.  (March  25,  1933) 
shows  that  37  Ohio  hosiptals  have  been  approved 
by  the  Council  for  intern  training.  They  are: 

City  Hospital,  Akron  ; St.  Thomas  Hospital,  Akron  ; 
Mercy  Hospital,  Canton  ; Bethesda  Hospital,  Cincinnati  ; 
Christ  Hospital,  Cincinnati  ; Cincinnati  General  Hospital ; 
Deaconess  Hospital,  Cincinnati  ; Good  Samaritan  Hospital, 
Cincinnati ; Jewish  Hospital,  Cincinnati  ; St.  PJary’s  Hos- 
pital, Cincinnati ; Charity  Hospital,  Cleveland  ; City  Hospital, 
Cleveland  ; Lakeside  Hospital,  Cleveland  ; Mt.  Sinai  Hospital, 
Cleveland;  St.  Alexis  Hospital,  Cleveland;  St.  John’s  Hos- 
pital, Cleveland ; St.  Luke’s  Hospital,  Cleveland ; Woman’s 
Hospital,  Cleveland ; Grant  Hospital,  Columbus  ; Mt.  Carmel 
Hospital,  Columbus ; St.  Francis  Hospital,  Columbus ; Starl- 
ing-Loving University  Hospital,  Columbus ; White  Cross 
Hospital,  Columbus ; Miami  Valley  Hospital,  Dayton ; St. 
Elizabeth’s  Hospital,  Dayton ; Elyria  Memorial  Hospital ; 
Mercy  Hospital,  Hamilton ; St.  Rita’s  Hospital,  Lima ; 
Springfield  City  Hospital ; Flower  Hospital,  Toledo ; Lucas 
County  Hospital,  Toledo;  Mercy  Hospital,  Toledo;  St.  Vin- 
cent’s Hospital,  Toledo  ; Toledo  Hospital ; St.  Elizabeth’s  Hos- 
pital, Youngstown  ; Youngstown  City  Hospital,  and  Huron 
Road  Hospital,  Cleveland. 

Residencies  for  training  in  one  or  more  of  the 
specialties  are  offered  by  25  Ohio  hospitals,  in- 
dicating how  Ohio  hospitals  ai'e  cooperating  in 
the  field  of  post-graduate  training.  Ohio  institu- 
tions approved  for  residencies  in  specialities  are: 

Children’s  Hospital,  Akron  ; City  Hospital,  Akron  ; Chil- 
dren’s Hospital,  Cincinnati  ; Cincinnati  General  Hospital  ; 
Cincinnati  Sanitarium  ; Good  Samaritan  Hospital,  Cincinnati  ; 
Babies’  and  Children’s  Hospital,  Cleveland  : Charity  Hos- 
pital, Cleveland  ; City  Hospital,  Cleveland  ; Cleveland  State 
Hospital ; Lakeside  Hospital,  Cleveland  ; Maternity  Hospital, 
Cleveland  ; Mt.  Sinai  Hospital,  Cleveland  ; St.  Alexis  Hospital, 
Cleveland ; St.  Ann’s  Maternity  Hospital,  Cleveland ; St. 
Luke’s  Hospital,  Cleveland  ; St.  John’s  Hospital,  Cleveland  ; 
Children’s  Hospital,  Columbus ; Columbus  State  Hospital  • 
Dayton  State  Hospital ; Massillon  State  Hospital ; Ohio  State 
Sanatorium,  Mt.  Vernon  ; Toledo  State  Hospital ; Women’s 
and  Children’s  Hospital,  Toledo,  and  Rainbow  Hospital, 
South  Euclid. 

Ohio  is  well  supplied  with  first-class  and  ap- 
proved hospitals,  sanatoriums  and  related  institu- 


tions. Those  in  this  state  which  have  been  ap- 
proved by  the  A.M.A.  Council  number  265,  with  a 
total  bed  capacity  of  47,754. 

In  conclusion,  your  committee  wishes  to  re- 
emphasize the  great  responsibility  which  rests  on 
the  medical  profession,  especially  during  the 
present  period  of  readjustment,  in  seeing  that  the 
challenges  of  changing  conditions  are  met  by  pro- 
viding medical  services  and  facilities  which  will 
meet  these  new  conditions  and  give  the  public  as  a 
whole  the  high  type  of  service  to  which  it  is  en- 
titled. 

To  quote  again  from  the  report  of  the  Commis- 
sion on  Medical  Education: 

“Success  in  the  war  on  disease  is  not  a matter 
of  physical  equipment,  organizations,  numbers  of 
professional  workers,  or  even  extensive  knowledge 
of  the  problems  involved.  It  depends  primarily 
upon  trained  physicians  and  other  workers  and 
the  proper  aiTiculation  of  the  necessary  facilities 
and  personnel  for  education  and  medical  care. 
* * * Emphasis  must  be  kept  constantly  upon  the 
fact  that  only  through  a sufficient  number  of 
pr’operly  trained  physicians  can  a community  ex- 
pect to  meet  its  responsibility  for  the  c&re  and 
prevention  of  illness  and  the  protection  of  health. 
There  is  no  substitute  for  this  essential  feature.” 


National  Recovery  Administration  Inter- 
pretation Affecting  the  Medical 
Profession 

Interpretation  by  federal  authorities  of  the 
National  Recovery  Act  and  the  National  Re- 
covery Administration  codes  holds  that  profes- 
sions, including  the  medical  profession,  do  not 
come  under  the  act  and  the  administration  in  as 
far  as  wages  and  hours  are  concerned. 

A number  of  questions  have  arisen  as  to 
whether  or  not  the  employes  of  physicians  are 
subject  to  the  act  and  to  the  codes  adopted  pur- 
suant thereto. 

Although  official  determination  had  not  yet 
been  made  at  the  time  this  was  written  some 
authorities  contend  that  since  physicians  in  their 
professional  care  of  the  sick  and  injured  could  not 
practically  be  brought  under  the  codes  based  on 
the  National  Recovery  Act,  that  their  employes 
who  assist  them  in  the  care  of  the  sick  and  in- 
jured are  likewise  outside  the  terms  of  the  Recov- 
ery Act  and  the  codes.  However,  by  implication, 
at  least  one  interpretation  holds  that  if  a physi- 
cian employs  more  than  two  persons  in  his  office 
or  in  his  pratice  of  the  class  of  clerical  employes 
(non-professional,  excluding  technicians,  nurses, 
etc.),  that  such  employes  would  be  subject  to  the 
minimum  wage  and  maximum  hour  provisions  of 
the  N.R.A. 

In  view  of  the  administrative  problems  in  hos- 
pitals, it  has  been  held  that  unless  such  institu- 
tions conform  to  the  codes,  in  as  far  as  employes 
are  concerned,  in  the  safety  and  care  of  patients, 
they  are  exempt.  Naturally,  if  hospitals  are  out- 
side the  terms  of  the  National  Recovery  Act,  then 
by  analogy  physicians  would  be,  irrespective  of 
the  number  of  employes.  In  view  of  the  confusion 
and  conflicting  opinions  on  this  matter,  it  is  sug- 
gested that  physicians  await  a definite  determina- 
tion yet  to  be  worked  out  which  will  be  announced 
from  time  to  time. 


Annual  Keport  of  the  Committee  on  Preventive  Medicine 
and  Periodic  Health  Examinations 


V.  C.  Rowland,  Chairman Cleveland 

Jonathan  Forman  Columbus 

Beatrice  T.  Hagen Zanesville 

R.  R.  Hendershott Tiffin 

C.  I.  Stephen Ansonia 

Don  K.  Martin,  Secretary Columbus 


Developments  of  the  past  year  indicate  that  a 
partial  solution  of  some  of  the  complex  social  and 
economic  problems  resulting  from  disabling  illness 
and  injury  can  be  brought  about  by  a more  gen- 
eral application  of  the  present-day  knowledge  re- 
garding the  prevention  of  disease  and  disability. 

Well-informed  authorities  have  pointed  out  that 
the  nation’s  bill  for  sickness  and  economic  loss 
from  disabling  illness  could  be  reduced  materially 
if  more  effective  preventive  measures  were  made 
available  and  taken  advantage  of  by  a larger  por- 
tion of  the  public. 

Moreover,  it  has  been  pointed  out  that  medical 
science  has  proven  that  a large  proportion  of  dis- 
ease and  disability  is  actually  preventable  but  that 
studies  of  the  health  and  medical  needs  of  many 
communities  reveal  glaring  defects  in  existing 
methods  of  supplying  the  public  with  services  for 
the  prevention  of  disease. 

Because  of  the  present  economic  situation,  these 
and  other  factors  entering  into  the  economic  as- 
pects of  disabling  illness  and  medical  costs  have 
been  given  an  unusual  amount  of  study  and  con- 
sideration. 

During  the  current  period  of  economic  distress, 
unemployment,  etc.,  many  individuals  who  nor- 
mally could  do  so  have  been  unable  to  meet  the 
costs  of  medical  care  and  in  addition  have  suf- 
fered financial  losses  through  lost  time  because  of 
illness.  As  a result,  the  load  carried  by  relief 
agencies  and  the  charity  burden  of  the  medical 
profession  have  multiplied  many  times. 

It  has  been  asserted  by  some  who  have  studied 
these  problems  that  if  a substantial  proportion  of 
disabling  illness  could  be  prevented,  there  would 
result  a proportionate  decrease  in  the  economic 
loss  sustained  by  many  because  of  lost  time  in 
gainful  pursuits;  a reduction  in  the  nation’s  bill 
for  medical,  hospital  and  nursing  services,  etc., 
and  a decrease  in  the  amount  of  free  service  be- 
ing rendered  by  physicians,  hospitals,  nurses,  etc., 
to  those  unable  to  pay  for  such  services. 

Another  important  point  which  has  been  ad- 
vanced is  that  relative  to  the  additional  economic 
benefits  which  would  be  derived  by  the  medical 
profession  from  a general  expansion  of  private 
medical  practice  to  include  preventive  services  for 
apparently  well  individuals. 

Your  committee  is  of  the  opinion  that  the  fore- 
going suggestions  deserve  serious  consideration 


on  the  part  of  the  medical  profession  and  that 
now  is  a most  appropriate  time  for  giving  them 
thorough  study. 

Prevention  of  disease  and  the  protection  of  pub- 
lic health  are  not  new  phases  in  the  field  of  medi- 
cine. Protection  of  the  public  against  the  health 
hazards  of  group  life,  on  which  modem  public 
health  administration  is  based,  has  become  one  of 
the  primary  responsibilities  of  government.  Sta- 
tistics show  that  the  improvement  in  the  public 
health  has  been  remarkable  and  steady  in  occur- 
rence over  a considerable  period  of  time  because  of 
constructive  health  safeguards  conceived,  pro- 
moted and  supported  by  the  medical  profession. 
Organized  effort  and  proper  planning  have  re- 
sulted in  the  instigation  of  legal  standards  and 
regulations  and  sound  policies  calling  for  proper 
sanitation,  pure  water  supplies,  adequate  sewage 
disposal,  compilation  of  vital  statistics,  reporting 
and  control  of  communicable  diseases,  quarantine, 
inspection  of  food  supplies,  immunization,  etc. 
Such  services  have  become  essential  and  necessary 
in  every  community  and  have  been  of  immeasur- 
able benefit  to  the  public  generally. 

individual  attention  essential 

Recently,  however,  it  has  become  increasingly 
evident  that  only  a paid;  of  the  problem  of  the  pre- 
vention of  preventable  diseases  and  disabilities  is 
being  met  by  those  services  which  concern  them- 
selves with  protection  of  the  health  of  a com- 
munity as  a whole.  It  is  obvious  that  public 
health  administration  cannot  and  should  not  be  ex- 
pected to  deal  with  the  health  problems  of  each 
individual  or  to  supply  the  innumerable  types  of 
services  necessary  to  meet  the  needs  of  individual 
cases. 

Organic  and  degenerative  disorders  are  at  pres- 
ent the  chief  causes  of  death  and  disability.  The 
mortality  rates  of  heart  disease,  cancer,  diabetes, 
etc.,  have  been  increasing  annually.  Mortality 
and  morbidity  from  typhoid  fever,  smallpox,  and 
similar  infections  and  communicable  diseases  have 
been  controlled  to  a large  extent.  How  to  mini- 
mize the  disorders  which  have  supplanted  the  lat- 
ter group  as  the  leading  causes  of  death  and  dis- 
ability is  the  problem  confronting  the  medical  pro- 
fession at  this  time. 

The  answer  lies  in  the  inclusion  of  the  practice 
of  personal  preventive  medicine  in  the  general 
practice  of  medicine.  The  prevention  and  treat- 
ment of  chronic  and  organic  disorders  is  solely  a 
problem  affecting  the  individual  in  which  only  an- 
other individual  can  function  satisfactorily  as  a 
diagnostician  and  therapeutist.  In  other  words, 
the  task  and  responsibility  of  providing  services 
for  the  protection  of  the  individual  against 
chronic  and  organic  disorders,  so  far  as  possible. 


576 


September,  1933 


Annual  Reports 


577 


rest  with  the  individual  practitioner  of  medicine. 

Obviously,  the  prevention,  as  well  as  the  treat- 
ment, of  disorders  requiring  individualized  pro- 
cedure cannot  be  carried  on  successfully  and  com- 
petently on  a mass  and  standardized  basis.  Such 
services  must  be  1’endered  by  trained  and  skillful 
medical  men,  preferably  the  family  physician  of 
the  individual  seeking  the  service,  who  knows  the 
patient,  his  family  history,  his  business  career,  his 
social  and  economic  status,  his  habits  and  diver- 
sions, his  mental  attitude,  his  environment,  etc. 

BENEFITS  TO  PUBLIC  ENUMERATED 

The  benefits  available  to  the  public  from  utili- 
zation of  preventive  measures  which  meet  the 
needs  of  the  individual  are  innumerable.  Many  of 
these  were  summarized  and  discussed  in  an  article 
written  by  Dr.  V.  C.  Rowland,  chairman  of  this 
committee,  which  was  published  in  the  February, 
1933,  issue  of  The  Ohio  State  Medical  Journal, 
with  the  sanction  and  approval  of  the  committee. 
That  article  should  be  considered  a part  of  this  re- 
port inasmuch  as  it  expresses  the  views  of  the 
Committee  on  Preventive  Medicine  and  Periodic 
Health  Examinations  on  this  subject. 

How  individuals  of  all  age  groups  may  benefit 
by  taking  advantage  of  instruction  in  personal 
hygiene,  immunization,  prophylactic  procedures, 
periodic  physical  examinations,  etc.,  offered  by 
physicians  in  private  practice,  was  analyzed  by 
Dr.  Rowland.  We  urge  every  member  of  the  State 
Association,  if  he  has  not  already  done  so,  to  read 
and  study  Dr.  Rowland’s  presentation,  as  we  be- 
lieve it  will  inspire  all  to  take  a more  active  inter- 
est and  part  in  this  important  phase  of  medical 
practice. 

The  medical  profession  need  not  interest  itself 
particularly  in  the  matter  of  promoting  preventive 
medicine  among  the  laity.  The  public  in  increas- 
ing numbers  is  seeking  and  demanding  the  bene- 
fits which  preventive  medicine  offers.  This  is  evi- 
denced by  the  remarkable  increase  in  the  number 
of  persons  who  are  availing  themselves  periodic- 
ally of  routine  physical  examinations  which  offer 
a splendid  opportunity  for  the  detection  of  func- 
tional disorders  and  the  prescribing  of  corrective 
measures  promptly,  and  before  the  condition  has 
reached  a stage  of  hopelessness. 

.However,  it  is  most  essential  that  the  medical 
profession  take  appropriate  steps  to  provide  this 
type  of  service  for  those  now  demanding  it.  Too 
many  physicians  are  neglecting  this  important 
phase  of  medical  practice.  Too  many  physicians 
have  failed  to  realize  that  medical  practice  in- 
cludes the  practice  of  preventive  as  well  as  cura- 
tive medicine. 

We  must  not  overlook  the  fact  that  the  public 
is  determined  in  increasing  numbers  to  have  this 
service.  If  unable  to  get  it  from  private  phy- 
sicians, it  will  be  left  with  but  one  alternative — 
to  obtain  the  desired  services  from  organizations, 
groups  and  individuals  bent  on  commercializing 
such  practice  and  in  many  instances  not  qualified 


to  render  adequate  and  competent  service.  Apathy 
on  the  part  of  many  physicians  toward  making  the 
practice  of  preventive  medicine  a part  of  their 
daily,  routine  practice  has  deprived  many  indi- 
viduals of  the  benefits  modern  medicine  has  to 
offer  them.  At  the  same  time,  it  has  proven  a 
short-sighted  business  policy  on  the  part  of  the  in- 
different physician. 

The  average  physician  is  well  prepared  to  sup- 
ply his  patients  with  the  benefits  of  preventive 
medicine.  He  can,  and  should,  minister  to  those 
seeking  physical  check-ups  and  advice  regarding 
how  to  pi’otect  and  preserve  their  health.  By 
broadening  his  sphere  of  practice  to  include  peri- 
odic health  examinations,  immunization,  prophy- 
lactic procedures  and  the  offering  of  advice  con- 
cerning diet,  rest,  recreation,  etc.,  the  physician 
will  be  performing  a beneficial  service  for  the  pub- 
lic and  at  the  same  time  will  be  improving  his  own 
economic  standing. 

RESPONSIBILITIES  OF  ORGANIZED  MEDICINE 

Organized  medicine  has  an  important  duty  to 
perform  in  promoting  and  stimulating  among  its 
members  the  desire  to  make  the  practice  of  per- 
sonal preventive  medicine  an  integral  part  of  pri- 
vate medical  practice.  There  never  has  been  a 
more  opportune  time  for  serious  consideration  of 
this  problem. 

Activities  along  this  line  should  originate  in  and 
be  carried  on  by  county  medical  societies  and 
academies  of  medicine.  Each  society  should  have 
a committee  to  carry  on  promotional  activities 
among  the  members  of  the  society.  Each  society 
should  devote  one  or  more  meetings  each  year  to  a 
symposium  on  preventive  medicine,  including  lec- 
tures by  competent  internists,  round-table  discus- 
sions, and  if  possible,  demonstrations  on  proper 
ways  to  conduct  routine  physical  examinations, 
immunization,  etc.  Only  by  continuously  empha- 
sizing and  re-emphasiz'ng  the  subject  can  societies 
hope  to  accomplish  the  desired  results. 

Included  in  county  society  activities  of  this  kind 
should  be  a provision  for  cooperation  with  local 
health,  civic  and  welfare  groups  interested  in  the 
promotion  of  preventive  medicine  among  the 
laity.  The  advice  and  counsel  of  the  medical  pro- 
fession should  be  given  to  such  groups  to  guide 
them  in  their  activities.  Naturally,  it  is  the  duty 
of  each  physician  to  counsel  his  own  patients  re- 
garding the  protection  of  their  health.  In  fact, 
promotion  of  preventive  medicine  by  individual 
physicians  among  their  own  clientele  is  a far 
more  effective  and  much  safer  method  of  educat- 
ing the  public  than  sporadic  campaigns  and  dem- 
onstrations which  may  result  in  misunderstand- 
ings and  misinterpretations  of  the  motives  or  in- 
tentions of  the  medical  profession. 

In  conclusion,  your  committee  desires  to  em- 
phasize the  point  that  it  is  becoming  more  and 
more  apparent  that  the  physician  of  the  future 
will  depend  to  an  increasing  extent  for  his  exist- 
ence on  the  practice  of  preventive  medicine.  The 


578 


The  Ohio  State  Medical  Journal 


September,  1933 


medical  profession  as  a whole  must  adjust  itself 
to  meet  this  development.  It  must  provide  the 
public  with  services  which  the  medical  profession 
itself  conceived  and  has  proved  to  be  of  great 
public  benefit.  The  inclusion  of  personal  preven- 


tive medicine  as  an  integral  part  of  the  practice  of 
every  medical  practitioner  is,  your  committee  be- 
lieves, one  of  the  most  important  and  resourceful 
steps  which  the  medical  profession  as  a whole 
could  take  at  the  present  time. 


Annual  Meport  of  the  Committee  on  Auditing  and 

Appropriations 

(Including  Jointly  the  Report  of  the  Treasurer  and  the  Annual  Audit) 


S.  J.  Goodman,  Chairman Columbus 

John  A.  Caldwell Cincinnati 

I.  P.  Seiler Piketon 


For  obvious  reasons,  the  responsibilities  of  the 
Committee  on  Auditing  and  Appropriations  of  the 
State  Association  have  increased  both  as  to  num- 
ber and  importance  during  the  past  year. 

Due  to  the  prolonged  economic  stress,  physi- 
cians as  individuals,  as  a profession,  and  as  an 
organization  have  been  confronted  with  new  and 
serious  financial  problems  since  the  last  annual 
meeting.  We  have  been,  and  still  are,  faced  with 
a situation  demanding  rigid  economy  in  our  social, 
business  and  organization  activities.  „ 

At  the  same  time,  because  of  the  innumerable 
economic  problems  and  social  and  governmental 
developments  which  have  arisen,  affecting,  di- 
rectly or  indirectly,  the  medical  profession,  public 
health,  and  medical  practice,  there  has  developed 
a more  urgent  need  for  strong,  harmonious  and 
effective  medical  organization. 

Charged  by  the  Council  with  the  responsibility 
of  supervising  the  financial  affairs  of  the  State 
Association  and  The  Journal,  the  Committee  on 
Auditing  and  Appropriations  during  the  past  year 
was  confronted  with  the  difficult  task  of  handling 
the  funds  of  the  Association  in  such  a manner 
that  all  the  above  mentioned  conditions  could  be 
met.  In  other  words,  it  was  the  aim  of  your  com- 
mittee during  the  past  twelve  months  to  see  that 
the  funds  of  the  State  Association  were  used  in 
an  even  more  economical  manner  than  in  previous 
years,  at  the  same  time,  to  see  that  sufficient 
funds  were  available  for  carrying  on  regular  or- 
ganization activities  as  well  as  additional  ac- 
tivities deemed  necessary  to  meet  new  pi’oblems 
and  situations. 

Realizing  that  judicious  budgeting  is  essential 
to  insure  careful  and  efficient  use  of  funds,  your 
committee  at  the  beginning  of  1932  and  1933  sub- 
mitted a tentative  budget  to  The  Council.  These 
budgets  subsequently  were  approved  by  the  Coun- 
cil and  used  as  the  basis  for  the  financial  opera- 
tions of  the  State  Association  during  those  cal- 
endar years.  The  appropriations  for  1933  were 
somewhat  smaller  than  for  the  previous  year. 
Cuts  were  made  in  sums  budgeted  for  routine  ex- 
penses and  in  items  where  reductions  would  not 
handicap  the  Association  in  performing  functions 


of  service  and  benefit  to  the  membership  gen- 
erally. 

During  the  year,  as  in  the  past,  all  bills  were 
carefully  examined  and  re-examined  by  your  com- 
mittee before  approved  for  payment.  No  bills 
were  paid  until  vouchers  were  certified  to  and 
approved  by  the  committee.  No  expenses  were  in- 
curred unless  authorized  in  advance  by  this  com- 
mittee or  through  proper  budgeting  by  the 
Council. 

Because  of  the  systematic  manner  in  which  the 
financial  affairs  of  the  State  Association  were 
supervised,  the  efficient  management  of  our  state 
headquarters  office,  and  the  careful  way  in  which 
the  organization  activities  were  planned  and 
regulated,  all  expenditures  were  kept  within  the 
budgetary  allowances  and  authorizations. 

In  fact,  the  State  Association  closed. the  year 
1932  with  an  accumulated  balance  which  has  been 
added  to  the  reserve  funds  of  the  Association, 
now  invested  in  government  bonds  and  securities. 
The  fact  that  we  were  able  to  add  to  our  reserve 
fund  during  that  unsettled  period,  we  believe, 
speaks  well  for  the  careful,  conservative  and  busi- 
ness-like manner  in  which  the  Committee  on 
Auditing  and  Appropriations  has  functioned  and 
for  the  effective  cooperation  which  has  been  given 
the  committee  by  the  state  headquarters  office. 

The  sound  financial  condition  of  the  State  As- 
sociation and  The  Journal  is  revealed  in  the  re- 
port of  the  certified  public  accountant  employed 
by  your  committee  to  audit  the  financial  records 
of  the  Association  and  The  Journal  for  the  cal- 
endar and  fiscal  year  1932.  The  accountant’s  re- 
port, appended  to  this  report  of  your  committee, 
also  evidences  the  efficiency  of  the  system  utilized 
in  supervising  and  regulating  the  financial  trans- 
actions of  the  Association  and  The  Journal.  It  is 
the  opinion  of  the  Auditing  and  Appropriations 
Committee  that  in  view  of  present  business  con- 
ditions and  after  obtaining  information  on  other 
voluntary  associations  and  organizations,  the  Ohio 
State  Medical  Association  is  in  a remarkably  fav- 
orable financial  condition. 

Undoubtedly,  we  will  be  confronted  with  new 
problems,  financial  and  otherwise,  during  the  en- 
suing months.  We  must  meet  them  in  the  same 
way  we  have  met  and  disposed  of  those  of  the 
past. 

It  is  vital  that  a policy  of  strict  economy  and 


September,  1933 


Annual  Reports 


579 


of  providing  adequate  funds  for  only  necessary 
organization  activities  be  adhered  to  at  all  times. 
This  attitude  on  the  part  of  your  committee 
was  reflected  in  the  1933  budget,  submitted  to  and 
approved  by  The  Council  at  its  meeting  on  De- 
cember 11,  1932  (January,  1933,  issue  of  The 
Journal ) , and  in  which  further  reductions  in 
authorizations  for  various  activities  were  made. 

On  the  other  hand,  your  committee  and  The 
Council  were  careful  that  adequate  provision  was 
made  for  essential  organization  activities  during 
the  current  year  so  that  the  service  of  the  State 
Association  to  all  its  members  will  not  be  crippled 


in  any  way.  It  is  quite  apparent  that  it  is  rela- 
tively more  important  that  medical  organization 
machinery  be  maintained  at  a higher  degree  of 
efficiency  now  than  ever  before.  Unless  adequate 
financial  support  is  given  to  activities  and  jrro- 
grams  designed  to  aid  and  assist  the  medical  pro- 
fession, individually  and  collectively , the  effective- 
ness of  those  activities  and  functions  is  certain  to 
be  diminished. 

The  above-mentioned  audit  of  the  finances  of 
the  State  Association  and  The  Journal  by  cer- 
tified public  accountants  for  the  calendar  and 
fiscal  year  1932  follows: 


Accountant’s  Report  Re  Ohio  State  Medical  Association  for  the  Year 
Ending  December  31,  1932 


Chairman  Auditing  Committee, 

Ohio  State  Medical  Association, 

Columbus,  Ohio. 

Dear  Sir: 

In  accordance  with  your  instructions,  we  have 
audited  the  books  of  the  Ohio  State  Medical  Asso- 
ciation, for  the  year  ended  December  31,  1932  and 
submit  herewith  our  report,  including  as  a part 
thereof  the  following  described  Schedules: 

SCHEDULE  A — Statement  of  Cash  Receipts  and 
Disbursements  for  the  year 
ended  December  31,  1932. 
SCHEDULE  B — Statement  of  Cash  Reconcilia- 
tion at  December  31,  1932. 
AUDIT — All  recorded  cash  was  traced  to  the 
depository.  Disbursements  were  verified  by  exam- 
ination of  cancelled  checks,  supported  by  vouchers 
properly  approved.  Cash  on  deposit  at  December 
31,  1932,  as  shown  by  a certificate  from  the  bank, 
was  reconciled  with  the  balance  as  shown  by  the 
books  at  that  date. 

Certificates  of  deposit  and  United  States  Bonds 
were  verified  by  inspection. 

CERTIFICATE — We  therefore  certify  that,  in 
our  opinion,  the  statement  herein  contained  cor- 
rectly states  the  cash  receipts  and  disbursements 
of  the  Ohio  State  Medical  Asociation  for  the 
year  ended  December  31,  1932. 

Respectfully  submitted, 

Keller,  Kirschner  & Martin, 
Certified  Public  Accountants. 

Schedule  A — Statement  of  Cash  Receipts  and 
Disbursements  for  the  Year  Ended 
December  31,  1932. 

Cash  on  Hand  and  on  Deposit  at  Jan- 


uary 1,  1932  r $ 2,907.34 

Certificate  of  Deposit 5,000.00 

United  States  Bonds 55,000.00 

Total  Cash  January  1,  1932  $62,907.34 


Receipts 


Membership  Dues  1932 $26,565.00 

Annual  Meeting  2,217.60 

Interest  1,879.97 


Total  Receipts  30,662.57 


Total  to  be  accounted  for $93,569.91 

Disbursements 

Ohio  State  Medical  Journal $ 7,000.00  , 

Executive  Secretary — Salary  6,600.00 

Executive  Secretary — Expense  479.97 

Assistant  Executive  Sec’y — Salary 3,850.00 

Assistant  Executive  Sec’y — Expense 49.35 

President’s  Expense  113.91 

Treasurer’s  Salary  300.00 

Council  567.33 

Annual  Meeting  a 1,291.20 

Auditing  100.00 

Committee  on  Public  Policy 429.74 

Medical  Defense  2,340.86 

Miscellaneous  Committee  Expense 71.34 

Stationary  and  Supplies 307.05 

Postage  and  Telegraph 548.64 

General  Counsel — Salary 2,100.00 


Total  Disbursements  $26,149.39 

Cash  on  Hand  and  on  Deposit — 

December  31,  1932 67,420.52 


Total  accounted  for $93,569.91 


Schedule  B — Statement  of  Cash  Reconcilia- 
tion at  December  31,  1932. 

The  Huntington  National  Bank 

Balance  as  shown  by  bank  statement 

December  31,  1932 $ 1,181.90 

Less  Outstanding  Checks--. — 761.38 


Balance  as  shown  by  books  at  De- 
cember 31,  1932 $ 420.52 

Certificates  of  Deposit : 

No.  30425  Huntington  National  Bank  $ 5,000.00 

No.  30426  Huntington  National  Bank  - 7,000.00  12,000.00 


Government  Bonds : 

U.  S.  Liberty  Bonds  41/4 — Registered  $25,000.00 

U.  S.  Treasury  Bonds  3 3/8 30,000.00  55,000.00 


Total  balance  as  shown  by  the  books 

at  December  31,  1932 $67,420.52 


Accountant’s  Report  Re  Ohio  State  Medical  Journal  for  the  Year  Ending 

December  31,  1932 


To  The  Committee  on  Auditing  of  the 
Ohio  State  Medical  Journal, 

Columbus,  Ohio. 

Gentlemen : 

In  accordance  with  your  instructions,  we  have 
audited  the  books  of  the  Ohio  State  Medical  Jour- 
nal, for  the  year  ended  December  31,  1932,  and 


submit  herewith  our  report,  including  as  a part 
thereof  the  following  described  schedules: 

SCHEDULE  A — Balance  Sheet  at  December  31, 
1932. 

SCHEDULE  B — Statement  of  Revenue  and  Ex- 
pense for  the  year  ended  Decem- 
ber 31,  1932. 

These  schedules  are  supported  by  exhibits. 


580 


The  Ohio  State  Medical  Journal 


September,  1933 


showing  details  of  various  accounts  incorporated 
therein. 

Financial  Condition 

The  financial  condition  of  the  Ohio  State  Medi- 
cal Journal  at  December  31,  1932  (as  shown  in 
detail  in  Schedule  A)  was  as  follows: 

Cash  on  Hand  and  on  Deposit $ 1,363.42 

Accounts  Receivable 578.48 


$ 

1,941.90 

46.00 

$ 

1,895.90 

1,908.78 

- $ 

3,804.68 

The  above  is  represented  by: 

Surplus $ 3,804.68 


AUDIT — All  recorded  cash  was  traced  to  the 
depository.  ^Disbursements  were  verified  by  ex- 
amination of  cancelled  checks,  supported  by 
properly  approved  invoices.  Cash  on  deposit  at 
December  31,  1932,  as  shown  by  a certificate  from 
the  bank,  was  reconciled  with  the  balance  as 
shown  by  the  books  at  that  date.  Petty  cash 
vouchers  were  checked  and  the  amount  of  petty 
cash  on  hand  was  verified  by  count  as  of  a present 
date  during  the  audit. 

CERTIFICATE — We  therefore  certify  that, 
in  our  opinion,  the  statements  herein  contained 
correctly  state  the  financial  condition  of  the  Ohio 
State  Medical  Journal  at  December  31,  1932,  and 
the  Revenue  and  Expense  for  the  year  ended  on 
that  date. 

Respectfully  submitted, 

Keller,  Kirschner  & Martin. 

Certified  Public  Accountants. 

Schedule  A — Balance  Sheet  at  December 
31,  1932. 

ASSETS 

Current  Assets 

Cash — The  Ohio  National  Bank $ 1,353.42 

Cash — Petty  10.00 

Total  Cash  $ 1,363.42 

Accounts  Receivable  578.48 

Total  Current  Assets $ 1,941.90 

Property  Assets 

Furniture  and  Fixtures 1,908.78 


LIABILITIES 

Current  Liabilities 

Subscriptions  Prepaid $ 46.00 

SURPLUS 

Surplus  at  December  31,  1931 $ 3,970.34 

Less — Expense  in  excess  of  Revenue 

for  the  year  ended  Dec.  31,  1932  . 165.66 

Surplus  at  December  31,  1932 3,804.68 

Total  Liabilities  and  Surplus $ 3,850.68 


Schedule  B — Statement  of  Revenue  and  Ex- 
pense for  the  Year  Ended 
December  31,  1932. 

Revenue 


Advertising  $ 9,104.56 

Less — Commissions $725.13 

Cash  Discount 268.89  994.02  $ 8,110.54 


Circulation 7,000.00 

Miscellaneous  103.50 

Bad  Debts  Collected 53.72 


Total  Revenue  $15,267.76 

Expense 

Journal  Printing $ 7,911.31 

Office  Salaries  3,754.50 

Rent  1,500.00 

Journal  Postage  460.04 

Telephone  and  Telegraph 195.82 

Depreciation  209.31 

Bad  Debts  323.00 

Journal  Envelopes  385.48 

Office  Supplies  and  Expense 266.56 

Stencils  and  Mimeograph  Supplies 74.34 

Dues  and  Subscriptions  107.70 

Water,  Ice  and  Towel  Service 105.08 

News  Clipping  Service 71.50 

Repairs  and  Cleaning 48.48 

Halftones  and  Etchings 4.00 

Express  and  Delivery  Service 7.30 

Miscellaneous  Expense  19.00 


Total  Expense 15,433.42 


Expense  in  Excess  of  Revenue  for  the 

year  ended  Dec.  31,  1932 $ 166.66 


Statement  of  Cash  Reconciliation  at 
December  31,  1932. 

The  Ohio  National  Bank 

Balance  as  shown  by  Bank  Statement  at  De- 
cember 31,  1932  $ 2,044.95 

Less  Outstanding  Checks 691.53 


Balance  as  shown  by  Books  at  Dec.  31,  1932  $ 1,353.42 

Petty  Cash  10.00 


Total  Assets 


$ 3,850.68  Total  Cash 


$ 1,363.42 


Annual  Keporf  of  the  Committee  on  Military  and  Veterans' 

Affairs 


C.  W.  Stone,  Chairman Cleveland 

Fred  K.  Kislig  (deceased) Dayton 

A.  E.  Brant Youngstown 

Don  K.  Martin,  Secretary Columbus 

Pursuant  to  action  taken  by  the  House  of  Dele- 
gates of  the  Ohio  State  Medical  Association  at 
the  1932  meeting  of  the  State  Association,  the 
President  appointed  this  committee  to  study  medi- 
cal and  hospital  problems  arising  from  the  vet- 
erans’ relief  activities  of  the  Federal  Govern- 
ment; to  contact  and  cooperate  with  officials  of 
veterans’  organizations  and  other  agencies  inter- 
ested in  the  question ; to  assist  in  the  promotion  of 
enlistments  in  the  medical  units  of  the  Regular 


Army,  Ohio  National  Guard  and  the  Officers’  Re- 
serve Corps;  and  to  act  as  a contact  committee 
between  the  medical  profession  and  individuals 
and  groups  interested  in  military  activities  gen- 
erally. 

During  the  past  year,  data  and  problems  rela- 
tive to  veterans’  benefits  have  been  reviewed  and 
analyzed.  New  developments  have  been  followed 
closely.  Contacts  have  been  established  with  offi- 
cials of  veterans’  organizations  through  confer- 
ences and  correspondence. 

Since  this  committee  began  to  function,  im- 
portant developments  having  a direct  bearing  on 
the  question  of  veterans’  benefits,  including  rued- 


September,  1933 


The  Ohio  State  Medical  Journal 


581 


ical  and  hospital  care  for  ex-service  men,  have 
taken  place. 

Shortly  after  the  United  States  Congress  had 
convened  in  special  session  at  the  call  of  Presi- 
dent Roosevelt,  it  enacted  emergency  legislation, 
known  as  the  “Economy  Act”,  giving  to  the  Chief 
Executive  dictatorial  powers  to  modify  and  re- 
vamp the  existing  Federal  veterans’  relief  pro- 
gram and  repealing  all  laws  and  regulations  per- 
taining to  veterans’  benefits. 

Under  the  authority  granted  him  by  Congress, 
President  Roosevelt  immediately  promulgated  new 
rules  and  regulations  governing  veterans’  bene- 
fits. These  supercede  the  provisions  of  the  re- 
pealed World  War  Veterans’  Act  and  other  stat- 
utes pertaining  to  veterans’  benefits.  They  estab- 
lish a new  basic  policy  in  the  distribution  of  bene- 
fits to  former  service  men ; eliminate  many  of  the 
inequalities  which  had  grown  up  under  the  old 
system,  and  make  material  changes  in  the  sched- 
ule of  benefits,  which,  it  is  estimated,  will  result 
in  an  annual  savings  of  almost  half  a billion  dol- 
lars to  the  Federal  Government. 

Detailed  explanations  of  the  new  regulations 
were  published  in  the  April  and  May,  1933,  issues 
of  The  Ohio  State  Medical  Journal.  All  mem- 
bers of  the  State  Association  are  urged  to  read 
those  articles  carefully,  if  they  have  not  already 
done  so. 

In  brief,  the  regulations  provide: 

1.  Adequate  compensation  for  all  ex-service 
men  disabled  as  a result  of  injuries  or  disease 
sustained  in  line  of  duty  in  the  military  or  naval 
service  and  adequate  pensions  for  the  dependents 
of  those  who  died  in  the  service  or  as  a result  of 
service-connected  disabilities. 

2.  Adequate  medical,  hospital  and  nursing  care 
for  veterans  suffering  from  service-connected  in- 
juries or  disabilities. 

3.  Domiciliary  care  for  ex-service  men  suffer- 
ing from  permanent  disabilities,  or  tuberculosis 
or  neuropsychiatric  ailments  which  incapacitate 
them  from  earning  a living,  regardless  of  the 
origin  of  the  disability. 

4.  No  compensation  for  former  service  men 
suffering  from  non-service  connected  disabilities 
unless  they  are  permanently  and  totally  disabled. 

5.  No  medical  and  hospital  care  for  veterans 
suffering  from  non-service  connected  temporary 
conditions. 

6.  Abandonment  of  the  costly  hospital  building 
program  of  the  Federal  Government  on  the  theory 
that  present  veterans’  hospital  facilities  are  en- 
tirely adequate  to  care  for  all  ex-service  men 
eligible  to  hospitalization  under  the  new  regu- 
lations. 

Action  of  the  Federal  Government  in  modifying 
its  policy  relative  to  veterans’  benefits  and  estab- 
lishing a merit  system  for  the  care  of  deserving 
ex-service  men  or  their  dependents  followed 
pressing  and  widespread  demands  for  construc- 
tive changes  in  the  administration  of  veterans’ 
relief. 

The  procedure  established  by  the  new  regula- 
tions is  based  on  sound  economic  principles  and 
good  governmental  policy.  It  is  expected  to  re- 
sult in  material  savings  to  the  Federal  Govern- 


ment and,  at  the  same  time,  provide  adequate 
and  equitable  benefits  for  those  who  are  entitled 
to  them  and  in  need  of  them. 

COOPERATION  OF  PROFESSION  VITAL 

The  new  national  policy  exemplified  by  the 
Roosevelt  regulations  for  dealing  with  all  ex- 
service  men  is  in  line  with  the  long-established 
policy  of  organized  medicine  of  Ohio  with  respect 
to  this  vital  governmental  and  economic  problem. 

As  recently  as  May,  1932,  the  House  of  Dele- 
gates of  the  State  Association  adopted  a resolu- 
tion re-affirming  the  attitude  of  medical  organiza- 
tion on  this  question.  The  policy  of  the  State 
Association  always  has  been,  and  still  is,  that 
adequate  provision  should  be  made  for  those 
whose  physical  disabilities  were  incurred  in  or 
resulted  from  military  service  and  for  the  de- 
pendents of  those  who  sacirficed  their  lives  in  the 
service  of  their  country,  but  compensation  should 
not  be  paid  to,  and  medical  and  hospital  care 
provided  at  government  expense  for  ex-service 
men  whose  disabilities  were  not  incurred  in  or 
the  result  of  military  or  naval  service. 

It  is  to  be  hoped  that  the  administrators  of  the 
new  set-up  in  the  handling  of  veterans’  benefits 
will  be  given  the  support  and  cooperation  of  the 
medical  profession  in  their  official  duties  in  carry- 
ing out  the  provisions  of  the  program  which 
promises  to  eliminate  abuses  and  inequalities  in 
veterans’  relief ; reduce  materially  the  Federal 
budget;  minimize  government  competition  with 
individual  practitioners  of  medicine  and  privately- 
owned  and  operated  hospitals,  and  establish  a 
national  policy  in  conformity  with  sound  eco- 
nomic principles  and  good  government  procedure. 

The  fact  should  not  be  overlooked  that  whatever 
regulations  respecting  veterans’  benefits  are  in 
effect  at  the  end  of  two  years,  dating  from  March 
20,  1933,  shall  continue  operative  until  Congress 
by  law  shall  otherwise  provide. 

Whether  the  regulations  promulgated  by  Presi- 
dent Roosevelt  are  to  become  permanent,  perpetu- 
ating a new  national  policy  on  veterans’  relief, 
will  depend  to  a large  extent  on  the  experience 
of  the  Veterans’  Administration  during  the  next 
two  years. 

It  is  of  extreme  importance  to  the  medical  pro- 
fession that  this  new  policy  be  maintained  and 
that  the  evils  of  the  pre-exising  system  be  avoided. 
It  is  essential  that  we  give  our  united  and  active 
support  and  assistance  to  the  Veterans’  Adminis- 
tration in  carrying  out  the  provisions  of  the  new 
regulations.  Whether  or  not  they  will  succeed 
in  solving  the  serious  problems  incidental  to  dis- 
tribution of  veterans’  benefits  will  depend  largely 
on  the  degree  of  cooperation  accorded  the  Vet- 
erans’  Administration  by  all  directly  affected  by 
and  interested  in  the  veterans’  program. 

As  Dr.  E.  H.  Caiy,  last  retiring  president  of 
the  American  Medical  Association,  declared  re- 
cently : 

“Our  professional  welfare  is  definitely  affected 


582 


Annual  Reports 


September,  1933 


by  the  future  attitude  of  the  government.  With 
us  it  involves  the  progress  or  decline  of  the  art 
of  medicine,  and  the  remote  likelihood  of  the 
State  itself  assuming  all  responsibility  for  the 
medical  care  of  its  people.  If  the  government 
persists  in  this  plan,  individualism  in  medicine 
will  be  greatly  hampered  and  a multitude  of  evils, 
which  can  be  easily  understood,  will  follow  in  its 
wake.” 

An  important  step  towai’d  minimizing,  and  vir- 
tually eliminating,  one  of  the  greatest  menaces 
confronting  the  medical  profession  has  been  taken 
in  revision  of  the  veterans’  program.  We  should 
bend  every  effort  to  prevent  a return  of  the  un- 
just and  inequitable  system  which  had  been  the 
soui-ce  of  widespread  dissatisfaction  and  criticism 
and  an  unfair  financial  burden  on  the  nation  as  a 
whole. 

MEDICAL  RESERVE  ENLISTMENTS  GAIN 

Since  the  close  of  the  World  War,  the  Ohio 
State  Medical  Association  through  its  special  com- 
mittee on  military  affairs  has  maintained  a close 
contact  with  the  medical  departments  of  the  Regu- 
lar Ai'my  and  the  Ohio  National  Guard. 

As  demonstrated  during  the  World  War,  a well- 
organized,  well-trained  and  well-equipped  medical 
and  sanitary  unit  is  indispensable  to  combat 
troops  and  to  the  success  of  army  maneuvers. 

Under  the  present  National  Defense  Program, 
the  Organized  Reserve  Corps  plays  an  important 
role,  since  it  would  be  expected  to  supply  a large 
proportion  of  the  officers  for  an  American  army 
in  case  of  future  conflicts.  Many  of  the  officers 
for  medical  units  in  event  of  war  would  be  chosen 
from  the  Organized  Medical  Reserve  Corps. 

For  this  reason,  the  State  Association  has  felt 
it  is  highly  important  that  enlistments  in  the 
Organized  Officers  Reserve  Corps  be  encouraged 
and  that  the  activities  of  the  medical  units  of  the 
War  Department  be  promoted  among  members  of 
the  medical  profession. 

Under  the  present  War  Department  mobiliza- 
tion plan,  32  Medical  Department  Reserve  units, 
located  in  Ohio  are  designated  for  mobilization  on 
M-Day,  or  day  of  mobilization.  This  number  does 
not  include  National  Guard  or  Resei've  units  and 
detachments  assigned  to  divisions  or  line  troops. 
These  units  are  classed  as  Non-Divisional  Medical 
Department  Units  and  Regular  Army  Inactive 
Units. 

The  distribution  of  the  units  throughout  the 
state  is  as  follows:  Cleveland  12,  Columbus  6, 

Cincinnati  6,  Dayton  3,  Springfield  3,  Bucyrus  1, 
and  Bellefontaine  1.  As  far  as  practicable,  the 
personnel  for  the  various  units  is  drawn  from  the 
city  and  vicinity  in  which  they  are  located. 

Each  year  all  graduates  of  the  medical  schools 
in  the  state  are  invited  to  join  the  Resei’ve  Corps 
upon  graduation  and  when  they  have  successfully 
passed  the  State  Board  examination.  Promotion 
is  now  made  upon  a Certificate  of  Capacity  for 
Promotion.  This  cex-tificate  may  be  earned  by 
taking  a written  examination  in  certain  specified 


military  subjects  and  a practical  test,  the  suc- 
cessful completion  of  which  establishes  the  offi- 
cer’s eligibility  for  promotion  when  he  has  served 
sufficient  time  in  grade  and  a vacancy  occurs. 

New  Army  Extension  School  courses  cover  a 
number  of  military  subjects  which  would  confront 
the  citizen  officer  upon  assuming  his  duties  as  an 
officer  in  time  of  emergency.  Basic  courses  have 
been  prepared  by  the  staff  of  the  Medical  Field 
Sei-vice  School,  Carlisle  Bain-acks,  Pennsylvania, 
and  the  more  advanced  courses  have  been  pre- 
pared by  the  staff  of  the  Command  and  General 
Staff  School,  Fort  Leavenwoi’th,  Kansas. 

The  object  of  the  Extension  School  is  to  fit  the 
Resei’ve  Officer  who  finds  that  he  does  not  have 
time  to  devote  to^  active  duty  training  in  peace 
time  for  the  duties  which  would j confront  him  in 
time  of  war.  On  December  31,  1932,  310  Medi- 
cal Department  Reserve  Officers,  residents  of  the 
State  of  Ohio,  were  enrolled  in  the  Extension 
School. 

Enlistments  in  the  medical  units  of  the  Or- 
ganized Reserve  Corps  of  Ohio  showed  a sub- 
stantial increase  during  1932.  However,  the  pro- 
curement quota  for  the  Fifth  Corps  Area,  com- 
prising Ohio,  Indiana,  Kentucky  and  West  Vir- 
giana,  has  not  been  attained  and  there  still  are 
vacancies  in  every  branch  of  the  medical  de- 
partment. 

The  following  figures  furnished  by  Colonel 
David  Baker,  Fifth  Corps  Area  Surgeon,  show 
the  distribution  of  Ohioans  enrolled  in  the  medi- 
cal units  and  groups  of  the  Officers  Reserve  Corps 
at  the  end  of  1932,  and,  for  comparison,  in  1931: 


RESERVE  OFFICERS  OF  OHIO 
Active,  Corps  Area  Assignment  Group 

(Under  Corps  Area  Commander) 


Branch 

o 

O 

Lt.  Col. 

Major 

Capt. 

1st  Lt. 

2nd  Lt. 

Total 

1931 

Med. cal 

16 

45 

66 

62 

353 

0 

542 

509 

Dental 

0 

4 

21 

29 

292 

0 

346 

309 

Sanitary 

0 

0 

5 

3 

5 

54 

67 

59 

Med.  Admin.  0 

0 

0 

7 

20 

48 

75 

72 

Veterinary 

0 

0 

1 

5 

4 

5 

15 

15 

Totals 

16 

49 

93 

106 

674 

107 

1045 

964 

Inactive,  Corps  Area  Assignment  Group 

(Under  Corps  Area  Commander) 

1931 

Medical 

. 0 

2 

12 

28 

99 

0 

.141 

142 

Dental 

0 

0 

3 

9 

55 

0 

67 

57 

Sanitary 

. 0 

0 

1 

4 

1 

7 

13 

14 

Med.  Admin. 

0 

0 

0 

0 

3 

15 

18 

16 

Veterinary 

0 

0 

0 

0 

0 

0 

0 

0 

Totals 

0 

2 

16 

41 

158 

22 

239 

228 

Active, 

Arm 

and  Service  Assignment  Group 

(Under  Chief  of  Branch) 

1931 

Medical 

1 

1 

2 

4 

9 

0 

17 

20 

Dental 

0 

0 

0 

2 

2 

0 

4 

6 

Veterinary 

. 0 

0 

0 

0 

1 

1 

2 

3 

Med.  Adm. 

0 

0 

0 

0 

1 

1 

2 

6 

Sanitary 

0 

0 

5 

4 

0 

1 

10 

8 

Totals 

1 

1 

7 

10 

13 

3 

35 

42 

September,  1933 


The  Ohio  State  Medical  Journal 


583 


Inactive,  Arm  and  Service  Assignment  Group 

(Under  Chief  of  Branch) 

1931 


Medical 

1 

0 2 

2 

5 

0 

10 

9 

Dental 

0 

0 0 

0 

2 

0 

2 

1 

Veterinary  

0 

0 1 

2 

0 

0 

3 

4 

Med.  Admin. 

0 

0 0 

0 

2 

0 

2 

2 

Sanitary 

0 

0 1 

0 

0 

1 

2 

3 

Totals 



1 

0 4 

4 

9 

1 

19 

19 

NATIONAL  GUARD 

(Dual 

Status) 

1931 

Medical 

1 

2 9 

27 

10 

0 

49 

41 

Dental 

0 

0 1 

5 

4 

0 

10 

10 

Veterinary  .... 

0 

0 1 

6 

1 

1 

9 

7 

Med.  Admin. 

0 

0 0 

6 

i 

3 

10 

7 

Sanitary 

0 

0 0 

0 

0 

0 

0 

0 

Totals 

1 

2 11 

44 

16 

4 

78 

65 

NEW 

APPOINTMENTS 

IN 

1932 

Medical 

Dental 

Veterinary 

Med.  Admin. 

Sanitary 

Total 

83 

47 

18 

12 

1 

161 

PROMOTIONS  IN 

1932 

Medical 

Dental 

Veterinary 

Med.  Admin. 

Sanitary 

Total 

12 

7 

1 

4 

0 

24 

Your  committee  recommends  that  members  of 
the  medical  profession  take  an  active  interest  in 
the  medical  activities  of  the  Ohio  National  Guard. 
Enrollment  in  the  National  Guard  offers  a phy- 
sician practical  training  with  troops,  especially 
while  the  various  guard  units  are  in  camp  at 
Camp  Perry.  Many  physicians  who  are  members 
of  the  Organized  Reserve  have  enlisted  in  the 
National  Guard  to  obtain  this  training  and  to 
place  themselves  in  a position  for  promotion  in 
the  Officers’  Reserve  Corps. 

This  report  would  not  be  complete  without  ap- 
propriate mention  and  an  expression  of  sorrow 
relative  to  the  untimely  death  of  Dr.  Fred  K. 
Kislig,  Dayton,  a member  of  this  committee.  Dr. 
Kislig  was  intensely  interested  in  the  problems 
discussed  in  this  report.  His  counsel  and  military 
experience  were  of  great  value  to  the  committee 
in  consideration  of  these  questions.  Death  has 
removed  from  our  ranks  one  who  served  his 
country  well  in  a period  of  emergency;  a leader 
in  the  activities  of  medical  organization  in  his 
community,  and  a capable  and  competent  phy- 
sician, respected  by  all  who  knew  him. 


Submitted  by  S.  J.  Goodman,  M.D.,  Secretary  of  Council. 


While  serving  as  administrator  of  the  executive 
affairs  of  the  Ohio  State  Medical  Association 
since  the  last  annual  meeting,  the  Council  has 
had  an  opportunity  to  view  from  many  angles  the 
activities  of  organized  medicine  in  Ohio  and  to 
study  intimately  many  of  the  important  problems 
which  confront  the  medical  profession. 

Without  fear  of  contradiction,  the  Council  is 
of  the  opinion  that  there  never  has  been  a time  in 
the  history  of  medicine  when  there  has  been  a 
greater  need  for  understanding,  harmony,  co- 
hesion and  genuine  cooperative  activity  on  the 
part  of  the  medical  profession  in  every  com- 
munity, in  every  state  and  throughout  the  entire 
nation. 

Developments  of  the  past  year  have  empha- 
sized the  necessity  for  organized  endeavor  within 
the  medical  profession.  They  have  demonstrated 
how  futile  it  is  for  the  individual  physician  to 
attempt  to  stand  alone  in  an  effort  to  solve  the 
serious  economic,  social,  governmental  and  pro- 
fessional problems  which  confront  him.  They 
should  serve  as  a warning  to  us  that  we  are  cer- 
tain to  fail  unless  we  present  a united  front  and 
take  a militant  stand  in  defense  of  the  principles 
and  policies  we  know  to  be  correct. 

Our  observations  relative  to  the  needs  for 
strong,  united  medical  organization  have  strength- 
ened our  conviction  that  the  basic  element  in 
medical  organization  is  the  county  medical  society. 
Without  the  support  and  active  cooperation  of  the 
various  county  medical  societies  and  academies  of 


medicine,  state  and  national  medical  organizations 
cannot  function  efficiently  and  effectively. 

Ohio  is  fortunate  in  that  it  has  an  unusually 
large  number  of  strong  and  active  county  medical 
societies.  For  this  reason  and  because  of  the 
strong  leadership  which  has  been  provided  for  the 
State  Association  year  after  year  over  a long 
period  of  time,  medical  organization  in  Ohio  has 
been  able  to  accomplish  much  and  to  serve  well 
the  medical  profession  of  Ohio. 

However,  there  are  some  county  societies  which 
have  failed  to  function  properly;  have  failed  to 
cooperate  at  all  times  in  the  activities  of  the  State 
Association.  They  have  been  unable  to  win  the 
active  interest  of  the  physicians  of  their  com- 
munity. They  have  failed  to  realize  that  they 
can,  and  should,  be  an  active  and  efficient  in- 
strumentality for  promoting  the  art  and  science 
of  medicine,  the  betterment  of  public  health,  and 
in  aiding  in  a solution  of  the  complex  and  vital 
questions. 

Until  it  has  the  active  cooperation  of  every 
county  medical  society  in  the  state,  the  State  As- 
sociation cannot  function  with  a maximum  of 
effectiveness.  Moreover,  until  each  county  society 
has  the  wholehearted  support  and  active  interest 
of  every  eligible  physician  within  its  jurisdiction, 
it  cannot  meet  all  its  obligations  nor  become  a 
powerful  influence  in  its  community.  As  Dr.  Olin 
West  has  well  said:  “As  long  as  so  many  mem- 
bers of  our  own  organization  dissipate  their 
loyalty  and  scatter  their  fealty  over  so  many  in- 
dependent medical  organizations,  just  so  long  will 


584 


The  Ohio  State  Medical  Journal 


September,  1933 


they  contribute  toward  the  weakening  of  the 
fundamental  organization  of  medicine  in  the 
United  States”. 

One  of  the  biggest  jobs  that  needs  to  be  done 
during  the  ensuing  year,  your  Council  believes,  is 
that  of  strengthening  every  county  medical  so- 
ciety and  academy  of  medicine  in  Ohio  and  to  re- 
animate those  few  which  have  failed  to  function 
in  a way  they  are  capable  of  functioning.  The 
task  cannot  be  done  by  the  Council,  the  officers  of 
the  State  Association  or  any  of  the  committees  of 
the  State  Association  acting  alone.  It  is  a job 
which  the  officers  of  the  individual  county  societies 
and  the  physicians  of  each  community  must  under- 
take. 

STRONG  LOCAL  UNITS  ESSENTIAL 

Every  eligible  physician  in  every  community 
should  be  enrolled  in  medical  organization.  Strong 
leadership  should  be  provided  each  county  society. 
Committeemen  should  be  selected  from  among 
those  who  are  willing  to  give  their  time  and  effort 
to  the  work  delegated  to  them.  Programs  should 
be  formulated  in  a careful  and  studious  manner, 
the  aim  being  to  stimulate  attendance  at  regular 
meetings  and  to  present  material  which  will  be 
beneficial  to  all  members  of  the  society.  Time 
should  be  provided  at  regular  meetings  for  a dis- 
cussion of  social,  economic,  governmental  and  or- 
ganization questions.  Effective  public  relations 
should  be  established  so  that  the  medical  view- 
point on  questions  of  public  concern  can  be  pre- 
sented. Eery  physician  should  be  made  to  realize 
that  his  active  support  is  necessary  in  the  pro- 
motion of  the  aims  of  medical  organization  and 
that  he,  in  turn,  receives  many  benefits  from  the 
organization  which  he  helps  to  maintain. 

Naturally,  the  individual  Councilors  and  officers 
of  the  State  Association  will  be  available  at  all 
times  to  assist  local  societies  in  every  way  pos- 
sible. During  the  past  year,  the  members  of  the 
Council  have  frequently  been  called  upon  for  ad- 
vice and  counsel  by  the  respective  societies  of 
their  districts.  As  customary,  every  Councilor  has 
endeavored  to  visit  each  society  of  his  district  at 
least  once  during  the  year.  Circumstances  have 
prevented  some  Councilors  from  visiting  every 
society  in  his  district  but  this  does  not  in  any  way 
indicate  that  he  is  not  sincerely  interested  in  the 
affairs  of  each  society  and  ready  at  all  times  to 
be  of  service  to  all  of  them.  Members  of  the 
Council  are  anxious  to  serve  their  constituents 
and  eager,  in  turn,  to  receive  their  advice  and 
criticism. 

During  the  ensuing  year,  it  will  be  especially 
important  that  close  contact  be  maintained  be- 
tween the  Council  and  the  county  societies.  Prob- 
lems and  situations  have  arisen  which  call  for  ex- 
perienced judgment,  calm  deliberation  and  con- 
certed action.  Members  of  Council  should  be  kept 
informed  of  local  problems  and  local  activities. 


Maintenance  of  close  and  systematic  contact  be- 
tween the  Council  and  officers  of  the  State  Asso- 
ciation and  the  various  county  societies  is  most 
essential  to  good  state-wide  organization. 

Although  the  Council  is  always  ready  to  lend  a 
sympathetic  ear  to  all  questions,  local  or  other- 
wise, affecting  public  health  and  medical  practice 
and  to  offer  advice  and  suggestions,  frequently  it 
is  called  upon  to  consider  questions  entirely  local 
in  scope  and  effect.  The  Council  is  of  the  opinion 
that  questions  of  this  character  should,  if  pos- 
sible, be  decided  by  the  local  county  society  in 
accord  with  local  conditions  and  sentiment.  The 
fundamental  principles  and  policies  of  medical 
organization,  promulgated  from  time  to  time  by 
the  House  of  Delegates  of  the  State  Association, 
are  broad  enough  to  cover  most  local  situations. 
If  interpreted  properly  and  applied  judiciously  by 
the  local  county  societies,  they  will  provide  an 
answer  for  most  of  the  questions  which  arise 
from  time  to  time  in  the  different  communities. 
Of  course,  the  Council  will  continue  to  analyze 
questions  state-wide  in  scope  and  importance  and 
will  take  definite  action  for  the  information  and 
guidance  of  the  local  societies  and  the  member- 
ship as  a whole  when  such  action  is  deemed  ad- 
visable. 

No  detailed  review  of  the  activities  of  the  Coun- 
cil will  be  presented  in  this  report,  since  they  are 
reflected  for  the  most  part  in  the  minutes  of  the 
regular  meetings  of  the  Council,  published  in  the 
June,  1932,  August,  1932,  November,  1932,  Janu- 
ary, 1933,  April,  1933,  June,  1933,  and  August, 
1933,  issues  of  The  Journal.  In  all  its  activities 
the  Council  has  tried  to  be  consistent,  un- 
biased and  sympathetic.  It  has  devoted  care- 
ful study  and  consideration  to  all  questions 
presented  to  it.  It  has  attempted  to  base  all 
its  decisions  on  the  policies  and  principles  laid 
down  by  the  House  of  Delegates.  At  all  times,  it 
has  kept  foremost  in  mind  the  fact  that  its  actions 
and  conclusions  must  be  determined  by  what  is 
best  for  the  majority  of  the  members  of  the  State 
Association  and  most  beneficial  to  the  health  and 
welfare  of  the  public. 

MEMBERSHIP  DATA 

First  District 

John  A.  Caldwell,  M.D.,  Cincinnati,  Councilor 

Paid  Membership 


for 

to  Aug.  12, 

County 

1932 

1933 

Adams  

13 

14 

Brown  

8 

6 

Butler  

....  79 

62 

Clermont  

.. ..  17 

20 

Clinton  - 

24 

23 

Fayette  

. 18 

16 

Hamilton  

. 537 

542 

Highland  . ... 

....  17 

18 

Warren  

21 

18 

Total  

734 

719 

September,  1933 


Annual  Reports 


585 


Second  District 

E.  M.  Huston,  M.D.,  Dayton,  Councilor 


Paid  Membership 
for  to  Aug.  12, 

County  1932  1933 

Champaign  19  20 

Clark  67  65 

Darke  33  31 

Greene  . 34  31 

Miami  ._ _ 46  48 

Montgomery  „ 266  252 

Preble  17  15 

Shelby  22  22 


Total  504  484 

Third  District 

O.  P.  Klotz,  M.D.,  Findlay,  Councilor 

Allen  76  69 

Auglaize  26  27 

Hancock  36  36 

Hardin  .. 22  22 

Logan  26  22 

Marion  ... 40  34 

Mercer  16  14 

Seneca  38  39 

Van  Wert 22  23 

Wyandot  9 11 


Total  311  297 

Fourth  District 

B.  J.  Hein,  M.D.,  Toledo,  Councilor 

Defiance  16  16 

Fulton  19  18 

Henry  11  14 

Lucas  311  221 

Ottawa  13  13 

Paulding  10  11 

Putnam  24  25 

Sandusky  37  29 

Williams  20  16 

Wood  33  32 


Total  494  395 

Fifth  District 

Harry  V.  Paryzek,  M.D.,  Cleveland,  Councilor 

Ashtabula  38  40 

Cuyahoga  998  873 

Erie  34  29 

Geauga  10  10 

Huron  .... 18  18 

Lake  21  18 

Lorain  101  95 

Medina  25  20 

Trumbull  52  41 


Total  ...rr 1297  1144 

Sixth  District 

Harry  S.  Davidson,  M.D.,  Akron,  Councilor 

Ashland  21  18 

Holmes  8 7 

Mahoning  181  188 

Portage  25  26 

Richland  55  56 

Stark  ; 177  155 

Summit  249  225 

Wayne  45  45 


Total  761  720 


Seventh  District 

E.  B.  Shanley,  M.D.,  New  Phila.,  Councilor 
Paid  Membership 


for 

to  Aug.  12, 

County 

1932 

1933 

Belmont  

Carroll  (With  Stark  Co. 

. 55 

48 

Society)  

.... 

Columbiana  

._  51 

49 

Coshocton  

..  24 

20 

Harrison  

..  7 

7 

Jefferson  

__  42 

44 

Monroe  

..  9 

10 

Tuscarawas  

..  43 

46 

Total  

_.  230 

224 

Eighth  District 


E.  R.  Brush,  M.D.,  Zanesville,  Councilor 


Athens • _ . 

36 

34 

Fairfield  

33 

31 

Guernsey  

29 

30 

Licking  

49 

45 

Morgan  

9 

10 

Muskingum  

51 

48 

Noble  (With  Washington 

Co.  Society)  

2 

1 

Perry  

20 

19 

Washington  

36 

35 

Total  

265 

253 

Ninth  District 


I.  P. 

Seiler,  M.D.,  Piketon, 

Councilor 

Gallia  

22 

23 

Hocking 

14 

13 

Jackson  ... 

17 

12 

Lawrence 

17 

16 

Meigs  - 

12 

13 

Pike  

9 

6 

Scioto  

76 

63 

Vinton  

4 

3 

Total 

171 

149 

Tenth  District 

S.  J.  Goodman,  M.D.,  Columbus,  Councilor 


Crawford  27  28 

Delaware  24  19 

Franklin  424  382 

Knox  26  25 

Madison  13  12 

Morrow  6 7 

Pickaway  11  10 

Ross  37  36 

Union  17  16 


Total  585  535 


GRAND  TOTAL..  .5352  4920 


CKE asocxxxxiooooooooocxxxxDOocooociocxjaaxxxxDoooco^ 

l^^The  President's  P&gef|§p  ( 

A Personal  Communication  to  the  Membership  from 

C.  L.  Cummer,  M.D.,  President-Elect,  Cleveland,  Ohio 


Are  you  in  doubt  about  going  to  Akron  for  the  annual  meeting?  If  you  are,  please 
read  this;  it  is  addressed  especially  to  you.  Look  over  the  program  which  was  printed 
in  the  August  issue  and  ask  yourself  if  you  can  afford  to  miss  the  scientific  opportuni- 
ties it  offers.  It  has  been  carefully  arranged  so  that  you  can  hear  instructive  talks 
of  practical  interest  on  problems  which  constantly  face  you,  and  the  schedule  has  been 
arranged  to  avoid  conflict  in  time  assigned  to  papers  of  leading  interest  to  the  general 
practitioner.  Glance  at  the  schedule  of  clinics  arranged  by  our  Akron  colleagues  and 
weigh  the  opportunities  presented  for  seeing  bed-side  or  operating  room  demonstra- 
tions, presented  by  men  who,  like  yourself,  are  meeting  the  daily  problems  of  practice. 

Osier  said  that  we  doctors  do  not  “take  stock”  often  enough,  and  are  very  apt  to 
carry  on  our  shelves  stale,  out-of-date  goods.  The  medical  society,  he  added,  helps 
to  keep  a man  up  to  the  times,  and  enables  him  to  refurnish  his  mental  shop  with  the 
latest  wares;  it  keeps  his  mind  open  and  receptive,  and  counteracts  that  tendency  to 
premature  senility  which  is  apt  to  overtake  a man  who  lives  in  a routine.  This  is 
the  strongest  argument  we  can  make  for  attendance  at  the  annual  meeting. 

You  may  have  had  many  sober  thoughts  as  to  the  economic  side  of  medicine  during 
the  last  few  years.  You  may  have  pondered  the  important  matters  of  income  and  ex- 
pense, and  had  misgivings  about  the  encroachments  upon  that  domain  of  private  prac- 
tice which  we  physicians  have  long  tended  faithfully  and  which  we  feel  to  be  our 
own.  Perhaps  the  shortage  of  currency,  be  it  inflated  or  otherwise,  has  been  a factor 
in  making  your  plans.  Then  by  all  means  it  is  you  who  should  attend.  See  what 
is  provided  for  your  enlightment  on  this  score  and  I am  sure  that  you  will  decide 
that  the  budget  will  stand  the  small  additional  strain. 

If  you  are  an  officer  of  your  county  society  or  a delegate  or  alternate,  the  call  of 
duty  is  an  especially  compelling  one.  Your  attendance  is  vitally  important,  for  both 
the  State  Association  and  your  colleagues  at  home  depend  upon  you  to  raise  your  voice 
or  cast  your  vote  in  the  decision  of  the  policies  which  will  guide  organized  medicine 
in  this  state  during  the  coming  year,  possibly  for  many  years  to  come.  It  is  you  in 
turn  who  can  go  home  to  your  local  society  and  keep  all  working  together  in  harmony 
and  effectiveness  for  the  same  purposes. 

Furthermore,  your  attendance  at  Akron  will  be  the  best  evidence  of  your  genuine 
loyalty  and  interest  and  will  encourage  those  who  have  striven  in  your  interest 
during  the  past  difficult  fifteen  months.  It  will  aid  both  you  and  them  in  the  year 
which  lies  ahead  of  us. 

And  finally,  the  medical  men  of  Akron  and  Summit  County  have  waited  long  for 
the  chance  to  be  your  hosts.  They  wish  to  show  you  their  attractive  city.  They  have 
made  careful  plans  to  make  your  stay  pleasant  and  profitable.  Let’s  accept  their 
hospitality  in  a whole-hearted  way.  Can’t  we  count  on  seeing  you  in  Akron? 


586 


September,  1933 


State  News 


587 


High  Spots  of  Program  and  Entertainment  Features  of 
Eighty^Seventh  Annual  Meeting,  Ohio  State 


September  7 and  8,  Akron,  Ohio 


WEDNESDAY,  SEPTEMBER  6 

Medical  and  surgical  clinics  at  various  Akron  hospitals  by  members  of  the 
Summit  County  Medical  Society. 

Annual  tournament  of  the  Ohio  State  Medical  Golfing  Association  at  the 
Portage  Country  Club. 

THURSDAY,  SEPTEMBER  7 

Opening  session  of  Annual  Meeting  and  first  meeting  of  the  House  of 
Delegates,  10  a.  m.,  Parlor  E,  northeast  corner,  third  floor,  Mayflower  Hotel. 

Organization  Luncheon  for  officers  and  legislative  and  medical  defense 
committeemen  of  the  component  county  medical  societies  and  academies  of 
medicine,  state  officers  and  district  councilors,  members  of  the  special  and  stand- 
ing committees  of  the  State  Association,  members  of  the  House  of  Delegates, 
and  officers  of  the  six  Scientific  Sections,  at  12  o’clock  noon,  Ballroom,  May- 
flower Hotel,  to  be  followed  by  an  address  by  Dr.  Geo.  Edw.  Follansbee,  Cleve- 
land, chairman  of  the  Judicial  Council, American  Medical  Association,  on  prob- 
lems of  professional  relations,  economics,  contract  practice,  hospital  problems, 
and  similar  timely  medico-social  questions. 

Sessions  of  the  six  Scientific  Sections,  2 p.  m.,  at  Mayflower  Hotel,  Polsky’s 
Auditorium  and  O’Neil’s  Auditorium.  i 

Annual  Banquet,  6 :30  p.  m.,  Ballroom,  Mayflower  Hotel,  to  be  followed  by 
annual  addresses  of  the  president-elect,  Dr.  C.  L.  Cummer,  Cleveland,  and  the 
retiring  president,  Dr.  H.  M.  Platter,  Columbus;  an  address  by  Dr.  Olin  West, 
Chicago,  secretary  and  general  manager  of  the  American  Medical  Association, 
and  an  informal  reception,  dancing  and  other  entertainment. 

FRIDAY,  SEPTEMBER  8 

General  Scientific  Session,  8 :30  a.  m.,  Ballroom,  Mayflower  Hotel,  at  which 
seven  papers  of  general  interest  will  be  presented. 

General  Scientific  Session,  1 :30  p.  m.,  Ballroom,  Mayflower  Hotel,  the  pro- 
gram to  be  presented  by  members  of  the  teaching  staff,  School  of  Medicine, 
Western  Reserve  University,  on  the  subject  “Intestinal  Obstruction”. 

Second  and  final  session  of  the  House  of  Delegates,  3:30  p.  m.,  Parlor  E., 
Mayflower  Hotel. 

Hs  H*  ijc 

Registration  Headquarters,  southwest  corner  of  second  floor,  Mayflower 
Hotel,  immediately  adjoining  the  Ballroom. 

Exhibits  in  Exhibit  Hall,  near  Ballroom,  Mayflower  Hotel. 

Scientific  Exhibits,  fifth  floor,  Mayflower  Hotel. 

* * * * 

Admission  to  all  sessions  will  be  by  badge  only,  obtainable  at  Registration 
Headquarters  upon  presentation  of  1933  membership  card. 


Special  Aiuioimcements  for  Annual  Meeting  In  Akron; 
Thursday  and  Friday,  September  7 ■and  8 


YOUR  ATTENTION  IS  CALLED  ESPE- 
CIALLY TO  THE  DETAILED  PROGRAM 
WITH  TIME  SCHEDULE  FOR  THE  ANNUAL 
MEETING,  PUBLISHED  IN  THE  AUGUST 
ISSUE  OF  THE  JOURNAL,  AS  WELL  AS 
THE  SCHEDULE  OF  RATES  AND  ACCOM- 
MODATIONS OF  AKRON  HOTELS,  PUB- 
LISHED IN  THE  JULY  AND  AUGUST  IS- 
SUES OF  THE  JOURNAL. 

The  Banquet  on  Thursday  Evening, 
September  7 

Special  attention  is  called  to  the  program  fol- 
lowing the  banquet  at  the  Mayflower  Hotel  on 
Thursday  evening,  September  7,  at  6:30  P.  M.,  at 
which  the  president-elect,  Dr.  C.  L.  Cummer,  and 
the  retiring  president,  Dr.  H.  M.  Platter,  will 
present  their  annual  addresses.  These  will  be  fol- 
lowed by  an  address  by  Dr.  Olin  West,  secretary 
and  general  manager  of  the  American  Medical 
Association,  on  “The  Need  for  Unity  in  the 
Medical  Profession  in  Facing  the  Economic  and 
Social  Problems  of  the  Day”. 

The  local  Banquet  Committee  anticipates  that 
the  reservations  for  the  banquet  will  be  in  great 
demand.  It  announces  that  there  will  be  600  ban- 
quet tickets  on  sale  at  $2.00  per  plate,  which  will 
include  the  banquet,  entertainment,  dancing,  etc., 
the  music  to  be  furnished  by  the  celebrated  Denny 
Thompson  orchestra. 

A number  of  valuable  prizes  are  to  be  awarded. 
Each  banquet  ticket  is  numbered  and  will  be 
taken  at  the  door.  These  numbers  will  be  drawn 
sometime  during  the  banquet  and  the  prizes  then 
awarded.  As  the  banquet  tickets  are  limited,  it  is 
requested  by  the  local  committee  that  members  or 
groups  wishing  reservations,  communicate  with 
Dr.  J.  H.  Weber,  Second  National  Bldg.,  Akron, 
Ohio,  enclosing  check. 

Golf  Tournament,  September  6 

The  thirteenth  annual  Tournament  of  the  Ohio 
State  Medical  Golfers’  Association  will,  as  stated 
in  earlier  issues  of  The  Journal,  be  held  at  the 
Portage  Country  Club  on  Wednesday,  September 
6.  This  club  is  Championship  course,  located 
within  the  city  limits  on  North  Portage  Path 
about  ten  minutes  from  the  downtown  section  of 
the  city.  Tee  off  at  8:00  A.M.  The  male  mem- 
bers of  the  Ohio  State  Medical  Association  who 
are  not  already  members  are  eligible  on  payment 
of  $2.00  to  life  membership  in  the  Ohio  State 
Medical  Golfers’  Association.  This  can  be  paid 
to  the  Secretary,  Dr.  John  B.  Morgan,  Medical 
Arts  Bldg.,  Cleveland,  or  on  the  first  tee  the  day 
of  the  tournament. 


The  charge  for  the  tournament  this  year  for 
members  will  be  $5.00,  which  covers  luncheon,  din- 
ner, green  fees  and  expenses  exclusive  of  caddy. 

The  local  committee  has  been  very  successful  in 
obtaining  one  of  the  very  best  list  of  prizes  ever 
held  for  a tournament,  and  they  are  well  distri- 
buted so  that  this  year  the  sharks  will  have  to 
divide  with  the  100  man  and  over.  Men  who  come 
singly  will  have  suitable  foursomes  arranged  for 
them,  and  are  urged  to  attend. 

Scientific  Exhibits 

The  Committee  on  Scientific  Exhibits  reports 
that  at  least  ten  excellent  and  unusual  scientific 
exhibits  have  been  arranged  in  connection  with 
the  annual  meeting.  Attention  of  those  in  at- 
tendance is  also  called  to  the  interesting  com- 
mercial exhibits.  Preliminary  announcement  of 
most  of  these  exhibits  was  carried  in  a preceding 
issue  of  The  Journal. 

Entertainment  for  Lady  Visitors 

On  Wednesday  morning,  September  6,  golf  will 
be  available  for  any  of  the  visiting  women  at  the 
Fairlawn  Country  Club  at  9:00  A.M.,  followed  by 
luncheon  at  the  same  place,  at  a total  cost  of 
$1.75  exclusive  of  the  caddy. 

On  Thursday,  September  7,  there  will  be  a 
luncheon  at  the  Portage  Country  Club,  at  a charge 
of  85  cents  each.  Following  this  will  be  a visit 
to  some  of  the  noted  gardens  in  the  vicinity  and 
other  points  of  interest.  Should  the  weather  be 
inclement,  there  will  be  bridge  or  other  entertain- 
ment. 

On  Friday  morning,  September  8,  it  is  planned, 
if  weather  permits,  to  give  wives  of  visiting  mem- 
bers who  desire  it,  a trip  in  one  of  the  Goodyear 
blimps. 

There  will  be  a luncheon  for  women  physicians 
at  the  Mayflower  Hotel  on  Friday,  September  8, 
at  a cost  of  $1.00  each. 

Bring  Your  1933  Membership  Card 

All  members  are  again  especially  urged  to  be 
sure  and  bring  their  1933  membership  cards  in 
the  Ohio  State  Medical  Asociation,  in  order  to 
facilitate  registration.  Only  those  eligible  to  at- 
tend who  have  registered  will  be  eligible  for  ad- 
mission to  the  various  sessions. 

Special  Badges 

Through  the  courtesy  and  kindness  of  the  B. 
F.  Goodrich  Company,  Akron,  attractive  and  dis- 
tinctive badges  are  furnished  for  the  annual 
meeting.  These  badges  are  characteristic  of 
Akron  as  the  “Rubber  City”.  To  Dr.  Don  B. 
Lowe  of  the  B.  F.  Goodrich  Company  goes  the 
credit  for  the  generous  courtesy  extended  by  his 
company. 


588 


September,  1933 


State  News 


589 


Program  of  Clinics  Preliminary  to  the 
Ohio  State  Medical  Meeting, 

Akron,  Ohio 

Clinics  will  be  held  at  the  Akron  hospitals  dur- 
ing the  whole  day  of  September  6 (in  connection 
with  the  Annual  Meeting  of  the  Ohio  State  Med- 
ical Association  on  September  7 and  8,  starting 
at  nine-thirty  in  the  morning  and  two  in  the 
afternoon  and  lunch  will  be  served  the  visiting 
members  at  all  hospitals.  A preliminary  program 
is  here  given  but  is  subject  to  change  and  addi- 
tion. On  the  night  before  and  the  day  of  the 
clinics,  a complete  program  will  be  available  at 
all  hotels  and  hospitals. 

CITY  HOSPITAL 

MEDICINE 

9.30 — 11:00 — Presentation  of  neurological  cases. 

(1)  Thallium  poisoning  two  years  after  onset. 

(2)  Polyneuritis  and  Disseminated  Myelitis. 

(3)  Marie’s  Cerebellar  Ataxia — family  his- 
tory and  cases  from  family,  R.  E.  Pinkerton. 

9:30 — 11:00 — Diabetic  clinic  with  demonstra- 
tions of  vascular  complications  such  as  gang- 
rene, F.  A.  Smith. 

SURGERY 

9:30 — 1:00 — Operative  Surgical  and  Gynecologi- 
cal Clinic,  J.  H.  Weber. 

9:30 — 11:00 — Operative  Proctologic  Clinic,  R.  H. 
Smith. 

10:00—12:00 — Bone  and  Joint  Surgery  and  dem- 
onstration of  Fractures  and  Orthopedic 
Cases,  H.  R.  Conn,  W.  A.  Hoyt,  R.  V.  Luce 
and  W.  A.  Parks. 

11:00—1:00 — Operative  General  Surgical  Clinic, 
C.  C.  Pinkerton. 

11:00 — 12:30 — Operative  Urologic  Clinic,  C.  E. 
Jelm. 

2:00 — 5:00 — Operative  Surgical  and  Gynecologi- 
cal Clinic,  L.  R.  C.  Eberhard. 

2:00—5:00 — Operative  Clinic — Chest  and  Sym- 
pathetic Nerve  Surgery,  C.  R.  Steinke. 

EYE,  EAR,  NOSE  AND  THROAT 
9:30 — 11:00 — Tonsillectomies.  General  and  local 
anesthesia,  L.  E.  Brown. 

9:30 — 12:00 — Bronchoscopy  Clinic,  M.  J.  Pierson. 
2:00 — 3:30 — Tonsillectomies.  General  and  local 
anesthesia,  L.  A.  Witzeman. 

DEPARTMENT  OF  PATHOLOGY 
9:30 — 5:00 — General  Pathological  Exhibit,  E.  L. 
Saylor. 

3:30 — 5:00 — Tumor  Clinic  under  direction  of  Dr. 
E.  L.  Saylor. 

Luncheon  will  be  served  to  guests  at  the  hospital 
at  1 :00  P.  M. 

CHILDREN’S  HOSPITAL 

SURGERY 

9:30 — 11:00 — Operative  Clinic  Surgery,  J.  D. 
Smith. 

11:00 — 11:30 — Urological  Conditions  in  Children, 
5th  Floor,  H.  H.  Musser. 

Demonstration  of  charts  showing  end  result 
of  operations  in  300  cases  of  empyema  in 
children,  C.  R.  Steinke. 

EYE,  EAR,  NOSE  AND  THROAT 
11:00 — 11:30 — Demonstration  of  Slides.  Second 
Floor,  R.  F.  Thaw. 


11:30 — 12:30 — Operative  Demonstration  of  New 
Technique  for  Strabismus — Surgery,  R.  F- 
Thaw. 

12:30 — 1:00 — -Demonstration  of  Operated  and 
non-operated  Strabismus  cases — 5th  Floor, 
U.  D.  Seidel. 

PEDIATRICS 

9:30 — 10:30 — Ward  Rounds,  E.  A.  Weeks. 

10:30 — 11:30 — Ward  Rounds,  J.  M.  Ulrich. 

11:30 — -12:00 — Review  of  Pyloric  Stenosis  Cases 
— 5th  Floor,  R.  S.  Friedley. 

1:00 — 2:00 — Lunch.  Served  at  Children’s  Hos- 
pital dining  room. 

ORTHOPEDICS 

2:00 — 5:00 — Demonstration  of  Orthopedic  cases 
showing  end  results,  W.  A.  Hoyt  and  F.  B. 
Roberts. 

Recent  advances  in  Diagnosis  and  Treatment 
in  the  Acute  Stage  of  Poliomyelitis,  J.  G. 
Kramer. 

Treatment  of  Muscular  Dystrophy  with 
Glycocoll — 5th  Floor,  C.  E.  Krill. 

PEOPLE’S  HOSPITAL 

Clinics  from  9:30 — 1:00. 

Lunch  served  from  1:00 — 2:00. 

SURGERY 

J.  G.  Blower  J.  D.  Smith  R.  H.  McKay 

B.  H Hildreth 

MEDICINE 

E.  B.  Dyson  C.  E.  Held  S.  E.  McMaster 

J.  C.  McClelland 

OBSTETRICS 

L.  L.  Bottsford 

RECTAL  SURGERY 

K.  H.  Harrington 

GENITO  URINARY  SURGERY 
Samuel  Miller 

PATOLOGY  AND  LABORATORY 

F.  C.  Potter 

ROENTGENOLOGY 

E.  L.  Voke 

EYE,  EAR,  NOSE  AND  THROAT 
R.  D.  Anderson  C.  M.  Clark  Dallas  Pond 
J.  R.  Shoemaker  J.  E.  Springer  L.  A.  Witzeman 

ST.  THOMAS  HOSPITAL 

SURGERY 

9:00 — Gastro-intestinal  Surgery,  C.  R.  Steinke. 
10:00 — Thyroidectomy,  H.  H.  Musser. 

11:00 — Hysterectomy;  Nephrectomy,  E.  C. 
Banker. 

EYE,  EAR,  NOSE  AND  THROAT 
9:30 — Radical  Mastoid,  J.  R.  Shoemaker. 

11:30 — Muscle  Advancement,  L.  A.  Witzeman. 
1:00 — Lunch  at  the  hospital. 

MEDICINE 

2:00 — Septicemia;  Acute  pulmonary  disease,  A. 
J.  J.  Devaney. 

3:00 — Diseases  of  the  Blood,  J.  E.  Monnig. 

3:30 — Cardio-vascular  disease,  S.  Morganroth. 
4:00 — Diabetes  in  the  younger  age  groups,  F.  A. 
Smith. 

ROENTGENOLOGY 
3:00 — Silicosis,  P.  C.  Langan. 

SPRINGFIELD  LAKE  SANATORIUM 

9:30 — 10:30 — Dry  clinic.  Joint  cases,  W.  A. 
Hoyt. 

10:30 — Pneumothorax  in  treatment  of  tuber- 
culosis, J.  R.  Villani  and  T.  L.  Bliss. 


The  Ohio  State  Medical  Journal 


September,  193o 


590 

10:30 — 11:30 — Dry  clinic.  Chest  Surgery,  C.  R. 
Steinke. 

1 :00 — Lunch. 

2:00 — Ward  Walks  and  Demonstrations,  C.  L. 
Hyde,  J.  R.  Villani  and  T.  L.  Bliss. 
Transportation  will  be  furnished  from  the  May- 
flower Hotel. 

Clinic  Committee, 

W.  A.  Hoyt,  Chairman 
D.  B.  Lowe, 

F.  B.  Roberts, 

H.  H.  Musser, 

J.  G.  Blower. 


Six  Ohio  Physicians  Scheduled  to  Address 
Inter-State  Assembly 

International  Assembly  of  the  Inter-State  Post- 
graduate Medical  Association  of  North  America 
will  be  held  in  the  Public  Auditoidum,  Cleveland, 
October  12  to  20,  inclusive.  A registration  fee  of 
$5.00  will  be  assessed  those  attending.  Sessions 
will  be  held  daily,  starting  at  8 a.  m.,  1 p.  m.  and 
7 p.  m.  On  Saturday,  October  21,  post-assembly 
clinics  will  be  presented  by  the  staffs  of  various 
Cleveland  hospitals. 

Several  Ohio  physicians  will  take  part  in  the 
program,  namely:  Dr.  R.  W.  Scott,  Dr.  Bernard 
H.  Nichols,  Dr.  Joseph  T.  Wearn,  Dr.  Louis  J. 
Karnosh,  Dr.  George  W.  Crile,  and  Dr.  William 

E.  Lower,  all  of  Cleveland. 

Among  others  who  will  address  the  assembly 
are:  Drs.  Harlow  Brooks,  New  York;  Charles  IT. 
Frazier,  Philadelphia;  John  M.  T.  Finney,  Balti- 
more; Arthur  D.  Bevan,  Chicago;  Charles  A. 
Elliott,  Chicago;  Fred  W.  Rankin,  Lexington, 
Ky. ; E.  Starr  Judd,  Rochester,  Minn.;  Cyrus  C. 
Sturgis,  Ann  Arbor,  Mich.;  Hugh  Cabot,  Roches- 
ter, Minn.;  Leonard  G.  Rowntree,  Philadelphia; 
Arthur  C.  Christie,  Washington,  D.  C.;  Burton  J. 
Lee,  New  York;  W.  McKim  Marriott,  St.  Louis; 
Frank  H.  Lahey,  Boston;  Elliott  C.  Cutler,  Bos- 
ton; Charles  H.  Mayo,  Rochester,  Minn.;  Dean  D. 
Lewis,  Baltimore;  William  D.  Haggard,  Nash- 
ville, Tenn.;  Elliott  P.  Joslin,  Boston;  Lewellys 

F.  Barker,  Baltimore;  Henry  A.  Christian,  Bos- 
ton; John  F.  Erdman,  New  York,  and  William  J. 
Mayo,  Rochester,  Minn. 


Military  Course  for  Reserve  Officers 

Inasmuch  as  no  medico-military  course  of  in- 
active duty  training  will  be  held  in  Ohio  this  year, 
Ohio  medical  reserve  officers  will  be  interested  in 
the  announcement  of  Colonel  George  A.  Skinner, 
corps  surgeon  of  the  Seventh  Corps  Area,  U.S.A., 
Omaha,  Nebraska,  that  the  ti-aining  school  for 
medical  reserve  officers  which  has  been  held  for 
the  past  four  years  at  the  Mayo  Clinic,  Rochester, 
Minnesota,  will  again  be  held  this  year  from 
October  1 to  October  14,  inclusive. 

Although  the  course  is  sponsored  by  and  under 
the  auspices  of  the  Seventh  Corps  Area,  it  is 
probable  that  the  benefits  of  the  two-weeks  train- 
ing may  be  extended  to  some  reserve  officers  of  the 


Fifth  Corps  Area  which  embraces  the  stc  .es  of 
Ohio,  Kentucky,  West  Virginia  and  Indiana. 

Applications  should  be  made  to  Colonel  Skin- 
ner and  should  state  the  character  of  the  work 
the  candidate  desires  to  follow  in  the  morning 
hours  which  will  be  devoted  exclusively  to  profes- 
sional subects.  The  afternoon  hours  will  be  taken 
up  with  medico-military  subjects,  and  the  eve- 
ning hours  are  covered  in  a lyceum  course  of  gen- 
eral interest. 

The  bulletin  states  that  it  will  be  equally  ap- 
plicable to  general  practitioners  and  specialists 
and  that  100  hours  credit  will  be  given. 

Ohio  reserve  officers  interested  in  enrolling  in 
the  training  school  are  advised  to  communicate  as 
soon  as  possible  with  Colonel  Skinner  in  order  to 
obtain  complete  information  concerning  the  course, 
eligibility  for  enrollment,  etc. 


County  Liable  for  Medical  Care  Rendered 
in  Rabies  Cases 

In  a recent  opinion  relative  to  the  liability  of 
the  county  commissioners  in  rabies  cases,  At- 
torney General  John  W.  Bricker  held: 

(1) .  Under  Section  5852,  General  Code,  county 
commissioners  are  bound  to  pay  valid  claims  for 
injuries  to  persons  bitten  or  injured  by  dogs 
afflicted  with  rabies,  even  though  such  persons  are 
financially  able  to  pay  the  physician  for  the  Pas- 
teur treatment  received. 

(2) .  The  county  commissioners  are  bound  to 
pay  valid  claims  in  such  cases  even  though  the 
persons  injured  are  the  owners  of  the  dog  so 
afflicted. 

(3) .  Where  the  commissioners  have  reimbursed 
a person  bitten  by  a dog  afflicted  with  rabies  for 
medical  attention,  there  is  no  legal  authority  for  a 
recovery  by  the  commissioners  against  the  owner 
of  the  dog. 

(4) .  Claims  filed  with  commissioners  in  such 
cases  are  not  valid  unless  itemized;  filed  within 
four  months  by  the  person  injured  by  the  dog,  his 
parent  or  guai'dian  if  a minor,  or  the  adminis- 
trator or  executor  of  a deceased  person,  and 
accompanied  by  the  affidavit  of  the  person  bitten 
or  his  parent,  guardian,  administrator  or  executor, 
and  an  affidavit  of  the  attending  physician. 


District  Meeting  Postponed 

The  Sixth  Councilor  District  Medical  Society 
(Union  Medical  Association)  in  view  of  the  an- 
nual meeting  of  the  State  Medical  Association  in 
Akron  on  Thursday  and  Friday,  September  7 and 
8,  has  postponed  its  regular  semi-annual  Fall 
meeting  until  sometime  in  January,  according  to 
announcement  received  from  Dr.  J.  H.  Seiler, 
Akron,  secretary  of  the  district  society.  At  the 
time  of  the  annual  meeting  of  the  State  Associa.- 
tion  in  Akron,  Dr.  A.  E.  Brant,  Youngstown, 
president  of  the  district  society,  will  call  a short 
business  session. 


'Workmen's  Compensation  Developments  Following  Audit 
of  Fund  and  Increase  in  Premiums  Assessed 
Against  Employers 


New  basic  premium  rates,  approximately  28.8 
per  cent  higher  than  those  charged  during  the 
year  ending  June  30,  1933,  have  been  ordered  by 
the  State  Industrial  Commission  and  will  be  as- 
sessed Ohio  employers  covered  by  the  state  work- 
men’s compensation  fund  during  the  ensuing  year. 

The  increase  in  premium  rates  was  authorized 
by  the  Commission  on  July  28,  effective  as  of 
July  1,  1933,  upon  the  recommendation  of  Miles 
M.  Dawson,  consulting  actuary,  New  York  City, 
after  an  actuarial  survey  of  the  state  insurance 
fund. 

In  announcing  the  new  rates,  the  Commission 
pointed  out  that  the  increase  is  necessitated  be- 
cause of  “the  greater  demand  upon  the  Fund  for 
benefits  to  injured  workers  and  decreasing  wage 
levels  against  which  premium  l'ates  are  applied”. 

Total  receipts  of  the  pi'ivate  employers’  fund 
for  the  year  1932,  as  showxi  by  the  Dawson  audit, 
amounted  to  $8,140,584.09  while  the  total  dis- 
bursements amounted  to  $14,406,006.65,  there  be- 
ing an  excess  of  disbursements  over  receipts  of 
$6,265,422.56.  The  catastrophe  and  general  sur- 
plus was  reduced  during  1932  from  $2,634,131.93 
to  $115,908.33. 

Commenting  on  reasons  for  the  increase  in 
basic  rates  and  in  general  on  the  serious  prob- 
lems which  have  confronted  it,  the  Commission 
said : 

“The  scarcity  of  employment  available  to  in- 
jured workers  has  resulted  in  prolonging  the 
healing  period  and  causing  partial  disabilities  to 
have  a greater  influence  in  reducing  the  earning 
capacity  of  the  injured  upon  recovery.  Older 
claims  as  well  as  new  claims  have  shown  an  in- 
creased cost  tendency.  The  compensation  to  the 
injured  worker  has  increased  10.4  per  cent  during 
the  year.  The  medical  and  hospital  cost  of  claims 
has  developed  a higher  increase  of  14.5  per  cent. 
Since  April  1,  1933,  medical  bills  have  been  ap- 
pi'oved  for  20  per  cent  below  the  previous  stand- 
ard. 

“It  should  be  remembered  that  the  rates  are 
based  on  experiences  covering  the  last  five-year 
period  preceding  revision.  This  statement  will 
bring  to  mind  the  fact  that  the  last  five-year 
pei’iod  included  thi’ee  extremely  lean  yeai’s,  namely 
1930,  1931  and  1932.  Dui'ing  those  thi’ee  years  we 
were  confronted  with  a situation  almost,  if 
not  wholly  unparalleled  in  the  history  of  this 
country.  Payrolls  that  ran  into  millions  have 
been  depleted  into  thousands;  payrolls  that  ran 
well  up  into  thousands  have  dropped  into  the 
hundreds  through  unemployment  and  rapidly  and 
continually  decreasing  payrolls  on  which  prem- 
iums are  based.  Business  failures  have  been  al- 


most innumerable,  leaving  claims  still  under  pay- 
ments of  compensation  with  no  premiums  forth- 
coming from  the  employers  represented  by  those 
claims.  Even  the  men  employed  have  of  neces- 
sity been  reduced  heavily  in  daily  and  hourly 
rates  of  wage. 

“Despite  the  necessity  of  the  increase  an- 
nounced, the  compensation  fund  for  Ohio  is  re- 
latively solvent,  but  as  safety  is  a slogan  for  the 
reduction  of  industrial  accidents  so  it  is  also  the 
watchword  for  the  fund.  The  future  can  only  be 
visioned  by  the  experiences  of  the  past  and  while 
it  is  believed  and  it  is  indicated  that  the  crisis 
has  passed,  no  one  can  read  the  future  definitely. 
Actuarially  the  experiences  of  the  three  lean 
years  make  safety  measures  imperative.  Reserves 
have  not  been  wiped  out  but  they  have  been  de- 
pleted and  no  one  can  say  that  such  disasters  as 
those  of  the  Millfield  Mine  and  the  Cleveland 
Clinic  will  not  recur  in  some  other  unfortunate 
and  unforeseen  locality.  For  such  possible 
emergencies  provision  must  be  made  without 
awaiting  further  depletion  of  reserves.” 

FOURTH  INCREASE  IN  FOUR  YEARS 

The  28.8  per  cent  increase  in  the  average  basic 
premium  rate  level  is  the  fourth  increase  au- 
thorized in  the  past  four  years.  On  July  1,  1930, 
the  basic  premium  rate  was  increased  5 per  cent; 
on  July  1,  1931,  10  per  cent,  and  on  July  1,  1932, 
17  per  cent,  making  with  the  1933  increase,  a total 
increase  of  60.8  per  cent  in  the  premiums  as- 
sessed Ohio  employers,  all  of  whom  have  been  con- 
fronted with  other  serious  financial  problems  as 
a result  of  the  long  period  of  adverse  business 
conditions. 

Amplifying  some  of  the  reasons  for  the  prem- 
ium rate  increase,  the  Commission  points  out: 

“In  recent  years  the  fund  has  been  receiving  an 
increasing  burden  in  providing  the  guarantee  of 
compensation  to  injured  workers  of  those  em- 
ployers who  were  amenable  to  the  Act  but  failed 
to  contribute  premiums  to  the  fund.  Likewise  the 
fund  has  been  required  to  meet  obligations  un- 
collectable  from  employers  for  additional  awards 
of  compensation  granted  to  employes  for  accidents 
due  to  violations  of  specific  safety  requirements.” 

Referring  to  the  increase  in  medical,  hospital 
and  nursing  costs,  the  Commission  declared: 

“This  increase  is  occasioned  to  a great  extent 
by  the  injured  worker  who,  unable  to  obtain  re- 
employment and  over-stressing  the  extent  of  dis- 
ability, thereby  prolongs  treatment  and  hospitali- 
zation in  many  instances.  This  condition  has  not 
been  peculiar  to  Ohio  but  is  a nation-wide  prob- 
lem and  has  given  all  workmen’s  compensation 


591 


592 


The  Ohio  State  Medical  Journal 


September,  1933 


carriers  great  concern,  they  having  experienced 
similar  abnormal  increase  in  medical  and  hos- 
pital costs.” 

Legal  problems  also  have  added  to  the  diffi- 
culties of  the  Commission,  it  is  pointed  out. 

“Through  liberalized  interpretation  of  the  law 
laid  down  by  the  courts,”  it  is  stated,  “there  has 
been  during  the  period  of  the  depression,  constant 
and  intensified  effort  on  the  part  of  a great  many 
claimants  and  their  representatives  to  employ 
every  known  avenue  for  the  re-opening  of  old  and 
all  but  forgotten  claims  through  which  to  restore 
thousands  of  one-time  injured  workers  to  com- 
pensation benefits.  Even  the  ten-year  statute  of 
limitation  has  not  provided  a barrier  beyond 
which  this  effort  has  not  obtained.  Appeals  to 
the  courts  have  grown  in  astonishing  numbers 
and  without  legislative  remedy  the  scope  of  this 
drainage  upon  the  fund  is  problematical.” 

SERIOUS  PROBLEMS  STILL  UNSOLVED 

Most  of  the  members  of  the  State  Medical  Asso- 
ciation undoubtedly  are  familiar  with  the  series 
of  conferences  held  between  members  of  the  Com- 
mission and  representatives  of  the  State  Medical 
Association  previous  to  the  20  per  cent  reduction 
in  medical  and  surgical  bills. 

An  article  concerning  these  conferences  was 
published  in  the  June,  1933,  issue  of  The  Journal, 
pages  377-380,  including  a report  of  the  Special 
Workmen’s  Compensation  Committee  of  the  State 
Association  submitted  to  the  Commission,  in 
which  vigorous  protest  was  made  against  a re- 
duction in  medical  fees  and  constructive  sug- 
gestions made  for  correcting  some  of  the  con- 
ditions which  have  been  contributing  to  the 
serious  financial  problems  confronting  the  Com- 
mission. 

As  pointed  out  in  a second  article  (July,  1933, 
issue  of  The  Journal,  pages  441-444),  the  Com- 
mission, while  agreeing  that  the  recommendations 
made  by  the  State  Medical  Association  for  meet- 
ing some  of  its  difficulties  were  all  “meritorious”, 
felt  that  they  would  not  result  in  the  immediate 
solution  of  the  Commission’s  problems  and  con- 
sequently authorized  the  temporary  20  per  cent 
reduction  in  medical  fees  as  of  April  1,  1933. 

In  spite  of  the  drastic  steps  which  have  been 
taken  by  the  Commission  to  meet  its  difficulties, 
some  of  its  serious  problems  remain  unsolved. 
Due  to  the  slowness  of  industrial  recovery,  the 
income  of  the  Commission  has  increased  little,  if 
any,  necessitating  delay  in  the  payment  of  com- 
pensation and  medical,  nursing  and  hospital  fees. 

Moreover,  a new  system  of  paying  medical 
bills  inaugurated  by  the  Commission,  calling  for 
the  payment  of  such  bills  but  once  a month,  has 
slowed  up  the  payment  of  physicians’  fees,  re- 
sulting in  some  instances  in  a delay  of  almost  two 
months  from  the  time  a bill  is  approved. 

Members  of  the  Commission  are  hopeful  of 
alleviating  this  condition  in  the  near  future.  In 
addition  to  unfavorable  financial  conditions,  two 


other  factors  have  contributed  to  the  delay  in  the 
payment  of  bills,  it  is  pointed  out.  One  of  these  is 
the  large  amount  of  additional  work  involved  in 
settling  claims  and  bills  which  accumulated  last 
Spring  when  the  Commission  found  it  necessary 
to  suspend  for  several  weeks  all  payments  from 
the  fund.  Another  is  the  shortage  of  office  per- 
sonnel. 


Licensed  to  Practice  In  Ohio  Through 
Reciprocity 

The  following  physicians  have  been  licensed 
through  reciprocity  by  the  State  Medical  Board 
to  practice  medicine  and  surgery  in  Ohio: 

Ezra  R.  Austin,  Circleville,  University  of 
Louisville;  Augustus  J.  Baker,  Cleveland,  St- 
Louis  University;  William  H.  Barnard,  Toledo, 
Vanderbilt  University;  Charles  A.  Bayer,  To- 
ledo, St.  Louis  University;  James  0.  Beavis, 
Dayton,  University  of  Michigan;  Charles  F. 
Berg,  Youngstown,  University  of  Pittsburgh; 
John  W.  Burrows,  Cleveland,  St.  Loius  Uni- 
versity; Theodore  Berg,  Cadiz,  University  of 
Colorado;  Harold  R.  Bolman,  Monroeville,  Jeffer- 
son Medical  College;  Edwin  P.  Bugbee,  Ravenna, 
Harvard  Medical  College;  Anthony  B.  Busch, 
Cincinnati,  University  of  Louisville;  Sherwood 

A.  Chamberlain,  Cincinnati,  University  of  Louis- 
ville; Paul  H.  Cope,  Elyria,  University  of  Roch- 
ester; Paul  Corso,  Salem,  St.  Louis  University; 
Joseph  C.  Fiala,  Akron,  St.  Louis  University; 
William  J.  Franke,  Anna,  University  of  Michi- 
gan; Walter  F.  Galbreath,  Findlay,  Indiana  Uni- 
versity; Emidio  L.  Gaspari,  Toledo,  Vanderbilt 
University;  Francis  E.  Gilfoy,  Cleveland,  George 
Washington  University;  Delbert  D.  Hamlin,  Al- 
liance, University  of  Louisville;  Isfrid  I.  Hof- 
bauer,  Cincinnati,  University  of  Vienna;  Gerald 

B.  Hurd,  Cleveland,  Johns  Hopkins  University; 
Ronald  Kaplan,  Cleveland,  University  of  Louis- 
ville; Frank  F.  Kennedy,  Youngstown,  Tulane 
University;  Charles  B.  Kingry,  Springfield,  Colo- 
rado University;  Ernest  Landy,  Rocky  River, 
Rush  Medical  College;  Norvil  A.  Martin,  Galli- 
polis,  Washington  University;  David  R.  Mathie, 
Newton  Falls,  University  of  Michigan;  Patrick 
J.  McCarthy,  Toledo,  St.  Louis  University;  James 
A.  McNalley,  Canton,  University  of  Kansas; 
John  F.  Miller,  Newark,  Harvard  Medical  Col- 
lege; Louis  B.  Owens,  Cincinnati,  Emory  Uni- 
versity; Benamin  Pilloff,  Cleveland,  St.  Louis 
University;  John  0.  Perkins,  Barnesville,  Jeffer- 
son Medical  College;  Francis  A.  Talaska,  Toledo, 
St.  Louis  University;  Elmer  G.  Wurst,  Defiance, 
St.  Louis  University;  John  R.  Gersack,  Hamilton, 
Indiana  University;  Harry  Goldston,  Cleveland, 
Medical  College  of  Virginia;  Lazar  Josif,  Cleve- 
land, Royal  Hungarian  University;  Arthur  A. 
Roth,  Cleveland,  St.  Louis  University;  Harold  E. 
Strieker,  University  of  Michigan;  H.  C.  Wilson, 
Columbus,  Temple  University. 


September,  1933 


State  News 


593 


Eva  F.  Collins,  M.D.,  Cleveland;  Cleveland  Uni- 
versity of  Medicine  and  Surgery,  1893;  aged  70; 
died  July  8 at  Charity  Hospital,  Cleveland,  a few 
hours  after  she  was  struck  by  an  automobile.  Dr. 
Collins  had  practiced  in  Cleveland  for  thirty 
years.  She  is  survived  by  her  husband,  two  sons 
and  two  daughters. 

Anna  M.  Dice,  M.D.,  Columbus;  Ohio  State  Uni- 
versity, College  of  Medicine,  Columbus,  1925; 
aged  50 ; member  of  the  Ohio  State  Medical  Asso- 
ciation and  the  American  Medical  Association; 
died  June  28,  of  fibroid  tumor.  Dr.  Dice  had  prac- 
ticed in  Columbus  since  her  graduation.  She  is 
survived,  by  her  husband. 

Mabel  G.  Dixey,  M.D.,  Fremont;  University  of 
Michigan,  Homeopathic  Medical  School,  Ann 
Arbor,  Michigan,  1893;  aged  66;  died  August  6 
of  heart  disease.  Dr.  Dixey  had  practiced  in  Fre- 
mont since  her  graduation  forty  years  ago. 

Willard  Clayton  Emery,  M.D.,  Kenton;  Pulte 
Medical  College,  Cincinnati,  1879;  aged  77;  died 
July  30  after  an  illness  of  three  years.  Dr.  Emei-y 
had  practiced  in  Kenton  for  nine  years.  Surviving 
are  his  widow,  three  daughters,  and  one  son,  Dr. 
C.  S.  Emery,  of  St.  Joseph,  Michigan,  and  three 
sisters. 

Jacob  D.  Fleming  M.D.,  Frazeysburg;  Columbus 
Medical  College,  Columbus,  1887;  aged  76;  former 
member  of  the  Ohio  State  Medical  Association; 
died  July  21  following  a year’s  illness.  Dr.  Flem- 
ing had  practiced  in  Frazeysburg  for  the  past 
forty-five  years.  He  was  a member  of  several 
Masonic  orders.  His  widow  and  one  son  survive 
him. 

William  Henry  Feurt,  M.D.,  Proctorville ; Miami 
Medical  College,  Cincinnati,  1876,  aged  81 ; died 
July  19  at  the  home  of  a niece  near  Portsmouth, 
where  he  had  made  his  home  for  the  past  month. 
Dr.  Feurt  practiced  at  Franklin  Furnace  before 
moving  to  Proctorville.  He  is  survived  by  two 
sons. 

Charles  U.  Hanna,  M.D.,  Zanesville;  Ohio  Medi- 
cal University,  Columbus,  1895;  aged  67;  member 
of  the  Ohio  State  Medical  Association  and  Fel- 
low of  the  American  Medical  Association,  died 
July  13  after  several  weeks’  illness  from  a heart 
ailment.  Dr.  Hanna  had  practiced  in  Zanesville 
since  1896  except  for  short  periods  spent  in  post- 
graduate work  in  Vienna,  Germany  and  France. 
Dr.  Hanna  was  active  in  church  and  fraternal 
circles,  being  a member  of  the  Central  Presby- 
terian church,  and  of  the  Masonic  lodge.  Sur- 


viving are  his  widow,  one  daughter  and  one 
brother. 

Norman  W.  Hole,  M.D.,  Alliance;  Cleveland 
College  of  Medicine  and  Surgery,  Cleveland,  1898; 
aged  64;  former  member  of  the  Ohio  State  Medi- 
cal Association;  died  August  1 of  heart  disease. 
Dr.  Hole  practiced  at  North  Jackson  from  1898  to 
1910  when  he  moved  to  Alliance.  He  was  a mem- 
ber of  the  City  hospital  staff.  He  was  a member 
of  the  Methodist  Episcopal  church  and  Alpha  Tau 
Omega  fraternity.  Besides  his  widow,  he  is  sur- 
vived by  two  sons. 

John  G.  Keller,  M.D.,  Toledo;  Toledo  Medical 
College,  Toledo,  1900;  aged  61;  member  of  the 
Ohio  State  Medical  Association  and  Fellow  of  the 
American  Medical  Asociation;  Fellow  of  the 
American  College  of  Surgeons,  and  member  o'f  the 
American  Urological  Association;  died  August  4. 
Dr.  Keller,  active  for  many  years  in  medical  or- 
ganization, was  councilor  of  the  Fourth  District 
of  the  State  Association  in  1919  and  1920.  He  was 
a member  of  the  staff  of  Toledo  hospital,  and  of 
various  Masonic  orders.  He  is  survived  by  a 
brother  and  two  sisters. 

Cary  F.  Legge,  M.D.,  Newark,  Ohio  Medical 
University,  Columbus,  1898;  aged  66;  member  of 
the  Ohio  State  Medical  Association  and  Fellow  of 
the  American  Medical  Asociation;  died  July  8 
following  an  illness  of  several  weeks.  Dr.  Legge 
had  practiced  in  Newark  since  his  graduation, 
and  had  served  three  terms  as  county  coroner. 
He  was  a member  of  the  Methodist  church;  the 
Masonic  lodge  and  the  Eagles.  His  widow  and  one 
sister  survive  him. 

William  L.  Shannon,  M.D.,  Cincinnati;  Uni- 
versity of  Cincinnati,  College  of  Medicine,  Cin- 
cinnati, 1913;  aged  47;  member  of  the  Ohio  State 
Medical  Association  and  the  American  Medical 
Association;  died  July  29.  Dr.  Shannon  served  his 
internship  at  General  Hospital.  During  the  World 
War,  he  was  a First  Lieutenant  in  the  Medical 
Corps,  stationed  at  Camp  Zachary  Taylor.  He 
had  practiced  in  Cincinnati  since  his  discharge 
from  service.  Besides  his  widow,  he  is  survived 
by  his  mother  and  one  brother. 

Samuel  Shawaker,  M.D.,  Dover;  College  of 
Physicians  and  Surgeons,  Baltimore,  Maryland, 
1893;  aged  71;  died  July  12,  following  a long  ill- 
ness. Dr.  Shawaker,  one  of  the  oldest  physicians 
in  Tuscarawas  County,  had  practiced  in  Dover 
from  1910  until  his  retirement  about  five  years 
ago.  He  practiced  in  Shanesville  before  locating 
in  Dover.  Dr.  Shawaker  was  a member  of  the 


594 


The  Ohio  State  Medical  Journal 


September,  1933 


German  Lutheran  church,  the  Elks,  Knights  of 
Pythias,  Modern  Woodmen  and  the  Royal  Neigh- 
bors lodges  of  Dover.  From  1923  to  1928  he  was 
president  of  the  First  National  Bank  of  Dover. 
Besides  his  widow,  he  is  survived  by  two  sons, 
Drs.  K.  E.  and  Max  Shawaker,  Dover  physicians; 
one  daughter,  and  one  brother. 

James  D.  Thompson,  M.D.,  Granville;  Jefferson 
Medical  College,  of  Philadelphia,  1878;  aged  80; 
Dr.  Thompson,  a life-long  resident  of  Licking 
County,  practiced  in  Johnstown  from  1878  to  1895, 
when  he  moved  to  Granville.  He  was  a member 
of  the  Presbyterian  church,  and  the  Knights  of 
Pythias  lodge.  Surviving  him  are  his  widow,  one 
daughter  and  two  sons. 

Manifred  P.  Woodfin,  M.D.,  Ironton;  Howard 
University  School  of  Medicine,  Washington,  D.  C., 
1912;  aged  54;;  former  member  of  the  Ohio  State 
Medical  Association;  died  July  10  following  a long 
illness.  Dr.  Woodfin,  a native  of  Ironton,  was 
active  in  local  medical  circles  until  forced  to  retire 
three  years  ago  because  of  ill  health.  A son  and 
daughter  survive  him. 


KNOWN  IN  OHIO 

William  Watson  Conger,  M.D.,  New  Haven, 
Connecticut;  Jefferson  Medical  College  of  Phila- 
delphia, 1903;;  aged  61;  former  member  of  the 
Ohio  State  Medical  Association  and  Fellow  of  the 
American  Medical  Association;  died  June  28  at 
his  post  at  the  U.  S.  Army  hospital  in  New 
Haven,  of  heart  disease.  Dr.  Conger,  formerly  of 
Mt.  Gilead,  served  as  a private  in  the  Spanish- 
American  War.  After  completing  his  medical 
course,  Dr.  Conger  practiced  in  Toledo  until 
called  into  service  and  sent  to  the  Mexican  border. 
Since  the  World  War,  he  was  commissioned  a 
Major  in  the  Regular  Army,  and  had  been  sta- 
tioned at  Hoboken,  Panama  Canal  Zone,  Wash- 
ington, New  Haven  and  New  York.  He  is  sur- 
vived by  his  widow,  two  brothers  and  a sister. 

Henry  J.  Cordier,  M.D.,  Denver,  Colorado;  Uni- 
versity of  Michigan  Medical  School,  Ann  Arbor, 
Michigan,  1879;  aged  72;  former  member  of  the 
Ohio  State  Medical  Association  and  the  Mercer 
County  Medical  Society;  died  July  25.  Dr.  Cordier 
practiced  at  Rockford  and  Celina  before  his  re- 
tirement and  removal  to  Colorado  several  years 
ago.  Surviving  him  are  his  widow  and  two  daugh- 
ters. 

Florentine  P.  Herman,  M.D.,  West  Palm  Beach, 
Florida;  Eclectic  Medical  College,  Cincinnati, 
1922;  aged  39;  Fellow  of  the  American  Medical 
Association;  died  July  6 at  Norwalk,  Ohio.  Dr. 
Herman  had  practiced  in  Georgia  and  at  West 
Palm  Beach  for  several  years,  and  only  recently 
returned  to  Norwalk.  He  is  survived  by  his 
widow  and  one  sister. 


I.  Ward  Sampsell,  M.D.,  New  York  City;  North- 
western University  Medical  School,  Chicago;  Fel- 
low of  the  American  Medical  Association;  died 
July  3 at  his  home  at  Little  Neck,  Long  Island. 
Dr.  Sampsell  was  resident  physician  at  River 
Crest  hospital,  New  York,  for  many  years.  He  is 
survived  by  his  widow,  one  daughter,  two  sisters, 
and  a brother,  Dr.  Jesse  Sampsell,  of  Van  Wert. 


County  Home  Physicians  Must  Furnish 
Medicine  According  to  Attorney 
General  Opinion 

A physician  employed  under  a contract  with  the 
county  commissioners  to  render  medical  service  to 
the  inmates  of  a county  home  is  not  entitled  to 
additional  compensation  for  the  costs  of  medicines 
used  by  him  in  rendering  such  medical  care,  ac- 
cording to  an  opinion  recently  rendered  by  At- 
torney General  John  W.  Bricker. 

Attorney  General  Bricker  in  interpreting  Sec- 
tion 2546,  General  Code,  which  reads  in  part: 
“The  county  commissioners  may  contract  with  one 
or  more  competent  physicians  to  furnish  medical 
relief  and  medicine  necessary  for  the  inmates  of 
the  infirmary,  but  no  contract  shall  extend  beyond 
one  year”,  stated: 

“To  permit  or  require  county  commissioners  to 
enter  into  separate  contracts  for  medical  services 
and  for  medicines,  it  would  be  necessary  to  read 
the  word  ‘and’  as  ‘or’  in  the  statute.  Such  words 
may  be  interchanged  if  the  sense  requires  it  by 
virtue  of  Section  27  of  the  General  Code,  but  such 
words  should  be  read  as  they  appear  when  the 
statute  gives  a clear  meaning  without  inter- 
changing.” 

In  support  of  his  opinion,  Mr.  Bricker  quotes 
from  an  early  attorney  general  opinion  which 
said  in  part: 

“The  medicines  referred  to  are  such  as  are 
directly  connected  with  and  incidental  to  the 
work  of  furthering  medical  relief  contracted  for. 
If  the  legislature  had  intended  that  separate  con- 
tracts should  be  entered  into  for  each  purpose,  it 
would  not  have  compelled  a contract  to  be  made 
for  medicines  with  physicians  alone;  it  would 
have  authorized  such  contract  to  be  made  with 
druggists,  dealers  or  other  persons  able  to  furnish 
the  same,  if  it  had  not  intended  that  the  same 
contract  was  to  include  both  medicines  and  medi- 
cal relief.  * * * The  statute  authorizes  but  one 
contract  to  be  entered  into  for  both  medical  re- 
lief and  medicines.” 

Physicians  in  making  future  contracts  with 
county  commissioners  for  furnishing  medical  re- 
lief to  inmates  of  the  county  home  should  take  into 
consideration  this  opinion  of  Attorney  General 
Bricker  and  should  make  sure  that  the  fee  stipu- 
lated in  their  contracts  is  sufficient  to  cover  both 
costs  of  services  rendered  and  medicine  furnished. 


September,  1933 


State  News 


595 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

THE  PIONEER  POST-GRADUATE  MEDICAL 
INSTITUTION  IN  AMERICA 


UROLOGY 

Including 

Surgical  Anatomy  Operative  Urology  (Cadaver)  Dermatology  and  Syphilology 

Cystoscopy  and  Endoscopy  Diagnosis  and  Office  Treatment  Roentgenology 

Pathology  Regional  Anesthesia  Proctology 

Neurology  Medicine  Diathermy 


For  Information  Address 

MEDICAL  EXECUTIVE  OFFICER 

345  West  50th  Street  NEW  YORK  CITY 


COOK  COUNTY  GRADUATE  SCHOOL  OF  MEDICINE 

(In  affiliation  with  Cook  County  Hospital) 


ANNOUNCES  CONTINUOUS  COURSES 


MEDICINE — General  and  Intensive  courses,  all  branches. 
PEDIATRICS — Informal  course. 

OBSTETRICS — Informal  Course — Two  Weeks’  Intensive 
Coufse. 

GYNECOLGY  — Three  Months  Course  — Two  Weeks 
Course — Special  Courses. 


FRACTURES  AND  TRAUMATIC  SURGERY  — General 
Course — Intensive  Course. 

ROENTGENOLOGY — Special  and  Comprehensive  Courses. 
UROLOGY  — General  Course  Two  Months — Intensive 
Course  two  weeks. 

CYSTOSCOPY — Intensive  Course. 


TOPOGRAPHICAL  AND  SURGICAL  ANATOMY. 


SURGERY — General  Course  One,  Two,  Three  and  Six  Months,  Surgical  Technique  Two  Weeks  Intensive  Course — 
Special  Courses. 

General,  Intensive  or  Special  Courses  in  Tuberculosis,  Orthopaedic  Surgery,  Dermatology  and  Syphilis,  Ophthalmology, 
Ear,  Nose  and  Throat,  Pathology,  Neurology,  Proctology. 

TEACHING  FACULTY— Attending  Staff  of  Cook  County  Hospital. 

Address:  Registrar,  427  South  Honor©  Street,  CHICAGO,  ILLINOIS 


CURDOLAC  FOODS 

FULFILL  THE  A.  B.  C.’s  OF  THE 
DIABETIC  DIET  PERFECTLY  — 

Curdolac  Breakfast  Cereal 

Curdolac  Soya  Flour 

Curdolac  Wheat-Soya  Flour 

Curdolac  Soya  Cereal  Johnny  Cake  Flour 

Curdolac  Soya-Bran  Breakfast  Food 

Curdolac  Soya-Bran  Flour 

Adequate  in  nourishment 
Beautiful  to  the  sight 
Correct  in  food  value 

Samples  and  Literature  on  request 

CURD  OfcL  A C F.O.O^D  COMPANY 

Box  299  Waukesha,  Wis. 


596 


The  Ohio  State  Medical  Journal 


September,  1933 


iWSNOTWOHIO 


Dayton — Dr.  Frank  H.  Gordon,  chief  medical 
officer  at  the  U.  S.  Hospital,  Dwight,  Illinois,  has 
been  appointed  superintendent  of  the  Veterans’ 
Hospital,  here,  succeeding  the  late  Colonel  Vernon 
Roberts.  Announcement  also  has  been  made  of  the 
appointment  of  Dr.  R.  C.  Robertson,  formerly  of 
Leavenworth,  Kansas,  as  full-time  consulting 
psychiatrist. 

Defiance — Dr.  B.  W.  Travis,  formerly  of  To- 
ledo, has  become  an  associate  of  Dr.  D.  J.  Slosser, 
this  city. 

West  Lafayette — Dr.  H.  H.  Schwindt,  formerly 
of  Stonecreek,  has  opened  offices  here. 

Bellaire — Dr.  David  M.  Creamer,  who  recently 
completed  his  internship  at  the  Ohio  Valley  Gen- 
eral Hospital,  Wheeling,  West  Va.,  has  opened 
offices  here. 

Akron — Dr.  Wendell  T.  Bucher,  resident  phy- 
sician at  the  Akron  City  Hosiptal,  has  been 
awarded  a scholarship  in  surgery  at  the  Uni- 
versity of  Pennsylvania,  created  by  Dr.  C.  R. 
Steinke,  Akron  physician. 

Toledo — Announcement  has  been  made  of  the 
marriage  of  Miss  Maxine  Elizabeth  Cross  and 
Dr.  Harold  H.  Strieker,  both  of  Toledo. 

Sycamore — Dr.  F.  M.  Smith,  formerly  an  in- 
tern at  St.  Francis  Hospital,  Columbus,  has 
located  here. 

Kenton — Offices  have  been  opened  here  by  Dr. 
Calvin  G.  Jackson,  formerly  resident  physician  at 
University  Hospital,  Columbus. 

Eaton — Dr.  J.  C.  Ryder  is  recovering  from 
poisoning  resulting  from  a bite  by  a tarantula 
hidden  in  some  bananas  which  he  had  purchased. 

Ashtabula — Physicians,  attorneys,  dentists,  and 
pharmacists  and  their  families  of  this  city  held 
an  outing  August  3 at  the  Ashtabula  Country 
Club. 

W elision — Dr.  E.  T.  Dando  addressed  the 
Wellston  Rotary  Club  on  “Heart  Disease”. 

Bethel — Dr.  W.  E.  Thompson,  the  oldest  prac- 
ticing physician  in  Ohio,  recently  celebrated  his 
98th  birthday  anniversary.  He  has  practiced  in 
Bethel  for  73  years. 

Ashtabula — Dr.  A.  M.  Mills  addressed  the 
Kiwanis  Club  on  “Quack  Doctors”. 

Worthington — Dr.  Warren  G.  Harding,  Second, 
son  of  Dr.  and  Mrs.  G.  T.  Harding  of  Worthing- 
ton, who  has  been  studying  in  Edinboro,  Scotland, 
has  been  voted  a Fellowship  in  the  Royal  College 
of  Surgeons  and  will  sail  from  Edinboro  soon  for 
Sydney,  Australia,  where  he  will  join  the  surgical 
staff  of  Wahroonga  Sanatorium.  Dr.  Frances  K. 
Harding,  his  wife,  will  be  associated  with  the  in- 
stitution as  anesthetist. 


Greenville — The  local  Rotary  Club  was  ad- 
dressed by  Dr.  Robert  Austin,  Dayton,  on  “The 
History  of  Medicine”. 

Cleveland — Dr.  Robert  Allan  Moore,  instructor 
in  pathology,  School  of  Medicine,  Western  Re- 
serve University,  and  assistant  pathologist  at 
Lakeside  Hospital,  has  accepted  the  position  cf 
assistant  professor  of  pathology  at  Cornell  Uni- 
versity, College  of  Medicine,  New  York  City. 

Campbell — Dr.  W.  P.  Young  has  been  appointed 
city  physician. 

Findlay — Dr.  Porter  C.  Pennington,  lieutenant 
colonel,  medical  reserve  corps,  has  returned  from 
Fort  Benjamin  Harrison  where  he  was  stationed 
on  active  duty  training. 

Columbus — Dr.  and  Mrs.  Frank  E.  Hamilton 
have  sailed  for  Europe  where  Dr.  Hamilton,  fol- 
lowing a brief  vacation  tour,  will  take  post- 
graduate work  at  Vienna. 

Cincinnati — Dr.  John  Phair,  former  bacter- 
iologist for  the  Cincinnati  Board  of  Health,  has 
been  appointed  a member  of  the  international 
health  division  of  the  Rockefeller  Foundation  and 
will  be  located  in  the  undulant  fever  research  cen- 
ter at  Montpelier,  France. 

Cleveland — Announcement  has  been  made  of  the 
marriage  of  Miss  Lucile  Hertzer,  technical  re- 
search assistant,  Western  Reserve  University, 
and  Dr.  Harold  A.  Conrad,  both  of  Cleveland. 

Wilmington — Dr.  Robert  Conrad  addressed  the 
Commercial  Club  on  “Advance  Guard  of  Medi- 
cine”. 

Painesville — Dr.  John  Dudley  Marsh  has  joined 
his  father.  Dr.  V.  N.  Marsh,  in  the  practice  of 
medicine  here. 

Xenia — Announcement  has  been  made  of  the 
marriage  of  Miss  Roberta  Shaw,  graduate  nurse, 
and  Dr.  A.  D.  DeHaven,  both  of  this  city. 

Defiance — Dr.  W.  S.  Powell,  veteran  Defiance 
physician,  recently  celebrated  his  57th  anniver- 
sary of  his  entrance  into  medicine. 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  advertisements  under  this  heading  are  60  cents 
per  line,  payable  in  advance.  Minimum  charge  of  $1.00 
for  each  insertion.  Price  coders  the  cost  of  remailing 
answers.  Forms  close  16th  of  the  month  preceding 
publication. 


Assistance  to  Medical  Writers — Abstracts,,  Translations, 
Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  Place,  Chicago, 
Illinois. 


Wanted — Physician  at  Windsor,  Ohio.  Good  pay,  good 
roads.  Large  country  practice,  forty  miles  from  Cleveland. 
Address  L.  C.  A.,  care  Ohio  State  Medical  Journal. 


Wanted — Physician  at  Hendrysburg,  Ohio.  For  par- 
ticulars, write  Mrs.  Mary  E.  Clark,  Hendrysburg,  Ohio, 
Box  32. 


September,  1933 


State  News 


597 


Edward  Reinert 

Ph.G.,  M.D. 

247  East  State  Street  Columbus,  Ohio 

Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 

FRANK  GALLEN,  M.D.,  LEE  A.  HAYS,  M.D., 

Dermatology  Roentgenology 

Tel.  Main  1537  University  5842 


W.  H.  MILLER,  M.  D. 

328  East  State  St.  Columbus,  Ohio 

Office  Telephone,  MAin  3743  Residence,  EVergreen  5644 

(L/e) 

Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

Prompt  and  Full  Report 


598 


The  Ohio  State  Medical  Journal 


September,  1933 


POSTGRADUATE  COURSE 

For  Graduates  in  Medicine 

Eye,  Ear,  Nose  and  Throat 

A house  doctor  is  appointed  July  1st  and 
January  1st 


LABORATORY  COURSE 

For  Nurses  and  Graduates  of  High  School 
CLASSES  LIMITED  TO  SIX 
X-ray,  Basal  Metabolism,  Electro-cardiography  and 
Physical  Therapy 


150  clinical  patients  daily  provide  material  for  classes. 

Positions  with  attractive  salaries  in  hospitals  and  with  group  doctors  await  qualified  Technicians 


For  particulars  regarding  either  course  write 

CHICAGO  EYE,  EAR,  NOSE  AND  THROAT  HOSPITAL,  231  W.  Washington  St.  Chicago,  Illinois 


New 

County  Soci 


rjrom 

d Academies 


First  District 

Adams  County  Medical  Society  was  entertained 
August  16  by  Dr.  and  Mrs.  0.  E.  McHenry  of 
Blue  Creek.  The  following  program  was  pre- 
sented: “Diagnosis  and  Management  of  Some  of 
the  Gastro-Intestinal  Cases”,  Dr.  F.  C.  Leeds, 
Winchester;  discussion  by  Dr.  Ray  Vaughan, 
Cedar  Mills;  “Some  Consideration  in  the  Diag- 
nosis and  Treatment  of  Thyroid”,  Dr.  Dewey  H. 
Reps,  Cincinnati;  discussion  by  Dr.  Samuel  Clark, 
Cherry  Fork;  “The  New-Born  Child”,  Dr.  R.  Y. 
Littleton,  Stout;  discussion  by  Dr.  G.  W.  Chabot, 
Peebles. — Bulletin. 

Clermont  County  Medical  Society  was  addressed 
by  Dr.  D.  F.  Gerber,  Middletown,  at  its  meeting 
July  19  at  Loveland.  Luncheon  was  served  pre- 
ceding the  program.— Bulletin. 

Clinton  County  Medical  Society  met  in  regular 
session  July  11  at  Wilmington.  There  was  a 
round-table  discussion  of  case  reports.  A review 
of  the  1933  meeting  of  the  American  Medical  As- 
sociation meeting  at  Milwaukee  was  presented  by 
Dr.  Robert  Conrad,  Wilmington. 

Highland  County  Medical  Society  was  addressed 
by  Dr.  W.  N.  Taylor,  Columbus,  at  its  meeting 
August  2 at  the  Parker  Hotel,  Hillsboro.  Dr.  Tay- 
lor discussed  “Genito-Urinary  Diseases”. — News 
Clipping. 

Second  District 

Greene  County  Medical  Society  heard  an  illus- 
trated lecture  on  “Spinal  Meningitis”,  by  Dr. 
Frank  E.  Stevenson,  Cincinnati,  at  its  regular 
meeting  August  3.  The  society  was  entertained 
by  Dr.  A.  C.  Messenger,  resident  physician  at  the 
Ohio  Soldiers’  and  Sailors’  Home,  Xenia.  Follow- 
ing the  program  and  a luncheon,  the  members 
were  taken  for  a tour  of  the  home  and  grounds. 

At  its  July  meeting  on  July  13,  the  society  was 
addressed  by  Dr.  D.  C.  Houser,  Urbana,  last  re- 
tiring president  of  the  Ohio  State  Medical  Asso- 
ciation on  “The  Future  of  Medicine”. — News 
Clippings. 

Fifth  District 

Medina  County  Medical  Society  held  a joint 
meeting  with  the  township  trustees  and  clerks  of 


the  county  on  July  20  at  the  Court  House,  Medina. 
Questions  relative  to  medical  and  hospital  care  of 
indigents  were  discussed. — News  Clipping. 

Sixth  District 

Wayne  County  Medical  Society  held  its  annual 
picnic  on  July  11  at  the  State  Institution  for 
Feeble-Minded  at  Apple  Creek.  About  55  mem- 
bers and  guests  attended  as  guests  of  Dr.  and 
Mrs.  L.  W.  Yule,  superintendent  of  the  institution 
and  his  wife.  Following  the  picnic  dinner,  Dr. 
Yule  told  of  the  work  being  done  at  the  institu- 
tion and  took  the  visitors  on  a tour  of  the  build- 
ing and  grounds. — R.  C.  Paul,  M.D.,  Secretary. 

Seventh  District 

Tuscarawas  County  Medical  Society  at  its  meet- 
ing July  13  at  Newcomerstown  entertained  the 
members  of  the  Coshocton  County  Medical  Society. 
The  guest  speakers  were  Dr.  H.  G.  Beatty  and  Dr. 
R.  C.  Baker,  both  of  Columbus.  The  society 
adopted  a resolution  requesting  the  continuance 
of  the  Primrose  School  for  Crippled  Children  at 
Dennison  and  asking  the  county  commissioners  to 
employ  a nurse  to  assist  in  the  work  of  the 
school — News  Clipping. 

Eighth  District 

Guernsey  Comity  Medical  Society  was  enter- 
tained July  13  at  the  Swan  Hospital.  Wives  of 
the  members  were  guests  at  the  chicken  dinner 
served  in  the  hospital  grounds.  About  80  were 
present.  Following  the  dinner  the  pupils  of  a 
Cambridge  dancing  school  entertained  with  a pro- 
gram of  fancy  dancing  and  a musical  program 
was  presented. 

At  its  meeting  July  20,  the  society  was  ad- 
dressed by  Dr.  Fred  Lane,  Cambridge  on  “Es- 
sential Hypertension”. 

On  August  3,  Dr.  Reo  M.  Swan,  Cambridge, 
addresesd  the  society  on  “Recent  Advances  in 
Medicine”. — News  Clipping. 

Perry  County  Medical  Society  held  a luncheon 
meeting  July  20  at  the  Park  Hotel,  New  Lexing- 
ton. A round-table  discussion  of  case  reports  was 
held.- — News  Clipping. 


October,  1933 


Advertisements 


601 


THE  SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 

TREATS  NERVOUS  AND  MENTAL  DISEASES 


OCCUPATION  THERAPY  is  rapidly  becoming  one  of  the  most  important  measures  for  the  relief  of 
Nervous  and  Mental  Diseases.  The  Sawyer  Sanatorium  has  a well  equipped  work  therapy  department^ 
presided  over  by  a competent  teacher. 


Send  For  House  Book.  Address 

Sawyer  Sanatorium,  White  Oaks  Farm,  Marion,  Ohio 


The  Ohio  State  Medical  Association 


Ohio  State  Medical  Journal  ■ 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone : ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year;  single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 

Andrews  Rogers.  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M.D.  (1936) Cleveland 

Gilbert  Micklethwaite,  M.D.  (1935) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager  | 


Officers  1933-1934 

PRESIDENT 

C.  L.  Cummer,  M.D Cleveland 

PRESIDENT-ELECT 

John  A.  Caldwell,  M.D Cincinnati 

TREASURER 

James  A.  Beer,  M.D Columbus 

EXECUTIVE  SECRETARY 
Don  K.  Martin Columbus 

ASS’T  EXECUTIVE  SECRETARY 
Charles  S.  Nelson Columbus 

State  Council 

First  District 

Park  G.  Smith,  M.D Cincinnati 

Second  District 

E.  M.  Huston,  M.D Dayton 

Third  District 

0.  P.  Klotz,  M.D Findlay 

Fourth  District 

B.  J.  Hein,  M.D Toledo 

Fifth  District 

H.  V.  Paryzek,  M.D Cleveland 

Sixth  District 

H.  S.  Davidson,  M.D Akron 

Seventh  District 

E.  B.  Shanley,  M.D New  Philadelphia 

Eighth  District 

E.  R.  Brush,  M.D Zanesville 

Ninth  District 

1.  P.  Seiler,  M.D Piketon 

Tenth  District 

S.  J.  Goodman,  M.D Columbus 

Ex-Officio,  The  Ex-President 
H.  M.  Platter,  M.D Columbus 


602 


The  Ohio  State  Medical  Journal 


October,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 


Societies  President  Secretary 

First  District 

Adams _ L.  H.  Leonard,  Manchester. O.  T.  Sproull,  West  Union 3d  Wednesday  in  April,  June,  A ns. 

Oct. 

Brown R.  B.  Hannah,  Georgetown -Geo.  P.  Tyler,  Jr.,  Ripley 4th  Wednesday  in  Feb.,  May  and 

Nov. 

Butler H.  O.  Lund,  Middletown — Walter  Roehl,  Middletown 2d  Wednesday,  monthly. 

Clermont J.  K.  Ashburn,  Batavia. Allan  B.  Rapp,  Owensville 3d  Wednesday,  monthly. 

Clinton F.  A.  Peele,  Wilmington Wm.  L.  Regan,  Wilmington 1st  Tuesday,  monthly. 

Fayetta S.  E.  Boggs,  Washington  C.  H. J.  F.  Wilson,  Washington  C.  H—  1st  Thursday,  monthly. 

Hamilton — . Parke  G.  Smith,  Cincinnati — Geo.  B.  Topmoeller,  Cincinnati — . Monday  evening  of  each  waak 

Highland C.  C.  Cropper,  Lynchburg.... _.W.  B.  Roads,  Hillsboro 1st  Wednesday,  monthly. 

Warren J.  E.  Witham,  Waynesville James  Arnold,  Lebanon 1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 


Second  District  Cyril  Hussey,  Sidney H.  R.  Huston,  Dayton 

Champaign N.  M.  Rhodes,  Urbana L.  A.  Woodburn,  Urbana 


W. 

L. 

- _F. 

Montgomery 

A. 

Preble 

C. 

C.  W.  Evans,  Springfield  . 


W.  T.  Fitzgerald,  Greenville. 


C.  M.  Treffinger,  Eaton 


Roger  Marquart,  Springfield 

W.  D.  Bishop,  Greenville 

— H.  C.  Schick,  Xenia 

...  G.  A.  Woodhouse,  Pleasant  Hill 

Miss  M.  E.  Jeffrey,  Dayton 

C.  J.  Brian,  Eaton 


Third  District 


C. 

.L. 


Auglaize 

E. 

F. 

Heffner,  Wapakoneta 

c. 

Hancock 

A. 

E. 

King,  Mt..  Cory 

H, 

Hardin  . 

F. 

M. 

Elliott,  Ada 

W 

Logan 

O. 

C. 

Amstutz,  Bellefontaine— 

w. 

Marion 

E. 

L. 

J. 

Mercer. 

M. 

B. 

F. 

Seneca 

. Paul  Leahy.  Tiffin 

..  . R. 

E.  Hufford,  Toledo 

C.  Thomas,  Lima 

C.  Berlin,  Wapakoneta 

O.  Crosby,  Findlay 

N.  Mundy,  Forest 


Van  Wert 

Wyandot 


H.  Carey,  Bcllefontaine 

W.  Jolley,  Marion 

E.  Ayers,  Celina 

E.  Hershberger,  Tiffin 

-R.  H.  Good,  Van  Wert 

B.  A.  Moloney,  Upper  Sandusky W.  L.  Naus,  Upper  Sandusky— 


— A.  T.  Rank,  Van  Wert.. 


Fourth  District...  (With  Third  District  in  Northwestern  Ohio  District) 
Defiance S.  E.  DeMuth,  Hicksville D.  J.  Slosser,  Defiance 


Fulton 

Henry 

Lucas 

Ottawa 

Paulding 

Putnam 

Sandusky  

Williams 

W ood 


P.  S.  Bishop,  Delta 

_T.  P.  Delventhal,  Napoleon 

. L.  R.  E filer,  Toledo.. 

-R.  A.  Willett,  Elmore 

_C.  E.  Houston,  Paulding 

E.  Blackburn,  Kalida 

D.  W.  Philo,  Fremont 

-B.  C.  Bly,  Bryan 


-Geo.  McGuffin,  Pettisville 

_F.  M.  Harrison,  Napoleon 

_A.  P.  Hancuff,  Toledo 

—Cyrus  R.  Wood,  Port  Clinton 

. Gaile  L.  Doster,  Paulding 

—W.  B.  Light,  Ottawa — 

_J.  C.  Boyce,  Fremont 

_ H.  R.  Mayberry,  Bryan 


F.  L.  Sterling,  Bowling  Green R.  N.  Whitehead,  Bowling  Green- 


Fifth  District— 

Ashtabula 

Cuyahoga 

Erie 

Geauga 


_H.  V.  Paryzek,  Councilor 

J.  F.  Docherty,  Conneaut 

H.  V.  Paryzek,  Cleveland 

_ J.  C.  Kramer,  Sandusky . .. 

H.  E.  Shafer,  Middlefield 


Chrm.  Com.  on  Arrangements 

_A.  M.  Mills,  Ashtabula 

-Clarence  H.  Heyman,  Cleveland- 

-G.  A.  Stimson,  Sandusky 

-Isa  Teed-Cramton,  Burton 


Lake  . 

B 

Lorain 

-Herman  Campbell,  Elyria 

w. 

Medina  

Harry  Streett,  Litchfield. 

J. 

Trumbull 

E.  P.  Adams,  Warren 

R. 

2d  Thursday,  monthly. 

2d  and  4th  Wednesday  noon 
2nd  Friday,  monthly. 

1st  Thursday,  monthly. 

1st  Friday,  monthly,  except  Jaly 
and  August. 

1st  and  3d  Friday  each  month. 

3d  Thursday,  monthly. 

1st  Friday,  monthly. 

Tiffin,  Oct.  3,  1933 
3d  Tuesday,  monthly. 

2nd  Thursday,  bi-monthly. 

1st  Thursday,  monthly. 

17th  of  each  month. 

1st  Friday,  monthly. 

1st  Tuesday,  monthly. 

2d  Thursday,  monthly. 

3rd  Thursday,  monthly. 

1st  Tuesday,  monthly. 

1st  Thursday,  monthly. 


3d  Thursday,  monthly,  except 
July,  August,  December. 

2nd  Thursday  monthly. 

1st  Wednesday,  monthly. 

Friday,  each  week. 

2d  Thursday,  monthly. 

3d  Wednesday,  monthly. 

1st  Tuesday,  monthly. 

Last  Thursday,  monthly. 

3d  Thursday,  monthly. 

3d  Thursday,  monthly. 

Cleveland. 

2nd  Tuesday,  monthly. 

3d  Fri.  Feb.,  March,  May,  Sept., 
Nov.,  Dec. 

Last  Wednesday,  monthly,  except 
July,  Aug.,  Sept. 

Last  Wednesday,  Apr.  to  Oct. 

3d  Tuesday,  Feb-  May, 

August,  Nov. 

4th  Tuesday,  monthly. 

2d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Sd  Thursday,  monthly,  excep' 
June,  July,  August. 


October,  1933 


The  Ohio  State  Medical  Journal 


603 


Societies 


President 


Secretary 


Sixth  District A.  E.  Brant,  Youngstown J.  H.  Seiler,  Akron 

Ashland H.  M.  Gunn,  Ashland  Paul  E.  Kellogg,  Ashland 

Holmes Clyde  Bahler,  Walnut  Creek C.  T.  Bahler,  Walnut  Creek 

Mahoning J.  P.  Harvey,  Youngstown W.  M.  Skipp,  Youngstown 

Portage S.  U.  Sivon,  Eavenna E.  J.  Widdecombe,  Kent 

Richland C.  H.  Bell,  Mansfield Mabel  Emery,  Mansfield 

Stark . H.  Welland,  Canton F.  S.  VanDyke,  Canton 

Summit J.  H.  Selby,  Akron A.  S.  McCormick,  Akron 

Wayne W.  A.  Morton,  Wooster R.  C.  Paul,  Wooster 


2d  Wed.,  Jan.,  April  & Oct. 

2nd  Friday,  Sept,  to  May. 

1st  Tuesday,  quarterly.  Jan.,  April, 
July,  October. 

3d  Tuesday,  monthly. 

1st  Thursday,  monthly. 

Last  Thursday,  monthly. 

2d  Tuesday,  monthly. 

1st  Tuesday,  monthly. 

2d  Tuesday,  monthly. 


Seventh  District. 


Belmont G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire 

Carroll __(With  Stark  Co.  Society) 

Columbiana J.  W.  Robinson,  Lisbon John  Fraser,  East  Liverpool- — 

CoBhocton Floyd  Craig,  Coshocton J.  D.  Lower,  Coshocton 

Harrison A.  C.  Grove,  Jewett W.  C.  Wallace,  Hopedale 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville 

Monroe G.  W.  Steward,  Woodsfield A.  R.  Burkhart,  Woodsfield 

Tnecarawna  F.  B.  Larimore,  New  Phila. G.  L.  Saekett.  New  Phila 


1st  Thurs.,  monthly,  4 p.  m.. 
except  July  and  August. 

2d  Tuesday,  monthly. 

Last  Thursday,  monthly 
3d  Wednesday,  monthly. 

Last  Thursday,  monthly. 

2d  Wednesday,  monthly. 

2d  Thursday,  monthly. 


Eighth  District  _ 


Athens C.  E.  Welch,  Nelsonville T.  A.  Copeland,  Athens 1st  Monday,  monthly. 

Fairfield E.  B.  Roller,  Lithopolis C.  W.  Brown,  Lancaster 2d  Tuesday,  monthly. 

Guernsey C.  C.  Headley,  Cambridge E.  F.  Hunter,  Cambridge 1st  and  3rd  Thursday  each  month 

Licking Geo.  W.  Sapp,  Newark G.  A.  Gressle,  Newark Last  Friday,  monthly. 

Morgan D.  G.  Ralston,  McConnelsville C.  E.  Northrup,  McConnelsville 3d  Wednesday,  monthly. 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 1st  Wednesday,  monthly. 

Noble 


Parry James  Miller,  Corning _F.  J.  Crosbie,  New  Lexington 3d  Monday,  monthly. 

Washington  W.  W.  Sauer,  Marietta G.  M.  James,  Marietta 2d  Wednesday,  monthly 


Ninth  District 


Gallia O.  A.  Vornholt,  Gailipolis Milo  Wilson,  Gallipolis 1st  Wed.,  Feb.,  May,  Sept,  and  Dec 

Hocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan Quarterly. 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 2nd  Tuesday,  monthly. 

Lawrence Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 1st  Thursday,  monthly. 

Haigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 3d  Thursday,  bi-monthly 

Pika L.  E.  Wills,  Waverly R.  T.  Leever,  Waverly 1st  Monday,  monthly. 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 2d  Monday,  monthly. 

Vinton O.  S.  Cox,  McArthur H.  S.  James.  McArthur 3d  Wednesday,  monthly 


Tenth  District — _ 

Crawford E.  C.  Brandt,  Crestline : R.  L.  Solt,  Bucyrus 1st  Monday,  monthly 

Delaware Geo.  D.  Lowry,  Delaware J.  G.  Parker,  Delaware 1st  Tuesday,  monthly. 

Franklin Jonathan  Forman,  Columbus John  H.  Mitchell,  Columbus Every  Monday,  8:30  p.  m. 

Knox S.  O.  Gantt,  Centerburg R.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  Jefferson 4th  Wednesday,  monthly. 

Borrow F.  M.  Hartsook,  Cardington T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly 

Pickaway C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville 1st  Friday,  monthly. 

Ross Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 1st  Thursday,  monthly. 

Union E.  J.  Marsh,  Broadway Angus  Maclvor,  Marysville 2d  Tuesday,  monthly 


604 


Advertisements 


October,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 

This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL,  M.D. 

Medical  Directors. 

Dayton,  Ohio 

MRS.  GEORGE  V.  SHERIDAN, 
President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

NAOMI  VOGE,  R.  N. 

Resident  Superintendent 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


Windsor  Hospital 

The  Windsor  Hospital  and  Sanitarium  is 
completely  equipped  with  all  the  best  appa- 
ratus for  giving  Hydrotherapy,  Occupa- 
tional Therapy,  and  other  treatments  for 
all  types  of  Nervous  disorders,  acute  and 
chronic. 

John  H.  Nichols,  M.D. 

Medical  Director 

Phone  Chagrin  Falls  360 
CHAGRIN  FALLS,  OHIO 

ESTABLISHED  35  YEARS 


A MODERN  ETHICAL  HOSPITAL 

Rates:  $25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alcohol,  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  Not  limited  as  to  the  quantity 
used  but  can  give  the  patient  as  much  whiskey  as  his  condition  requires. 

NERVOUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoscine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  that  their  own 
home  affords. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 

tal. Female  attendants  only ; absolute  privacy ; com- 
fortable, well-appointed  ladies’  lounge. 

Cherokee  Road  (Long  Distance  Phone  East  1488) 

THE  STOKES  SANATORIUM 

Louisville,  Ky.  27  Years  Treating  Nervous  Patients. 


FIRE  PROOF  — COMPLETELY  EQUIPPED 


THE  OXFORD  RETREAT 

Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 
— WRITE  FOR  DESCRIPTIVE  CIRCULAR 


PUBLIC  HEALTH- SOCIAL  WBLFAm: 
MIEMCLfi 
&M<d  ©3E©^ 

cWith  Editorial  Comment  by  D.KM.  ^==^( 


The  Eighty-Seventh  Annual  Meeting  of  the 
Ohio  State  Medical  Association  held  September  7 
and  8 at  Akron,  detailed  accounts  of  which  are 

to  be  found  elsewhere 
in  this  issue  of  The 
Journal,  was  more  than 
a most  successful  ob- 
servance of  the  passing 
of  another  milestone  by 
medical  organization  in  Ohm  and  the  close  of 
another  period  of  outstanding  activity  and  ac- 
complishments on  the  part  of  organized  medicine. 


The  Spirit  of 
Leadership  At 
Annual  Meeting 


The  Akron  meeting  was  in  many  respects  a 
glowing  tribute  to  the  collective  character  of  the 
medical  profession  of  Ohio ; undisputable  proof 
that  the  profession  possesses  ample  courage  and 
ability  to  chart  its  own  destiny,  and  unmistakable 
evidence  that  the  principles  and  ideals  which  have 
guided  the  profession  throughout  its  long  period 
of  unselfish  and  devoted  public  service  still  pre- 
vail. 


The  spirit  manifest  by  those  who'  attended  the 
Akron  gathering  was  nothing  short  of  remarkable 
considering  the  fact  that  the  past  year  has  been 
the  most  difficult  in  many  respects  ever  ex- 
perienced by  the  physicians  of  Ohio.  The  calm, 
rational,  considerate,  uncomplaining  attitude  of 
practically  every  physician  in  attendance  was  re- 
freshing and  characteristic  of  a profession  whose 
sincerity  of  purpose,  honesty  in  its  professional 
dealings,  and  devotion  to  the  welfare  of  the  peo- 
ple have  won  for  it  the  respect  and  devotion  of 
the  public.  Once  more  the  medical  profession  has 
shown  that  it  can  meet  adversity  unflinchingly 
and  with  its  courage  undiminished. 

On  the  other  hand,  the  spirit  which  permeated 
the  1933  meeting  was  not  one  of  resignation,  sub- 
mission or  hopelessness.  There  were  many  in- 
dications that  the  medical  profession  of  Ohio  has 
struck  a militant  attitude  in  defense  of  its  ideals 
and  in  safeguarding  its  integrity.  There  was  over- 
whelming evidence  that  the  physicians  of  Ohio  are 
prepared  to  stand  shoulder  to  shoulder  to  battle 
those  promoting  unsound  theories  which  would 
eventually  menace  the  health  and  welfare  of  the 
people,  destroy  the  professional  aspects  of  medical 
practice,  and  reduce  the  physician  to  the  status 
of  a hireling.  There  were  indications  that  the 
honest,  ethical  and  qualified  physicians  of  Ohio 
have  determined  to  wage  open  warfare  upon  dis- 
honest and  unworthy  practitioners  and  to  put  an 


end,  if  possible,  to  racketeering  in  the  field  of 
medicine. 

The  spirit  of  sincerity  displayed  by  those  at- 
tending the  meeting  and  the  serious  manner  in 
which  they  considered  questions  presented,  scien- 
tific and  otherwise,  demonstrated  that  the  pro- 
fession is  fully  aware  of  its  responsibilities  and 
obligations,  and  that  it  is  honestly  striving,  as  in 
the  past,  to  better  itself  and  to  improve  the  ser- 
vice it  is  expected  to  render. 

Moreover,  the  1933  meeting  re-demonstrated  the 
attitude  of  the  great  majority  of  physicians  to- 
ward the  activities,  purposes  and  programs  cf 
medical  organization.  The  fine  spirit  of  coopera- 
tion, unity  and  active  enthusiasm  displayed  in- 
dicated that  the  membership  is  appreciative  of 
the  benefits  and  services  which  membership  in  or- 
ganized medicine  offers  them.  It  proved  beyond 
all  doubt  that  medical  organization  has  the  whole- 
hearted and  active  support  of  the  qualified  and 
worthy  members  of  the  profession  and  that  medi- 
cal organization  with  the  united  backing  of  mem- 
bers of  this  caliber  can  advance,  accomplishing 
even  greater  things  and  rendering  more  beneficial 
service  to  the  profession  as  a whole.  The  active 
interest  taken  by  such  a representative  group 
shows  that  the  membership  generally  is  keenly 
aware  of  the  value  of  organized  activity  and  ef- 
fort, the  need  for  continuous  unity  and  harmony, 
and  the  necessity  for  maintaining  at  maximum 
strength  organization  machinery,  both  state  and 
local. 

Those  chosen  by  the  membership  to  represent  it 
in  the  House  of  Delegates  again  discharged  their 
duties  in  a laudable  way,  making  their  decisions 
in  a fearless  manner  and  basing  their  actions  in 
accordance  with  sound  principles  and  with  what 
they  believed  to  be  best  for  the  public  and  the 
profession  at  .large. 

In  his  appealing  address  at  the  annual  banquet 
on  Thursday  evening,  Dr.  Olin  West,  secretary 
and  general  manager  of  the  American  Medical 
Association,  complimented  the  State  Association 
on  its  wisdom  in  selecting  its  leaders  throughout 
the  years,  declaring  that  to  have  played  no  small 
part  in  the  outstanding  success  of  medical  or- 
ganization in  Ohio  in  the  past.  Refusing  to  lower 
the  high  standard  of  leadership  which  has  been 
established  in  Ohio,  the  House  of  Delegates  made 
certain  that  the  affairs  of  the  State  Association 
would  remain  in  efficient  and  capable  hands  dur- 
ing the  next  two  years  and  that  leadership  of  as 


617 


618 


The  Ohio  State  Medical  Journal 


October,  1933 


high  a type  as  that  furnished  in  the  past  would 
be  assured. 

Through  the  inauguration  of  Dr.  C.  L.  Cum- 
mer, Cleveland,  as  president  of  the  State  Associa- 
tion, the  House  of  Delegates  assured  the  associa- 
tion of  a continuation  of  the  constructive  leader- 
ship which  was  given  it  during  the  past  difficult 
year  by  Dr.  H.  M.  Platter,  Columbus,  the  retiring 
president. 

With  Dr.  Platter  at  the  helm,  med’cal  organiza- 
tion in  Ohio  has  been  marked  by  harmony  and 
high  accomplishment.  Long  experience  in  organi- 
zation activities,  thorough  knowledge  of  economic, 
social  and  governmental  questions,  keen  judgment, 
and  unfailing  belief  in  the  ideals  of  medicine 
qualified  Dr.  Platter  exceptionally  well  for  the 
arduous  task  which  was  his  as  head  of  the  State 
Association  during  the  past  year.  Under  less  able 
leadership  medical  organization  might  have  lost 
ground.  Instead,  under  the  guiding  hand  of  Dr. 
Platter  with  his  constant,  faithful  service  and 
daily  sacrifice  of  time,  thought  and  effort,  medical 
organiation  achieved  much,  kept  its  ranks  strong 
and  united,  and  prepared  the  profession  to  better 
meet  the  serious  problems  of  the  future. 

That  the  State  Association  will  make  equally 
as  great  advances  during  the  coming  year  under 
the  presidency  of  Dr.  Cummer  is  certain.  Dr. 
Cummer  has  rendered  long  and  valuable  service 
in  medical  organiation,  both  in  the  State  Associa- 
tion and  in  his  local  society.  His  wide  acquaint- 
anceship, deep  devotion  to  the  purposes  and  aims 
of  organied  medicine,  and  his  genius  for  organi- 
zation equip  him  exceptionally  well  for  the  re- 
sponsibilities which  have  been  entrusted  to  him. 
Dr.  Cummer’s  enthusiasm,  earnestness,  tireless 
zeal,  keen  judgment,  and  courage  to  face  all  issues 
assure  the  State  Association  of  the  kind  of  leader- 
ship which  will  be  indispensable  during  the  en- 
suing year. 

By  selecting  Dr.  John  A.  Caldwell,  Cincinnati, 
as  president-elect,  the  House  of  Delegates  made 
certain  that  only  genuine  and  representative 
leaders  shall  be  honored  with  the  presidency  of 
the  State  Association.  Dr.  Caldwell’s  devotion  and 
loyalty  to  the  cause  of  medical  organization  is  evi- 
denced by  the  fact  that  for  the  past  five  years  he 
has  served  faithfully  and  meritoriously  as  a mem- 
ber of  the  Council  and  by  his  recent  election  to  the 
presidency  of  the  Cincinnati  Academy  of  Medi- 
cine, indicating  that  his  local  colleagues  regard 
him  as  one  with  the  attributes  of  leadership. 
Dr.  Caldwell’s  modest  and  scholarly  manner  has 
won  for  him  the  esteem  and  affection  of  the  pro- 
fession throughout  the  state.  His  sound  and  wise 
judgment  on  organization  matters  and  medico- 
social  problems  has  won  the  respect  of  his  fellow 
Councilors  and  has  attracted  his  colleagues  to  him 
for  counsel  and  advice  on  many  occasions.  With 
Dr.  Caldwell  at  the  helm  two  years  hence  the 
State  Association  can  feel  confident  of  construct- 


ive leadership  and  each  member  of  kindly,  cour- 
teous consideration. 

Having  provided  itself  with  leadership  of  the 
highest  caliber  and  having  assured  itself  of  the 
active  interest,  cooperation  and  devotion  of  the 
physicians  of  Ohio  to  the  cause  of  organized  medi- 
cine, the  State  Association  should  face  the  future 
with  courage  and  assurance,  eager  to  render  still 
greater  service  to  the  public  and  determined  to 
use  its  united  strength  to  preserve  the  principles 
of  medicine  and  safeguard  the  rights  of  the  medi- 
cal practitioner. 


Commenting  recently  on  some  of  the  important 
ethical  and  economic  questions  which  had  been 
considered  by  organized  medicine  in  his  state 
during  the  past  year,  the 
Ethical  a and  editor  of  the  Texas  State 

, Medical  Journal  refers  to  a 

Economic  series  of  conferences  be- 

Question.s  tween  officers  of  the  Texas 

medical  association  and 
officials  of  a railroad  company  offering  hospital 
and  medical  services  to  its  employes. 

When  the  railroad  decided  to  admit  to  its  hos- 
pital dependent  members  of  families  of  its  em- 
ployes upon  the  payment  of  a hospital  charge 
only,  the  medical  society  of  the  county  in  which 
the  hospital  is  located  protested  on  the  ground 
that  such  action  on  the  part  of  the  hospital  as- 
sociation was  unethical. 

Judging  from  the  observation  of  the  Texas 
State  Medical  Journal’s  editor,  the  county  society 
and  the  officers  of  the  State  Association  got  no- 
where as  long  as  they  based  their  protest  on  the 
grounds  of  bad  ethics.  However,  as  soon  as  the 
matter  was  presented  to  the  railroad  people  in 
the  light  of  poor  economics  and  bad  business  prin- 
ciples, the  controversy  was  quickly  ended  and  the 
new  plan  suspended,  for  as  Dr.  Taylor  points  out 
“the  railroad  people  did  not  understand  medical 
ethics  and  had  very  little  concern  with  any  situa- 
tion based  thereon,  but  they  did  understand 
economics  and  fair  treatment  of  working  men”. 

The  lesson  to  be  learned  from  this  experience 
of  our  Texas  colleagues  appears  to  be  that  or- 
ganized medicine  should  not  depend  too  much  on 
charges  of  bad  ethics  and  unprofessional  conduct 
in  its  controversies  with  those  outside  the  pro- 
fession who  are,  or  planning  to,  promote  activities 
which  the  profession  believes  to  be  bad  public 
policy  and  detrimental  to  the  public,  as  well  as 
the  profession. 

Of  course,  most  of  the  schemes  b>  which  the 
medical  profession  has  objected,  and  will  continue 
to  protest,  aive  a violation  of  the  principles  of 
ethics  and  professional  relations.  However,  the 
average  layman  is  somewhat  mystified  by  the 
term  “ethics”  in  the  first  place,  and  gives  the 
matter  but  mild  consideration,  in  the  second.  But, 
show  him  Where  the  program  is  unsound  from  an 


October,  1933 


Editorial 


619 


economic  standpoint  and  he  will  sit  up  and  take 
notice. 

The  proper  approach  of  component  county  med- 
ical societies  in  contacting-  individuals  and  groups 
promoting  medical  and  hospital  projects  is 
through  their  committee  on  medical  economics 
which  should  be  fully  armed  with  accurate  data 
and  information  concerning  the  proposed  plan  and 
with  arguments  showing  conclusively  that  the 
program  contemplated  would  be  bad  business  and 
contrary  to  sound  public  policy.  Questions  of 
ethics  may  be  involved  but  should  not  be  relied 
upon  exclusively  in  consideration  of  such  prob- 
lems. After  all,  ethics  can  be  interpreted  to 
laymen,  by  properly  informed  physicians,  in 
terms  of  sound  public  policy  and  good  economics. 


Loose  talk  and  unsound  thinking  in  efforts  to 
educate  the  public  on  health  and  medical  matters 
have  been  on  the  increase  during  the  past  five 
years. 

Perhaps  this  was  in- 
evitable because  of  the 
rapid  growth  of  organ- 
ized movements  to  make 
the  public  health-minded 
and  to  keep  it  informed  on  ways  and  means  of 
protecting  and  safeguarding  its  health. 


of  Health 


However,  the  reaction  to  the  overdose  of  health 
propaganda  which  has  been  given  the  public  by 
over-zealous,  but  perhaps  sincere,  advocates  of 
health  education  has  caused  many  who  have 
looked  into  the  question  to  stop,  look  and  consider 
whether  it  would  not  be  wise  to  rationalize  this 
important  phase  of  public  education. 

As  evidence  of  the  dubious  attitude  of  the 
whole  matter  taken  by  some  of  those  who'  are 
recognized  leaders  in  public  health  activities,  is 
an  editorial,  headed  “Common  Sense  in  Health 
Propaganda”,  published  in  a recent  issue  of  the 
American  Journal  of  Public  Health,  in  which  con- 
siderable emphasis  is  placed  on  the  fact  that  the 
medical  practitioner  is  in  the  final  analysis  the 
best  qualified  to  instruct  the  public  on  health,  as 
well  as  medical  matters,  and  that  cooperation  be- 
tween official  health  departments  and  their  local 
medical  profession  in  this  connection  will  do  more 
good  than  all  other  types  of  health  education 
schemes. 


The  comments  of  the  editor  of  the  public  health 
journal  on  the  question  in  part  were: 

“Presumably  evex-yone  who  has  studied  the 
question  of  health  propaganda  has  idealized  that  a 
certain  amount  of  harm  can  be  done  by  unwise 
health  preaching.  Many  people  are  more  or  less 
ill  balanced,  and  just  as  the  medical  student,  ac- 
cording to  the  old  saying,  has  for  a while  every 
disease  which  he  studies,  so  do  nervous  persons 
suffer  from  imaginary  dangers  and  diseases.  This 
view  is  certainly  not  a new  one,  since  many  years 
ago  it  was  held  that  writing  concerning  disease  in 
ordinary  language  instead  of  in  classical  Latin 
would  increase  both  real  and  imaginax-y  illnesses. 

“For  some  yeax-s  thei’e  has  been  no  lack  of 


medical  and  alleged  medical  infox-mation  given  to 
the  public  by  the  daily  px-ess.  Many  organizations 
which  have  done  a vast  amount  of  good  have  with 
the  vex-y  best  intentions  put  on  campaigns  for  the 
instruction  of  the  public.  Periodic  medical  ex- 
aminations have  been  ux-ged  by  the  highest  au- 
thorities, and  it  is  hard  to  doubt  that  they  have 
had  on  the  whole  a good  effect.  On  the  other  hand, 
it  seems  equally  cex-tain  that  some  people  have 
been  frightened,  and  that  there  has  been  at  least 
a tendency  to  make  the  public  ‘disease-conscious’. 

“A  thoughtful  and  wise  presentation  has  re- 
cently appeared  in  which  the  ground  is  taken  that 
in  this  matter  of  health  propaganda,  the  pi'ac- 
titioner  and  the  health  officer  should  woi'k  in 
closer  ccopei*ation.  There  is  no  question  that 
many  of  the  px-opositions  put  forward  on  this  sub- 
ject come  from  those  who  do  not  know  sick  people, 
whether  or  not  they  are  graduates  in  medicine. 
The  clinician  on  the  other  hand,  and  especially 
the  old  time  family  doctor,  knows  human  nature 
and  sick  people  as  the  laboratory  man  and  the 
layman  can  never  do,  and  his  advice  is  corre- 
spondingly valuable. 

“Just  how  far  it  is  advisable  or  wise  to  frighten 
a person  depends  lai’gely  upon  the  individual.  No 
less  an  authority  than  Sir  Thomas  Horder  has  re- 
cently said,  ‘Concern  about  high  blood  pressure  is 
one  of  the  chief  factors  in  maintaining  it,  and  this 
holds  good  whether  the  concern  be  on  the  patient’s 
pai't  or  upon  the  part  of  the  doctor.’  Another  man 
of  long  experience  has  said  that  many  young 
women  ax-e  frightened  out  of  having  children. 
This  might  have  been  understood  before  the  days 
of  antisepsis,  and  though  even  now  maternal  mor- 
tality is  too  high,  generally  speaking,  child  birth 
is  reasonably  safe. 

“Another  instance  is  the  propaganda  for  eaxTy 
diagnosis  of  cancer.  Many  people,  especially 
women,  spend  their  lives  di'eading  cancer.  Here 
there  seems  little  doubt  that  the  propagandists 
have  exaggerated  somewhat  for  the  pui-pose  of 
putting  the  point  over,  as  well  as  enlisting  the 
sympathy  of  the  philanthropists  in  oi'der  to  raise 
money  for  a pux-pose  which  unquestionably  has  a 
sound  foundation. 

“Our  local,  state,  and  fedex-al  health  authorities 
must  continue  to  preach  public  health  and  to  give 
out  interviews  through  the  press  and  over  the 
I'adio.  These  are  now  well  I'ecognized  and  widely 
practised  procedui’es.  We  may  well  ask  what  ef- 
fect they  have  had  on  the  genei-al  health.  The 
answer  is  that  for  most  people  it  has  been  good, 
though  we  recognize  that  some  phobias  have  been 
induced. 

“Many  believe  that  the  futui-e  control  of  con- 
tagious disease  lies  largely  in  px-ophylactic  vac- 
cination, and  all  over  the  woi’ld,  efforts  are  being 
made  to  discover  vaccines.  Concerning  these, 
when  they  are  discovered,  as  well  as  for  those  for 
which  vaccines  are  ali’eady  known,  there  must  be 
given  to  the  public  information  accompanied  by 
advice  which  may  be  so  urgent  as  to  pax-take 
somewhat  of  the  character  of  compulsion.  How 
should  such  a campaign  be  carx-ied  out?  The 
highest  success  has  been  attained  by  enlistixxg  the 
aid  and  cooperation  of  the  family  physician — in 
other  words,  the  clinician.  It  is  a matter  of  wis- 
dom for  the  health  officer  to  keep  in  close  touch 
with  those  who  reach  the  largest  px-oportion  of 
the  population,  to  consxxlt  with  theixx,  and  to  ac- 
cept their  advice.  Any  antagonism  which  may  be 
aroused  seriously  injures  the  cause  which  the 
health  officer  has  at  heart,  and  may  x'esult  in  a 
lax-ge  degree  of  failure,  not  only  for  that  par- 
ticular scheme,  but  for  others  of  like  character 
elsewhere.” 


620 


The  Ohio  State  Medical  Journal 


October,  1933 


Those  active  in  promoting  the  inauguration  of 
health  and  medical  insurance  schemes  as  a sub- 
stitute for  the  existing  system  of  medical  ser- 
vice in  this  country  have  ral- 
lied to  a defense  of  the  na- 
tional health  insurance  sys- 
tem in  Great  Britain  and  have 
endeavored  to  prove  that  the 
British  plan  is  beneficial  in  its  entirety. 

However,  information  from  sources  which  the 
advocates  of  health  insurance  have  chosen  to 
ignore  indicates  that  all  is  not  serene  in  Eng- 
land with  respect  to  medical  socialism.  In  fact,  a 
recent  report  from  the  London  correspondent  of 
The  Journal  of  the  American  Medical  Association 
intimates  that  the  medical  situation  in  England  at 
present  is  more  critical  than  ever  before,  and  is 
giving  government  officials,  as  well  as  leaders  of 
the  medical  profession,  considerable  anxiety. 

The  A.M.A.  correspondent  quotes  from  an  ad- 
dress by  Sir  Henry  Brackenbury,  chairman  of  the 
council  of  the  British  Medical  Association,  in 
which  Sir  Henry  asked:  “Is  it  possible  that  the 
national  health  insurance  scheme  is  becoming  not 
primarily  a method  of  securing  medical  advice  for 
the  insured  but  primarily  a machine  for  doling 
out  to  them  small  sums  of  money  week  by  week  or 
month  by  month?” 

“Today,  more  than  ever”,  Brackenbury  is 
quoted  as  having  said,  “I  find  public  attention 
concentrated  on  the  cash  benefits  which  may  be 
claimed  rather  than  on  the  medical  attention.  To 
a not  inconsiderable  degree  the  national  health  in- 
surance system  is  in  danger  of  becoming  a gigan- 
tic machine  for  the  distribution  of  shillings  and 
only  secondai'ily  a beneficient  medical  service.  I 
suggest  that  it  is  necessary  and  that  it  is  time 
that  these  two  aspects  of  the  scheme  should  be 
separated.” 

Voicing  his  own  opinions  on  the  situation,  the 
London  observer  declared: 

“The  great  defect  of  the  national  health  in- 
surance act  is  that  it  is  socialistic  and  therefore 
manifests  the  viciousness  inherent  in  all  socialism. 
The  selfishness  of  human  nature  is  the  rock  on 
which  the  finance  of  all  socialistic  schemes  breaks. 
There  is  no  efficient  check  on  the  unemployed,  who 
by  means  of  exaggerating  trivial  complaints  can 
convert  insurance  benefit  into  a dole.  Sometime 
ago  the  ministry  of  health  had  to  complain  that 
the  finances  of  the  insurance  system  were  en- 
dangered.” 

So,  despite  the  assuring  statements  of  those 
who  would  like  to  see  this  country  embark  on  the 
sea  of  medical  socialism,  it  is  apparent  that  the 
“slippery  slope  of  medical  socialism”  is  still  slip- 
pery and  is  leading  England  into  greater  diffi- 
culties than  she  has  faced  in  the  past. 

Of  course,  if  the  American  public  is  ready  to 
take  a whirl  at  socialization  of  everything,  it  can 
get  away  to  a flying  start  by  junking  its  present 
system  of  medical  service  and  substituting  some 


scheme  like  the  one  Great  Britain  has  found  to 
be  costly,  ineffective  and  economically  unsound. 


An  interesting  piece  of  investigation  was  done 
recently  by  the  Indiana  State  Medical  Association 
with  regard  to  group  medical  and  hospital  in- 
surance. 

Hospital  Swamped  with  questions 

concerning  group  insurance 
Insurance;  of  this  type  and  lacking  au- 

thoritative statistics  on  the 
matter,  the  Indiana  Association  decided  to  begin 
collecting  figures  and  information. 

The  first  step  was  to  send  a letter  to  10  of  the 
major  insurance  companies  of  the  country  asking 
their  opinions  on  the  idea  of  partial  payment 
plans  to  take  care  of  hospital  costs  of  patients 
and  the  experience  they  had  had,  if  any,  in  this 
field. 

According  to  an  account  of  this  investigation 
published  in  the  August  issue  of  The  Indiaua 
State  Medical  Journal,  “the  answers  are  extreme- 
ly interesting  and  without  exception  there  is  noth- 
ing in  any  one  of  these  letters  from  these  major 
companies  which  would  give  one  a basis  to  ad- 
vocate such  scheme  of  insurance  with  con- 
fidence”. 

One  insurance  executive  wrote,  according  to  the 
Indiana  journal : 

“It  must  be  recognized  that  the  incidence  of 
disease  or  accident  requiring  hospital  treatment  is 
not  steady  enough  to  be  relied  upon  as  a basis 
for  premiums.  This  company  is  not  interested  in 
hospital  insurance.” 

Another  stated  that  he  knew  of  only  one  com- 
pany that  tried  the  kind  of  insurance  referred  to, 
“and  it  was  not,  however,  very  successful”. 

The  vice  president  of  another  large  insurance 
company  declared  that  his  company  felt  “it  would 
be  unsatisfactory  to  attempt  to  sell  the  coverage 
at  what  they  considered  adequate  premiums  be- 
cause these  premiums  would  be  prohibitive  in 
most  cases”. 

“Due  to  some  rather  sad  experiences  our  com- 
panies had  a few  years  ago  with  a so-called  hos- 
pital expense-only  policy  (the  loss  ratios  were 
terrific  and  the  companies  withdrew  from  the 
field),  our  companies  are  now  reluctant  to  enter 
into  this  field  again”,  the  secretary  of  a large 
conference  of  health  and  accident  underwriters  re- 
plied. 

Additional  opinions  quoted  all  were  to  the  effect 
that  such  insurance  is  felt  to  be  questionable  in 
effect  or  unsatisfactory. 

In  view  of  this,  and  other  data,  on  hospital  in- 
surance and  kindred  periodic  payment  plans  for 
financing  hospital  service,  it  is  obvious  that 
amateurs  in  the  field  of  insurance  should  hesitate 
in  thoughtful  meditation  before  they  follow  paths 
which  large  companies  with  decades  of  experience, 
and  with  a wealth  of  actuarial  information  at 
their  command,  fear  to  tread. 


Medical 

Socialism 


A Glance  At  Our  Balance  Sheet 

ANNUAL  ADDRESS  OF  THE  RETIRING  PRESIDENT 
H.  M.  Platter,  M.D.,  Columbus,  Ohio 


BY  constitutional  decree  each  administration 
at  its  close  must  render  an  account  of  its 
stewardship.  The  reports  of  Council  and 
committees  appearing  in  the  last  issue  of  The 
Ohio  State  Medical  Journal  set  forth  in  rather 
minute  detail  the  efforts  put  forth  by  your  rep- 
resentatives to  uphold  our  time-tested  policies. 
Let  me  urge  that  you  read  and  digest  them.  By 
so  doing  you  will  acquaint  yourselves  with  the 
problems  we  have  faced  and  you  will  be  enabled 
to  evaluate  our  efforts. 

It  is  fitting  that  I should  first  bear  tribute  to 
the  spendid  cooperation  we  have  received  from 
the  membership  and  particularly  from  those 
members  who  have  served  on  committees.  Without 
such  support  your  Committee  on  Public  Policy 
and  Legislation  could  not  report  to  you  that  all 
proposals  destructive  to  medical  practice  intro- 
duced in  the  last  legislature  have  been  defeated. 
Almost  one  hundred  bills,  directly  or  indirectly, 
affecting  the  medical  practitioner  were  introduced. 
Through  your  efforts  and  those  of  the  Committee 
and  the  tireless  service  rendered  by  our  efficient 
Secretary  and  his  able  corps  of  assistants  we  have 
“held  the  line”  during  a turbulent  session. 

PROBLEMS  OF  MEDICAL  EDUCATION 
The  criticisms  of  the  present  day  practitioner 
seem  to  center  about  his  education,  the  quality  of 
his  service,  and  the  fees  which  he  receives.  Let 
us  consider  these  items  in  order. 

In  the  recently  published  survey  of  Medical 
Education  many  things  are  pointed  out  which 
need  improvement.  However,  as  one  reads  this 
splendid  report  there  must  come  over  him  a 
feeling  of  satisfaction  for  the  progress  which  has 
been  made  and  the  conviction  grows  that  further 
discoveries  from  which  the  public  will  derive 
great  benefit  are  in  the  making. 

The  study,  instigated  by  the  Association  of 
American  Medical  Colleges,  searchingly  analyzes 
modern  medical  education,  gives  attention  to  the 
social  aspects  of  medical  practice,  medical  econo- 
mics, physicians’  incomes,  and  specialism. 

With  the  conception  that  medical  education  is 
a continuous  process  from  the  time  of  enrollment 
in  the  medical  school  until  death  there  can  be  no 
quarrel  for  all  of  us  will  agree  that  the  study  of 
medicine  is  never  completed.  Particular  emphasis 
is  placed  on  the  idea  of  continuous  education  of 
graduates  through  the  medical  society,  the  clinics, 
and  other  postgraduate  courses.  Likewise  the  sub- 
ject of  health  is  incorporated  in  the  medical  curri- 


Delivered  at  the  87th  Annual  Meeting  of  the  Ohio  State 
Medical  Association,  Mayflower  Hotel,  Akron,  ThursHav  eve- 
ning, September  7,  1933. 


culum  and  emphasis  is  placed  upon  teaching 
facilities  to  include  preventive  as  well  as  curative 
medicine.  There  is  no  defeatist  tone  in  the  report. 
Improvements  in  medical  education  which  have 
been  inaugurated  are  commended.  At  the  same 
time  the  report  of  the  Committee  insists  “that 
ideal  training  cannot  be  provided  through  peda- 
gogic devices  nor  can  it  be  transmitted  by  a 
faculty”  and  further  observes  that  “the  learning 
of  medicine  is  most  likely  to  be  accomplished 
through  a relationship  of  the  student  and  a master 
clinician”  by  which  the  elusive  talent  known  as 
the  art  of  medicine  is  best  developed  for  the  art 
is  a composite  scientific  knowledge  and  method. 

Applying  these  observations  to  our  own  Asso- 
ciation it  would  seem  that  one  of  our  major  duties 
is  to  enlist  every  eligible  physician  who  prac- 
tices ethical  medicine  and  that  our  county  societies 
should  insist  upon  attendance  at  meetings  as  well 
as  membership.  In  this  way  can  the  continuous 
process  of  medical  education  best  be  carried  out. 

MEDICAL  LEADERSHIP 

We  are  all  familiar  with  the  rapid  advances  of 
medical  education  and  it  is  indeed  refreshing  in 
these  days  of  criticisms  to  read  a report  wherein 
the  conclusion  is  reached  that  the  profession 
itself  possesses  enough  brains  and  integrity  to 
manage  its  own  affairs.  Says  the  report: 

“The  medical  profession  is  the  trustee  of  the 
essential  knowledge  and  has  the  personnel  neces- 
sary to  solve  a large  national  problem.  Possessing 
that  knowledge  it  is  in  the  position  to  make  a 
vital  contribution  to  public  welfare.  Medicine  will 
occupy  its  proper  place  in  society  to  the  extent 
that  it  provides  leadership  and  properly  trained 
personnel  for  the  program  of  medical  service 
which  should  be  built  upon  thoughtfully  conceived 
plans  of  medical  and  postgraduate  education, 
proper  organization  of  the  profession  and  the  ad- 
vocacy of  unselfish  and  courageous  public  and 
professional  policies.” 

Contrast  these  conclusions  if  you  will  with  the 
recommendations  contained  in  the  majority  report 
of  the  Costs  of  Medical  Care  which  was  brought 
out  during  the  current  year.  Here  it  seems  to  me 
a retreat  is  sounded,  an  admission  that  our  house 
is  not  in  order  and  that  our  best  method  of  escape 
is  to  ally  ourselves  in  groups  around  the  hospital 
and  surrender  our  independence  to  lay  adminis- 
trators whose  first  duty  most  likely  will  be  to 
make  a financial  showing  with  little  or  no  regard 
for  medical  ethics.  Such  a condition  threatens 
our  ideals  and  reduces  the  profession  to  a level  of 
a trade.  It  is  my  conception  that  the  majority 
of  our  members  chose  medicine  as  a vocation  and 


621 


622 


The  Ohio  State  Medical  Journal 


October,  1933 


a career  of  service  and  not  as  a short  cut  to 
affluence. 

VITAL,  QUESTIONS  OP  MEDICAL,  ECONOMICS 

Medicine  and  economics  are  not  incompatible 
unless  over-emphasis  is  placed  on  economics.  As 
an  organization  we  must  oppose  those  measures 
which  threaten  economic  security  and  we  must 
assert  our  leadership  to  prevent  our  being  swal- 
lowed up  in  the  clinic,  hospital,  or  insurance  pro- 
gram. We  must  continue  as  individualists  who 
are  interested  in  the  welfare  of  the  community 
but  insist  upon  no  violation  of  the  confidential 
relationships  which  should  exist  between  the  doc- 
tor and  his  patient.  It  does  not  seem  possible  that 
any  nation-wide  movement  can  be  launched  effec- 
tively which  will  satisfactorily  solve  our  many 
problems  for  they  differ  in  character  in  the 
different  sections  of  our  country,  even  in  the 
same  state. 

With  the  belief  that  a constantly  improving 
medical  education  is  pouring  into  our  ranks  a 
better  qualified  set  of  practitioners  each  year  and 
that  their  membership  and  interest  in  the  county 
medical  society  will  best  solve  our  problems  by 
giving  to  the  people  of  a community  a better 
quality  of  service,  I would  submit  the  problems 
which  accrue  in  any  community  to  the  local  med- 
ical organization,  believing  its  solution  probably 
will  be  more  sane  and  equitable  than  the  dictum 
of  any  group  of  medical  or  sociological  higher- 
ups  who  treat  the  problems  in  an  abstract  way. 

I wish  a more  appropriate  term  than  Medical 
Economics  had  been  coined  for  somehow  the  pub- 
lic gains  a false  conception  of  its  meaning  as 
applied  to  medicine  and  confuses  it  with  the  eco- 
nomics of  general  business.  The  practitioner  of 
today  has  forgotten  the  saddle  bags  and  the 
buggy  and  serves  a community  of  greater  scope 
by  means  of  the  automobile.  Some  of  our  forward 
looking  members  even  resort  to  the  air.  All  of 
them  practically  have  served  an  apprenticeship  of 
seven  or  more  years  with  considerable  attendant 
expense  before  being  permitted  to  engage  in  prac- 
tice. Projected  into  a ticker  minded,  pleasure 
loving  world  they  are  expected  to  practice  modern 
medicine  with  well  appointed  offices,  and  socially 
keep  up  with  the  Joneses.  Only  a little  compu- 
tation is  necessary  to  prove  that  a practitioner’s 
living  expense  is  far  greater  than  that  of  his 
forebears,  and  yet  he  must  make  a decent  living 
for  himself  and  family.  It  is  strange  that  some 
of  our  socially  minded  people  feel  that  the  charge 
of  a fee  for  honest  service  is  beneath  him.  How 
else  can  he  exist?  How  long  can  he  continue 
to  exist  with  the  modern  clinic,  hospital,  and 
social  worker  preaching  the  false  doctrine  that 
only  the  very  rich  or  very  poor  receive  adequate 
medical  service? 

If  the  report  on  Medical  Education,  to  which  I 
have  already  referred,  is  true  then  properly 
trained  young  men  are  being  inducted  into  an 
overcrowded  profession  with  the  door  of  oppor- 


tunity to  make  a living  closed  to  them.  For  ex- 
ample, all  well  trained  general  practitioners  are 
abundantly  able  to  care  for  the  ordinary  case 
of  obstetrics  and  to  supervise  infant  feeding,  yet 
in  the  large  cities  we  witness  a constant  encroach- 
ment in  this  field  by  clinics  and  field  workers. 

PUBLIC  HEALTH  FUNCTIONS 

Times  of  adversity,  such  as  the  great  depres- 
sion, should  develop  our  fraternal  spirit  and 
bring  us  to  realize  that  the  economic  security  of 
a professional  brother  who  practices  ethical  medi- 
cine is  a matter  of  concern  to  each  one  of  us.  I 
believe  that  the  most  pressing  immediate  prob- 
lem which  confronts  the  organization  is  the  dis- 
semination of  existing  medical  knowledge  to  the 
membership  with  insistence  that  the  economic 
security  of  the  practitioner  shall  be  preserved. 

I quite  agree  with  Doctor  Cushing  that  the  re- 
mark often  repeated  to  the  effect  that  the  family 
doctor  will  come  to  be  replaced  and  crowded  out 
by  the  local  health  officer  is  pernicious.  Public 
Health  administration  owes  its  greatest  stimulus 
and  its  greatest  support  to  medical  organization. 
We  conceive  its  proper  function  to  be  as  defined 
by  our  President  of  last  year  “the  protection  of 
the  public  environment”  and  that  “this  protection 
has  three  subdivisions:  A.  Sanitation,  B.  Com- 

municable disease  control,  C.  Public  information 
and  education.”  However,  in  the  control  of  com- 
municable disease  recognition  must  be  had  that 
this  function  is  subdivided  into  quarantine  and 
immunization,  and  the  profession  rightfully  be- 
lieves that  immunization  is  a means  of  treatment 
which  should  not  be  employed  at  public  expense 
except  in  the  case  of  indigents. 

I might  mention  the  following  condition  or  cir- 
cumstance which  might,  and  often  does,  arise  to 
create  difficulties  between  the  medical  society  and 
local  boards  of  health;  namely,  the  establishment 
of  clinics  in  great  numbers  not  sanctioned  or 
supervised  by  the  medical  society  where  little  or 
no  effort  is  made  to  ascertain  the  financial  status 
of  the  recipients  and  the  stimulation  of  the  pub- 
lic by  publicity  or  other  means  to  patronize  these 
clinics. 

Again,  I find  it  necessary  to  repeat  the  policies 
of  the  Association  on  matters  of  this  sort.  These 
policies  have  been  established  by  the  House  of 
Delegates.  “Being  preventive  and  educational  the 
function  of  public  health  is  not  the  treatment  of 
disease  except  in:  (a)  Institutional  care  of  wards 
of  the  state,  delinquent,  diseased,  and  defective, 
(b)  The  treatment  of  those  whose  treatment  is 
essential  to  prevention,  (c)  The  inspection,  recog- 
nition, and  recommendation  for  correction  of  the 
common  defects  of  school  children  as  a primary 
feature  of  health  education.”  It  logically  follows 
that  public  clinics  conducted  by  health  agencies 
should  be  restricted  to  educational  purposes  only 
and  should  be  held  under  the  direction  and  super- 


October,  1933 


A Glance  at  Our  Balance  Sheet — Platter 


623 


vision,  or  with  the  approval,  of  the  local  medical 
society. 

V PREVENTIVE  MEDICINE 

fet- 

Our  efforts  to  stimulate  the  membership  to  prac- 
tice pi’eventive  medicine  includes  the  practice  of 
immunization  and  wherever  possible  this  should 
be  assumed  as  a function  of  private  medical  prac- 
tice. Periodic  health  examinations  and  diagnosis 
of  diseases  is  an  essential  part  of  medical  practice 
and  public  health  agencies,  official  or  voluntary, 
should  be  so  advised.  We  are  indeed  fortunate 
that  in  the  state  of  Ohio  our  policy  has  been 
closely  followed  by  the  State  Department  of 
Health,  and  local  health  officers.  However,  as  one 
reads  the  comments  of  editorial  writers  on  the 
recently  submitted  reports  of  the  Committee  on 
the  Costs  of  Medical  Care  it  is  significant  that 
many  of  these  laymen  have  put  their  fingers  on 
the  sore  spots  which  have  plagued  us  and  quite 
properly  have  called  attention  to  racketeering 
which  has  been  practiced  quite  widely  in  the 
name  of  health. 

In  the  health  field  as  in  the  field  of  medical 
economics  the  remedy  lies  in  our  own  hands,  and 
while  the  signers  of  the  majority  and  minority 
reports  agree  that  an  extension  of  sound  public 
health  service  is  desirable,  it  is  to  be  regretted 
that  the  signers  did  not  interpret  this  phrase  not 
only  for  the  medical  profession  but  for  the  public 
at  large. 

THE  NEED  FOR  EFFECTIVE  ORGANIZATION 

The  observations  I have  made  and  the  conclu- 
sions I have  reached  are  formulated  upon  the 
belief  that  our  people  are  best  served  by  a free 
and  unhampered  profession  performing  its  duties 
in  an  individual  way  and  answerable  to  a high 
code  of  ethics.  Such  a profession  must  maintain 
its  interests  and  contact  with  public  questions  in- 
volving the  health  and  welfare  of  the  people,  and 
must  give  expression  to  its  views  through  a cen- 
tralized unit  which  must  function  in  conformity 
with  our  established  policies. 

As  previously  stated  this  means  that  the  mem- 
bership should  be  recruited  to  its  fullest  capacity; 
that  attendance  at  meetings  should  be  stimulated, 
and  that  local  committees  should  be  appointed  and 
empowered  to  speak  in  the  name  of  the  society 
on  questions  involving  medical  practice. 

Graduate  medical  education  should  be  stimu- 
lated and  a strong  central  organization  should  be 
maintained  to  function  in  conformity  with  the 
wishes  of  the  House  of  Delegates.  To  the  Coun- 
cil of  such  an  organization  comes  many  distressing 
and  controversial  problems  for  the  Council  acts 
for  the  House  of  Delegates  between  sessions. 

Unquestionably  the  effectiveness  of  our  organi- 
zation is  measured  by  the  number  of  members 
who  aid  in  promulgation  and  support  of  our 
policies.  At  no  time  has  it  been  so  necessary  to 
keep  in  touch  as  at  the  present.  Upheavals  in 
government  and  in  business  threaten  our  social 


structure,  and  while  cooperation  with  various 
agencies  must  be  our  constant  effort  we  must  not 
forget  that  cohesion  is  fully  as  important.  Mem- 
bers who  consider  themselves  as  “above  the  law” 
which  applies  to  most  of  us  should  be  brought  to 
see  the  harm  they  do  and  a policy  determined 
should  be  supported  by  us  all  until  repealed. 

Is  it  any  wonder  that  during  the  period  of 
affluence  some  of  “Dame  Medicine’s”  sons  may 
have  philandered  a little,  or  that  we  have  some 
Pharisees  and  Sadducees  in  our  ranks,  but  does 
not  a careful  consideration  of  the  evidence  fully 
justify  the  belief  that  practitioners  of  medicine 
as  a rule  are  men  of  Samaria?  I believe  our 
organization  to  be  solvent  in  every  way  and  that 
we  are. not  so  bad  after  all.  While  the  continuing 

■i' 

depression  has  unsettled  our  economic  security  I 
do  not  believe  it  will  be  found  to  have  broken  our 
sp;rit.  Generally  speaking,  there  is  no  greater 
frozen  asset  today  than  character,  but  the  forti- 
tude displayed  by  our  membership  in  meeting  the 
demands  made  upon  it  leads  me  to  believe  that 
we  shall  go  forward  under  our  own  leadership. 
And  so,  I turn  the  destinies  of  the  organization 
to  other  hands  and  retire  to  the  ranks  with  ‘a  full 
and  sincere  appreciation  of  the  great  honor  you 
have  paid  me  and  a desire  to  join  with  you  to 
aid  my  friend  and  colleague  in  his  labors  in  behalf 
of  our  beloved  profession. 

“By  the  oath  of  Hippocrates  the  practitioner  of 
ancient  times  bound  himself  to  enter  his  patient’s 
home  with  the  sole  purpose  of  doing  him  good  and 
so  conducting  himself  as  to  avoid  the  very  ap- 
pearance of  evil.  Let  the  physicians  of  today  be- 
gin by  coming  up  to-  this  standard  and  add  to  it 
all  the  more  recently  discovered  virtues  and 
graces Your  relationships  to  your  pro- 

fessional brethren  may  be  a source  of  life  long 
happiness  and  growth  in  knowledge  and  char- 
acter, or  they  may  make  you  wretched  and  end  by 
leaving  you  isolated  from  those  who  should  be  your 
friends  and  counsellors.  The  life  of  a physician 
becomes  ignoble  when  he  suffers  himself  to  feed  on 
petty  jealousies  and  sours  his  temper  in  perpetual 
quarrels The  great  majority  of  the  pro- 

fession are  peacefully  inclined.  Their  pursuits  are 
eminently  humanizing,  and  they  look  with  dis- 
gust on  the  personalities  which  intrude  them- 
selves into  the  placid  domain  of  an  art  whose 
province  is  to  heal  and  not  to  wound.” 

— 0.  W.  Holmes. 

185  E.  State  Street. 


According  to  the  Bureau  of  Investigation, 
American  Medical  Association,  a fraud  order  has 
been  issued  against  the  Glow  of  Life  Laboratories, 
Columbus,  Ohio,  by  the  Post  Office  Department 
and  the  company  debarred  from  using  the  mails. 
The  company  had  been  marketing  an  aphrodisiac 
nostrum  which  the  promoters  claim  would  re- 
store lost  manhood  or  cure  sexual  impotence  or 
frigidity. 


624 


The  Ohio  State  Medical  Journal 


October,  1933 


CLYDE  L.  CUMMER,  M.  D.,  CLEVELAND 

President  of  The  Ohio  State  Medical  Association  for  the  year  1933-1934 


The  Educational  Tiunetioiris  oiF  the  State  Medical  Association 

INAUGURAL  ADDRESS  OF  THE  INCOMING  PRESIDENT 
Clyde  L.  Cummer,  M.D.,  Cleveland,  Ohio 


WE  are  gathered  together  for  this,  our 
87th  annual  meeting,  to  exchange  ideas 
as  to  the  practice  of  medicine  in  all  its 
branches  and  to  formulate  policies  which  will 
guide  us  as  a coherent  group,  as  well  as  for  joy 
which  comes  in  meeting  old  friends  and  making 
new  ones  whose  purposes  are  as  our  own.  All  of 
us  must  feel  deep  in  our  hearts  a sense  of  abiding 
satisfaction  that  we  are  physicians,  members  of 
an  ancient  and  honorable  profession,  devoting  our- 
selves to  the  prevention  of  disease,  the  healing  of 
the  sick,  the  alleviation  of  the  pangs  of  suffering; 
and  that  so  many  of  our  number  have  come  to- 
gether in  this  hospitable  city  with  the  hope  that 
we  may  return  to  our  homes  better  able  to  serve 
our  patients. 

As  physicians  we  have  genuine  cause  for  self- 
congratulation  in  that  we  have  selected  a vocation 
from  which  we  hope  to  gain  a living  for  ourselves 
and  those  dependent  upon  us,  but  which  gives  us 
occupation  for  our  hands  with  an  appeal  to  our 
hearts,  and  in  which  we  always  have  the  oppor- 
tunity of  adding  some  small  building  stone  to  the 
temple  of  knowledge.  We  can  never  forget  that 
Jenner,  Beaumont,  and  Koch  were  mere  doctors 
like  ourselves,  working  in  outposts  of  medical 
practice  without  benefit  of  well-organized  labora- 
tories or  research  institutes,  and  yet  who  started 
new  epochs  in  medicine  by  careful  observation  and 
well-planned  experimentation.  And  while  our 
faculties  and  circumstances  may  never  enable  us 
to  attain  even  a fragmentary  paid;  of  such 
achievements,  still  we  may  emulate  them  and  in 
so  doing,  become  better  physicians. 

THE  DOCTOR’S  TASK  AND  OPPORTUNITIES 

It  seems  to  me  that  essentially  the  very  worth- 
whileness  of  our  daily  work  is  the  factor  which 
sustains  our  interest  in  it  and  gives  us  strength 
to  meet  the  minor  irritations  and  often  the  great 
difficulties  which  ai’e  the  lot  of  many.  We  realize, 
perhaps  only  subconsciously,  that  we  are  doing 
something  which  should  be  done,  contributing 
something  necessary  to  happy  and  useful  lives, 
striving  to  help  people  to  live  longer  and  to  make 
their  lives  more  worth  the  living  by  easing  the 
burden  of  pain  and  disability. 

“A  wise  physician  skilled  our  wounds  to  heal, 

Is  more  than  armies  to  the  public  weal.” 

(Iliad,  Pope’s  translations.) 

The  task  before  us,  as  individuals  or  as  a pro- 


Delivered  at  the  87th  Annual  Meeting  of  the  Ohio  State 
Medical  Association,  Mayflower  Hotel,  Akron,  Ohio,  Thurs- 
day evening,  September  7,  1933. 


fession,  is  one  which  can  never  be  satisfactorily 
completed.  While  many  of  the  infectious  diseases 
have  been  mastered  through  discovery  of  their 
causes  and  of  specific  means  of  treatment,  alto- 
gether too  many  maladies  are  still  mysterious  in 
nature  and  baffling  as  to  cure,  and  the  constant 
change  of  environmental  conditions  and  the  ad- 
dition of  new  occupational  and  other  hazards  con- 
stantly add  to  the  long  list  of  unsolved  problems. 
Then,  too,  while  many  more  of  the  population 
survive  the  perils  of  infancy  and  childhood,  just 
so  many  more  reach  adult  life  or  even  more  ad- 
vanced years  and  consequently  we  are  faced  with 
a correspondingly  greater  number  of  individuals 
suffering  with  the  degenerative  diseases  peculiar 
to  these  periods  of  life.  The  frontiers  of  medical 
knowledge  must  be  advanced  continually.  Alex- 
ander cried  for  fresh  fields  to  conquer.  Each  gen- 
eration of  physicians  finds  new  fields  waiting  for 
them;  their  cry  must  be  for  new  weapons  and 
greater  skill  in  the  use  of  those  found  helpful  in 
the  warfare  of  the  past. 

This  has  always  been  the  stirring  challenge  to 
us  as  an  organized  profession.  The  discovery  of 
causes  and  remedial  agents  is  a matter  for  in- 
dividuals among  us  and  for  research  organiza- 
tions; the  dissemination  of  these  discoveries  and 
their  practical  application  is  the  cardinal  purpose 
of  such  a group  as  ours.  The  state  medical  society 
has  a great  field  of  usefulness  as  a school  for  post- 
graduate instruction,  and  the  meeting  which  you 
are  now  attending  was  arranged  to  help  in  carry- 
ing out  that  purpose.  The  medical  society  which 
fails  to  keep  educational  purposes  in  the  forefront 
descends  to  the  level  of  a trades  union  or  a mer- 
cantile association. 

Osier  remarked  that  no  class  of  men  needs  to 
call  to  mind  more  often  that  wise  comment  of 
Plato  that  education  is  a life  business.  The  phy- 
sician must  constantly  revise  his  knowledge,  gain 
new  ideas,  and  discard  those  which  have  not  stood 
the  test  of  time. 

EDUCATIONAL  FUNCTIONS  ARE  IMPORTANT 

The  educational  feature  of  our  activities  is  one 
which  merits  frank  and  earnest  discussion;  it  is 
the  burden  of  my  thesis.  In  recent  years,  there 
has  been  a growing  feeling  that  our  programs, 
excellent  though  they  were,  were  not  appealing  to 
the  membership  sufficiently.  Therefore,  and  in 
direct  proportion  to  the  deficiency  of  their  appeal, 
they  were  failing  in  their  purpose  because  an  ad- 
dress delivered  at  a state  meeting  to  a corporal’s 
guard  is  unsuccessful,  while  one  on  a subject  of 
such  vital  interest  that  it  attracts  a large  audi- 


625 


626 


The  Ohio  State  Medical  Journal 


October,  1933 


ence,  provided  , it  be  delivered  in  a telling  way,  is 
of  benefit  to  all." 

The  feeling  that  our  programs  were  inadequate 
was  voiced  in  resolutions  introduced  on  the  floor 
of  the  House  of  Delegates  in  1931,  and  the  result 
was  the  appointment  of  a committee  to  consider 
the  matter.  Your  present  president,  Dr.  H.  M. 
Platter,  served  as  chairman  of  that  committee  and 
after  sending  out  questionnaires  and  making  an 
analysis,  he  concluded  that  the  emphasis  had  been 
placed  too  strongly  upon  the  specialities  as  such, 
detached  from  the  rest  of  medicine,  and  that  more 
time  should  be  given  to  subjects  of  general  inter- 
est to  men  doing  general  practice. 

Who  are  the  men  to  whom  our  programs  should 
be  made  attractive?  Examination  of  the  directory 
of  the  American  Medical  Association  shows  that  a 
relatively  small  proportion  of  the  physicians  of 
Ohio  list  themselves  as  limiting  their  practice  to  a 
particular  specialty,  which  means  that  an  even 
smaller  number  are  actually  engaged  exclusively 
in  special  practice.  The  great  majority  of  our 
members  are  working  in  that  broad  field  which  we 
call  general  practice.  It  is  for  the  benefit  of  these 
men  of  inclusive  interest  that  the  programs  should 
be  planned.  Consequently  the  subjects  chosen 
should  be  not  only  modern  in  nature  but  of  wide 
scope  and  practical  in  every  bearing. 

As  for  the  specialists,  I cannot  make  myself  be- 
lieve that  they  too  will  not  profit  from  well-ar- 
ranged general  programs.  The  really  great  spe- 
cialists are  those  who  do  have  the  broad  point  of 
view,  and  breadth  does  not  necessarily  detract 
from  that  intensity  of  detailed  knowledge  requi- 
site in  a specialist.  To  select  only  one  example 
from  many  which  could  be  chosen,  witness  Jono- 
than  Hutchinson,  whose  contributions  to  dermat- 
ology and  particularly  to  syphilology  are  of  last- 
ing importance,  but  who  also  achieved  reputation 
and  success  as  a competent  neurologist,  ophthal- 
mologist, and  general  surgeon. 

Therefore,  with  the  realization  that  our  pro- 
grams should  have  wider  appeal,  steps  were  taken 
to  stress  the  general  sessions  at  the  Dayton  meet- 
ing. Diverse  subjects  of  general  interest  were 
selected  and  presented  by  experienced  clinical 
teachers.  This  year  we  have  arranged  for  two  gen- 
eral sessions,  making  this  increase  at  the  expense 
of  the  sections,  which  have  been  limited  to  a half 
day.  We  have  followed  last  year’s  precedent  in 
asking  the  medical  schools  to  furnish  a symposium 
for  one  of  the  general  sessions,  but  in  addition 
you  will  hear  tomorrow  morning  seven  papers  of 
general  and  diversified  interest. 

THIS  YEAR’S  PROGRAM  REVIEWED 

This  has  been  done  with  no  desire  to  curtail  the 
sections  unduly,  but  with  the  feeling  that  those 
interested  in  the  sections  will  remember  that 
there  is  ample  provision  for  the  specialists  in 
myriad  national,  regional  and  local  special  so- 
cieties, and  furthermore  that  even  in  the  sections 


it  should  be  necessary  to  provide  papers  of  suffi- 
ciently broad  scope  to  interest  general  practition- 
ers as  well  as  specialists.  Recent  programs  have 
provided  many  examples  of  this  type  of  splendid 
paper. 

We  do  not  regard  this  year’s  program  as  ab- 
solutely ideal  or  as  entirely  fulfilling  the  con- 
ception just  outlined,  but  we  think  that  it  is  a 
step  in  the  right  direction.  An  ideal  program  for 
a state  meeting,  or  for  any  other  meeting,  would 
have  some  provision  for  the  presentation  of  pa- 
tients. The  meeting  would  take  on  the  nature  of 
a clinic,  at  least  in  part,  and  by  this  we  do  not 
mean  merely  clinics  held  in  hospitals  remote  from 
the  place  of  general  meeting  on  the  preceding  day 
and  therefore  in  reality  quite  apart  from  the  con- 
vention sessions.  The  patients  should  be  brought 
into  our  meetings,  furnishing  the  text  for  the 
clinician’s  discourse,  exactly  as  in  the  clinics  of 
teaching  hospitals. 

The  presentation  of  patients  is  most  important 
for  psychological  reasons.  The  average  listener  is 
always  interested  in  the  concrete,  the  definite,  the 
objective.  When  he  listens  to  many  formal  writ- 
ten discourses  he  is  bored  with  the  abstract,  but 
when  listening  to  the  story  of  a living  patient  who 
sits  before  him,  his  wandering  attention  finds 
something  upon  which  to  focus.  On  the  other 
hand,  the  speaker  is  always  more  natural,  force- 
ful and  fluent  when  talking  about  a patient  whom 
he  can  demonstrate.  To  be  convinced,  introduce  a 
patient  and  watch  the  immediate  change  in  the 
mental  atmosphere  of  an  audience  which  has  be- 
come somewhat  tired  of  listening  to  abstract  dis- 
sertations. 

CLINICAL  DEMONSTRATIONS  VALUABLE 

Thirty  years  ago  that  great  physician  and  edu- 
cator, William  Osier,  delivered  an  address  at  the 
centennial  celebration  of  the  New  Haven  Medical 
Association  in  which  he  said: 

“Of  still  greater  educational  value  is  the  clinical 
side  of  the  society.  No  meeting  should  be  arranged 
without  the  presentation  of  patients,  particularly 
those  illustrating  rare  and  unusual  forms  of  dis- 
ease. Many  diseases  of  the  skin  and  the  joints,  a 
host  of  nervous  affections,  and  many  of  the  more 
remarkable  maladies,  as  myxoedema,  cretinism, 
achondroplasia,  etc.,  are  seen  so  rarely  and  are  so 
distinctive  requiring  only  to  be  seen  to  be  recog- 
nized, that  it  is  incumbent  upon  members  to  use 
the  society  to  show  such  cases.  A clinical  evening 
devoted  to  those  rarer  affections  is  of  very  great 
help  in  diffusing  valuable  knowledge.” 

(Osier,  “On  the  Educational  Value  of  the  Medi- 
cal Society”,  Aequanamitas  and  Other  Addresses, 
Page  355.') 

While  these  remarks  were  addressed  to  a local 
medical  society,  they  strike  me  as  equally  ap- 
plicable to  larger  units.  Indeed,  I think  that  the 
striking  success  of  the  Interstate  Post-graduate 
Assembly  is  due  not  only  to  the  selection  of  live 


October,  1933 


The  Educational  Function — Cummer 


827 


subjects  and  experienced  speakers,  but  to  the  pre- 
sentation of  patients. 

In  addition,  your  program  committee  has  tried 
to  correct  another  evil,  the  yearly  repetition  of 
subjects.  In  programs  as  well  as  in  the  tables  of 
contents  of  medical  journals,  there  are  fads  and 
fashions  in  subjects.  When  an  especially  good 
paper  is  given  one  year,  the  following  year  brings 
several  requests  for  places  on  the  program  for 
papers  on  the  same  or  closely  related  subjects,  it 
sometimes  seeming  that  all  the  specialists  in  the 
state  had  taken  up  their  literary  tomahawks  as 
at  a tocsin  call.  This  repetition  of  subjects  makes 
impossible  a diversified  program  if  one  views  the 
programs  as  part  of  a continuous  educational  pro- 
ject. Consequently  this  year  we  prepared  a care- 
ful author  and  subject  index  of  the  programs  of 
recent  years  hoping  to  obviate  undesirable  repe- 
tition. 

The  section  officers  have  been  very  helpful  in 
the  effort  to  build  up  an  integrated  program;  and 
we  are  grateful  to  them.  For  continued  success 
and  further  improvement,  we  must  have  their  con- 
tinued understanding  and  cooperation.  We  feel 
that  they  will  realize  that  the  entire  program  is 
more  important  than  any  part  thereof,  and  that 
the  elaboration  of  a well-balanced  general  offering 
of  papers  is  the  goal  for  which  all  must  strive. 

EXHIBITS  AS  EDUCATIONAL  AIDES 

As  part  of  our  plans  for  broadening  the  edu- 
cational value  of  our  meetings,  I hope  to  see  the 
continuation  of  the  scientific  exhibits  and  their 
very  great  development.  We  have  had  them,  in- 
termittently, but  they  have  been  small  in  number 
and  size,  due  to  lack  of  room.  The  excellent  ex- 
hibits at  the  Dayton  meeting  in  1932  were  crowded 
in  with  the  commercial  exhibits  through  necessity. 
This  year  the  scientific  exhibits  are  excellent  but 
again  the  local  committee  has  been  greviously 
handicapped  by  limited  space.  The  scientific  ex- 
hibits of  the  American  Medical  Association  have 
evolved  into  an  outstanding  feature,  well  worth  a 
journey  of  many  miles.  Unfortunately,  distance 
and  expense  keep  many  of  our  members  from  this 
great  nat:onal  meeting;  consequently  it  is  in- 
cumbent upon  us  to  compensate  to  them  as  far  as 
we  can  by  having  our  own  exhibits.  Sudh  exhibits 
are  effective  because  objective.  A long  and  other- 
wise difficult  lesson  is  often  learned  readily  and 
easily  by  a visit  to  an  exhibit  which  has  been  so 
conceived  and  arranged  as  to  have  genuine  teach- 
ing value.  The  exhibits  are  especially  valuable 
when  illustrative  of  papers  read  at  the  sessions. 
It  is  our  hope  that  they  may  be  developed  con- 
tinuously. 

A vital  factor  in  our  scientific  advancement  is 
The  Journal  carrying  to  all  our  membership  the 
papers  presented  at  the  meetings  as  well  as  other 
original  contributions.  It  is  also  invaluable  as  an 
instrument  for  organization  purposes.  The  qual- 
ity of  its  art'cles  has  been  elevated  in  recent  years 
and  it  is  generally  recognized  as  one  of  the  best 


state  Journals.  To  the  efficient  and  hard-working 
publication  committee  and  to  our  headquarters 
staff  the  entire  membership  owes  a debt  of  grati- 
tude. 

LOCAL  TALENT  SHOULD  BE  USED 

The  educational  work  of  the  state  society  can 
be  carried  on  only  in  part  by  itself.  It  is  regret- 
table that  but  a fraction  of  the  membership  can  be 
reached  by  the  annual  meetings,  the  average  at- 
tendance being  only  about  20  per  cent  of  the  total 
membership.  The  papei’s  there  presented  are 
printed  in  The  Journal,  where  all  may  read  them, 
although  a published  paper  lacks  the  stimulating- 
quality  infused  by  an  enthusiastic  speaker.  How- 
ever, it  is  evident  that  there  is  about  80  per  cent 
of  our  membership  which  must  have  other  op- 
portunity for  the  interchange  of  ideas.  It  is  this 
need  which  the  local  county  societies  must  supply, 
and  do  supply  with  varying  measures  of  success. 
The  programs  of  some  are  of  the  highest  edu- 
cational oi’der.  While  I should  not  disparage  the 
practice  of  occasionally  importing  speakers,  I am 
convinced  that  many  societies  weaken  themselves 
by  relying  entirely  or  too  much  upon  imported 
talent;  and  that  at  least  frequent  intervals  the 
program  should  be  furnished  by  local  members. 
The  preparation  of  a formal  paper  to  read  before 
a handful  of  one’s  friends  is  sometimes  discourag- 
ing, but  the  profit  to  the  writer  is  that  which  ac- 
crues to  any  student,  viz.,  self-improvement.  An 
occasional  round-table  discussion  of  interesting 
clin'cal  obsei-vations  taking  the  form  of  an  ex- 
perience meeting,  is  an  excellent  means  of  draw- 
ing all  present  into  the  argument.  Local  secre- 
taries or  program  committees  who  labor  faithfully 
to  set  intellectual  meat  before  their  colleagues  are 
entitled  to  the  encouragement  of  full  attendance. 

In  concluding  this  discussion  of  the  educational 
functions  of  the  society,  I realize  that  the  ideas 
advanced  are  not  original,  being  adaptations  of 
those  found  useful  elsewhere.  Time  prevents  my 
developing  them  more  fully,  but  they  represent 
deliberate  opinions  based  on  experience  in  the  work 
of  your  association  as  section  officer,  councilor  and 
member  of  program  and  convention  arrangement 
commitees.  It  is  my  feeling  that  they  may  be 
the  same  as  your  own,  but  of  this  no  one  can  be 
sure  unless  you  let  the  officers  and  councilors 
know  your  opinions,  whether  in  agreement  or  not. 
The  council  and  future  program  committees  will, 
I know,  appreciate  and  be  guided  by  constructive 
criticism,  for  their  natural  desire  is  to  provide  the 
members  with  the  type  of  program  acceptable  to 
the  majority. 

The  reason  for  devoting  this  address  largely  to 
the  educational  possibilities  of  the  association  is 
because  of  the  realization  that  this  is  one  of  its 
cardinal  purposes.  To  keep  alight  the  lamp  cf 
scientific  learning  is  the  primary  duty  of  the 
votaries  of  our  guild. 

UNITY  IN  ORGANIZATION  VITAL 

While  there  is  little  time  to  speak  of  the  other 


628 


The  Ohio  State  Medical  Journal 


October,  1933 


purposes  of  this  association,  I have  no  desire  to 
minimize  them.  To  further  all  actions  protecting 
the  public  health,  to  advance  or  preserve  proper 
legislation,  to  represent  and  protect  the  interests 
of  the  medical  profession  in  relation  to  official  and 
unofficial  administration  of  movements  and  func- 
tions in  the  field  of  public  health  and  medical 
practice,  and  to  represent  effectively  the  interests 
of  the  profession  as  a whole  on  public  problems  of 
a social,  welfare,  economic  and  health  nature.  To 
draw  the  societies  of  the  88  counties  of  this 
populous  state  together  into  one  association,  lift- 
ing up  the  faint-hearted  and  strengthening  the 
weak  among  them,  doing  for  their  members  that 
which  they  would  be  powerless  to  do  alone;  and  in 
turn  to  unite  with  the  association  of  the  47  other 
states  to  form  the  American  Medical  Association, 
are  most  potent  reasons  for  our  being,  and  at  the 
same  time,  profound  sources  of  our  strength. 

But  perhaps  above  all  else  is  filling  the  need  in 
all  professions  and  crafts  for  unity,  and  this  all- 
essential unity  can  be  had  only  upon  a basis  of 
friendship  and  mutual  understanding.  There  are 
situations  in  which  we  all  find  it  easy  to  differ 
with  our  colleagues,  and  such  differences  are  often 
fanned  to  devastating  flames  by  idle  talk  or 
malicious  gossip.  In  non-essentials,  we  must  man- 
ifest to  our  brother  doctors  a broad  spirit  of  tol- 
erance, remembering  that  all  can  never  think  and 
feel  exactly  alike. 

In  her  delightful  book  on  Mere  Marie  of  the 
Ursulines,  Agnes  Repplier  tells  us  that  Charles 
V spent  years  of  his  retirement  in  the  monastery 
of  St.  Yuste  in  becoming  an  expert  clock-maker, 
and  yet,  in  spite  of  his  proficiency  his  clocks  would 
never  strike  exactly  in  unison ; so  he  fell  to  asking 
himself  whether  it  were  possible  to  force  men’s 
minds  into  accord,  when  he  was  unable  to  ac- 
complish perfect  precision  with  wheels  and 
springs  over  which  he  had  apparent  control. 
Gatherings  such  as  this  and  those  of  our  local 
units  make  for  a generous  spirit  of  personal  tol- 
erance. It  is  hard  to  quarrel  with  your  fellow 
doctor  about  non-essentials  when  you  look  him  in 
the  eye  and  shake  his  hand,  and  the  free  discus- 
sion of  the  open  meeting  and  the  opinions  of 
others  there  expressed,  should  serve  to  clarify  the 
differences  of  professional  and  personal  opinion. 

On  the  other  hand,  there  are  fundamental  ques- 
tions of  basic  principles  such  as  those  enunciated 
in  the  Principles  of  Ethics  on  which  no  deviation 
should  be  permitted;  here  we  must  have  unity. 
And  on  many  matters  of  public  and  economic  re- 
lations the  only  salvation  of  our  profession  is  in 
the  universal  adherence  to  a strong  policy  con- 
ceived for  the  public  good  and  approved  by  the 
majority.  These  likewise  are  essentials,  so  let  us 
then  adopt  as  our  guiding  precept  the  words:  “In 
essentials,  unity;  in  non-essentials,  liberty;  and 
in  all  things,  charity.” 

1010  Hanna  Bldg. 


County  Home  Rule  Amendment  Up  to 
the  Voters 

At  the  forthcoming  November  general  election, 
the  voters  of  Ohio  will  be  given  an  opportunity 
to  vote  on  an  amendment  to  the  Ohio  Constitu- 
tion, known  as  the  County  Home  Rule  Amend- 
ment, designed  to  permit  the  State  Legislature  to 
enact  enabling  legislation  for  the  reorganization 
of  county  government. 

Sponsors  of  the  amendment  contend  that  it  is  a 
step  toward  economy  and  efficiency  in  county 
government.  Like  the  municipal  home  rule  amend- 
ment adopted  in  1912,  the  County  Home  Rule 
Amendment  does  not  change  the  existing  county 
government  system  directly,  its  sponsors  point 
out,  but  makes  certain  changes  possible.  Any 
changes  recommended  by  the  Legislature,  should 
the  amendment  be  adopted,  would  be  optional 
with  the  various  counties  and  would  not  become 
operative  in  any  county  until  approved  by  the 
electors  of  such  county. 

Specifically,  the  amendment  would  accomplish 
four  things,  its  sponsors  declare,  namely: 

1.  Eliminate  the  constittuional  obstacles  now 
blocking  reorganization  of  county  governments. 

2.  Permit  the  Legislature  to  enact  optional 
plans  of  county  government,  any  one  of  which 
could  be  selected  by  a county  by  popular  vote  if  a 
change  is  desired. 

3.  Permit  any  county  to  frame  its  own  plan  of 
county  government,  suited  to  its  needs  and  wishes, 
through  the  framing  of  a charter  to  be  submitted 
to  popular  vote. 

4.  Enable  a county  upon  approval  of  the  elect- 
ors to  consolidate  county  functions;  create  a re- 
sponsible executive  head;  merge  various  county 
and  municipal  services;  and  to  take  other  steps 
leading  to  a more  unified  administration  of  gov- 
ernmental activities  within  the  county. 

Sponsors  of  the  amendment  point  out  that  the 
amendment  would  not  affect  the  public  school  sys- 
tem; change  or  abolish  townships,  or  permit  cities 
to  annex  or  absorb  suburbs  against  the  wishes  of 
the  suburban  population. 

Moreover,  it  is  pointed  out,  the  amendment 
would  not  alter  the  present  system  of  public 
health  administration.  It  would  not  make  the 
health  commissioner  an  elective  official  and,  there- 
fore, would  preserve  the  existing  plan  whereby 
the  health  commissioner  is  appointed,  which  keeps 
the  office  out  of  politics  and  removed  from  politi- 
cal pressure.  However,  it  would  permit  counties, 
if  they  so  desire,  to  set  up  a different  plan  for  the 
appointment  of  their  public  health  administrators. 
For  example,  a county  might  provide  for  the  ap- 
pointment of  its  board  of  health  by  some  board  or 
official  chosen  by  popular  vote,  rather  than  having 
the  board  of  health  selected  by  the  village  mayors 
and  township  trustees  as  at  present,  thus  fixing 
the  responsibility  of  public  health  administration 
more  definitely  and  permitting  the  county  health 
department  to  share  directly  in  the  county  budget. 


e Ulcerative  Colitis  With  Illustrative  Cases 

V.  C.  Rowland,  A.M.,  M.D.,  Cleveland,  Ohio 


THE  differential  diagnosis  in  chronic  or  re- 
curring diarrhoea  and  the  various  forms  of 
colitis  often  presents  a problem  of  con- 
siderable difficulty.  Before  considering  the  dif- 
ferential diagnosis  of  a true  colitis  one  must  ex- 
clude the  symptomatic  diarrhoeas  of  achylia  gas- 
trica,  pernicious  anemia,  hyperthyroidism,  mucus 
or  allergic  colitis,  cirrhosis  of  the  liver,  congestive 
heart  failure,  chronic  uremia,  or  pancreatitis, 
metallic  or  other  exogenous  poisoning  such  as 
mercury,  arsenic  and  alcohol,  also  pellagra  and 
sprue,  and  occasional  cases  of  intestinal  para- 
sites and  gastrocolic  fistula  especially  following 
gastro-enterostomy.  The  occasional  occurrence  of 
amoebic  dysentery  when  least  suspected,  or  of  a 
tuberculous  colitis  without  pulmonary  signs  or 
even  the  unusual  case  of  malignant  disease  of  the 
colon  should  make  one  cautious  in  the  diagnosis. 

DIAGNOSIS 

Ulcerative  colitis  must  be  diagnosed  largely  by 
exclusion.  Bargen’s  diplococcus  cannot  yet  be  re- 
garded as  sufficiently  specific  in  ulcerative  colitis 
to  be  used  as  a primary  diagnostic  criterion.  The 
organism  is  not  found  in  all  cases  and  has  ad- 
mittedly been  found  in  the  normal  bowel.  Cuth- 
bert  Dukes  states  that  it  occurs  in  the  ulcerations 
of  uremia  and  the  toxic  metals.  In  these  con- 
ditions there  is  more  or  less  hemorrhage  into  the 
lumen  of  the  bowel.  Brown  and  Paulson  in  re- 
jecting the  specificity  of  the  Bargen  organism 
supplied  evidence  that  the  predominance  of  cocci 
in  colitis  is  due  to  the  survival  of  those  organisms 
and  the  dying  out  of  other  organisms  in  the  pres- 
ence of  blood  which  is  almost  constantly  present 
in  the  bowel  contents  in  ulcerative  colitis. 

Ulcerative  colitis  has  also  supervened  upon 
bacillary  dysentery  and  other  infections.  Fur- 
thermore, ulcerative  colitis  has  no  absolutely  dis- 
tinctive pathology.  Grossly  at  autopsy  there  may 
be  large  ulcers  throughout  the  colon  with  un- 
determined edges  and  tunneling,  highly  suggestive 
of  amoebic  dysentery,  as  in  Case  I,  below  reported. 
This  being  true,  it  follows  that  the  sigmoidoscopic 
appearance  of  ulcers,  however  suggestive,  cannot 
be  recognized  as  absolutely  diagnostic.  X-ray 
evidence  is  very  helpful  but  the  final  diagnosis 
must  be  established  or  supported  by  bacteriologi- 
cal methods,  which  are  essential  also  for  the  con- 
trol of  treatment. 

In  differentiating  dysentery  it  is  very  easy  to 
recognize  the  motile  amoebae  containing  a num- 
ber of  red  blood  corpuscles  when  these  organisms 
are  present  in  the  rectal  mucus  or  in  material  ob- 
tained from  the  floor  of  ulcers  through  the  procto- 
scope. After  the  acute  stage,  however,  when  the 
amoebae  have  encysted  and  after  various  kinds  of 
treatment  it  may  be  difficult  to  find  and  identify 


the  amoebae  histolytica  cysts.  It  should  be  re- 
membered also  that  as  high  as  60  per  cent  of 
cases  with  positive  stool  findings  will  not  show 
ulcers  by  sigmoidoscopic  examination.  The  cecal 
region  is  the  site  of  predilection  for  amoebic 
ulcers. 

Cysts  in  the  stool  may  be  concentrated  by  cen- 
trifuging two  cubic  centimeters  of  the  specimen  in 
ten  cubic  centimeters  of  water  at  1500  revolu- 
tions per  minute  for  twenty  seconds.  The  super- 
natant fluid  is  then  quickly  decanted  and  the  tube 
refilled  with  water  and  the  same  process  repeated 
several  times.  Ova  and  larvae  are  segregated  by 
the  same  technique.  Cysts  are  recognized  as  thin- 
walled,  retractile  spheres  with  a chromidial  bar. 

In  case  of  doubt  the  final  test  is  by  wet  smears 
fixed  in  Schaudinn’s  solution  and  stained  with 
iron  hematoxin.  In  this  way  the  four  nuclei  and 
the  finer  structure  of  entamoeba  histolytica  may 
be  recognized. 

The  great  majority  of  the  cases  in  the  North 
will  prove  to  be  non-specific  infections  at  the  time 
of  examination,  the  predominating  organism  being 
the  Bargen  diplococcus,  streptococci,  various  en- 
terococci and  B.  fecalis  alkaligenes  or  other 
Gram  negative  bacilli.  J.  P.  Lockhart  Mummery 
has  found  the  pneumococcus  at  times  to  be  the 
immediate  exciting  cause.  Garrod  reports  the 
Bargen  organism  with  positive  agglutinins  in  11 
of  17  cases.  There  were  two  amoebic  infections  in 
a series  of  forty  cases  of  chronic  colitis  at  St. 
Luke’s  Hospital  in  Cleveland.  Five  per  cent  is 
about  the  proportion  found  elsewhere  in  similar 
studies.  In  the  same  series,  eight  cases  showed 
diplococci  morphologically  of  the  Bargen  type. 
There  may  be  a dysenteric  or  other  initial  infec- 
tion as  the  primary  cause  of  the  disease  in  some 
cases,  but  it  seems  highly  probable  that  many  are 
simple  septic  infections  resulting  from  such  fac- 
tors as  nutritional  deficiencies,  focal  infections, 
severe  prolonged  irritation,  and  nervous  per- 
versions of  the  motor  and  secretory  functions  of 
the  colon.  The  Bargen  diplococcus  has  been  cul- 
tured from  the  tonsils  and  other  foci  of  infection. 
Some  cases  of  ulcerative  colitis  occur  in  anemic 
and  under-nourished  individuals;  others  occur  in 
the  obese  taking  an  excessively  rich  diet.  More 
commonly  the  patient  is  or  soon  becomes  of  the 
under-nourished  anemic  type  requiring  a nutrit- 
ious, high  vitamin,  low  residue  diet.  A few  of  our 
cases  followed  alcoholic  excesses.  One  young  man 
of  27  had  a persistent  diarrhoea  from  heavy 
drinking  at  Christmas  time  lasting  until  his  ad- 
mission to  the  hospital  on  February  5th,  when 
X-ray  showed  quite  characteristic  dehaustration 
and  narrowing  of  the  descending  colon.  In  fact 
from  the  X-ray  standpoint  alone  the  colon  looked 


629 


630 


The  Ohio  State  Medical  Journal 


October,  1933 


as  bad  as  that  of  Case  I just  before  his  last  and 
fatal  attack  with  high  fever  and  hemorrhage. 

The  characteristic  lesions  of  ulcerative  colitis 
occur  in  the  lower  colon  as  diffuse  miliary  ab- 
scesses about  one  millimeter  in  diameter  and  con- 
tinue as  minute,  discrete  bleeding  miliary  ulcers 
dispersed  with  the  pocks  of  previously  healed 
ulcers,  some  from  previous  attacks  of  the 
d'sease.  This  is  the  so-called  “hammered  copper'' 
appearance  of  the  mucosa.  As  is  well  known,  the 
disease  extends  upward  from  the  rectum  leading 
to  a loss  of  haustration  and  gradual  thickening 
and  straightening  of  the  bowel  wall  and  narrow- 
ing of  its  lumen,  even  to  stricture  formation.  The 
ulcerations  do  not  tend  to  penetrate  the  mus- 
eularis  as  readily  as  in  amoebic  colitis. 

BACTERIOLOGY 

Bargen’s  work  represents  the  most  exhaustive 
scientific  study  of  ulcerative  colitis  from  the 
bacteriological  viewpoint.  Whether  his  diplo- 
ccccus  is  the  specific  etiological  cause  of  the  dis- 
ease or  a secondary  invader  following  upon  nu- 
tritional deficiencies  and  other  factors  remains  tc 
be  proved.  However,  the  organism  may  be  re- 
covered in  a large  percentage  of  cases  and  is 
useful  in  diagnosis  and  treatment.  Bargen  claims 
to  have  completed  the  experimental  cycle  of  pro- 
ducing the  typical  lesions  by  intravenous  injec- 
tions and  to  have  recovered  the  organism  from  the 
lesions.  The  organism  is  described  as  a large 
gram-positive  lancet-shaped  diplococcus  with  no 
capsule,  aerobic,  non-hemolytic  on  blood  agar  and 
not  bile  soluble — really  a species  of  streptococcus 
viridans.  It  does  not  ferment  inulin  or  mannite, 
is  not  agglutinated  by  pneumococcus  antisera  but 
produces  specific  agglutinins.  Fresh  strains  al- 
ways ferment  lactose.  The  medium  used  is  dextrose 
brain  broth  for  the  primary  24  hour  culture  and 
is  then  sub-cultured  to  blood  agar  or  lactose  agar 
plates.  The  organism  has  been  recovered  from  the 
blood  stream  in  five  cases  by  Bargen  and  in  three 
cases  by  Crohn.  Bargen  in  1931,  reported  on  cul- 
tures made  from  curettings  of  ulcer  bases  in  56 
cases  of  ulcerative  colitis.  No  organisms  sugges- 
tive of  dysentery  bacilli  were  found  as  reported 
by  Hurst.  Three  cases  showed  B.  pyocyaneus 
and  the  diplostreptococcus  was  found  in  45  or 
80.4  per  cent. 

The  disease  is  characterized  by  remissions  and 
exacerbations  as  in  most  other  forms  of  colitis. 
The  chronic  course,  the  debilitating  effect  upon 
body  and  mind  make  it  a formidable  disease.  It 
attacks  adults  most  commonly  between  20  and  40 
and  the  sexes  about  equally.  The  first  case  in  a 
child  was  reported  by  Helmholtz  in  1926.  It 
seems  to  be  world-wide  in  distributiton.  Compli- 
cations are  relatively  rare  despite  the  extensive 
area  of  septic  infection.  Liver  abscess  almost 
never  occurs.  Pyelitis  is  comparatively  rare,  al- 
though the  normal  bowel  is  often  suspected  to  be 
the  source  of  acute  pyelitis.  Perforation,  though 
very  fatal,  is  not  common  and  almost  limited  to 


the  acute  stage.  Hemorrhage  in  small  amounts  is 
frequent.  Occasionally  it  is  profuse.  Case  I died 
following  a severe  hemorrhage. 

In  1933  Bargen  reported  on  a ten  year  survey 
of  1348  cases  from  the  Mayo  Clinic.  In  80  per 
cent  of  these  the  diplococcus  was  isolated  and 
very  few  seemed  to  have  any  relationship  to 
bacillary  dysentery.  Of  the  whole  group,  67  per 
cent  are  symptom  free  for  a period  of  three 
years,  23  per  cent  are  improved,  and  10  per  cent 
are  dead.  Bargen  compares  the  disease  with  tu- 
berculosis in  that  it  is  a chronic  infection  in 
which  all  measures  to  improve  specific  and  gen- 
eral resistance  are  important.  He  advises  against 
irrigations  and  depends  mainly  on  prolonged  rest, 
bland,  high  vitamin,  usually  milk  free  diet  and 
vaccine  therapy.  He  uses  his  specific  serum  in 
the  very  acute  cases. 

COMPLICATIONS 

Statistics  as  to  the  relative  frequency  of  com- 
plications vary  considerably.  In  693  cases  re- 
ported from  the  Mayo  Clinic,  there  were  18  per- 
forations, 59  strictures,  26  perirectal  abscesses, 
30  cases  of  arthritis,  69  with  adenomatous  polyp- 
osis and  15  with  carcinoma.  Dukes  likewise  as- 
sessed the  cancer  incidence  at  2.6  per  cent.  Ma- 
lignant degeneration  is  rare  in  true  ulcerations 
of  any  type  in  the  colon  but  frequent  in  polyps  or 
adenomata. 

One  apparently  characteristic  complication 
more  recently  recognized  is  that  of  a persistent 
streptococcus  ulceration  of  the  skin  known  as 
pyoderma  gangrenosum.  A most  obstinate  form 
of  it  occurred  on  the  shin  and  under  each  ear  of 
ease  III.  Five  cases  of  pyoderma  were  ex- 
haustively studied  by  Brunsting,  Goeckerman 
and  O’Leary  at  the  Mayo  Clinic.  Four  were  in 
association  with  ulcerative  colitis;  the  fifth  with 
chronic  empyema. The  lesion  begins  as  a simple 
furuncle  but  progresses  to  a marginated  under- 
mined suppurative  condition  which  resists  all 
local  antiseptics  or  other  treatment,  including 
bacteriophage  preparations.  Curettage  or  other 
surgical  treatment  is  not  successful  and  the  pa- 
tient reacts  badly.  The  lesion  is  suggestive  of 
a fungus  or  amoebic  infection  since  amoebiasis 
cutis  has  been  reported,  but  all  cultures  and 
biopsies  have  been  entirely  negative  except  for 
streptococci.  The  ulcer  usually  appears  during 
an  active  febrile  stage  of  the  colitis  and  heals 
with  the  colitis  after  general  management  and 
prolonged  bed  rest.  Sometimes  these  ulcers  are 
multiple  and  with  fever  and  anemia  the  patient 
presents  a picture  suggestive  of  septicemia. 
However,  blood  cultures  are  usually  negative. 
Transfusions  and  iron  ammonium  citrate  for  the 
secondary  anemia,  together  with  bed  rest  and 
dietetic  and  general  management,  finally  avail 
in  overcoming  the  active  infection  in  the  bowel 
and  skin  simultaneously. 

Another  misleading  complication  in  the  acute 
stage  of  ulcerative  colitis  when  especially  intense 


October,  1933 


Ulcerative  Colitis — Rowland 


631 


Pyoderma  Gangrenosum  over  the  tibia  in  a case  of  chronic 
ulcerative  colitis.  There  is  a piling  up  of  granulation  tissue 
with  extensive  crust  formation.  The  epidermis  at  the 
periphery  is  dissected  up  by  pus. 

in  the  pelvic  colon,  is  extension  through  the 
lymphatics  or  by  direct  contact  to  the  uterus  and 
tubes  or  to  the  prostate,  giving  suggestive  symp- 
toms and  local  inflammatory  tenderness  on  pal- 
pation. One  of  our  cases  closely  simulated  a 
severe  salpingitis.  Another  case  in  a man  of 
fifty  had  quite  sharp  prostatic  irritability.  All 
symptoms  cleared  up  after  the  subsidence  of  the 
acute  stage  of  the  colitis. 

The  confusion  of  the  early  symptoms  of  ulcer- 
ative colitis  with  those  of  irritated  hemorrhoids 
should  also  be  kept  in  mind.  Hemorrhoid  op- 
erations as  the  disease  is  coming  on,  may  be 
complicated  by  infection  and  sloughing.  Re- 
peated attacks  of  proctitis  undoubtedly  precede 
certain  cases  of  ulcerative  colitis.  One  of  our 
cases  began  immediately  after  confinement  and 
without  treatment  continued  with  varying  inten- 
sity for  two  and  one-half  years  thereafter.  Stric- 
ture formation  also  is  responsible  for  the  contin- 
uring  or  recurring  course  of  some  of  the  intrac- 
table cases. 

SPECIAL  TREATMENT 

In  a symposium  on  ulcerative  colitis  at  the 
American  Gastro-Enterologica!  Association  in 
May,  1933,  surgical  treatment  was  generally  re- 
garded as  having  a very  limited  field  in  treatment 
except  as  a life  saving,  emergency  measure  in 
acute  toxemia  and  hemorrhage.  Under  these  cir- 


cumstances a double-barrelled  ileostomy  was  re- 
garded the  procedure  of  choice.  It  may  need  to 
be  permanent  and  even  then  may  not  control  the 
disease.  Judd,  in  discussing  his  experience  with 
colectomy  at  the  Mayo  Clinic,  stated  that  he  had 
learned  to  “keep  away  from  the  infected  colon.” 
It  is  always  a very  dangerous  operation,  espe- 
cially from  the  standpoint  of  extension  of  infec- 
tion. He  regarded  “segmental  colectomy”  as 
more  safe  by  operating  through  normal  tissues, 
wide  of  the  ulcerated  areas.  However,  there 
have  been  cases  of  recurrence  of  ulceration  in 
other  parts  of  the  colon  after  segmental  resection. 
Hence  rest,  dietetic,  medicinal  and  vaccine  ther- 
apy are  usually  better  than  surgery  except  in 
acute  emergencies.  In  the  latter,  especially  with 
hemorrhage  and  exhausting  diarrhoea,  transfu- 
sion may  tide  over  the  crisis. 

There  may  also  be  occasional  opportunity  to 
pass  the  Einhorn  or  Levine  tube  into  the  ileum 
for  drainage  in  cases  where  the  patient  cannot 
stand  the  shock  of  operation. 

Andresen  has  reported  remarkable  results  in 
the  treatment  of  thirty  cases  of  ulcerative  colitis 
by  intravenous  mercurochrome — 15  cc.  of  % per 
cent  solution  every  four  days.  There  was  evi- 
dence that  the  excretion  of  the  mercurial  dye 
through  the  bowel  leads  to  a more  concentrated 
attack  upon  bacteria  in  the  tissues.  Red  stools 
and  diarrhoea  were  often  observed  after  the  in- 
jection. A few  cases  had  a temperature  up  to 
102  and  casts  in  the  urine  temporarily. Healing 
was  extraordinarily  rapid  in  48  hours  in  some 
cases.  There  also  have  been  some  conspicuous 
failures  with  mercurochrome  treatment. 

Sodium  ricinoleate  may  find  a place  as  an  ad- 
junct in  the  therapy  of  the  toxic  stage  of  ulcera- 
tive colitis.  The  results  in  a few  instances  have 
not  been  striking.  Further  careful  observations 
are  desirable. 

With  any  treatment  permanent  cure  in  chronic 
ulcerative  colitis  has  been  very  difficult.  Early 
diagnosis  is  essential.  There  is  need  of  more 
definite  knowledge  of  preclinical  evidences  of  the 
disease  and  of  its  exact  pathogenesis.  As  in  most 
serious  diseases,  prevention  will  probably  ulti- 
mately be  more  practicable  than  cure. 

CASE  REPORTS 

The  following  case  reports  include  two  of 
proved  amoebiasis  and  one  of  tuberculous  colitis 
in  order  to  illustrate  the  difficulties  of  differential 
diognosis. 

Case  I.  Ulcerative  colitis — recurrent — suggest- 
ing amoebiasis.  Fatal  attack  simulating  ap- 
pendicitis at  onset,  terminating  with  hemorrhage. 
Autopsy. 

Man  of  28,  who  has  always  lived  in  Ohio. 
Family  and  past  histoiy  not  significant  except 
that  he  has  always  been  subject  to  attacks  of  ab- 
dominal pain  and  occasional  loose  bowels  with  in- 
discretion in  eating.  Bowel  function  was  usually 
good — one  or  two  movements  a day.  He  had  severe 
attacks  of  tonsillitis  about  once  a year,  the  last 


632 


The  Ohio  State  Medical  Journal 


October,  1933 


one  four  weeks  before  the  onset  of  his  definite 
colitis  in  August  of  1930.  He  was  rather  under- 
nourished and  pale  and  suspected  to  have  an  early 
tuberculosis,  but  no  definite  signs  ever  developed. 

With  his  colitis  there  were  eight  to  ten  stools  a 
day  and  considerable  pain  localized  mostly  in  the 
appendix  region  with  a spastic,  sausage  shaped, 
readily  palpable  ascending  colon  and  sensitiveness 
over  the  sigmoid.  He  was  in  the  hospital  from 
August  30th  to  September  23,  1930,  when  the 
acute  condition  subsided.  No  amoebae  were  found. 
Cysts  were  once  reported  but  not  confirmed.  A 
short  course  of  emetin  and  stovarsol  was  given. 
Stool  cultures  showed  a predominance  of  lactose 
fermenters  and  also  enterococci,  not  of  the  Bar- 
gen  type.  Sigmoidoscopic  showed  intense  hyper- 
emia with  small  ulcers  on  the  summits  of  folds 
oozing  with  pus  and  blood.  X-ray  showed  typical 
dehaustration  and  ulceration  throughout  the  colon. 

Beginning  about  October  7,  1930,  the  patient 
improved  rapidly,  gaining  forty  pounds  in  weight 
up  to  160  pounds  and  from  3,700,000  l'ed  count  to 
5,200,000. 

On  June  14,  1931,  he  was  readmitted  after  nine 
months  without  diarrhoea,  with  an  acute  recur- 
rence, eight  to  fourteen  stools  a day.  It  began  a 
week  before  his  pain  and  tenderness  in  the  ap- 
pendix region  and  a temperature  of  101  and  a 
white  count  of  22,000.  The  picture  shifted  to  that 
of  a diffuse  colitis  with  increasing  toxemia  and 
dehydration.  On  July  5th  there  was  profuse 
hemorrhage  from  the  bowel.  In  spite  of  trans- 
fusions, intravenous  glucose,  etc.,  death  occurred 
on  July  6th.  During  this  last  admission,  amoebae 
and  tubercle  bacilli  were  searched  for  in  vain. 
Culture  showed  B.  coli  communis,  enterococci  and 
a motile  Gram  negative  bacillus  with  the  mor- 
phology and  cultural  characteristics  of  B.  fecalis 
alkaligenes. 

Autopsy  showed  extensive  ulceration  from  the 
anus  throughout  the  colon  to  20  cm.  beyond  the 
ileocecal  valve.  The  ulcers  were  punched  out, 
undermined  and  often  connected  with  adjacent 
ulcers  by  tunnelling  under  the  mucosa.  Some 
were  round  or  ovoid,  others  were  elongated  fis- 
sures. The  appendix  was  normal.  There  was  no 
evidence  of  tuberculosis  in  the  bowel  or  lungs. 
The  spleen  grossly  was  normal  in  size  and  shape 

Microscopically,  the  ulcerations  extended  to  the 
submucosa  but  not  to  the  muscularis.  The  mucosa 
near  the  ulcers  showed  pus  within  the  crypts.  In 
some  sections,  especially  in  the  ileum,  the  ulcers 
showed  partial  healing  without  regeneration  of 
the  crypts.  The  interstitial  infiltration  in  the  wall 
of  the  intestine  contained  all  varieties  of  inflam- 
matory cells,  the  mononucleated  cells  often  in  a 
state  of  mitosis. 

Amoebae  were  absent.  Many  blocks  were  cut 
and  some  fixed  in  Shaudinn’s  solution  and  a care- 
ful search  for  amoebae  made  with  negative  re- 
sults. 

Case  II.  Amoebic  Colitis  with  multiple  per- 
forations— Peritonitis — Autopsy. 

A man  of  65  who  had  always  lived  in  Ohio  and 
enjoyed  ordinary  health.  He  was  always  quite 
fond  of  strong  alcoholic  beverages  and  rich  food. 
His  weight  was  215  pounds.  Six  weeks  before  ad- 
mission to  the  hospital,  he  was  taken  with  diar- 
rhoea with  large  watery  stools  containing  mucus 
and  some  blood,  which  he  attributed  to  hemor- 
rhoids. With  increasing  frequency  of  stools,  there 
was  some  incontinence  of  feces.  Two  weeks  be- 
fore admission  he  had  had  a hemorrhoid  operation. 
He  lost  26  pounds  in  weight.  He  developed  fever 
with  a clinical  picture  suggestive  of  typhoid. 
There  was  left  lower  abdominal  pain.  White 


blood  count  was  10,000  to  15,000.  Blood  culture 
was  Widal,  negative.  X-ray  showed  an  extensive 
colitis  most  marked  in  the  region  of  the  cecum. 
Death  occurred  on  the  fifth  day. 

Autopsy  showed  amoebic  colitis  with  extensive 
ulcerations  and  multiple  perforations  and  general 
peritonitis.  Microscopically  there  was  extensive 
necrosis  of  the  mucosa  extending  into  the  muscu- 
laris, both  layers  showing  large  number  of  amoe- 
bae. In  some  areas  amoebae  were  seen  in  the 
crypts. 

Case  III.  Ulcerative  Colitis  with  Persistent 
Skin  Ulcers — Pyoderma  Gangrenosa. 

Woman  of  33  who  had  recurring  attacks  of 
diarrhoea  for  the  past  six  or  eight  years.  In  the 
fall  of  1931  an  attack  began  with  blood  and  mucus 
in  the  stool.  While  under  ambulatory  treatment 
patient  developed  fever,  anemia  of  3,680,000  red 
blood  count  and  white  blood  count  of  11,800  and 
abscesses  leaving  chronic  ulcers,  especially  on  the 
shin  and  under  both  ears.  Blood  culture  was 
negative.  The  ulcers  resisted  all  treatment. 
Curettings  showed  granulation  tissues  and  for- 
eign body  giant  cells.  Layer  encrustations  formed 
over  the  ulcers.  Culture  showed  only  cocci.  Stool 
cultures  likewise  showed  B.  Coli  and  enterococci. 
Amoebic  cultures  and  smears  were  repeatedly 
negative.  The  patient  was  in  bed  under  treat- 
ment by  vaccines,  X-ray,  antiseptics,  light,  medi- 
cation and  diet  from  November  3,  1931,  to  March 
1,  1932,  before  the  ulcer  healed.  The  colitis  sub- 
sided during  the  same  period.  The  mucosa  of  the 
rectum  showing  the  “hammered  copper”  appear- 
ance of  healed  small  ulcers. 

Case  IV.  Amoebic  Colitis — long  unrecognized 
with  severe  anemia  and  emaciation. 

Boy  of  17  who  has  always  been  well,  and  trav- 
eled through  the  southern  and  western  states  in 
1927,  three  months  before  a rather  gradual  onset 
of  diarrhoea  (two  or  three  stools  in  twenty-four 
hours)  and  only  slight  abdominal  discomfort.  This 
lasted  about  two  months,  was  checked  medicinally 
for  about  three  months  when  there  was  an  exa- 
cerbation of  symptoms  and  some  blood  in  the 
stool.  He  was  then  hospitalized  and  a diagnosis 
of  ulcerative  colitis  made  after  X-ray  and  sig- 
moidoscopic examination.  There  was  considerable 
anemia,  at  first  suspected  to  be  primary.  Local 
treatment  and  transfusion  were  given  followed  by 
vaccine  therapy. 

With  the  above  history,  the  patient  entered  St. 
Luke’s  Hospital  January  25,  1928,  with  diarrhoea 
and  abdominal  pain,  a weight  loss  from  148  to 
122,  and  anemia.  The  blood  showed  3,340,000 
R.  B.  C.,  70%  hemoglobin  and  6,000  W.  B.  C. 
Differential  count  of  42%  polymorphs,  36%  small 
monos,  16%  large  monos  and  2%  eosinophils. 
Platelets,  96,000. 

Amoebic  dysentery  was  suspected  at  once  and 
histolytica  cysts  were  reported  in  the  first  stool 
Emetin  was  started  at  once,  but  a series  of  stools 
following  in  the  next  week  showed  no  cysts.  In- 
oculation of  kittens  was  unsuccessful.  A series  of 
stool  specimens  was  sent  to  Washington  for  ex- 
amination and  a final  negative  report  received. 
Emetin  injections,  Emetin  bismuth  iodide  and 
stovarsol  by  mouth  and  some  irrigations  were 
used.  The  patient  was  discharged  March  4,  1928, 
much  improved.  He  continued  to  improve  in 
every  way  for  about  a year,  when  an  acute  diar- 
rhoea recurred.  At  this  time,  large  numbers  of 
vegetative  and  encysted  amoebae  were  found  in 
the  stools.  A'-ray  showed  extensive  ulceration. 
Thorough  and  prolonged  treatment  was  carried 


October,  1933 


Ulcerative  Colitis — Rowland 


633 


out  with  control  of  active  symptoms,  but  a condi- 
tion of  irritable  colon  and  nervous  instability  has 
persisted  since,  but  is  steadily  improving.  The 
general  health  is  now  good. 

Case  V.  Tuberculous  Colitis — without  active 
pulmonary  disease — Operation. 

A young  man  of  28  with  negative  family  his- 
tory and  with  good  general  health  except  for  an 
attack  of  pleurisy  six  years  before  without  ever 
any  cough  or  expectoration.  His  primary  com- 
plaint was  four  or  five  bowel  movements  a day. 
At  first  there  was  no  abdominal  pain  or  general 
disturbance.  This  condition  continued  intermit- 
tently from  May  until  October  when  there  was 
an  attack  of  appendicitis.  Convalescence  was  un- 
eventful but  a crarnpy  pain  persisted  in  the  region 
of  the  cecum  and  the  looseness  of  the  bowels 
became  a little  more  aggravated.  At  times  there 
was  slight  fever. 

Examination  showed  evidence  of  slight  old  tu- 
berculous scarring  in  the  chest,  but  physical  signs 
of  activity  were  absent.  Stool  examinations  were 
negative  for  tubercle  bacilli  at  the  onset  of  the 
colitis.  One  could  see  and  the  patient  could  feel 
frequent  localized  contractions  of  the  colon  es- 
pecially in  the  region  of  the  cecum.  Radiographs 
showed  marked  hypermotility  of  the  colon  and 
typical  Sterlin  filling  defects  in  the  cecum  and  as- 
cending colon.  This  appearance  is,  however,  not 
unlike  that  seen  in  severe  amoebic  colitis.  Sec- 
tions of  the  appendix  showed  tubercles  in  the 
midst  of  suppurative  inflammation  as  if  the  latter 
were  an  incident  in  the  course  of  the  chronic 
disease.  He  later  went  to  Saranac  where  a new 
set  of  A-ray  films  seemed  to  show  a rather  lo- 
calized disease  suggesting  the  possibility  of  re- 
section which  the  patient  was  very  eager  to  ac- 
cept. Dr.  Archibald  of  Montreal  operated  but  was 
disappointed  to  find  extensive  involvement  of  the 
colon  and  a large  part  of  the  ileum.  Resection 
was  out  of  the  question.  There  had  been  no  evi- 
dence of  involvement  of  the  small  intestine.  Ileo- 
sigmoidostomy  was  done  and  surgical  convales- 
cence was  again  very  smooth.  There  was  some 
relief  from  pain  and  soreness  in  the  short-cir- 
cuited cecal  region  but  in  general  the  diarrhoea 
and  general  condition  were  not  improved.  The 
patient  declined  more  rapidly  than  he  probably 
would  have  in  the  natural  course  of  his  disease. 
Emaciation  was  rapid  until  his  death  about  one 
year  after  the  onset  of  symptoms.  At  no  time 
was  there  any  cough  or  evidence  of  active  pul- 
monary disease.  Except  for  the  histological  ex- 
amination of  the  appendix,  there  would  have  been 
considerable  diagnostic  difficulty  in  establishing, 
with  certainty,  the  nature  of  the  colitis  except  in 
the  later  stages. 

7016  Euclid  Ave. 

In  the  absence  of  any  charter  provision  relat- 
ing thereto,  the  director  of  public  safety  should 
fix  the  rates  charged  for  services  to  patients  in 
municipally  owned  hospitals  if  there  is  no  muni- 
cipal ordinance  with  reference  thereto,  but  if  there 
be  ordinances  regulating  the  rates  to  be  charged, 
then  such  ordinances  would  be  controlling,  At- 
torney General  Brieker  held  in  a recent  opinion. 

Dr.  Leo  L.  Thomas,  Portsmouth,  known  to  phys- 
icians throughout  the  state,  died  August  24  follow- 
ing a long  illness.  For  the  past  number  of  years 
Dr.  Thomas  had  been  representative  for  a surgi- 
cal equipment  firm. 


Eosinophilia  75  Per  Cent 

A.  Cowan,  M.D.,  Cleveland,  Ohio 

This  case  is  being  reported  because  of  two  par- 
ticular reasons.  First,  it  presents  an  unusual 
blood  picture;  second,  because  of  the  difficulties  in 
diagnosis. 

N.  P.  Male,  a Grecian,  age  12  years,  was  ad- 
mitted to  Milwaukee  Children’s  Hospital  January 
26,  1932,  on  the  advice  of  his  attending  physician. 

resent  Illness:  The  patient  was  in  excellent 
health,  attending  school,  until  taken  acutely  ill 
early  in  October,  1931.  This  illness  was  char- 
acterized chiefly  by  apparent  muscular  pains  in 
the  right  thigh  which  were  severe  enough  to  pre- 
vent him  from  walking.  There  were  less  severe 
pains  in  the  region  of  the  shoulders  and  knees, 
not  accompanied  by  any  redness  or  swelling  of 
the  parts  involved.  There  were  no  other  symp- 
toms. The  patient  was  confined  to  bed  for  a period 
of  one  month,  during  which  time  a physician  was 
in  attendance,  and  a daily  fever  up  to  102°  was 
present  for  many  days.  The  pains  gradually  sub- 
sided so  that  at  the  end  of  one  month,  recovery 
seemed  apparent  and  the  lad  returned  to  school 
for  about  three  weeks,  at  which  time  he  con- 
tracted a chest  cold.  About  eight  weeks  after  the 
initial  illness,  he  became  sick  with  identical 
symptoms  as  of  the  first  attack,  except  that  this 
time  he  suffered  with  pain  in  his  left  thigh.  He 
became  again  confined  to  bed,  running  tempera- 
ture for  many  days.  This  illness  lasted  about  two 
months,  the  patient  being  hospitalized  January 
26,  1932. 

Past  History:  He  had  had  diphtheria,  measles, 
pneumonia,  scarlet  fever,  German  measles,  and 
occasional  attacks  of  tonsillitis,  with  complete  re- 
covery in  each  instance.  The  personal  and  family 
histories  were  essentially  negative. 

Physical  Examination:  The  patient  was  an  in- 
telligent male,  well  nourished,  not  acutely  ill,  pale- 
looking, ambulant,  and  his  only  complaint  was 
some  pain  in  the  lumbo-sacral  region  on  walking. 

In  addition  to  a mild  secondary  anemia,  there 
were  dental  caries,  infected  tonsils,  a faint  systolic 
murmur  localized  to  the  apex  of  the  heart  (which 
was  otherwise  normal),  a spleen  barely  palpable 
at  the  costal  margin,  and  muscular  atrophy  of  the 
left  thigh  and  leg  (interpreted  as  an  old  infantile 
paralysis) . 

Clinical  Course  in  Hospital:  He  remained  in 

the  hospital  from  January  26,  1932  to  April  3, 
1932,  being  then  discharged  to  the  out-patient  de- 
partment for  check  up.  During  his  hospitalization 
there  were  no  complaints,  no  symptoms,  and  with 
the  exception  of  a temperature  of  101°  (R)  on 
the  day  of  admission,  his  course  was  essentially 
afebrile.  On  discharge  the  spleen  was  not  pal- 
pable. 

He  was  readmitted  to  the  hospital  in  May  for 
several  days,  in  an  attempt  to  make  a diagnosis. 
His  third  hospital  admission  occurred  in  June, 
1932,  at  which  time  a tonsillectomy  was  per- 
formed, the  patient  being  discharged  shortly 
after  the  operation. 

Laboratory  Findings : The  outstanding  feature 
was  the  blood  picture,  which  was  characterized  by 
a persistent  eosinophilia,  which  on  one  occasion 
reached  77  per  cent.  A leucocytosis  was  present 
on  several  of  the  examinations,  the  highest  total 
count  reaching  93,600.  The  reader  is  referred  to 
the  chart  for  the  complete  blood  findings.  On  the 
smear,  the  eosinophiles  always  appeared  to  be  of 


634 


The  Ohio  State  Medical  Journal 


October,  1933 


the  mature  normal  variety.*  This  fact  was  cor- 
roborated as  a result  of  examinations  by  the  De- 
partments of  Pathology  at  the  University  of  Wis- 
consin Medical  School,  and  the  Mayo  Clinic. 

Blood  counts  were  made  on  the  remainder  of 
the  members  of  the  family  and  are  recorded  in 
the  chart.  Other  laboratory  findings  were  as  fol- 
lows: mantoux  test  (.1  mg.)  negative;  blood 

Wassermann  negative,  sedimentation  time  normal, 
icterus  index  2,  Van  Den  Bergh  negative.  The 
stools  showed  the  presence  repeatedly  of  giardia 
lamblia.  X-ray  of  the  long  bones  was  negative. 
An  X-ray  of  the  lungs  reported,  “A  bilateral  root 
increase  with  linear  extension  in  right  infra- 
clavicular  region,  with  right  interlobar  pleura 
visible,  and  soft  shadow  increase  in  left  lung  field 
about  the  heart  border.” 

Three  basal  metabolic  determinations  were 
made,  in  each  instance  being  a minus  reading 
within  normal  limits. 

Biopsy  was  done  on  a portion  of  muscle  of  the 
left  thigh.  On  examination  however,  trichinella 
spiralis  were  not  found.  Precipitive  tests  for 
trichiniasis  were  kindly  done  by  Dr.  D.  L.  Au- 
gustine of  The  Harvard  University  Medical 
School,  Department  of  Comparative  Pathology. 
This  test  was  done  on  samples  of  blood  from  the 
patient  and  a sister.  In  both  instances  they  were 
negative.  A stool  examination  was  made  on  a 
sister  of  the  patient,  and  endolinax  nina  were 
found.  Examination  histological  of  the  tonsils 
showed  no  particular  pathology.  Permission  for  a 
bone  marrow  puncture  was  not  obtainable. 

DISCUSSION 

The  outstanding  feature  in  this  case  is  the 
blood  picture,  with  its  persistent  eosinophilia, 
ranging  from  its  lowest  figure  6 per  cent,  to  the 
highest,  77  per  cent.  The  total  white  count  is 
strikingly  elevated  on  several  occasions.  The 
highest  one  being  93,600.  And,  as  has  been  pre- 
viously stated,  the  eosinophiles  and  other  blood 
cells  being  always  of  normal  appearance.  The 
eosinophilia  is  absolute. 

Our  impression  on  the  day  of  admission  was 
that  of  a rhemuatic  infection.  Further  question- 
ing into  history  along  with  laboratory  findings  are 
sufficient  to  rule  out  the  diagnosis  of  rheumatic 
fever,  at  least  we  cannot  see  any  relation  between 
the  blood  picture  and  a rheumatic  process. 

The  causes  of  eosinophilia  are  numerous.  Tric- 
hiniasis must  always  be  ruled  out  with  an 
eosinophilia  of  high  degree.  Our  case  was  sug- 
gestive of  this  type  of  infection  only  because  of 
apparent  muscular  pains  and  continued  fever. 
There  were  absent,  however,  the  typical  signs  of 
edema,  and  there  were  no  gastro-intestinal  symp- 
toms. Furthermore,  the  negative  precipitive  tests 
and  biopsy  findings  speak  against  a triehinous  in- 
fection. 

Eosinophilic  leukemia  appears  to  be  a distinct 
clinical  entity.  Recently  Bass"  described  a case  of 
eosinophilic  leukemia  in  an  eight-year  old  Porto 
Rican  boy  and  also  reviewed  ten  other  cases,  in- 
cluding a previous  one  of  his  own.  Bass  char- 
acterizes eosinophilic  leukemia  as  follows : 

1.  These  cases  show  a persistent  increased 
white  cell  count. 

(*By  the  laboratory  of  Milwaukee  Children’s  Hospital.) 


2.  The  per  cent  of  eosinophiles  is  strikingly 
large. 

3.  The  eosinopholies  are  of  the  mature  variety. 

4.  Enlargement  of  the  spleen  is  usually  present. 

5.  Fever  may  or  may  not  be  present. 

6.  The  course  is  usually  chronic. 

7.  Severe  anemia  and  hemoi'rhagic  tendencies 
are  usually  absent. 

8.  Autopsy  and  biopsy  show  a characteristic  in- 
filtration of  the  tissues  with  eosinophiles. 

He  further  regards  a strikingly  elevated  basal 
metabolic  rate  as  significant  in  classifying  these 
cases,  under  the  title  of  leukemia. 

In  our  reported  case  we  find  neither  an  elevated 
basal  rate  or  tissue  infiltration  with  eosinophiles, 
so  that  we  would  hesitate  to  designate  it  as  a case 
of  eosinophilic  leukemia. 

Myelogenous  leukemia  may  at  times  give  a 
blood  picture  with  decided  eosinophilia,  however, 
the  smears  would  show  immature  eosinophiles. 

We  did  not  perform  tests  for  allergy,  since 
there  is  nothing  suggestive  of  an  allergic  state  in 
either  the  history  or  course  of  our  case. 

Echinococcus  disease  may  give  rise  to  an 
eosinophilia.  There  were  no  symptoms  or  signs 
referable  to  hydatid  disease,  consequently  diag- 
nostic tests  were  not  performed. 

Hodgkins  disease  rarely  gives  an  eosinophilia 
to  such  a striking  degree.  Stewart1  reports  a case 
of  proven  Hodgkin’s  disease,  in  which  the  white 
count  averaged  100,000,  and  the  eosinophiles 
(mature)  being  as  high  as  90  per  cent.  Our  case 
is  in  no  way  suggestive  of  Hodgkin’s  disease. 

Other  skin  diseases,  notably  pemphigus,  pru- 
rigo, psoriasis  and  urticaria,  may  cause  an 
eosinophilia  of  moderate  degree.  There  were  no 
skin  manifestations  at  any  time  in  our  patient. 

The  presence  of  an  eosinophilia  in  two  other 
members  of  the  family  of  our  patient  brings  up 
the  question  of  familial  eosinophilia.  Familial 
eosinophilia  is  very  uncommon  and  implies  the 
presence  of  an  unexplained  eosinophilia  in  several 
members  of  a family. 

Armand-Delille,  Hurst  and  Sorapure2  described 
a case  of  a family  in  which  six  members  had  an 
unexplained  eosinophilia,  all  without  symptoms. 
In  one  member  the  eosinophiles  gave  a total  of 
62.5  per  cent. 

These  authors  were  able  to  find  the  records  of 
only  three  families  with  an  eosinophilia  of  un- 
explained origin.  We  feel  that  the  presence  of 
symptoms  and  the  finding  of  lamblia  intestinalis 
would  probably  suffice  to  rule  our  patient  out  of 
the  class  of  familial  eosinophilia. 

Sorapure2  observed  a case  of  having  an  eosino- 
philia of  57.3  per  cent  without  determining  the 
cause,  and  whose  blood  examination  was  made 
when  the  patient  complained  of  aching  in  the 
calves,  thighs  and  back  after  a febrile  attack  of 


October,  1933 


Eosinopophilia — Cowan 


635 


TABLE,  SHOWING  RESULTS  OF  BLOOD  COUNTS  AND  SMEARS 


Patient 

(N.P.) 

Date 

White  Blood 
Cells 

Polys 

Small 

Lymphs 

Large 

Lymphs 

Monocytes 

Eosino- 

philes 

Red  Blood 
Basophiles  Cells 

Hgb. 

(Dare) 

1/27/32 

28,800 

11.5 

13 

.5 

75 

3.58 

65% 

1/28/32 

23,200 

12 

18.5 

3.5 

i 

65 

3.78 

65% 

2/  1/32 

27,400 

8 

9 

9 

73 

i 

2/  6/32 

26,800 

18 

9 

5 

68 

2/  8/32 

29,800 

19 

9.5 

3.5 

i 

67 

2/15/32 

25,800 

16 

16.5 

4.5 

62 

i 

2/27/32 

15,800 

45 

23 

6 

i 

25 

3/  2/32 

19,200 

42 

16 

7 

2 

31 

2 

3/  7/32 

13,000 

34 

21 

5 

1 

39 

3/11/32 

22,600 

53 

17 

5.5 

24.5 

3/15/32 

25,200 

28 

23 

7 

41.5 

.5 

3/22/32 

38,000 

35.5 

18 

4 

42.5 

4.75 

75% 

3/28/32 

29,600 

39 

13 

5.5 

1.5 

41 

3/31/32 

28,000 

28.5 

15 

2.5 

.5 

53.5 

4/  8/32 

93,600 

11 

7 

3.5 

1 

77 

.5 

4/14/32 

15,900 

39.5 

21.5 

13 

.5 

25.5 

4/19/32 

9,800 

39 

44.5 

4 

11.5 

1 

4/25/32 

10,000 

63 

23 

7.5 

6.5 

4/28/32 

13,800 

47 

31.5 

6 

15 

.5 

4.3 

72% 

5/  6/32 

11,600 

51 

29.5 

6 

15.5 

5/12/32 

15,000 

49.5 

29 

6 

15.5 

5/20/32 

8,600 

49 

30 

7 

14 

5/26/32 

17,000 

42 

26.5 

6 

25.5 

6/  9/32 

34,300 

42.5 

16.5 

9 

2.5 

28.5 

1 

6/24/32 

14,600 

45.5 

25 

13.5 

2.5 

13.5 

• 

7/15/32 

13,100 

71 

10 

10 

3 

6 

4.22 

75% 

8/12/32 

13,800 

50.5 

30 

8 

1 

10.5 

10/  7/32 

12,000 

53.5 

26 

6 

1.5 

12 

1 

11/18/32 

14,200 

47 

36 

4 

13 

12/30/32 

11,600 

39 

40 

9 

1 

9 

2 

4.66 

80% 

Sister 

2/29/32 

19,400 

35 

18 

12 

1 

34 

4/13/32 

10,800 

53 

12 

24.5 

2 

8.5 

5/12/32 

15,200 

70.5 

18.5 

7.5 

2.5 

1 

5/26/32 

15,200 

51 

33.5 

10.5 

4 

1 

Brother 

4/  1/32 

11,200 

51 

35.5 

10 

2.5 

1 

Mother 

3/29/32 

9,200 

71 

18 

2 

7 

2 

Father 

3/29/32 

15,200 

61 

31 

4 

4 

two  days’ 

duration 

. Tlrs  picture  comes 

closer 

to  surrounding  tissue. 

Obviously 

our  case 

is  not  a 

resembling  our  case  than  any  that  we  have  read  polymyositis. 

about.  In  conclusion  we  are  aware  of  the  fact  that 


Intestinal  parasites  other  than  trichinella  para- 
sites are  definitely  known  to  cause  eosinophil 'a  of 
varying  degrees.  However,  we  are  not  inclined  to 
believe  that  lamblia  giardia  is  one  of  those  para- 
sites. In  the  literature  there  is  a diversity  of 
opinion  as  to  whether  lamblia  is  pathogenic. 
Todd4  considers  this  to  be  the  most  prevalent  of 
intestinal  flagellates  in  this  country,  and  although 
it  may  be  responsible  for  a chronic  entero-colitis, 
he  thinks  it  is  of  little  pathogenic  importance. 

Logan  and  Sanford’  made  a study  of  the  blood 
in  a series  of  66  cases  harboring  lamblia  intes- 
tinalis  and  found  no  change  in  the  eosinophiles. 
We  feel  that  the  finding  of  lamblia  in  our  case  is 
incidental  and  bears  no  relation  to  the  symptom- 
atology or  the  blood  picture. 

Dermatomyositis  is  a definite  clinical  entity 
which  may  give  rise  to  a high  grade  eosinophilia. 

Fiedler0  reported  a case  of  chronic  polymositis 
with  an  eosinophilia  reaching  76  per  cent,  with 
periods  of  fever.  This  disease  is  characterized  by 
definite  inflammatory  changes  in  the  muscle  and 


our  diagnosis  has  not  been  established.  It  is 
hoped  that  the  publication  of  this  report  will  fur- 
nish the  diagnostic  clue. 

SUMMARY 

This  is  a report  of  a case  of  unusual  eosino- 
philia with  a brief  discussion  of  some  of  the 
causes  of  eosinophilia.  The  diagnostic  difficulties 
are  apparent. 

REFERENCES 

1.  Stewart,  E.  G.  : Hyperleukocytosis  in  Hodgkin’s  Dis- 

ease, with  Familial  Eosinophilic  Diatheses.  Arch.  Int.  Med. 
44:772  (Nov.)  1929. 

2.  Armand-Delille,  P.  F.,  Hurst,  A.  F.,  and  Sorapure, 

V.  E. : Familial  Eosinophilia,  Guy’s  Hospital  Reports, 

80:248  (April)  1930. 

3.  Bass,  M.  H. : Eosinophilic  Leukemia,  Am.  J.  Dis. 

Child.  44:1394  (June)  1931. 

4.  Todd,  J.  C. : Clinical  Diagnosis  by  Laboratory  Meth- 
ods, Fifth  Edition  (page  484). 

5.  Logan,  A.  H.  and  Sanford,  A.  H.  : Significance  of 

Lamblia  intestinalis  in  stool  examinations.  J.  Lab.  and 
Clin.  Med.  2:618  (June)  1917. 

6.  Fiedler,  E.  : Chronic  Polymositis  with  Marked  Eosin- 
ophilia and  Periodically  Recurrent  Febril  Exacerbations. 
Munchen  Med.  Wchnschr.  78:1176  (July  10th)  1931. 

Appreciation  is  here  expressed  to  Drs.  R.  Greenthal  and 
M.  Peterman  for  their  interest  and  advice. 

1407  Superior  Road. 


Official  Proceedings  of  the  House  of  Delegates^  Ohio  State 
Medical  Association  Annual  Meeting,  Akron, 
September  7 and  S,  1933 


Minutes 

The  87th  Annual  Meeting-  of  the  Ohio  State 
Medical  Association  convened  officially  in  Parlor 
E,  Mayflower  Hotel,  Akron,  at  10:00  A.  M. 
on  Thursday,  September  7,  1933.  Dr.  J.  H.  Selby, 
president  of  the  Summit  County  Medical  Society, 
officially  welcomed  the  Annual  Meeting  to  Akron. 
He  pointed  out  that  this  was  the  first  time  that 
the  Ohio  State  Medical  Association  had  met  in 
that  city,  and  expressed  the  hope  that  this  meet- 
ing would  be  so  successful  that  Akron  would  be 
selected  for  meetings  from  time  to  time  in  the 
future. 

Dr.  Platter,  president  of  the  State  Association, 
then  being  presented,  called  the  House  of  Dele- 
gates into  official  session. 

Under  the  first  order  of  business  announced  by 
the  President,  the  roll  call  of  officers  and  delegates 
showed  83  delegates  and  officers  present,  this 
being  the  majority  of  those  registered  and  con- 
stituting a quorum  under  the  Constitution.  (See 
tabulation  for  roll  call  attendance  on  page  645). 

On  motion  by  Dr.  Carley,  seconded  by  Dr. 
Thomas  and  carried,  the  minutes  of  the  House  of 
Delegates  of  the  86th  Annual  Meeting  held  in 
Dayton,  May  3 and  4,  1932,  were  approved  as  pub- 
lished on  pages  443  to  456,  inclusive,  of  the  June, 
1932,  issue  of  The  Journal. 

Attention  was  called  by  the  President  to  the 
requirement  that  all  resolutions  to  be  introduced 
later  in  this  session  must  be  referred  to  the  Com- 
mittee on  Resolutions  for  consideration  by  the 
committee  and  transmission  to  the  House  of  Dele- 
gates at  the  Friday  afternoon  session,  thus  re- 
quiring that  all  resolutions  to  be  considered  at 
this  Annual  Meeting  must  be  introduced  at  the 
present  session.  He  also  announced  that  all  reso- 
lutions must  be  introduced  in  typewritten  form, 
in  duplicate,  and  signed  by  the  author. 

The  Annual  Reports 

As  the  next  order  of  business,  President  Platter 
then  called  for  the  annual  reports  of  officers, 
standing  committees  and  special  committees. 
These  reports  were  published  in  full  in  the  Sep- 
tember, 1933,  issue  of  The  Journal  and  were  sub- 
mitted, as  published,  for  the  consideration  of  the 
House  of  Delegates,  these  reports  being: 

Reports  of  Standing  Committees : 

(a)  Public  Policy — John  B.  Alcorn,  Columbus, 
Chairman,  pages  557  to  562. 

(b)  Medical  Economics — J.  Craig  Bowman, 
Upper  Sandusky,  Chairman,  pages  563  to  568. 

(c)  Publication — Andrews  Rogers,  Columbus, 
Chairman,  pages  568  and  569. 

(d)  Medical  Defense — J.  E.  Tucker-man,  Cleve- 


land, Chairman,  pages  570  to  573. 

(e)  Medical  Education  and  Hospitals — Ben  R. 
McClellan,  Xenia,  Chairman,  pages  573  to  575. 

(f)  Auditing  and  Appropriations — S.  J.  Good- 
man, Columbus,  Chairman,  pages  578  to  580. 

Reports  of  Special  Committees : 

(a)  Preventive  Medicine  and  Periodic  Health 
Examinations — V.  C.  Rowland,  Cleveland,  Chair- 
man, pages  576  to  578. 

(b)  Military  and  Veterans’  Affairs — C.  W. 
Stone,  Cleveland,  Chairman,  pages  580  to  583. 

Report  of  Officers: 

(a)  Treasurer’s  Report  combined  with  report 
of  Committee  on  Auditing  and  Appropriations, 
pages  578  to  580. 

(b)  Reports  of  Councilors  as  to  the  condition 
of  the  societies  in  their  respective  districts,  pages 
583  to  585. 

President  Platter  announced  that  all  the  fore- 
going reports  were  referred  at  this  time  without 
discussion  to  the  Reference  Committee  on  Annual 
Reports  to  be  announced  later  at  this  session,  and 
for  consideration  and  report  by  the  Reference 
Committee  at  the  Friday  (September  8)  after- 
noon session  of  the  House  of  Delegates. 

Appointment  of  Reference  and  Active  Committees 
The  President  announced  the  appointment  of 
reference  and  active  committees  of  the  House  of 
Delegates  as  follows : 

Annual  Addresses  of  the  President  and  Presi- 
dent-Elect— H.  G.  Sloan,  Cleveland,  Chairman; 
George  P.  Tyler,  Jr.,  Ripley;  H.  R.  Neeland, 
Cambridge;  C.  K.  Startzman,  Belief ontaine ; G. 
R.  Micklethwaite,  Portsmouth. 

Annual  Reports  of  Standing  and  Special  Com- 
mittees— R.  R.  Hendershott,  Tiffin,  Chairman: 
Louis  Feid,  Jr.,  Cincinnati;  John  F.  Wright,  To- 
ledo; Geo.  J.  Waggoner,  Ravenna;  C.  E.  North- 
rup,  McConnelsville. 

Resolutions — E.  J.  Emerick,  Columbus,  Chair- 
man; A.  W.  Carley,  Dayton;  C.  W.  Kirkland, 
Bellaire;  Joseph  Rosenfeld,  Youngstown;  Guy  E. 
Noble,  St.  Marys. 

Credentials  of  Delegates — C.  S.  McDougall 
Athens,  Chairman;  Mary  L.  Austin,  Gallipolis; 
R.  B.  Wynkoop,  Ashtabula;  H.  J.  Pool,  Port 
Clinton ; R.  E.  Amos,  Akron. 

Tellers  and  Judges  of  Election — D J.  Slosser, 
Defiance,  Chairman;  C.  C.  Hussey,  Sidney;  K.  H. 
Barth,  New  Washington;  Robert  T.  Leever, 
Waverly;  R.  J.  Foster,  New  Philadelphia. 

Election  of  Nominating  Committee 
In  compliance  with  the  constitutional  provisions 
in  selecting  members  of  the  Nominating  Corn- 


636 


October,  1933 


House  of  Delegates  Proceedings 


637 


mittee,  one  from  each  of  the  ten  councilor  dis- 
tricts, the  following  personnel  of  such  committee 
was  nominated  and  duly  elected: 

First  District — Otto  Seibert,  Cincinnati,  nom- 
inated by  Dr.  Kiely. 

Second  District — A.  W.  Carley,  Dayton,  nomi- 
nated by  Dr.  Bryant. 

Third  District — Guy  E.  Noble,  St.  Marys,  nomi- 
nated by  Dr.  Morgan. 

Fourth  District — John  F.  Wright,  Toledo,  nomi- 
nated by  Dr.  Lukens. 

Fifth  District — J.  E.  Tuckerman,  Cleveland, 
nominated  by  Dr.  Waltz. 

Sixth  District — F.  C.  Potter,  Akron,  nominated 
by  Dr.  Amos. 

Seventh  District — C.  W.  Kirkland,  Bellaire, 
nominated  by  Dr.  Foster. 

Eighth  District — Emmett  A.  Moore,  Newark, 
nominated  by  Dr.  McDougall. 

Ninth  District — J.  L.  Frazer,  Wellston,  nomi- 
nated by  Dr.  Seiler. 

Tenth  District — John  B.  Alcorn,  Columbus, 
nominated  by  Dr.  Thomas. 

On  motion  duly  seconded  and  carried,  the  House 
of  Delegates  elected  by  acclamation  each  of  the 
above  members  nominated  for  the  Nominating 
Committee. 

President  Platter  then  announced  the  official 
personnel  of  the  Nominating  Committee  as  elected 
by  the  House  of  Delegates,  as  follows: 

First  District — Otto  Seibei't, 

Second  District — A.  W.  Carley, 

Third  District — Guy  E.  Noble, 

Fourth  District — John  F.  W right, 

Fifth  District — J.  E.  Tuckerman, 

Sixth  District — F.  C.  Potter, 

Seventh  District — C.  W.  Kirkland, 

Eighth  District — Emmett  A.  Moore, 

Ninth  District — J.  L.  Frazer. 

Tenth  District — John  B.  Alcorn. 


Nominations  to  be  Made 

The  President  issued  instructions  to  the  Nomi- 
nating Committee,  under  the  constitutional  pro- 
visions, and  requested  them  to  meet  and  decide 
upon  one  nominee  for  each  of  the  offices  to  be 
filled  at  this  Annual  Meeting,  except  for  the  office 
of  president-elect,  which  latter  office  is  to  be  upon 
nomination  on  the  floor  of  the  House  of  Delegates 
at  the  Friday  afternoon  session. 

Introduction  of  Resolutions 

In  the  next  order  of  business,  the  President 
called  for  the  introduction  of  resolutions.  The  fol- 
lowing resolutions  were  then  introduced  and  on 
motion  duly  seconded  and  carried,  were  each  re- 
ferred to  the  Committee  on  Resolutions  for  con- 
sideration and  report  at  the  second  session  of  the 
House  of  Delegates. 


Resolution  A.  introduced  by  C.  W.  Waltz, 
Cleveland: 

Whereas,  New  Federal  regulations  pertaining 
to  veterans’  benefits  and  to  medical  and  hospital 
care  for  ex-service  men  have  been  placed  into 
operation,  and 

Whereas,  These  regulations  are  in  line  with 
the  established  policy  of  medical  organization  in 
Ohio,  that  adequate  and  equitable  provision  should 
be  made  for  those  ex-service  men  whose  dis- 
abilities were  incurred  in,  or  resulted  from,  mili- 
tary service  and  for  the  dependents  of  those  who 
gave  their  lives  in  the  service,  but  benefits  and 
hospital  and  medical  care  should  not  be  provided 
generally  at  government  expense  for  those  whose 
disabilities  were  not  incurred  in,  or  the  result  of, 
military  service,  and  especially  when  those  with 
nonservice-connected  disabilities  are  amply  able 
to  pay  for  their  own  medical  and  hospital  ser- 
vices, therefore,  be  it 

Resolved,  That  the  Ohio  State  Medical  Asso- 
ciation commends  and  approves  the  principles 
underlying  the  new  Federal  veterans’  regulations 
and  pledges  the  cooperation  and  support  of  the 
medical  profession  of  Ohio  to  methods  devised  to 
administer  such  regulations  in  a way  which  will 
be  reasonable  and  equitable  to  the  deserving 
veteran  and  to  the  public  at  large. 


Resolution  B.  Introduced  by  H.  S.  Davidson, 
Akron  : 

Whereas,  During  the  recent  important  regular 
session  of  the  90th  Ohio  General  Assembly  an  un- 
usual number  of  serious  and  complicated  ques- 
tions of  vital  concern  to  the  medical  profesion 
were  considered,  and 

Whereas,  The  spirit  of  the  times  encouraged 
the  presentation  of  an  unprecedented  number  of 
experimental,  questionable  and  destructive  meas- 
ures, adding  tremendously  to  the  activities  and  re- 
sponsibilities of  those  particularly  interested  in 
the  preservation  of  present  sound  laws  and  in  the 
defeat  of  legislative  proposals  dangerous  to  public 
health  and  scientific  medicine,  and 

Whereas,  Largely  through  the  efforts  of  medi- 
cal organization  in  keeping  members  of  the  Gen- 
eral Assembly  fully  informed  at  all  times  con- 
cerning the  sound  and  correct  medical  viewpoint 
on  matters  affecting  public  health  and  scientific 
medicine,  and  in  opposing  dangerous  and  de- 
structive medical  and  health  proposals,  no  legisla- 
tion inimical  to  public  health,  scientific  medicine, 
medical  education  and  medical  practice  was  en- 
acted, therefore,  be  it 

Resolved,  That  the  House  of  Delegates  of  the 
Ohio  State  Medical  Association  in  annual  session, 
September  7 and  8,  1933,  expresses  appreciation 
and  approval  to  the  Committee  on  Public  Policy, 
the  legislative  committeemen  of  the  various  com- 
ponent county  medical  societies  and  academies  of 
medicine,  and  the  members  of  the  state  headquar- 
ters staff  for  their  effective  services  in  behalf  of 
the  public  and  in  the  interests  of  scientific  medi- 
cine and  public  health  during  the  recent  legislative 
session,  and  that  special  appreciation  be  expressed 
to  those  earnest  and  high-minded  members  of  the 
General  Assembly  who  cooperated  with  the  repre- 
sentatives of  medical  organization  during  the  ses- 
sion and  who  gave  serious  and  thoughtful  con- 
sideration to  the  sound  and  conservative  medical 
viewpoint  on  health  and  medical  questions,  and 

Be  It  Further  Resolved,  That  it  is  the  sense 
of  the  House  of  Delegates  that  the  methods  and 
procedure  adopted  by  medical  organization  in  its 


638 


The  Ohio  State  Medical  Journal 


October,  1933 


legislative  activities  are  correct  and  practical  and 
of  the  greatest  benefit  to  the  public,  and  that  it 
is  of  vital  importance  that  our  present  organiza- 
tion machinery  which  has  proven  so  successful 
and  effective  in  the  past  be  maintained  in  order 
that  our  interests,  as  well  as  those  of  the  public 
may  be  safeguarded  in  the  future. 


Resolution  C.  Introduced  by  C.  H.  Heyman, 
Cleveland  : 

Whereas,  The  income  of  the  medical  profes- 
sion of  the  State  of  Ohio  is  seriously  affected  by 
the  present  economic  conditions,  and 

Whereas,  The  county  medical  societies  in 
order  to  maintain  membership  rosters  of  normal 
size  are  being  forced  to  reduce  their  dues  and  cur- 
tail expenses,  and 

Whereas,  The  State  Medical  Association 
through  the  loyal  support  of  its  county  societies 
and  through  good  management  has  been  enabled 
to  accumulate  a surplus,  and 

Whereas,  The  State  Medical  Society  despite  the 
reduction  in  membership  will  this  year  show  a 
surplus  over  expenditures,  be  it 

Resolved,  That  the  Council  of  the  Ohio  State 
Medical  Association  be  instructed  to  grant  a dis- 
count of  20  per  cent  on  the  dues  of  each  member 
for  the  current  year  of  1934. 


Resolution  D.  Introduced  by  D.  M.  Glover, 
Cleveland  : 

Whereas,  The  Ohio  Workmen’s  Compensation 
Fund  is  confronted  by  serious  problems,  on  ac- 
count of  decreased  income,  relatively  larger  com- 
pensation costs,  uncertain  value  of  securities  con- 
stituting the  reserve  fund,  prolongation  of  cases 
of  disability,  and  other  causes,  and 

Whereas,  The  medical  and  surgical  fee  sched- 
ule adopted  in  1920  is  sufficiently  low,  even  in 
these  times,  without  the  temporary  reduction  of 
20  per  cent,  and 

Whereas,  The  Special  Committee  of  the  Ohio 
State  Medical  Association  on  Workmen’s  Com- 
pensation has  made  constructive  suggestions  for 
improvement  in  administrative  procedure  in  the 
Industrial  Commission  for  the  purpose  of  pre- 
serving the  fund,  faster  termination  of  cases, 
eliminating  abuses  and  preventing  violations  of 
the  law  and  regulations,  and 

Whereas,  Our  committee  has  opposed  reduction 
of  the  medical  and  surgical  fees  in  Workmen’s 
Compensation  as  being  inadequate  in  effect,  and 
discriminating  against  the  great  majority  of 
honest  physicians,  therefore,  be  it 

Resolved,  By  the  House  of  Delegates  of  the 
Ohio  State  Medical  Association  in  annual  session 
September  7 and  8,  1933,  that  endorsement  and 
approval  be  given  to  the  activities  and  recom- 
mendations of  our  Committee  on  Workmen’s  Com- 
pensation and  we  recommend  to  the  Industrial 
Commission  the  early  institution  of  the  reforms 
in  procedure  recommended  in  that  report. 

Be  It  Further  Resolved,  That  we  respectfully 
urge  the  Commission  to  rescind  its  order  re- 
ducing physicians’  fees  as  soon  as  practical,  and 
Be  It  Further  Resolved,  That  we  pledge  our 
organization  to  thorough  cooperation  in  carrying 
out  the  plans  recommended  to  the  Industrial  Com- 
mission. 


Resolution  E.  Introduecd  by  J.  P.  DeWitt, 
Canton : 

Whereas,  The  Women’s  Auxiliary  of  Stark 
County  Medical  Society  has  been  helpful  and  co- 


operative and  whereas  the  national  offices  of  the 
Women’s  Auxiliary  of  the  A.  M.  A.  would  be 
pleased  to*  have  an  official  Women’s  Auxiliary  in 
Ohio,  particularly  to  assist  in  entertainment 
features  at  the  meeting  in  Cleveland  next  year, 
therefore  we  submit  to  the  House  of  Delegates 
for  a vote  question  of  whether  the  Ohio  State 
Medical  Association  approve  and  establish  an 
official  Women’s  Auxiliary  in  this  state. 


Micellaneous  Business 

Announcements  were  made  by  the  chairmen  of 
the  various  reference  committees  of  the  time  and 
meeting  places  for  their  respective  committees,  in 
order  that  members  of  the  House  of  Delegates 
and  other  members  interested  in  matters  referred 
to  such  committees,  might  appear  at  such  meet- 
ings. 

Additional  business  was  called  for  and  there 
being  none  presented,  the  House  of  Delegates  ad- 
journed to  meet  in  the  ballroom,  Mayflower  Hotel, 
at  3:30  P.  M.,  on  the  following  day,  Friday,  Sep- 
tember 8,  1933. 


SECOND  SESSION 

The  second  and  final  session  of  the  House  of 
Delegates  during  the  Eighty-Seventh  Annual 
Meeting  was  called  to  order  by  President  Platter 
at  3:30  P.  M.,  Friday,  September  8,  1933,  in  the 
ballroom,  Mayflower  Hotel. 

Responses  to  the  roll  call  showed  77  delegates 
and  officers  present.  (See  page  645). 


Annual  Election 

The  next  order  of  business  being  nominations 
from  the  floor  for  president-elect,  nominations 
were  called  for.  Dr.  Upham  placed  in  nomination 
for  the  office  of  president-elect,  Dr.  John  A.  Cald- 
well of  Cincinnati,  and  called  attention  to  his  in- 
terest and  activity  in  medical  organization  in  the 
Academy  of  Medicine  of  Cincinnati  and  in  the 
State  Association,  including  six  years’  service  on 
the  Council.  The  nomination  was  seconded  by  Dr. 
Hendershott.  Further  nominations  being  called 
for  and  none  being  presented,  on  motion  by  Dr. 
DeWitt,  seconded  by  Dr.  Seibert  and  canned,  the 
nominations  were  closed  and  the  secretary  was  in- 
structed to  cast  the  unanimous  ballot  of  the  House 
of  Delegates  for  Dr.  John  A.  Caldwell,  Cincinnati, 
as  president-elect  of  the  Ohio  State  Medical  Asso- 
ciation. So  recorded  and  announced. 

The  President  then  called  upon  and  introduced 
Dr.  Caldwell,  who,  in  brief  remarks,  paid  a tribute 
to  preceding  presidents  and  pledged  his  best  ef- 
forts to  maintain  the  high  standard  of  administra- 
tive direction  exemplified  by  preceding  presidents. 


Election  of  Councilors 

Under  the  next  order  of  business,  the  Nominat- 
ing Committee  was  requested  to  report,  and 
through  Dr.  Alcorn,  the  chairman,  nominees  for 
the  office  of  Councilor  from  the  Second,  Fourth, 


► October,  1933 


House  of  Delegates  Proceedings 


639 


Sixth,  Eighth  and  Tenth  Councilor  Districts  were 
submitted. 

Second  District  Councilor  Election 

The  Nominating  Committee  announced  the  fol- 
lowing nomination  for  Councilor  from  the  Second 
District: — E.  M.  Huston,  Dayton. 

There  being  no  further  nominations  from  the 
floor,  on  motion  by  Dr.  Houser,  seconded  by  Dr. 
Carley  and  earned,  the  secretary  was  instructed 
to  cast  the  unanimous  ballot  of  the  House  of  Dele- 
gates for  E.  M.  Huston,  Dayton,  for  Councilor  of 
the  Second  District  for  the  constitutional  term  of 
two  years.  So  recorded  and  announced. 

Fourth  District  Councilor  Election 

The  Nominating  Committee  announced  the  fol- 
lowing nomination  for  Councilor  from  the  Fourth 
District: — B.  J.  Hein,  Toledo. 

There  being  no  further  nominations  from  the 
floor,  on  motion  by  Dr.  Hendershott,  seconded  by 
Dr.  Seibert  and  carried,  the  secretary  was  in- 
structed to  cast  the  unanimous  ballot  of  the  House 
of  Delegates  for  B.  J.  Hein,  Toledo,  for  Councilor 
of  the  Fourth  District  for  the  constitutional  term 
of' two  years.  So  recorded  and  announced. 

Sixth  District  Councilor  Election 

The  Nominating  Committee  announced  the  fol- 
lowing nomination  for  Councilor  from  the  Sixth 
District: — H.  S.  Davidson,  Akron. 

There  being  no  further  nominations  from  the 
floor,  on  motion  by  Dr.  Amos,  seconded  by  Dr. 
Paryzek  and  canned,  the  secretary  was  instructed 
to  cast  the  unanimous  ballot  of  the  House  of 
Delegates  for  H.  S.  Davidson,  Akron,  for  Coun- 
cilor of  the  Sixth  District  for  the  constitutional 
term  of  two  years.  So  recorded  and  announced. 

Eighth  District  Councilor  Election 

The  Nominating  Committee  announced  the  fol- 
lowing nomination  for  Councilor  from  the  Eighth 
District: — E.  R.  Brush,  Zanesville. 

There  being  no  further  nominations  from  the 
floor,  on  motion  by  Dr.  Loebell,  seconded  by  Dr. 
Moore  and  earned,  the  secretary  was  instructed 
to  cast  the  unanimous  ballot  of  the  House  of 
Delegates  for  E.  R.  Brush,  Zanesville,  for  Coun- 
cilor of  the  Eighth  District  for  the  constitutional 
term  of  two  years.  So  recorded  and  announced. 

Tenth  District  Councilor  Election 

The  Nominating  Committee  announced  the  fol- 
lowing nomination  for  Councilor  from  the  Tenth 
District: — S.  J.  Goodman,  Columbus. 

There  being  no  further  nominations  from  the 
floor,  on  motion  by  Dr.  Thomas,  seconded  by  Dr. 
Emerick  and  earned,  the  secretary  was  instructed 
to  cast  the  unanimous  ballot  of  the  House  of  Dele- 
gates for  S.  J.  Goodman,  Columbus,  for  Councilor 
of  the  Tenth  District  for  the  constitutional  term 
of  two  years.  So  recorded  and  announced. 

Election  of  A.  M.  A.  Delegates 

The  Nominating  Committee,  through  Dr.  Al- 


corn, chairman,  announced  the  nomination  of  the 
following  delegates  and  alternates  to  the  Ameri- 
can Medical  Association  for  a term  of  two  years: 
J.  P.  DeWitt,  Canton,  Delegate 
G.  F.  Zinninger,  Canton,  Alternate 
C.  E.  Kiely,  Cincinnati,  Delegate 
L.  H.  Schriver,  Cincinnati,  Alternate 
C.  W.  Waggoner,  Toledo,  Delegate 
Charles  Lukens,  Toledo,  Alternate 
There  being  no  nominations  from  the  floor,  on 
motion  by  Dr.  Barth,  seconded  by  Dr.  Smith  and 
carried,  the  secretary  was  instructed  to  cast  the 
unanimous  ballot  of  the  House  of  Delegates  for 
the  nominations  as  made  by  the  Nominating  Com- 
mittee. So  recorded  and  announced. 

First  District  Councilor  Election 
Attention  was  called  to  the  fact  that  since  the 
election  of  Dr.  Caldwell  to  the  office  of  president- 
elect, that  a vacancy  is  created  in  the  Councilor- 
ship  from  the  First  District.  Nominations  being 
called  for,  Dr.  Seibert  nominated  Parke  G.  Smith 
of  Cincinnati  to  fill  the  unexpired  term  of  Dr. 
Caldwell  as  Councilor  from  the  First  District. 
This  nomination  was  seconded  by  Dr.  Kiely.. 

There  being  no  further  nominations,  on  motion 
by  Dr.  Feid,  seconded  by  Dr.  Slosser  and  carried, 
the  secretary  was  instructed  to  cast  the  unani- 
mous ballot  of  the  House  of  Delegates  for  Parke 
G.  Smith,  Cincinnati,  for  Councilor  of  the  First 
District  for  the  term  ending  at  the  annual  meet- 
ing in  1934.  So  recorded  and  announced. 

Resolution  by  Nominating  Committee 
The  Nominating  Committee  having  concluded 
its  functions  for  nominees,  submitted  the  follow- 
ing report: 

The  Nominating  Committee  unanimously 
adopted  the  following:  The  Nominating  Commit- 
tee of  the  Ohio  State  Medical  Association  regrets 
the  break  in  its  organization  caused  by  the  illness 
of  its  potential  permanent  Chairman,  E.  0.  Smith 
of  Cincinnati,  and  wishes  him  a speedy  return  to 
active  endeavors,  and  expects  to  have  him  present 
next  year,  and  that  a copy  of  this  resolution  be 
sent  to  Dr.  Smith. 

(Signed)  J.  B.  Alcorn,  Chairman. 

E.  A.  Moore,  Secretary. 

By  unanimous  consent  the  House  of  Delegates 
received  the  resolution,  and  on  motion  by  Dr. 
Upharn,  seconded  by  Dr.  Paryzek  and  canned,  the 
resolution  was  adopted. 


Reports  of  Reference  Committees 
The  next  order  of  business  being  the  reports  of 
the  various  committees  appointed  by  the  President 
at  the  first  session  of  the  House  of  Delegates, 
Dr.  Sloan  presented  the  report  of  the  Committee 
on  Addresses  of  the  President  and  President- 
Elect. 

Annual  Addresses 
The  Address  of  Dr.  C.  L.  Cummer 

Dr.  Cummer  has  devoted  the  major  part  of  his 
address  to  the  value  of  the  educational  factor  that 


640 


The  Ohio  State  Medical  Journal 


October,  1933 


the  state  meetings  might  introduce  into  our  pro- 
grams. The  vast  majority  of  our  members  are 
engaged  in  general  practice  and  following  the 
opinion  of  the  House  of  Delegates  last  year  he 
thinks  it  will  be  wise  for  us  to  confine  ourselves 
principally  to  discussion  of  medical  problems  of 
broad  general  interest.  Such  programs  will  be 
of  interest  to  the  specialist  also  for  he  must 
necessarily  have  a broad  viewpoint  in  order  to 
successfully  carry  on  his  work  in  a special  field. 

Following  Osier’s  suggestion,  he  feels  that  the 
introduction  of  the  patients  themselves,  as  a con- 
crete example,  at  the  meeting  where  their  disease 
is  being  discussed,  will  create  new  interest.  The 
meetings  should  be  almost  a clinic.  The  showing 
of  patients  with  rare  diseases  will  create  wide- 
spread interest.  Scientific  exhibits  devoted  to  the 
teaching  of  a subject  give  a means  of  impressing 
a fact  on  the  observer  better  than  a paper  de- 
voted to  the  subject  because  our  visual  memory 
is  older  phylogenitically  than  our  memory  of 
spoken  words,  and  therefore  better  developed. 

In  closing,  he  calls  attention  to  the  fact  that 
all  men  do  not  think  exactly  alike — one  has  one  re- 
action, and  another  an  opposite  one,  on  certain 
subjects.  In  order  that  we  live  in  peace  with  our 
fellows  it  is  therefore  necessary  that  each  one 
have  a lot  of  tolerance.  But  when  it  comes  to  the 
Principles  underlying  our  Ethics  we  ought  to 
stand  firmly  united. 

The  Address  of  Dr.  H.  M.  Platter 

The  Committee  on  Public  Policy  and  Legislation 
reports  that  of  one  hundred  bills  affecting  the 
medical  practitioner  introduced  into  the  State 
Legislature  during  the  last  year  every  one  de- 
structive to  medical  practice  was  defeated.  Such 
a record  is  possible  only  because  of  the  untiring 
and  able  work  of  our  Secretary  and  his  helpers. 

Our  President  commends  the  report  of  the  As- 
sociation of  American  Medical  Colleges  on  medi- 
cal education.  Here  is  recognized  the  fact  that  our 
period  of  education  lasts  throughout  life — whether 
such  education  comes  from  reading,  post-grad- 
uate work,  medical  societies  or  clinics.  Attention 
is  further  drawn  to  the  fact  that  the  art  of  the 
practice  of  medicine,  one  of  the  doctor’s  most  im- 
portant assets,  is  not  learned  from  books  but  by 
personal  contact  with  a preceptor  whether  he  be 
an  older  associate  or  master  clinician. 

In  reviewing  the  report  of  the  Committee  on  the 
Costs  of  Medical  Care,  Dr.  Platter  has  drawn  at- 
tention to  the  statement  embodied  in  the  Minority 
Report  of  this  Committee,  namely,  that  the  medi- 
cal profession  has  the  brains  and  ability  to  solve 
this  national  problem  of  medical  care  and  does  not 
subscribe  to  the  principle  of  forming  medical 
groups  under  lay  supervision  where  the  profession 
would  be  reduced  to  a trade,  personal  ideals 
smothered  and  the  brilliant  students  discouraged 
from  entering  a profession  so  handicapped. 

Public  Health  Administration  owes  its  greatest 
stimulus  and  its  greatest  support  to  medical  or- 
ganization. Its  proper  function,  in  the  words  of 
our  president  of  last  year,  is  “the  protection  of 
the  public  environment”  and  “this  protection  has 
three  subdivisions:  A — Sanitation;  B — Com- 

municable Disease  Control;  C — Public  informa- 
tion and  education.” 

In  the  control  of  communicable  disease,  how- 
ever, recognition  must  be  had  that  this  function  is 
subdivided  into  quarantine  and  immunization.  The 
profession  rightfully  believes  that  immunization 
lies  in  the  province  of  the  practitioner  and  should 
not  be  done  at  public  expense  except  in  the  case 
of  the  indigent. 

Organized  medicine  does  not  approve  of  clinics 
formed  by  boards  of  health  which  are  not  sanc- 


tioned by  the  neighboring  medical  society.  Such 
clinics  often  make  little  effort  to  find  out  whether 
the  financial  status  of  patients  attending  makes 
them  eligible  for  such  service.  We  are  opposed  to 
stimulation  of  attendance  of  the  public  by  adver- 
tising of  such  clinics. 

Dr.  Platter  closes  his  address  with  a plea  for 
continued  unity,  kindliness  and  tolerance  in  the 
medical  brotherhood.  This  is  all  the  more  im- 
portant at  this  time  of  financial  depression  when 
also  the  role  of  the  individual  practitioner  is 
being  assailed  by  those  who  favor  group  practice 
of  medicine. 

(Signed)  H.  G.  Sloan,  Chairman, 
George  P.  Tyler,  Jr., 

H.  R.  Neeland, 

C.  K.  Startzman, 

C.  R.  Micklethwaite. 

On  motion  by  Dr.  Sloan,  seconded  by  Dr.  Pary- 
zek  and  earned,  the  above  report  was  accepted 
and  approved. 


Annual  Reports 

To  The  House  of  Delegates  of  the  Ohio  State 
Medical  Association: 

In  these  difficult  and  trying  times  of  rapid 
changes  in  government  and  social  structure,  with 
the  multiplying  problems  which  have  confronted 
the  medical  profession  because  of  its  fundamental 
relationship  to  public  and  community  life,  the  im- 
portance of  strong  and  effective  medical  organiza- 
tion has  been  correspondingly  increased. 

As  in  every  organization  of  the  extent  and  im- 
portance of  the  Ohio  State  Medical  Association, 
much  of  the  responsibility  and  constant  labor  on 
behalf  of  the  profession  as  a whole  has  rested 
upon  the  officers,  the  Council  and  the  committees, 
whose  success,  however,  could  have  been  made 
possible  only  through  the  sustained  interest,  sup- 
port and  cooperation  of  the  membership-at-large. 

While  endeavoring  at  all  times  to  base  their 
policies  and  activities  on  the  greatest  good  to  the 
public,  our  Council  and  committees  have  adhered 
to  the  fundamental  principle  that  anything  which 
would  be  detrimental  to  scientific  medicine  and 
the  medical  profession  would  inevitably  be  detri- 
mental to  the  public.  Therefore,  their  concern  on 
our  behalf  as  practicing  physicians  has  included 
thoughtful  consideration  for  our  economic  se- 
curity. 

The  functions  and  constant  activities  of  the 
committees  are  summarized  and  briefly  reflected 
in  the  annual  reports  published  in  the  September 
issue  of  our  Jotimwl  and  which  this  reference 
committee  of  our  House  of  Delegates  has  now  had 
under  consideration. 

I.  Annual  Repoi't  of  the  Committee  on  Public 
Policy. 

A clear  general  picture  of  the  vital  changes 
which  have  been  taking  place  in  long  established 
relationships  between  the  government  and  the 
public,  and  especially  in  the  field  of  legislation,  is 
set  forth  in  the  report  of  this  committee,  which 
includes  a tabulated  summary  of  numerous  meas- 
ures affecting  medical  practice  and  public  health 
which  were  pending  in  the  recent  prolonged,  diffi- 
cult and  complicated  session  of  the  Ohio  General 
Assembly. 

With  due  pride  and  with  acknowledgment  of 
support  by  the  legislative  committeemen  and  their 
colleagues  in  each  of  the  component  academies 
and  county  societies,  the  report  shows  that  in  spite 
of  formidable  and  hostile  interests,  organized 


October,  1933 


House  of  Delegates  Proceedings 


641 


medicine  was  successful  in  keeping  the  present 
health  and  medical  statutes  intact.  The  tine  re- 
sult attained  in  the  face  of  unprecedented  diffi- 
culties was  possible  only  through  wholehearted 
and  concerted  activity. 

II.  Annual  Report  of  the  Committee  on  Medical 
Economics. 

Particularly  on  account  of  the  prevailing- 
economic  unrest,  changing  social  conditions,  un- 
precedented extension  of  the  powers  and  activities 
of  government,  and  the  special  burdens  and  re- 
sponsibilities placed  upon  the  medical  profession, 
the  activities  of  this  committee  were  particularly 
important  during  the  past  year.  The  report  of 
this  committee  analyzes  a number  of  vital  prob- 
lems including  the  various  attempts  to  socialize 
medical  practice,  group  payment  and  insurance 
schemes,  the  effect  of  “relief”  legislation  and  ad- 
ministration, local  activities  and  responsibilities. 
Referred  to  in  this  report  as  a subject  of  im- 
portance and  natural  interest  by  the  committee  is 
the  activity  by  the  Special  Workmen’s  Compensa- 
tion Committee  and  the  special  committee  on  hos- 
pital contracts. 

III.  Annual  Report  of  the  Committee  on  Pub- 
lication. 

The  annual  report  of  this  committee  properly 
points  out  that  the  Ohio  State  Medical  Journal 
plays  an  indispensable  part  in  the  activities  of 
medical  organization  in  Ohio;  that  in  addition  to 
its  gradually  increased  scientific  value,  The 
Journal  includes  throughout  the  year  informative 
text  of  accounts  of  medical  society  and  academy 
activities  and  meetings;  news  regarding  physi- 
cians; activities  in  the  hospital  and  public  health 
fields;  legal  and  court  opinions  of  interest  to 
physicians;  legislative  and  governmental  develop- 
ments; summaries  of  new  laws  and  regulations 
affecting  physicians;  reviews  of  activities  of  allied 
and  related  groups  and  organizations;  comments 
and  criticisms  on  social  and  economic  questions 
affecting  medical  practice  and  scientific  medicine; 
reports  on  the  work  carried  on  by  the  officers, 
councilors  and  committees  of  the  State  Associa- 
tion, and  other  news  of  interest  to  the  profession 
generally.  Solicitation  of  assistance  by  the  officers 
and  membership  of  the  component  societies  in  in- 
creasing the  value  of  The  Journal  is  extended  by 
the  committee. 

IV.  Annual  Report  of  the  Committee  on  Medical 
Defense. 

Legal  phases  of  medical  practice,  especially  per- 
taining to  the  hazards  of  suits  for  alleged  mal- 
practice, are  summarized  in  an  informative  and 
convincing  manner  in  the  report  of  this  commit- 
tee, which  report  constitutes  a summarized  text- 
book, the  content  of  which  should  be  made  fa- 
miliar to  every  member. 

V.  Annual  Report  of  the  Committee  on  Medical 
Education  and  Hospitals. 

In  addition  to  emphasis  on  the  importance  of 
continuous  attention  by  every  physician  to  per- 
sonal application  and  study,  postgraduate  courses 
and  other  means,  this  committee  analyzes  the 
problem  of  supply  and  distribution  of  physicians 
and  properly  opposes  any  procedure  to  lower  the 
present  high  standards  of  medical  education, 
which  are  so  well  exemplified  in  Ohio’s  three  Class 
A medical  schools. 


VI.  Annual  Report  of  the  Committee  on  Pre- 
ventive Medicine  and  Periodic  Health  Exami- 
nations. 

The  unassailable  principle  that  physicians 
should  give  greater  consideration  to  the  inclusion 
of  preventive  medicine  in  their  private  practice 
with  a summary  of  the  benefits  not  only  to  them- 
selves but  to  their  patients,  forms  the  basis  of  the 
report  of  this  committee,  as  well  as  the  part 
which  medical  organization  may  properly  take  in 
a program  of  public  information. 

VII.  Annual  Report  of  the  Committee  on  Audit- 

ing  and  Appropriations. 

Close  attention  to  the  fiscal  affairs  of  our  Asso- 
ciation for  the  preservation  and  careful  expendi- 
ture of  our  funds  to  secure  the  maximum  of  re- 
turn is  shown  by  the  report  of  this  committee, 
which  includes  the  report  of  the  certified  public 
accountant  for  the  last  fiscal  year.  This  commit- 
tee properly  points  out  that:  “It  is  quite  apparent 
that  it  is  relatively  more  important  that  medical 
organization  machinery  be  maintained  at  a higher 
degree  of  efficiency  now  than  ever  before.  Unless 
adequate  financial  support  is  given  to  activities 
and  programs  designed  to  aid  and  assist  the  medi- 
cal profession,  individually  and  collectively,  the 
effectiveness  of  those  activities  and  functions  is 
certain  to  be  diminished”. 

VIII.  Annual  Report  of  the  Committee  on  Mili- 
tary and  Veterans’  Affairs. 

Analysis  of  the  Federal  Economy  Act  and  the 
revised  policy  of  our  federal  government  in  bene- 
fits extended  to  veterans  is  found  in  this  report 
It  is  pointed  out  that  the  revised  policy,  which 
includes  consideration  for  economy,  is  in  line  with 
that  previously  established  by  medical  organiza- 
tion to  the  effect  that:  “Adequate  provision  should 
be  made  for  those  whose  physicial  disabilities 
were  incurred  in  or  resulted  from  military  service 
and  for  the  dependents  of  those  who  sacrificed 
their  lives  in  the  service  of  their  country,  but 
compensation  should  not  be  paid  to,  and  medical 
and  hospital  care  provided  at  government  expense 
for  ex-service  men  whose  disabilities  were  not  in- 
curred in  or  the  result  of  military  or  naval  ser- 
vice”. Cooperation  of  the  medical  profession  is 
also  pledged  in  the  patriotic  program  for  medical 
reserve  enlistments. 

IX.  Annual  Report  of  Councilors. 

The  brief  report  of  the  Council  properly  refers 
to  the  minutes  of  that  body,  which  has  served  as 
our  executive  board  and  board  of  trustees.  Special 
mention  is  made  of  the  unusually  large  number 
of  strong  and  active  component  county  medical 
societies  which  form  the  basis  of  medical  organi- 
zation and  on  which  the  success  of  medical  organi- 
zation depends.  This  report  emphasizes  the  fact 
that  every  eligible  physician  in  each  community 
should  be  enrolled  in  medical  organization,  that 
the  maximum  of  beneficial  results  on  behalf  of 
physicians  generally,  depends  on  unity,  strength, 
fearless  policies  and  aggressive  action.  The  Council 
also  points  out  that  there  never  has  been  a time  in 
the  history  of  medicine  when  there  has  been  a 
greater  need  for  understanding,  harmony,  cohesion 
and  genuine  cooperative  activity  on  the  part  of  the 
medical  profession  in  every  community,  in  every 
state  and  throughout  the  entire  nation.  The 
“healthy  condition”  of  medical  organization  is 
shown  in  the  detailed  membership  tabulation  by 
Councilor  Districts.  It  is  observed  with  regret 
that  there  are  more  delinquent  members  than  in 
normal  times.  While  this  is  to  be  expected  and 


642 


The  Ohio  State  Medical  Journal 


October,  1933 


while  the  number  of  delinquents  is  much  less  in 
proportion  than  that  in  most  any  other  kind  of 
organization  in  Ohio,  we  are  hopeful  that  all 
eligible  physicians — former  members  and  those 
newly  entitled  to  practice — can  be  enlisted  in  ad- 
vance for  the  coming  year. 

The  Council  has  provided  effective,  trained  and 
faithful  headquarters  personnel  to  carry  out  its 
orders  and  to  serve  the  committees,  the  county 
societies,  The  Journal,  and  the  membership. 
Through  tireless  work  our  small  headquarters 
staff  has  been  able  to  handle  perhaps  more  diffi- 
cult problems  and  more  details  than  any  staff  of 
equal  size  serving  an  organization  of  similar  ex- 
tent and  importance. 

In  conclusion  we  urge  that  every  member  who 
has  not  already  done  so,  read  carefully  the  an- 
nual reports  published  in  the  September  Journal, 
in  order  that  he  may  be  convinced  not  only  of  the 
problems  but  of  the  activities  of  the  State  Asso- 
ciation, which,  however,  are  merely  reflected  and 
summarized  in  those  reports. 

(Signed)  R.  R.  Hendershott,  Chairman, 
Louis  Feid,  Jr., 

John  F.  Wright, 

Geo.  J.  Waggoner, 

C.  E.  Northrup. 

On  motion  by  Dr.  Hendershott,  seconded  by  Dr. 
Emerick  and  carried,  the  above  report  by  sections 
and  in  its  entirety  was  accepted  and  approved. 


Report  of  Committee  on  Resolutions 

Dr.  Emerick,  the  chairman,  on  behalf  of  the 
Committee  on  Resolutions,  presented  the  follow- 
ing: 

To  the  House  of  Delegates, 

Ohio  State  Medical  Association,  at  the  87th 
Annual  Meeting,  Akron,  Ohio. 

The  Committee  on  Resolutions  consisting  of  A. 
W.  Carley,  Dayton;  C.  W.  Kirkland,  Bellaire;  Guy 
E.  Noble,  St.  Marys;  Joseph  Rosenfeld,  Youngs- 
town; and  E.  J.  Emerick,  Chairman,  Columbus, 
met  on  Thursday  afternoon,  September  7th,  1933, 
at  which  there  were  also  present  authors  of  some 
of  the  resolutions  and  other  members  interested 
in  discussing  the  resolutions  introduced  at  the 
first  session  yesterday  morning. 

The  Resolutions  Committee  submits  for  your 
consideration  its  comments  as  follows: 

Resolution  A 

Introduced  by  Claude  D.  Waltz  (Cuyahoga 
County).  This  resolution  reaffirms  and  brings  up 
to  date  policies  previously  announced  by  the 
House  of  Delegates  on  the  question  of  Federal 
legislation  and  administration  in  relation  to 
medical  and  hospital  benefits  to  ex-service  men. 

This  committee  recommends  for  approval  the 
sentiment  expressed  in  that  resolution  as  indi- 
cated by  slight  amendments  and  changes  to  read 
as  follows: 

Whereas.  New  Federal  regulations  pertaining 
to  veterans’  benefits  and  to  medical  and  hospital 
care  for  ex-service  men  have  been  placed  into 
operation,  and 

Whereas,  These  regulations  are  in  line  with  the 
established  policy  of  medical  organizaton  in  Ohio 
that  adequate  and  equitable  provision  should  be 


made  for  those  ex-service  men  whose  disabilities 
were  incurred  in  or  resulted  from  military  service 
and  for  the  dependents  of  those  who  gave  their 
lives  in  the  service,  but  benefits  and  hospital  and 
medical  care  should  not  be  provided  generally  at 
government  expense  for  those  whose  disabilities 
were  not  incurred  in  or  the  result  of  military 
service. 

Resolved,  That  the  Ohio  State  Medical  Asso- 
ciation commends  and  approves  the  principles 
underlying  the  new  Federal  veterans’  regulations 
and  pledges  the  cooperation  and  support  of  the 
medical  profession  of  Ohio  to  methods  devised  to 
administer  such  regulations  in  a way  which  will 
be  reasonable  and  equitable  to  the  deserving 
veteran  and  to  the  public  at  large. 

On  motion  by  Dr.  Emerick,  seconded  by  Dr. 
DeWitt  and  carried,  Resolution  A was  accepted 
and  approved. 

Resolution  B 

Introduced  by  H.  S.  Davidson  (Summit 
County) , expresses  appreciation  to  the  Policy 
Committee,  legislative  committeemen  of  the 
academies  of  medicine  and  county  medical  so- 
cieties, and  our  headquarters  staff  for  successful 
efforts  in  connection  with  the  present  session  of 
the  Ohio  General  Assembly. 

This  is  a well  deserved  compliment,  and  our 
committee  recommends  the  adoption  of  the  resolu- 
tion with  slight  editorial  changes  to  read  as  fol- 
lows : 

Whereas,  During  the  recent  important  regular 
session  of  the  90th  Ohio  General  Assembly  an  un- 
usual number  of  serious  and  complicated  ques- 
tions of  vital  concern  to  the  medical  profession 
were  considered,  and 

Whereas,  The  spirit  of  the  times  encouraged 
the  presentation  of  an  unprecedented  number  of 
experimental,  questionable  and  destructive  meas- 
ures, adding  tremendously  to  the  activities  and  re- 
sponsibilities of  those  particularly  interested  in 
the  preservation  of  present  sound  laws  and  in  the 
defeat  of  legislative  proposals  dangerous  to  pub- 
lic health  and  scientific  medicine,  and 

Whereas,  Largely  through  the  efforts  of  medi- 
cal organization  in  keeping  members  of  the  Gen- 
eral Assembly  fully  informed  at  all  times  con- 
cerning the  proper  medical  viewpoint,  no  legisla- 
tion inimical  to  public  health,  scientific  medicine, 
medical  education  and  medical  practice  was 
enacted,  therefore,  be  it 

Resolved,  That  the  House  of  Delegates  of  the 
Ohio  State  Medical  Association  in  annual  session, 
September  7 and  8,  1933,  expresses  appreciation 
and  approval  to  the  Committee  on  Public  Policy, 
the  legislative  committeemen  of  the  component 
county  medical  societies,  and  the  members  of  the 
state  headquarters  staff  for  their  effective  ser- 
vices in  behalf  of  the  public  and  in  the  interest  of 
scientific  medicine  and  public  health,  and  that 
special  appreciation  be  expressed  to  those  earnest 
and  high-minded  members  of  the  General  As- 
sembly who  cooperated  with  the  representatives 
of  medical  organization  by  giving  serious  and 
thoughtful  consideration  to  the  conservative  medi- 
cal viewpoint  on  health  and  medical  questions, 
and  be  it  further 

Resolved,  That  it  is  the  sense  of  the  House  of 
Delegates  that  the  methods  and  procedure  adopted 
by  medical  organization  in  its  legislative  activities 
are  correct  and  practical  and  of  the  greatest 
benefit  to  the  public,  and  that  it  is  of  vital  im- 


October,  1933 


House  of  Delegates  Proceedings 


643 


portance  that  oux-  present  organization  which  has 
proved  so  effective  in  the  past  be  maintained  in 
order  that  our  interests,  as  well  as  those  of  the 
public,  may  be  safeguarded  in  the  future. 

On  motion  by  Dr.  Emerick,  seconded  by  Dr. 
Upham,  and  carried,  Resolution  B was  accepted 
and  approved. 

Resolution  C 

Introduced  by  C.  H.  Heyman  (Cuyahoga 
County) , seeks  to  instruct  the  Council  of  our 
State  Association  to  grant  a discount  of  20  per 
cent  in  the  dues,  in  the  form  of  reducing  the  per 
capita  dues  in  the  State  Association  for  1934. 

The  Resolutions  Committee  heard  a number  of 
speakers  for  and  against  this  resolution  and  de- 
liberated at  length  on  the  question  involved.  As  a 
matter  of  information,  the  committee  discovered 
that  the  Council  of  our  State  Association  had  con- 
sidered this  question  several  times  when  presented 
to  it  by  the  Cleveland  Academy  of  Medicine. 

We  find  that  all  other  large  state  medical  as- 
sociations comparable  in  size  and  importance  to 
the  Ohio  State  Medical  Association  have  per 
capita  annual  dues  much  larger  than  those  in  our 
Association. 

Several  of  the  state  medical  associations  with 
dues  larger  than  those  in  Ohio  have  much  more 
property  and  larger  reserve  funds  than  our  As- 
sociation and  in  spite  of  such  reserve  funds  their 
membership  dues  are  maintained  at  higher  figures 
than  those  in  our  state. 

With  the  possibility  of  monetary  inflation,  the 
uncerta'nty  of  the  future  purchasing  power  of  the 
dollar,  the  prospects  of  increased  Journal  print- 
ing costs,  costs  of  supplies,  etc.,  expenditures  for 
absolute  necessities  in  organization  activities  may 
be  much  greater  this  coming  year  than  in  the  past 
year. 

The  proposed  discount  of  20  per  cent  from  our 
$5.00  per  capita  annual  dues  would  amount  to  a 
saving  of  less  than  2 cents  per  member  per  week 
for  the  calendar  year,  but  would  mean  a deficit  of 
several  thousand  dollars  from  our  reserve  fund 
which  should  be  preserved  for  serious  emergencies 
which  may  arise  and  which  for  the  protection  of 
the  integrity  and  independence  of  the  medical 
profession,  might  require  most,  if  not  all,  of  our 
reserve.  Our  reserve  funds  may  be  needed  at  any 
time  for  such  emergencies  as : attempts  to  soviet- 
ize  medical  practice,  imposition  of  special  class 
privilege  taxes,  attempt  to  restrict  fees  by  legis- 
lation or  by  governmental  decree,  initiated  or 
other  proposals  to  destroy  health  and  medical 
statutes,  court  procedure  to  safeguard  the  medical 
profession,  public  education  efforts  to  counteract 
hostile  propaganda,  research  and  surveys  in 
medical,  economic  and  social  problems,  needs  for 
meeting  the  dangerous  increase  in  malpractice 
suits,  and  similar  protective  activities  of  benefit 
to  all  members. 

As  a matter  of  comparison,  based  on  recent  in- 
quiries and  investigation  in  other  states,  our  at- 
tention was  called  to  the  larger  dues  in  all  other 


state  medical  associations  of  importance,  even 
where  reductions  have  been  made:  Arizona, 

$12.50;  Colorado,  $10.00;  Illinois,  $7.00;  Indiana, 
$7.00;  Iowa,  $10.00;  Louisiana,  $7.00;  Maine, 
$8.00;  Massachusetts,  $10.00;  Michigan,  $8.75; 
Minnesota,  $15.00;  Missouri,  $8.00;  Nevada, 
$10.00;  New  Jersey,  $10.00;  New  York,  $10.00; 
Pennsylvania,  $7.50;  Texas,  $8.00;  West  Virginia, 
$10.00;  Wisconsin,  $12.00;  Kansas,  $7.00,  and 
California,  $10.00. 

Our  Resolutions  Committee  by  a vote  of  four 
to  one  recommends  that  Resolution  C be  rejected. 

On  motion  by  Dr.  Emerick,  seconded  by  Dr. 
DeWitt  and  carried,  the  House  of  Delegates  ap- 
proved by  a rising  vote  of  35  to  10  the  foregoing 
report  and  recommendations  of  the  Resolutions 
Committee  in  rejecting  Resolution  C. 

Resolution  D 

Introduced  by  D.  M.  Glover  (Cuyahoga  County), 
deals  with  important  problems  and  policies  of 
workmen’s  compensation.  It  commends  the  efforts 
of  our  State  Association  Special  Committee  on 
Workmen’s  Compensation,  and  pledges  our  organ- 
ization to  cooperate  in  all  constructive  efforts  in 
eliminating  delays  in  handling  workmen’s  com- 
pensation cases,  in  the  preservation  of  the  Work- 
men's Compensation  Fund,  and  in  the  elimination 
of  abuses. 

Our  Resolutions  Committee  recommends  the 
adoption  of  Resolution  D as  follows: 

Whereas,  The  Ohio  Workmen’s  Compensation 
Fund  is  confronted  by  serious  problems,  on  ac- 
count of  decreased  income,  relatively  larger  com- 
pensation costs,  uncertain  value  of  securities  con- 
stituting the  reserve  fund,  prolongation  of  cases 
of  disability,  and  other  causes,  and 

Whereas,  The  medical  and  surgical  fee  sched- 
ule adopted  in  1920  is  sufficiently  low,  even  in 
these  times,  without  the  temporary  reduction  of 
20  per  cent,  and 

Whereas,  The  Special  Committee  of  the  Ohio 
State  Medical  Association  on  Workmen’s  Com- 
pensation has  made  constructive  suggestions  for 
improvement  in  administrative  procedure  in  the 
Industrial  Commission  for  the  purpose  of  pre- 
serving the  fund,  prompter  termination  of  cases, 
eliminating  abuses  and  preventing  violations  of 
the  law  and  regulations,  and 

Whereas,  Our  committee  has  opposed  reduc- 
tion of  the  medical  and  surgical  fees  in  work- 
men’s compensation  cases  as  being  inadequate  in 
effect  and  discriminating  against  the  great  ma- 
jority of  honest  physicians,  therefore,  be  it 

Resolved,  By  the  House  of  Delegates  of  the 
Ohio  State  Medical  Association  in  annual  session 
September  7 and  8,  1933,  that  endorsement  and 
approval  be  given  to  the  activities  and  recom- 
mendations of  our  Committee  on  Workmen’s  Com- 
pensation and  we  recommend  to  the  Industrial 
Commission  the  early  institution  of  the  reforms 
in  procedure  recommended  in  that  report; 

Be  It  Further  Resolved,  That  we  respectfully 
urge  the  Commission  to  rescind  its  order  reducing 
physicians’  fees  as  soon  as  practical,  and 

Be  It  Further  Resolved,  That  we  pledge  our 
organization  to  thorough  cooperation  in  carrying 
out  the  plans  recommended  to  the  Industrial  Com- 
mission. 


644 


The  Ohio  State  Medical  Journal 


October,  1933 


On  motion  by  Dr.  Emerick,  seconded  by  Dr. 
Davidson  and  carried,  Resolution  D was  accepted 
and  approved. 

Resolution  E 

Introduced  by  J.  P.  DeWitt  (Stark  County), 
commends  the  cooperation  of  the  Woman’s  Aux- 
iliary in  Stark  County  with  the  Stark  County 
Medical  Society,  and  requests  official  action  by  the 
State  Association  in  inaugurating  a Woman’s 
Auxiliary  in  Ohio  to  assist  in  entertainment 
features  at  the  meeting  in  Cleveland,  and  for 
other  purposes. 

Records  of  the  Council  of  our  State  Association 
over  a period  of  years,  show  that  this  question 
has  been  frequently  and  repeatedly  discussed,  and 
that  the  Council  on  each  occasion  declined  to  ap- 
prove or  sponsor  a Woman’s  Auxiliary. 

In  view  of  the  fact  that  information  was  sub- 
mitted to  the  Resolutions  Committee  showing  that 
only  one  county  medical  society  in  Ohio  had  a 
Woman’s  Auxiliary,  and  in  the  absence  of  evi- 
dence indicating  general  interest  throughout  Ohio 
in  a Woman’s  Auxiliary,  we  recommend  that  this 
matter  be  left  with  the  county  medical  societies 
as  a local  problem. 

On  motion  by  Dr.  Emerick,  seconded  by  Dr. 
Brush  and  Dr.  Upham,  who  also  discussed  the 
resolution,  the  foregoing  report  and  recommenda- 
tions of  the  Resolutions  Committee  were  accepted 
and  approved. 

On  motion  by  Dr.  Emerick,  seconded  by  Dr. 
Slosser  and  carried,  the  House  of  Delegates  ap- 
proved the  action  and  recommendations  of  the 
Resolutions  Committee  as  a whole. 


Meeting  Place  for  1934 

Dr.  Paryzek  presented  to  the  House  of  Dele- 
gates an  invitation  to  select  Cleveland  as  the 
meeting  place  for  the  1934  Annual  Meeting  in 
connection  with  the  meeting  of  the  American 
Medical  Association  to  be  held  in  that  city  on 
June  11  to  15,  1934.  This  invitation  was  discussed 
by  Dr.  Emerick,  Dr.  Brush,  Dr.  Upham,  Dr. 
Davidson,  Dr.  Boylan,  Dr.  Houser  and  Dr.  Hen- 
dershott. 

It  was  pointed  out  in  the  discussion  that  if  the 
State  Association  met  at  the  same  time  as  the 
A.  M.  A.  in  Cleveland,  that  it  would,  of  course,  be 
necessary  to  hold  business  sessions  of  the  House 
of  Delegates  and  the  Council,  but  that  it  would 
probably  be  improper  to  hold  scientific  sessions  in 
view  of  the  scientific  sections  and  general  scien- 
tific program  of  the  American  Medical  Associa- 
tion. 

In  view  of  the  difference  of  opinion  on  this 
question,  and  on  motion  by  Dr.  Kiely,  seconded  by 
Dr.  Hendershott  and  carried,  the  entire  question 
of  time  and  place  of  the  1934  Annual  Meeting 
was  left  with  the  Council  for  official  decision. 


Words  of  Appreciation 

By  unanimous  consent,  the  House  of  Delegates 
accepted  the  introduction  of  the  following  resolu- 
tion submitted  by  Dr.  Klotz: 

The  House  of  Delegates,  on  behalf  of  all 
members  in  attendance,  expresses  appreciation 
to  the  medical  profession  of  Akron  and  Summit 
County  for  its  generous  hospitality,  to  the  local 
committees  for  their  splendid  services  which  were 
made  manifest  in  the  efficient  arrangements  for 
the  meeting,  to  the  management  of  the  Mayflower 
Hotel  and  its  staff  for  cordial  cooperation  and 
service,  to  the  management  of  Polsky’s  and 
O’Neils  for  the  use  of  their  auditoriums,  to  the 
local  committee  of  ladies  who  extended  hospitality 
to  the  visiting  women  guests,  to  the  Akron  news- 
papers, and  to  the  local  manufacturers,  merchants 
and  others  who  generously  rendered  assistance  in 
making  the  meeting  a success. 

By  acclamation,  the  foregoing  resolution  was 
unanimously  adopted. 


Installation  of  New  President 

Before  retiring  as  President  and  as  his  last 
official  act,  Dr.  Platter  expressed  appreciation 
for  support  and  cooperation,  and  in  turning  over 
the  official  gavel  and  inducting  Dr.  Cummer, 
President-Elect,  into  the  presidency,  he  called  at- 
tention to  the  unusual  qualifications  of  Dr.  Cum- 
mer for  that  position. 

On  being  installed,  Dr.  Cummer  paid  tribute  to 
the  fine  service  rendered  by  Dr.  Platter,  expressed 
his  hope  to  measure  up  to  the  duties  and  obliga- 
tions now  resting  upon  him,  reminded  the  mem- 
bership of  the  grave  problems  confronting  the 
profession,  and  emphasized  the  need  of  coopera- 
tion. 


Appointment  and  Confirmation  of  Standing 
Committees 

Under  the  next  order  of  business  of  the  House 
of  Delegates,  and  as  his  first  official  act,  Dr. 
Cummer,  in  conformity  to  Chapter  IX,  Section  1, 
of  the  By-Laws,  announced  the  appointment  of 
one  member  each  on  the  standing  committees  for 
a term  of  three  years  as  follows: 

Public  Policy: 

John  B.  Alcorn,  Columbus. 

Publication: 

A.  B.  Denison,  Cleveland. 

Medical  Defense  : 

W.  H.  Snyder,  Toledo. 

Medical  Education  and  Hospitals : 

John  F.  Wright,  Toledo. 

Medical  Economics: 

J.  Craig  Bowman,  Upper  Sandusky. 

On  motion  by  Dr.  Slosser,  seconded  by  Dr. 
McDougall,  and  carried,  the  House  of  Delegates 
concurred  in  the  foregoing  appointments. 

Dr.  Cummer  then  announced  the  complete  per- 
sonnel of  the  standing  committees  under  the  Con- 


October,  1933 


House  of  Delegates  Proceedings 


645 


stitution,  including  the  hold-over  members,  the 
year  in  which  the  terms  of  members  expire,  and 
the  chairman  designation,  as  follows: 

Committee  on  Public  Policy: 

C.  W.  Stone,  Chairman,  (1935),  Cleveland;  J. 
H.  J.  Upham,  (1934),  Columbus;  John  B.  Alcorn, 
(1936),  Columbus;  C.  L.  Cummer,  (Ex-Officio), 
Cleveland;  John  A.  Caldwell,  (Ex-Officio),  Cin- 
cinnati. 

Committee  on  Publication: 

Andrews  Rogers,  Chairman,  (1934),  Columbus; 
Gilbert  Micklethwaite,  (1935),  Portsmouth;  A.  B. 
Denison,  (1936),  Cleveland. 

Committee  on  Medical  Defense: 

J.  E.  Tuckerman,  Chairman,  (1934),  Cleveland; 


F.  P.  Anzinger,  (1935),  Springfield;  W.  H. 
Snyder,  (1936),  Toledo. 

Committee  on  Medical  Education  and  Hospitals : 
Ben  R.  McClellan,  Chairman,  (1934),  Xenia; 
R.  H.  Birge,  (1935),  Cleveland;  John  F.  Wright, 
(1936) , Toledo. 

Committee  on  Medical  Economics : 

J.  Craig  Bowman,  Chairman,  (1936),  Upper 
Sandusky;  A.  B.  Brower,  (1934),  Dayton;  E.  0. 
Smith,  (1935),  Cincinnati. 

Further  business  being  called  for  and  there 
being  none  presented,  the  House  of  Delegates  ad- 
journed to  meet  in  1934  on  dates  and  at  a place 
to  be  selected  by  the  Council. 

Attest:  Don  K.  Martin, 

Executive  Secretary. 


House  of  Delegates  Roll  Call 


First 

Second 

County 

Delegate 

Session 

Session 

Adams 

O.  T.  Sproull 

present 

present 

Allen 

Burt  Hibbard 

present 

present 

Ashland 

C.  B.  Meuser 





Ashtabula 

R.  B.  Wynkoop 

present 

present 

Athens 

C.  S.  McDougall 

present 

present 

Auglaize 

Guy  E.  Noble 

present 

Belmont 

C.  W.  Kirkland 

present 

present 

Brown 

Butler 

Champaign 

Geo.  P.  Tyler,  Jr. 

D.  M.  Blizzard 

E.  W.  Ludlow 

Clark 

D.  W.  Hogue 

present 

present 

Clermont 

Jam-s  K.  Ashburn 

present 

Clinton 

Elizabeth  Shrieves 

present 

present 

Columbiana 

J.  M.  Me  George 

present 

Coshocton 

J.  G.  Smailes 

present 

Crawford 

W.  K.  Barth 

present 

present 

Cuyahoga 

C.  D.  Waltz 

present 

present 

“ 

C.  H.  Heyman 

present 

present 

“ 

H.  C.  King 

present 

present 

H.  G.  Sloan 

present 

present 

C.  G.  LaRocco 

present 

present 

D.  M.  Glover 

present 

present 

Harold  Feil 

present 

M.  A.  Blankenhorn 



present 

J.  N.  Wychgel 

present 

“ 

J.  E.  Tuckerman 

present 

Darke 

C.  I.  Stephen 

Defiance 

D.  J.  Slosser 

present 

present 

Delaware 

D.  S.  James 

Erie 

F.  M.  Houghtaling 

Fairfield 

Ralph  Smith 

present 

present 

Fayette 

James  F.  Wilson 

present 

present 

Franklin 

I.  B.  Harris 

“ 

E.  J.  Emerick 

present 

present 

“ 

J.  H.  J.  Upham 

present 

present 

“ 

John  M.  Thomas 

present 

present 

“ 

John  B.  Alcorn 

present 

present 

Fulton 

C.  E.  Patterson 

. 



Gallia 

Mary  L.  Austin 

present 

present 

Geauga 

Lucy  S.  Hertzog 

Greene 

M.  M.  Best 

present 

present 

Guernsey 

H.  R.  Neeland 

present 

present 

Hamilton 

J.  V.  Greenebaum 

present 

present 

“ 

Otto  Seibert 

present 

present 

“ 

Louis  Feid,  Jr. 

present 

“ 

Chas.  E.  Kiely 

present 

present 

“ 

Ralph  W.  Good 

present 

present 

Hancock 

J.  M.  Firmin 

present 

present 

Hardin 

R.  G.  Schutte 

Harrison 

A.  C.  Grove 

Henry 

Thomas  Quinn 

Highland 

H.  W.  Chaney 

present 

present 

Hocking 

Holmes 

O.  V.  Donaldson 

— 

Huron 

Geo.  F.  Linn 

present 

Jackson 

A.  G.  Ray 

present 

“ 

J-  L.  Frazer 

present 

Jefferson 

Fred  H.  Riney 



Knox 

F.  C.  Anderson 

present 

present 

Lake 

V.  N.  Marsh 

present 

present 

Lawrence 

Cosper  Burton 

Licking 

Emmett  A.  Moore 

present 

present 

Logan 

C.  K.  Startzman 

Lorain 

S.  V.  Burley 

present 

present 

Lucas 

E.  J.  McCormick 

present 

John  F.  Wright 

present 

present 

Charles  Lukens 

present 

present 

First 

Second 

County 

Delegate 

Session 

Session 

Madison 

H.  P.  Sparling 



Mahoning 

Joe  Rosenfeld 

present 

present 

“ 

L.  G.  Coe 

present 

present 

Marion 

E.  H.  Morgan 

present 

present 

Medina 

E.  L.  Crum 

present 

present 

Meigs 

H.  M.  Crumley 

present 

present 

Mercer 

R.  E.  Riley 

* 

Miami 

Gainor  Jennings 



Monroe 



Montgomery 

A.  O.  Peters 

present 

present 

“ 

A.  W.  Carley 

present 

present 

“ 

W.  B.  Bryant 

present 

present 

Morgan 

C.  E.  Northrup 

present 



Morrow 

T.  Caris 





Muskingum 

M.  A.  Loebell 

present 

present 

Ottawa 

H.  J.  Pool 

present 

present 

Paulding 

L.  R.  Fast 



Perry 

J.  G.  McDougal 





Pickaway 

C.  G.  Stewart 





Pike 

Robert  T.  Leever 

Portage 

Geo.  J.  Waggoner 

present 

present 

Preble 

J.  1.  Nisbett 



Putnam 

J.  R.  Echelbarger 

present 

present 

Richland 

S.  C.  Schiller 



Ross 

0.  P.  Tatman 

— 

Sandusky 

C.  J.  Egger 



Scioto 

G.  R.  Micklethwaite 





Seneca 

R.  R.  Hendershott 

present 

present 

Shelby 

B.  A.  Welch 

present 

present 

St2rk 

Perry  King 

present 

present 

“ 

J.  P.  DeWitt 

present 

present 

Summit 

F.  C.  Potter 

present 

present 

” 

R.  E.  Amos 

present 

present 

” 

C.  R.  Steinke 

present 

present 

Trumbull 

John  D.  Knox 

present 

present 

Tuscarawas 

R.  J.  Foster 

present 

present 

Union 

J.  D.  Boylan 

present 

present 

Van  Wert 

C.  R.  Keyser 



Vinton 

A.  A.  Boal 



— 

Warren 

B.  H.  Blair 





Washington 

S.  E.  Edwards 

Wayne 

R.  C.  Paul 

present 

present 

Williams 

W.  A.  Held 

. ...... 

Wood 

F.  V.  Boyle 





Wyandot 

J.  Craig  Bowman 

OFFICERS 

present 

President 

H.  M'.  Platter 

present 

present 

President-Elect 

C.  L.  Cummer 

present 

present 

Ex-President 

D.  C.  Houser 

present 

present 

Treasurer 

James  A.  Beer 

COUNCILORS 

present 

present 

First  District 

John  A.  Caldwell 

present 

present 

Second  District 

E.  M.  Huston 

present 

present 

Third  District 

0.  P.  Klotz 

present 

present 

Fourth  District 

B.  J.  Hein 

present 

present 

Fifth  District 

H.  V.  Paryzek 

present 

present 

Sixth  District 

H.  S.  Davidson 

present 

present 

Seventh  District 

E.  B.  Shanley 

present 

present 

Eighth  District 

E.  R.  Brush 

present 

present 

Ninth  District 

I.  P.  Seiler 

present 

present 

Tenth  District 

S.  J.  Goodman 

present 



Total 

83 

77 

646 


The  Ohio  State  Medical  Journal 


October,  1933 


OHIO  STATE  MEDICAL  ASSOCIATION 

.j*  jt 


Officers  1933-1934 


PRESIDENT 

C.  L.  Cummer,  M.D. Cleveland 

PRESIDENT-ELECT 

John  A.  Caldwell,  M.D Cincinnati 

TREASURER 

James  A.  Beer,  M.D Columbus 

EXECUTIVE  SECRETARY 

Don  K.  Martin ...Columbus 

State  Council 

FIRST  DISTRICT 

Parke  G.  Smith,  M.D. Cincinnati 

SECOND  DISTRICT 

E.  M.  Huston,  M.D Dayton 

THIRD  DISTRICT 

0.  P.  Klotz,  M.D Findlay 

FOURTH  DISTRICT 

B.  J.  Hein,  M.D. Toledo 

FIFTH  DISTRICT 

H.  V.  Paryzek,  M.D Cleveland 

SIXTH  DISTRICT 

H.  S.  Davidson,  M.D Akron 

SEVENTH  DISTRICT 

E.  B.  Shanley,  M.D. New  Philadelphia 

EIGHTH  DISTRICT 

E.  R.  Brush,  M.D Zanesville 

NINTH  DISTRICT 

1.  P.  Seiler,  M.D Piketon 

TENTH  DISTRICT 

S.  J.  Goodman,  M.D Columbus 

EX-OFFICIO,  THE  EX-PRESIDENT 

H.  M.  Platter,  M.D Columbus 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

C.  W.  Stone,  Chairman,  (1935)— .Cleveland 


J.  H.  J.  Upham,  (1934) ..Columbus 

John  B.  Alcorn,  (1936) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

John  A.  Caldwell,  (ex-officio) Cincinnati 

PUBLICATION 


Andrews  Rogers,  Chairman,  (1934) 

Columbus 

Gilbert  Micklethwaite,  (1935)—  Portsmouth 

A.  B.  Denison,  (1936) Cleveland 

MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

F.  P.  Anzinger,  (1935) Springfield 

W.  H.  Snyder,  (1936) Toledo 

MEDICAL  EDUCATION  AND  HOSPITALS 

Ben  R.  McClellan,  Chairman,  (1934). Xenia 

R.  H.  Birge,  (1935) Cleveland 

John  F.  Wright,  (1936) Toledo 

MEDICAL  ECONOMICS 

J.  Craig  Bowman,  Chairman,  (1936) 

Upper  Sandusky 

A.  B.  Brower,  (1934) Dayton 

E.  O.  Smith,  (1935) Cincinnati 


SECTION  OFFICERS  FOR  1933-1934 


MEDICINE 

Cecil  Striker  Chairman 

700  Provident  Bank  Bldg.,  Cincinnati 

H.  W.  Gauchat Secretary 

615  First  National  Bank  Bldg.,  Canton 

SURGERY 

Norris  Gillette  Chairman 

320  Michigan  St.,  Toledo 

Verne  A.  Dodd Secretary 

327  East  State  St.,  Columbus 


EYE,  EAR,  NOSE  AND  THROAT 

Ivor  G.  Clark Chairman 

188  East  State  St.,  Columbus 

Orville  J.  Walker Secretary 

Home  Savings  and  Loan  Bldg.,  Youngstown 
NERVOUS  AND  MENTAL  DISEASES 

Henry  C.  Schumacher Chairman 

2525  Euclid  Ave.,  Cleveland 

C.  C.  Kirk ..Secretary 

Orient,  Ohio 


OBSTETRICS  AND  PEDIATRICS 

John  Toomey  Chairman 

City  Hospital,  Cleveland 

J.  K.  Hoerner Secretary 

400  Fidelity  Building,  Dayton 


PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 


R.  H.  Markwith Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 


Wells  Teachnor,  Sr.,  (1934) Columbus 

Ben  R.  McClellan,  (1934) Xenia 

E.  R.  Brush,  (1934)  Zanesville 

C.  W.  Stone,  (1934) Cleveland 

J.  P.  DeWitt,  (1935)  - Canton 

C.  E.  Kiely,  (1935)  Cincinnati 

C.  W.  Waggoner,  (1935)  Toledo 


ALTERNATES 

D.  H.  Morgan,  (1934)— Akron 

A.  C.  Messenger,  (1934) Xenia 

A.  Howard  Smith,  (1934) Marietta 

C.  L.  Cummer,  (1934)  Cleveland 

G.  F.  Zinninger,  (1935) Canton 

L.  H.  Schriver,  (1935) Cincinnati 

Charles  Lukens,  (1935) Toledo 


Council  Meeting  Minutes  During  87th  Annual  Meetin, 
of  the  Ohio  State  Medical  Association 


MINUTES 

The  Council  of  the  Ohio  State  Medical  Associa- 
tion met  at  dinner  in  Parlor  E,  Mayflower  Hotel, 
Akron,  Wednesday  evening,  September  6,  on  the 
evening  preceding  the  opening  of  the  87th  annual 
meeting  of  the  State  Association. 

The  Officers,  Councilors  and  committee  chair- 
men present  were:  President,  Dr.  Platter;  Presi- 
dent-Elect, Dr.  Cummer;  Ex-iPresident,  Dr. 
Houser;  Treasurer,  Dr.  Beer;  Councilors,  Drs. 
Caldwell,  Huston,  Klotz,  Hein,  Paryzek,  Davidson, 
Shanley,  Brush  and  Seiler;  Dr.  Alcorn,  chairman, 
and  Dr.  Upham,  member  of  the  Policy  Committee  ; 
Dr.  Rogers,  chairman,  Publication  Committee;  Dr. 
Tuckerman,  chairman,  Medical  Defense  Commit- 
tee; Dr.  McClellan,  chairman,  Committee  on 
Medical  Education  and  Hospitals;  Dr.  Bowman, 
chairman,  Medical  Economics  Committee;  Dr. 
Bigelow,  chairman,  special  committee  on  hospital 
contracts  with  Industrial  Commission  in  work- 
men’s compensation  cases;  Executive  Secretary 
Martin,  and  Assistant  Executive  Secretary  Nel- 
son. 

Other  guests  present  were:  Dr.  Selby,  presi- 
dent of  the  Summit  County  Medical  Society;  Dr. 
Weeks,  general  chairman  of  the  local  committees 
on  arrangements;  Dr.  Southard,  State  Director  of 
Health;  Dr.  Seiler,  secretary  of  the  Union  (Sixth 
District)  Medical  Association,  and  Dr.  Stone, 
former  president  of  the  State  Association. 

Following  the  dinner  the  Council  convened  in 
business  session  at  8:00  P.  M.  In  the  absence  of 
Dr.  Goodman,  secretary  of  Council,  the  Presi- 
dent appointed  Dr.  Hein  as  acting  secretary. 

The  minutes  of  the  Council  meeting  held  on 
July  9,  1933  (pages  509  to  511,  inclusive,  of  the 
August,  1933,  issue  of  The  Journal),  were  read, 
and  on  motion  by  Dr.  Huston,  seconded  by  Dr. 
Seiler  and  carried  were  approved. 

ANNUAL  MEETING  ARRANGEMENTS 

Dr.  Davidson,  chairman  of  the  Council  Commit- 
tee on  Arrangements,  Dr.  Selby,  president  of  the 
Summit  County  Medical  Society,  and  Dr.  Weeks, 
general  chairman  of  the  local  committees  on  ar- 
rangements, announced  the  completion  of  local 
details  on  arrangements  and  explained  the 
schedule  and  plan  for  handling  the  convention. 
Dr.  Cummer,  chairman  of  the  Program  Commit- 
tee, made  final  announcements  on  the  program 
set-up  and  schedule. 

workmen’s  compensation  problems 

On  behalf  of  the  special  committee  on  hospital 
contracts  in  workmen’s  compensation  cases,  Dr. 
Bigelow,  the  chairman,  reported  on  a conference 
held  on  the  afternoon  of  this  day  with  the  com- 
mittee of  the  Ohio  Hospital  Association,  as  a cul- 


mination of  previous  Conferences  and  correspond- 
ence. He  read  to  the  Council  the  final  agreed  joint 
communication  from  his  committee  and  the  com- 
mittee of  the  Ohio  Hospital  Association  to  the 
State  Industrial  Commission,  reading  as  follows: 

To  the  Industrial  Commission  of  Ohio, 

Columbus,  Ohio. 

Gentlemen : 

Attention : Medical  Department 

The  committees  of  the  Ohio  Hospital  Associa- 
tion and  the  Ohio  State  Medical  Association  ap- 
pointed to  confer  relative  to  terms  of  annual  hos- 
pital contracts  in  workmen’s  compensation  cases, 
and  especially  relating  to  problems  of  X-ray  ser- 
vice, are  in  agreement  that  the  modern  hospital  is 
expected  to  have  and  maintain  as  a part  of  its 
legitimate  overhead  expense,  a modern  X-ray  de- 
partment, just  as  it  maintains  and  includes  in  its 
overhead  modern  operating  rooms  with  sterilizing 
apparatus,  operating  room  nurses,  etc.  We 'are  in 
further  agreement  that  the  use  of  the  X-ray  de- 
partment and  the  interpretation  of  the  work  done 
therein  is  a professional  service  to  be  recognized 
and  paid  for  separately  in  accordance  with  a fee 
schedule,  exactly  as  the  professional  service  of 
the  surgeon  in  the  operating  room  is  recognized 
and  paid  for  according  to  a fee  schedule  without 
regard  to  the  overhead  expense  of  installation  and 
maintenance  of  operating  rooms,  etc.  This  means 
an  interpretation  by  a qualified  physician  of  ail 
X-rays  in  Industrial  Commission  (state  fund) 
cases,  and  payment  direct  by  the  Industrial  Com- 
mission to  such  physician  for  this  professional 
service  in  accordance  with  a definite  fee  schedule. 

Specifically,  we  believe  that  the  cost  of  operat- 
ing the  physical  equipment  owned  and  maintained 
by  hospitals  should  be  included  in  the  per  diem 
hospital  costs,  but  that  professional  service,  which 
can  be  rendered  only  by  physicians,  should  be 
paid  for  separately  direct  to  physicians.  The  1934 
contract  by  each  individual  with  the  Industrial 
Commission  for  workmen’s  compensation  cases 
should  set  forth  the  same  wording  and  schedule 
as  now  provided  in  Paragraph  3 on  the  face  of  the 
contract  form  for  1933,  and  should  be  checked  by 
each  hospital  to  indicate  which  of  the  services  are 
included  or  excluded  in  computing  the  per  diem 
contract  costs. 

We  believe  the  suggestions  herein  made  will 
eliminate  the  possibility  of  duplication  in  charges 
made  for  X-ray  services  in  workmen’s  compensa- 
tion cases  which  are  hospitalized,  by  specifically 
excluding  professional  service  rendered  by  phy- 
sicians from  the  hospital  per  diem  cost  contract 
rate. 

Special  Committee 
Ohio  Hospital  Association 
Dr.  E.  L.  Harmon,  Chm. 

Dr.  H.  L.  Rockwood 
Mr.  Guy  J.  Clark 
Mr.  A.  E.  Hardgrove 

On  motion  by  Dr.  Brush,  seconded  by  Dr. 
Davidson  and  carried,  the  Council  approved  the 
action  of  Dr.  Bigelow’s  committee. 

In  the  absence  of  Dr.  Follansbee,  chairman  of 
the  Special  Workmen’s  Compensation  Committee 
of  the  State  Association,  Dr.  Caldwell  and  Dr. 
Hein,  the  other  members,  discussed  recent  de- 


Srecirl  Committee 

Ohio  State  Medical  Assn. 
Dr.  J . L.  Bigelow.  Chm. 
Dr.  John  T.  Murphy 
Dr.  H.  V.  Paryzek 


647 


648 


The  Ohio  State  Medical  Journal 


October,  1938 


velopments  in  workmen’s  compensation  adminis- 
tration. They  called  attention  to  the  article  in 
the  September  Journal,  page  591,  as  well  as  to  the 
report  of  the  Workmen’s  Compensation  Commit- 
tee in  the  June  issue  of  The  Journal  and  the  ad- 
ditional article  on  workmen’s  compensation  de- 
velopments in  the  July  issue.  The  attitudes  of 
various  groups  directly  interested  in  workmen’s 
compensation  were  likewise  discussed  and  ana- 
lyzed, as  well  as  probable  developments  under  the 
special  State  Senate  Committee  now  investigating 
workmen’s  compensation  administration. 

Analysis  was  also  made  of  the  financial  status 
of  the  fund,  of  problems  creating  delays  in  the 
payment  of  medical  bills  and  compensation,  and 
the  prospects  of  improvement  in  administrative 
procedure. 

PROFESSIONAL  AND  ETHICAL  QUESTIONS 
There  was  submitted  for  the  information  and 
consideration  of  the  Council,  correspondence  per- 
taining to  solicitation  of  patients  by  groups  and 
individuals.  The  President  read  correspondence 
from  Cleveland  containing  complaints  in  that  city. 
Dr.  Cummer,  Dr.  Paryzek  and  Dr.  Tuckerman 
discussed  the  situation  and  submitted  information 
showing  steps  in  procedure  by  the  Academy  of 
Medicine  in  these  matters. 

PROBLEMS  OF  THE  INDIGENT  SICK 
Dr.  Southard  reported  on  the  results  of  a series 
of  conferences  participated  in  by  representatives 
of  the  State  Medical  Association,  the  State  De- 
partment of  Health  and  officials  of  the  Ohio  Re- 
lief Commission,  as  well  as  on  interpretations  on 
the  use  of  federal  relief  funds  to  supplement  local 
and  state  funds  to  compensate  physicians  for  the 
care  of  the  indigent  sick  and  especially  those  who 
are  already  receiving  other  relief  benefits  from 
public  funds.  He  reported  that  approximately 
$175,000  per  month  or  over  $2,000,000  per  year 
would  probably  be  made  available,  under  the 
direction  of  the  Ohio  Relief  Commission,  for  pro- 
viding medical  care  for  the  indigent  sick;  and 
that  in  those  communities  where  public  officials 
charged  with  responsibilities  in  these  matters 
have  not  already  made  provision  for  compensation 
to  physicians  for  the  care  of  the  needy  sick,  that 
the  Relief  Commission  would  suggest  a minimum 
fee  schedule  as  a basis  for  compensation. 

Attention  was  also  called  to  an  analysis  of  the 
relief  situation  in  the  annual  report  of  the  Com- 
mittee on  Medical  Economics,  published  in  the 
September,  1933,  issue  of  The  Journal,  as  well  as 
an  analysis  of  problems  and  developments  on  this 
question  in  the  August  issue  of  The  Journal, 
pages  516  to  518,  inclusive,  and  in  which  reference 
was  made  to  previous  publications  on  this  im- 
portant question. 

COMMUNICATION  FROM  STATE  NURSES’  ASSOCIATION 
For  the  information  of  the  Council,  the  Presi- 
dent submitted  the  following  communication  ad- 


dressed to  the  Council  from  the  Ohio  State  Nurses 
Association : 

To  the  Board  of  Councilors, 

Ohio  State  Medical  Association. 

My  Dear  Sirs: 

The  Board  of  Trustees  of  the  Ohio  State  Nurses’ 
Association  has  received  repeated  reports  from  all 
parts  of  the  State  of  Ohio  relative  to  the  lack  of 
professional  ethics  on  the  part  of  physicians  in 
discouraging  the  employment  of  registered  nurses, 
especially  among  families  of  higher  income  levels. 

The  Board  of  Trustees  and  the  individual  mem- 
bers of  the  Ohio  State  Nurses’  Association  are  not 
unmindful  of  the  fact  that  the  physician  has  the 
responsibility  of  directing  the  care  of  the  patient, 
but  it  would  seem  that  if  a patient  desires  to  em- 
ploy a graduate,  registered  nurse  and  have  her 
services  continue  over  a long  period  of  time,  the 
responsibility  of  employing  and  discharging  the 
nurse  should  be  given  to  the  patient  or  some  mem- 
ber of  his  family. 

During  the  last  two  years  our  State  Committee 
on  Registry  and  Distribution  of  Nursing  Service 
has  conducted  three  surveys  to  ascertain: 

(1)  The  number  of  calls  received  for  nurses. 
This  survey  shows  a 75%  decrease  in  the  number 
of  requests  for  nurses; 

(2)  The  number  of  unemployed  graduate, 
registered  nurses.  This  survey  (made  in  1932) 
showed  more  than  6,000  such  nurses  were  un- 
employed in  Ohio; 

(3)  The  number  of  nurses  giving  free  nursing 
service.  This  survey  showed  that  in  1932  nurses 
in  Ohio  gave  free  nursing  care  to  individual  pa- 
tients amounting  to  approximately  $40,000.  Dur- 
ing the  period  January-July,  1933,  free  nursing 
service  amounted  bo  more  than  $6,000. 

These  reports  were  given  us  by  Superintend- 
ents of  Nurses  in  Ohio  Hospitals  and  by  Regis- 
trars conducting  our  Official  Registries  for 
Nurses. 

Our  members  are  continuing  to  give  free  nurs- 
ing service  and  are  only  too  glad  to  cooperate  with 
physicians  in  caring  for  patients  who  are  unable 
to  meet  the  financial  obligations  of  illness. 

It  may  also  be  interesting  for  you  to  know  that 
our  nurses  employed  in  Ohio  hospitals  are  re- 
ceiving, in  many  instances,  no  salary — only  board, 
room  and  laundry  in  return  for  six  hours’  nursing 
service  per  day.  Then  there  is  another  group  re- 
ceiving $15.00  per  month,  in  addition  to  board, 
room  and  laundry;  and  still  another  group  re- 
ceiving $25.00-$50.00  per  month,  with  board,  room 
and  laundry,  for  an  eight  hour  day.  In  but  very 
few  instances  are  we  able  to  find  hospitals  meet- 
ing their  full  financial  responsibility  to  the  nurses 
employed  in  various  departments  in  hospitals. 

The  Board  of  Trustees  of  the  Ohio  State  Nurses’ 
Association  respectfully  requests  the  cooperation 
of  the  Ohio  State  Medical  Association. 

Respectfully, 

Board  of  Trustees, 
Ohio  State  Nurses’  Association. 

By  Elizabeth  P.  August,  R.  N., 
General  Secretary. 

On  motion  by  Dr.  Huston,  seconded  by  Dr. 
Shanley  and  earned,  the  Council  expressed  its 
friendly  interest  and  cooperation  in  the  problem 
set  forth  in  the  foregoing  communication. 

NRA  PROVISIONS 

There  was  a discussion  on  the  provisions  of  the 
National  Industrial  Recovery  Act  and  the  Na- 


October,  1933 


Annual  Meeting 


649 


tional  Recovery  Administration  as  they  may 
affect  the  medical  profession  and  employes  of 
physicians.  Reference  was  made  to  previous 
articles  on  this  question  in  recent  issues  of  the 
Journal  of  the  American  Medical  Association  and 
especially  to  the  article  on  page  575  of  the  Sep- 
tember, 1933,  issue  of  the  Ohio  State  Medical 
Journal,  in  which  it  is  set  forth  that  provisions 
of  the  uniform  code  under  the  National  Recovery 
Administration  do  not  and  cannot  apply  to  phy- 
sicians in  the  care  of  patients,  especially  the  pro- 
visions on  wages  and  hours. 

As  set  forth  in  the  article  in  the  September 
issue  of  the  State  Medical  Journal  here  referred 
to,  the  conflicting  and  unofficial  opinions  relative 
to  employes  of  physicians  have  not,  up  to  this 
time,  been  thoroughly  clarified. 

HOSPITAL  GROUP  PAYMENT  PLANS 

President  Platter  reported  in  detail  on  a num- 
ber of  proposed  hospital  group  payment  plans  and 
insurance  schemes  now  pending  before  the  State 
Insurance  Commission  and  some  of  which  have 
been  officially  submitted  to  the  Attorney  General’s 
Department  for  analysis  and  opinion. 

Dr.  Platter  and  others  discussed  the  several 
phases  of  group  plans  in  other  states,  as  well  as 
legal  and  technical  phases  which  might  directly 
affect  the  practice  of  medicine  and  the  free  choice 
of  physicians  by  patients.  This  discussion  also 
included  an  analysis  of  ethical  phases  of  the 
question. 

MISCELLANEOUS 

Several  members  of  Council  discussed  the  ques- 
tion of  whether  or  not  the  annual  meeting  of  the 
State  Association  in  1934  should  be  held  in  Cleve- 
land in  conjunction  with  the  annual  meeting  of 
the  American  Medical  Association,  June  11  to  15 
1934.  It  was  pointed  out  that  if  these  meetings 
are  held  jointly  that  the  House  of  Delegates  and 
other  business  sessions  of  the  State  Association 
would  necessarily  be  held  and  at  a time  during 
that  week  not  in  conflict  with  general  sessions  of 
the  A.  M.  A.  It  was  also  suggested  by  several 
members  of  Council  that  by  holding  the  state 
meeting  at  the  same  time,  the  membership  would 
be  encouraged  and  have  an  opportunity  to  attend 
the  scientific  program  of  the  A.  M.  A.  as  well  as 
the  extensive  scientific  exhibits.  Other  members 
of  Council  pointed  out  that  if  the  meetings  are 
held  jointly,  that  the  scientific  program  for  the 
State  Association  would  necessarily  be  abandoned, 
thus  suspending  interest  by  Section  officers  and 
prospective  essayists,  and  eliminating  much  val- 
uable scientific  material  for  the  State  Medical 
Journal.  Others  suggested  consideration  of  hold- 
ing the  meeting  of  the  State  Association  in  the 
Fall  next  year. 

Dr.  Davidson  moved,  seconded  by  Dr.  Seiler, 
that  it  be  the  sense  of  the  Council  that  the  1934 
meeting  of  the  State  Association  be  held  in  Cleve- 
and  at  the  time  of  the  A.  M.  A.  meeting.  Further 


discussion  was  held  and  it  was  the  sense  of  the 
Council  that  in  view  of  the  importance  of  this 
question  that  the  House  of  Delegates  be  requested 
to  make  the  decision  independent  of  recommenda- 
tions from  the  Council.  The  pending  motion  was 
therefore  withdrawn,  and  it  was  decided  that  the 
question  should  be  raised  in  the  House  of  Dele- 
gates for  decision  by  that  body. 

The  President  called  upon  the  chairmen  of  the 
State  Association  committees  present  for  com- 
ments and  suggestions.  Among  other  comments 
by  those  chairmen  was  the  expression  of  apprecia- 
tion by  Dr.  Alcorn,  chairman  of  the  Policy  Com- 
mittee, to  Dr.  Southard,  State  Director  of  Health, 
for  constant  cooperation  in  matters  of  policy,  pub- 
lic health  and  legislation.  Dr.  Rogers,  chairman 
of  the  Publication  Committee,  announced  that  it 
would  be  the  purpose  of  that  committee  to  main- 
tain the  high  scientific  standards  of  The  Journal 
for  the  forthcoming  year.  Dr.  Tuckerman,  chair- 
man of  the  Medical  Defense  Committee,  called  at- 
tention to  the  dangerous  increase  in  suits  and 
threats  of  suits  for  malpractice,  with  thq  pos- 
sibility of  still  larger  expenditures  for  medical 
defense  activities. 

Membership  figures  submitted  showed  4,96(1 
members  to  date  for  1933,  compai-ed  with  5,234  on 
the  same  date  last  year  and  with  the  total  for 
last  year  of  5,352. 

Attention  was  called  to  the  pending  amendment 
to  the  Constitution  of  Ohio  to  be  voted  on  at  the 
coming  November  election,  proposing  alternative 
changes  in  the  set-up  of  county  government, 
elimination  of  duplications,  etc.  Several  members 
of  Council  discussed  this  proposal. 

Other  business  being  called  for  and  none  being 
presented,  the  President  expressed  appreciation 
to  the  members  of  Council  for  their  constant  sup- 
port and  assistance  and  for  their  faithful  attend- 
ance at  meetings  during  his  administration.  He 
expressed  appreciation  to  the  State  Association 
committees  for  their  activities  and  accomplish- 
ments. 

The  Council  adjourned  to  meet  with  the  House 
of  Delegates  on  the  following  morning,  September 
7,  at  10  o’clock. 

WITH  THE  HOUSE  OE  DELEGATES 

The  Council  of  the  Ohio  State  Medical  Associa- 
tion met  with  and  as  a part  of  the  House  of  Dele- 
gates at  the  Mayflower  Hotel,  Akron,  on  Thurs- 
day, September  7,  at  10:00  A.  M.,  and  also  with 
the  second  and  last  session  of  the  House  of  Dele- 
gates during  the  annual  meeting  at  3:30  P.  M. 
on  Friday,  September  8,  and  participated  officially 
in  both  sessions.  Minutes  of  the  Council  meetings 
with  the  House  of  Delegates  are  included  as  part 
of  the  proceedings  of  the  latter  in  this  issue  of 
The  Journal. 

FINAL  COUNCIL  SESSION 

The  final  session  of  the  Council  during  the  87th 
annual  meeting  was  held  at  4:45  P.  M.  following 


650 


The  Ohio  State  Medical  Journal 


October,  1933 


the  final  adjournment  of  the  House  of  Delegates.  The  Council  adjourned  to  meet  at  the  call  of 
On  motion  by  Dr.  Klotz,  seconded  by  Dr.  Brush  the  President. 

and  carried,  Dr.  Goodman  was  again  selected  as  (Signed)  B.  J.  Hein,  M.D., 

secretary  of  Council  for  the  ensuing  year.  Acting  Secretary  of  Council. 


Successful  Annual  Meeting  Held  Innumerable  Attractions 

for  Those  in 


Eighty-Seventh  Annual  Meeting  of  the  Ohio 
State  Medical  Association,  held  September  7 and 
8,  at  Akron,  was  in  many  respects  tangible  evi- 
dence of  the  truth  and  wisdom  of  the  statement 
made  by  Dr.  H.  M.  Platter,  the  retiring  presi- 
dent, in  his  presidential  address  that  despite  un- 
settled conditions  which  have  seriously  affected 
every  physician,  the  spirit  of  the  profession  in 
Ohio  has  not  been  broken  and  it  is  determined  and 
fully  qualified  to  go  forward  under  its  own  leader- 
ship. 

From  the  standpoint  of  attendance,'  the  Akron 
meeting  surpassed  expectations,  attesting  to  the 
fortitude  of  the  profession,  its  loyalty  to  the  ac- 
tivities, principles,  and  ideals  of  medical  organi- 
zation, and  its  constant  desire  for  scientific  ad- 
vancement so  that  an  improved  public  service  can 
be  rendered.  Although  the  registration  at  the 
1933  meeting  was  not  as  large  as  it  undoubtedly 
would  have  been  in  normal  times,  it  was  but 
slightly  below  the  average  for  the  past  decade 
and  a half  and  was  remarkable  in  view  of  prevail- 
ing economic  conditions  and  when  compared  to  the 
decline  in  attendance  at  similar  professional  and 
business  gatherings  throughout  the  state  and 
nation  during  the  past  few  years. 

The  spirit  of  sincerity,  unity  and  active  en- 
thusiasm displayed  by  those  in  attendance  was 
not  only  a tribute  to  the  character  of  the  medical 
profession,  individually  and  collectively,  but  also 
to  the  principles,  objectives  and  value  of  medical 
organization.  The  fact  that  so  many  busy  physi- 
cians were  willing  to  sacrifice  time  and  travel 
many  miles,  in  many  instances,  to  hear  and  take 
part  in  the  scientific  discussions  presented  at  the 
Akron  gathering  and  to  listen  to  expositions  of 
some  of  the  serious  economic  and  social  questions 
confronting  the  profession  was  a striking  demon- 
stration that  the  medical  profession  of  Ohio  is 
fully  aware  of  its  duties  and  obligations  and  the 
immensity  of  its  responsibilities.  Moreover,  it  was 
significant  evidence  that  the  physicians  of  Ohio 
keenly  realize  the  good  which  medical  organiza- 
tion is  accomplishing  and  the  value  of  maintain- 
ing and  strengthening  organized  activity  so  that 
the  promotion  of  the  science  and  art  of  medicine 
and  the  protection  of  the  public  health  can  be 
continued  and  the  profession  as  a whole  be  better 
prepared  to  meet  important  problems  affecting 
scientific  medicine,  public  health  and  medical 
practice. 

The  outstanding  success  registered  by  the  1933 
annual  meeting,  coming  near  the  close  of  one  of 


the  most  difficult  periods  ever  experienced  by  the 
medical  profession,  is  a strong  indication  that  the 
physicians  of  Ohio  possess  the  ability,  initiative 
and  courage  to  solve  their  problems  and  through 
their  contributions  to  medical  organization  will  be 
able  to  satisfactorily  meet  the  questions  which 
affect  them  all. 

jfc  >fc 

From  a scientific  standpoint,  the  Akron  meet- 
ing was  one  of  the  finest  ever  held  by  the  State 
Association.  The  prevailing  sentiment  among 
those  who  attended  the  sessions  of  the  six  scien- 
tific sections  on  Thursday  afternoon,  September  7, 
and  the  two  general  scientific  sessions  Friday 
morning  and  afternoon  was  that  this  year’s  pro- 
gram was  exceptionally  well-balanced  and  varied, 
appealing  to  both  general  practitioners  and  spe- 
cialists. The  idea  of  devoting  more  time  on  the 
program  to  general  scientific  sessions  met  with 
widespread  approval,  proving  to  the  wisdom  and 
far-sightedness  of  the  Council  Program  Com- 
mittee, under  the  chairmanship  of  Dr.  C.  L.  Cum- 
mer. 

The  sessions  of  the  six  Scientific  Sections  were 
well-attended  and  the  programs  presented  at  each 
of  unusual  interest  and  value,  due  to  the  careful 
selection  of  essayists  by  the  officers  of  the  various 
sections  and  the  painstaking  preparation  made  by 
the  essayists  and  discussants  themselves. 

Large  audiences  heard  the  presentations  made 
at  the  general  scientific  sessions  on  Friday  when 
papers  of  outstanding  interest  and  covering  many 
phases  of  scientific  medicine  were  presented. 
Those  who  worked  long  and  faithfully  in  arrang- 
ing the  scientific  program  were  amply  repaid  for 
their  work  by  the  general  approval  accorded  the 
set-up,  as  well  as  the  quality  of  the  presentations 
themselves,  by  those  fortunate  enough  to  have 
been  in  attendance.  It  was  the  opinion  of  many 
physicians  who  expressed  themselves  regard’ng 
the  program  that  as  long  as  the  State  Association 
continues  to  give  its  members  this  annual  oppor- 
tunity to  listen  to  presentations  of  the  type  given 
at  the  Akron  meeting  it  will  be  contributing  much 
to  the  field  of  post-graduate  education  and  be  pro- 
viding a service  of  inestimable  value  to  its  mem- 
bers, as  well  as  carrying  on  meritorious  assist- 
ance in  the  advancement  of  scientific  medicine. 

'I* 

As  usual,  the  business  affairs  of  the  State  As- 
sociation were  transacted  in  an  efficient  manner 
by  the  House  of  Delegates,  evidencing  once  more 
the  wisdom  of  the  memberships  of  the  various 


October,  1933 


Annual  Meeting 


651 


county  medical  societies  and  academies  of  medi- 
cine in  the  selection  of  their  representatives  in 
that  body. 

Both  sessions  of  the  House  of  Delegates  were 
largely  attended  and  on  both  occasions  an  active 
interest  in  the  proceedings  was  manifest  by  most 
of  the  delegates,  indicating  those  selected  by  their 
colleagues  to  represent  them  in  the  business  af- 
fairs of  the  State  Association  are  well-informed 
on  the  important  questions  confronting  the  pro- 
fession and  are  vitally  concerned  in  meeting  these 
questions  in  a way  which  will  be  for  the  best  in- 
terests of  the  public  and  the  majority  of  the  pro- 
fession. 

Under  the  able  chairmanship  of  Dr.  H.  M. 
Platter,  Columbus,  the  retiring  president,  the 
business  before  the  House  of  Delegates  was  trans- 
acted with  efficiency  and  dispatch,  as  indicated  in 
the  official  minutes  of  the  proceedings  published 
elsewhere  in  this  issue  of  The  Journal. 

The  opening  session  of  the  House  of  Delegates, 
held  on  Thursday  morning,  was  opened  by  a brief 
address  of  welcome  by  Dr.  John  H.  Selby,  Akron, 
president  of  the  Summit  County  Medical  Society. 
Dr.  Selby  presented  Dr.  Platter  who  took  the 
chair  and  called  the  House  of  Delegates  to  order-. 
The  principal  business  transacted  at  the  opening 
session  consisted  of  presentation  of  the  annual 
reports  of  the  officers  and  the  standing  and  spe- 
cial committees  of  the  State  Association  (pub- 
lished in  the  September,  1933,  issue  of  The  Jour- 
nal) ; appointment  by  the  President  of  the  various 
reference  committees;  election  of  a nominating 
committee  and  introduction  of  resolutions. 

The  second  and  final  session  of  the  House  of 
Delegates  was  held  on  Friday  afternoon  when 
Dr.  C.  L.  Cummer,  Cleveland,  was  installed  as 
president  for  the  ensuing  year  and  Dr.  John  A. 
Caldwell,  Cincinnati,  since  1928  Councilor  of  the 
First  District  and  for  many  years  active  in  medi- 
cal organization  in  Cincinnati  and  Hamilton 
County,  was  elected  president-elect  for  1933-34. 

Five  members  of  the  Council  whose  terms  ex- 
pired were  re-elected,  namely:  Dr.  E.  M.  Huston, 
Dayton,  Second  District;  Dr.  B.  J.  Hein,  Toledo, 
Fourth  District;  Dr.  H.  S.  Davidson,  Akron, 
Sixth  District;  Dr.  E.  R.  Brush,  Zanesville, 
Eighth  District,  and  Dr.  S.  J.  Goodman,  Colum- 
bus, Tenth  District. 

Dr.  Parke  G.  Smith,  Cincinnati,  was  elected 
Councilor  of  the  Fifth  District,  succeeding  Dr. 
Caldwell  who  had  been  elected  president-elect. 

The  following  were  re-elected  delegates  from 
the  State  Association  to  the  American  Medical 
Association  for  terms  of  two  years:  Dr.  J.  P. 

DeWitt,  Canton;  Dr.  C.  E.  Kiely,  Cincinnati,  and 
Dr.  C.  W.  Waggoner,  Toledo.  The  following  alter- 
nates respectively,  were  selected:  Dr.  G.  F.  Zin- 
ninger,  Canton;  Dr.  L.  H.  Schriver,  Cincinnati, 
and  Dr.  Charles  Lukens,  Toledo. 

Dr.  Cummer,  following  his  installation  as  presi- 
dent, made  the  following  appointments  to  the 


standing  committees  of  the  State  Association, 
which  were  confirmed  by  the  House  of  Delegates  : 
Dr.  John  B.  Alcorn,  Columbus,  to  succeed  him- 
self on  the  Committee  on  Public  Policy;  Dr.  A.  B. 
Denison,  Cleveland,  to  succeed  himself  on  the 
Publication  Committee;  Dr.  W.  H.  Snyder,  Toledo, 
to  succeed  himself  on  the  Committee  on  Medical 
Defense;  Dr.  John  F.  Wright,  Toledo,  to  succeed 
himself  on  the  Committee  on  Medical  Education 
and  Hospitals,  and  Dr.  J.  Craig  Bowman,  Upper 
Sandusky,  to  succeed  himself  on  the  Committee 
on  Medical  Economics. 

Following  action  by  the  House  of  Delegates  on 
the  reports  of  the  reference  committees,  invita- 
tions to  hold  the  1934  annual  meeting  in  Cleve- 
land and  Columbus  were  presented  by  Dr.  H.  V. 
Paryzek,  Cleveland,  and  Dr.  J.  H.  J.  Upham,  Co- 
lumbus, respectively.  Dr.  Paryzek  in  his  pre- 
sentation pointed  out  that  it  might  be  desirable 
to  hold  the  1934  meeting  of  the  State  Association 
the  week  of  June  11-15,  1934,  in  Cleveland,  when 
the  annual  session  of  the  American  Medical  Asso- 
ciation will  be  held  in  that  city.  Following  a gen- 
eral discussion  of  the  matter,  the  House  of 'Dele- 
gates voted  to  refer  the  question  to  the  Council 
of  the  State  Association  for  determination  as  to 
the  time  and  place  for  the  1934  meeting. 

* * * * 

Climax  of  the  first  day’s  session  was  the  ban- 
quet given  Thursday  evening  in  the  beautiful 
ballroom  of  the  Mayflower  Hotel  by  the  Summit 
County  Medical  Society,  when  the  annual  ad- 
dresses of  the  President,  Dr.  Platter,  and  the 
President-elect,  Dr.  Cummer,  were  presented,  and 
an  inspiring  address  was  made  by  Dr.  Olin  West, 
Chicago,  secretary  and  general  manager  of  the 
American  Medical  Association. 

About  400  physicians  and  their  guests  attended 
the  banquet  and  the  reception  and  dance  which 
followed,  the  arrangements  for  which  were  made 
and  carried  out  by  the  Banquet  Committee  of  the 
Summit  County  Medical  Society,  headed  by  Dr. 
J.  H.  Weber  and  consisting  of  Drs.  E.  C.  Banker, 
R.  Barnwell,  R.  H.  Cather,  S.  B.  Conger,  H.  R, 
Conn,  C.  E.  Jelm,  A.  A.  Kohler,  J.  G.  Lemmon, 

J.  E.  Monnig,  D.  M.  McDonald,  J.  L.  McEvitt,  G. 

K.  Parke,  W.  A.  Parks,  M.  J.  Pierson,  F.  C.  Pot- 
ter, H.  V.  Sharp,  J.  D.  Smith,  G.  R.  Taylor,  J.  M, 
Ulrich,  and  C.  E.  Updegraff, 

Dr.  H.  S.  Davidson,  Councilor  of  the  Sixth  Dis- 
trict and  chairman  of  the  Council  Committee  on 
Annual  Meeting  Arrangements,  presided  at  the 
banquet  as  toastmaster. 

Following  the  addresses  of  Dr.  Platter  and  Dr. 
Cummer,  the  complete  texts  of  which  are  pub- 
lished elsewhere  in  this  issue  of  The  Journal,  Dr. 
Davidson  called  upon  Dr.  D.  C.  Houser,  Urbana, 
president  of  the  State  Association  in  1931-32,  to 
present  to  Dr.  Platter,  the  retiring  president,  an 
official  Past-President’s  gavel.  Dr.  Houser  in  pre- 
senting the  gavel  to  Dr.  Platter  as  a token  of  ap- 
preciation on  the  part  of  the  membership,  called 


652 


The  Ohio  State  Medical  Journal 


October,  1933 


attention  to  Dr.  Platter’s  successful  administra- 
tion and  his  faithful  and  untiring'  service  in  medi- 
cal organization  and  expressed  confidence  that  his 
successors  would  continue  to  give  to  medical  or- 
ganization in  Ohio  the  leadership  which  it  de- 
serves and  demands. 

Dr.  West  in  his  address  on  “The  Need  for 
Unity  in  the  Medical  Profession  in  Facing  the 
Economic  and  Social  Problems  of  the  Day”, 
lauded  the  achievements  and  accomplishments  of 
the  Ohio  State  Medical  Association  and  referred 
to  it  as  one  of  the  strongest  and  most  active  units 
of  medical  organization  in  the  nation.  He  con- 
gratulated the  medical  profession  of  Ohio  for  its 
attainments  in  the  field  of  scientific  medicine  and 
on  having  contributed  so  many  physicians  to 
places  of  honor  and  importance  in  the  activities 
of  the  American  Medical  Association.  Dr.  West 
expressed  the  opinion  that  as  long  as  medical  or- 
ganization in  Ohio  continues  to  function  as  ef- 
fectively as  it  has  in  the  past  and  continues  to 
exercise  the  same  care  and  wisdom  in  selecting  its 
leadership,  the  physicians  of  Ohio  will  be  in  a 
strong  position  to  promote  the  primary  objectives 
of  the  profession  and  to  combat  influences  seek- 
ing to  undermine  medicine  as  a profession. 

However,  Dr.  West  sounded  a note  of  warning 
against  complacency  and  lack  of  interest  on  the 
part  of  the  profession  regarding  the  serious  and 
vital  problems  now  confronting  the  profession  as 
a whole.  He  cited  the  annual  reports  of  several 
of  the  standing  committees  of  the  State  Associa- 
tion as  excellent  pictures  of  the  serious  situation 
facing  physicians  and  emphasized  the  point  that 
after  reading  these  reports  no  physician  should 
fail  to  see  why  it  is  vital  and  necessary  to  main- 
tain medical  organization  at  the  highest  degree  of 
efficiency  and  why  medical  organization  is  needed 
if  the  profession  is  to  survive  as  an  independent, 
unhampered,  scientific,  competitive  profession. 

It  is  most  essential,  Dr.  West  declared,  that 
medical  organization  maintain  the  highest  ideals 
and  traditions;  that  it  purge  itself  of  the  unfit, 
unethical  and  incompetent.  He  stated  that  the 
first  duty  of  the  physician  is  to  medicine  which, 
he  said,  in  the  final  analysis,  is  to  the  public. 
Nothing  is  good  for  medicine  which  is  not  good 
for  the  people,  he  said,  and  a group  without  ideals 
of  the  highest  character  cannot  hope  to  exist. 
The  practice  of  ethical  medicine  and  rendering  to 
the  people  honest  and  competent  medical  care  is 
the  first  duty  of  the  individual  physician,  Dr. 
West  pointed  out,  while  the  primary  duty  of  phy- 
sicians collectively,  working  through  medical  or- 
ganization, is  to  see  that  the  necessary  facilities 
for  the  promotion  of  medicine  are  provided,  false 
doctrines  are  exposed  and  torn  down,  the  health 
of  the  public  is  protected,  the  interests  of  the  pro- 
fession are  safeguarded,  and  the  unworthy  are 
excluded  from  the  ranks  of  organized  medicine. 

Commenting  specifically  on  some  of  the  economic 
and  social  problems  affecting  medical  practice,  Dr. 


West  declared  it  is  the  duty  of  medical  organiza- 
tion to  combat  artificial  schemes  which  have  been 
advanced  for  mechanizing  medical  practice  which, 
eventually,  would  destroy  scientific  ambition  and 
reduce  the  practice  of  medicine  to  the  status  of  a 
trade.  He  urged  that  every  physician  devote 
serious  study  to  every  proposal  for  changing 
medical  practice  or  the  distribution  of  medical 
care,  pointing  out  that  for  the  best  interests  of 
both  the  public  and  the  profession,  medical  ser- 
vice must  be  maintained  as  a professional  service 
rendered  on  a professional  basis  and  minus  lay  or 
political  domination. 

Many  of  the  statements  made  during  the  past 
year  by  investigating  bodies,  including  the  Com- 
mittee on  the  Costs  of  Medical  Care,  regarding 
the  economic,  social  and  scientific  aspects  of  medi- 
cal practice  are  not  facts  and  never  were  facts. 
Dr.  West  said,  adding  the  hope  that  they  never 
will  be  facts. 

Dr.  West  expressed  the  opinion  that  the  medical 
profession  has  the  ability  to  lead  itself  and  to 
solve  its  own  problems  and  will  exercise  this 
ability  in  such  a way  that  the  final  result  will  be 
beneficial  to  the  profession  and  the  public. 

In  concluding,  Dr.  West  re-emphasized  the 
necessity  for  unity  and  cohesion.  He  pointed  out 
that  physicians  dare  not  risk  meeting  prevailing 
serious  problems  and  those  quite  likely  to  arise  in 
the  future  as  individuals  but  must  stand  together, 
shoulder  to  shoulder,  meeting  all  issues  with 
unity,  with  a militant  spirit,  and  with  courageous 
action  based  on  fundamental  policies  and  the 
ideals  of  the  profession. 

jJj 

One  of  the  principal  reasons  for  the  outstand- 
ing success  of  the  87th  annual  meeting  was  the 
enthusiastic  and  effective  activity  of  the  mem- 
bers of  the  Summit  County  Medical  Society, 
especially  the  members  of  the  various  local  com- 
mittees who  had  charge  of  handling  the  many  de- 
tails in  connection  with  the  meeting. 

Under  the  able  and  untiring  leadership  of  Dr. 
J.  H.  Selby,  president  of  the  Summit  County 
Medical  Society;  Dr.  E.  A.  Weeks,  general  chair- 
man on  local  arrangements,  and  Dr.  H.  S.  David- 
son, councilor  of  the  Sixth  District,  the  work  of 
the  various  Akron  committees  was  synchronized 
in  such  a way  that  each  was  able  to  function  in  a 
most  efficient  manner  and  carry  out  its  particular 
responsibilities  with  a minimum  of  effort  but 
maximum  of  efficiency. 

To  the  chairman  and  the  members  of  the  dif- 
ferent committees  much  praise  is  due.  Every  de- 
tail of  the  meeting  was  carefully  planned  in  ad- 
vance and  all  the  committeemen  were  on  the  job 
constantly  to  see  that  nothing  was  left  undone  for 
the  accommodation  of  those  in  attendance  and  to 
insure  smoothness  in  carrying  out  the  program. 

There  was  a minimum  of  confusion  in  getting 
the  various  sessions  under  way  due  to  the  well- 
planned  work  of  the  Committee  on  Halls  and 


October,  1933 


Annual  Meeting 


653 


Meeting  Places,  headed  by  Dr.  R.  E.  Amos,  and 
composed  of  Dr.  G.  E.  Black,  Dr.  M.  B.  Crafts, 
Dr.  H.  E.  Groom,  Dr.  G.  M.  Logan,  Dr.  W.  D. 
Lyon,  Dr.  G.  K.  Pax-ke,  Dr.  R.  E.  Pinkerton  and 
Dr.  U.  D.  Seidel.  All  meeting  places  were  ade- 
quately marked  for  the  guidance  of  the  visiting 
physicians  and  everything  possible  was  done  to 
make  each  meeting  place  as  comfortable  as  pos- 
sible for  those  in  attendance. 

Under  the  chairmanship  of  Dr.  E.  A.  Freeman, 
the  Committee  on  Registration  and  Information 
rendered  much  assistance  at  the  Registration 
Headquarters  and  at  the  Information  Desk  which 
was  an  exceptionally  popular  place  among  those 
seeking  old  friends  and  acquaintances  or  desiring 
information  about  meeting  places  or  points  of  in- 
terest in  Akron.  Other  members  of  this  commit- 
tee were:  Dr.  M.  D.  Ailes,  Dr.  H.  R.  Baremore, 
Dr.  R.  S.  Friedley,  Dr.  J.  G.  Gage,  Dr.  R.  F. 
Jolley  and  Dr.  C.  H.  Kent. 

Arrangements  for  the  attractive  layout  of  ex- 
hibits were  carried  out  by  Dr.  C.  H.  Franks  and 
his  Committee  on  Commercial  Exhibits,  consist- 
ing of  Dr.  C.  R.  Anderson,  Dr.  O.  J.  Chaney,  Dr. 
M.  G.  Gibans  and  Dr.  W.  L.  Hogue.  The  fine  ac- 
commodations provided  for  the  exhibits  won  the 
approval  of  the  exhibitors  generally  while  the 
general  appearance  of  the  exhibit  hall  occasioned 
much  favorable  comment  from  many  of  the  mem- 
bers. Although  not  as  large  as  usual,  the  com- 
mercial exhibit  was  most  impressive  and  because 
of  its  location  adjoining  the  Registration  Head- 
quarters was  attended  by  practically  all  who 
registered. 

An  excellent  piece  of  work  was  done  by  the 
Committee  on  Projection  Apparatus  of  which  Dr. 
G.  A.  Ferguson  was  chairman,  and  consisting  of 
Dr.  H.  E.  Blass,  Dr.  M.  F.  Bossart,  Dr.  R.  A. 
Breckinridge,  Dr.  K.  H.  Harrington,  Dr.  I.  L. 
Houghton,  Dr.  V.  C.  Malloy,  Dr.  T.  J.  Murphy, 
Dr.  J.  P.  Sauvageot,  and  Dr.  R.  P.  Vivian.  Due 
to  the  care  with  which  this  important  activity  was 
handled  and  the  alertness  of  the  members  of  the 
committee,  there  were  few,  if  any,  delays  in  the 
section  meetings  due  to  stereopticon  trouble.  Lan- 
terns were  set  up  well  in  advance  of  the  opening 
of  the  sessions  and  each  was  manned  by  a trained 
operator. 

Equally  meritorious  work  was  performed  by  the 
Entertainment  Committee  and  the  Reception  Com- 
mittee. These  committees  were  on  the  job  at  all 
times  welcoming  visitors  and  extending  typical 
Akron  hospitality  which  won  widespread  approval 
among  all  in  attendance. 

The  Entertainment  Committee  consisted  of  Dr. 
J.  S.  Millard,  chairman,  Dr.  D.  C.  Brennan,  Dr. 
B.  H.  Gillespie,  Dr.  W.  McD.' Johnston,  Dr.  J.  G. 
Kramer,  Dr.  R.  V.  Luce,  Dr.  T.  K.  Moore,  Dr.  S. 
Morgenx’oth,  Dr.  R.  G.  Pearce,  Dr.  J.  E.  Springer, 
Dr.  Elizabeth  M.  Weaver  and  Dr.  J.  N.  Weller-. 
The  Reception  Committee,  headed  by  Dr.  J.  G. 
Blower,  was  on  the  job  constantly  welcoming  the 


visitors.  Others  on  the  committee  wei’e:  Dr.  L. 
L.  Bottsfox’d,  Di\  L.  E.  Brown,  Dr.  G.  M.  Camp- 
bell, Dr.  H.  I.  Cozad,  Dr.  R.  F.  Dxuxx-y,  Dr.  E.  B. 
Dysoix,  Dr.  L.  C.  Ebex-hard,  Dr.  G.  E.  Gardner, 
Dr.  C.  E.  Held,  Dx\  Carx'ie  A.  Herring,  Dr.  C.  T. 
Hill,  Dx\  T.  D.  Hollingsworth,  Dr.  W.  McK.  John- 
ston, Dr.  B.  E.  Miller,  Dr.  D.  H.  Mox-gan,  Dr.  A. 
S.  McConnick,  Dr.  S.  E.  McMaster,  Dr.  J.  H. 
Seiler,  Dr.  J.  R.  Shoemaker,  Dr.  H.  L.  Smallman, 
Dr.  A.  H.  Stall,  Dr.  E.  R.  Stumpf,  Dr.  R.  F. 
Thaw,  Dr.  M.  C.  Tuholske,  Dr.  R.  G.  Werner,  Dr. 
L.  A.  Witzeman,  Dr.  S.  St.  J.  Wx-ight  and  Dr.  C. 
C.  Nohe. 

Dr.  C.  C.  Pinkerton  and  his  Committee  on  Pub- 
licity laid  the  groundwork  for  the  fine  publicity 
given  to  the  meeting  by  the  Akron  newspapers 
through  their  contacts  with  the  press  before  and 
during  the  meeting.  Others  on  the  committee 
wex'e:  Dr.  W.  S.  Chase,  Dr.  C.  M.  Clark,  Dr.  H. 
J.  Gox’don,  Dr.  R.  H.  Max'kwith,  Dr.  F.  E.  Read 
and  Dr.  C.  R.  Steinke. 

Dr.  R.  H.  Markwith  as  adjutant  to  the  head- 
quarters staff  was  on  the  job  constantly  and 
handled  a myx'iad  of  details. 

Elsewhere  in  this  article  will  be  found  mention 
of  several  other  committees  in  connection  with 
some  of  the  events  which  helped  to  make  the 
Aki‘on  gathering  one  of  the  best  in  the  history  of 
the  State  Association. 

* * * * 

One  of  the  most  popular  attractions  of  the 
meeting  was  the  Scientific  Exhibit  on  the  fifth 
floor  of  the  Mayflower.  Hundreds  visited  this 
featux-e  of  the  pi-ogi’am  during  the  two-days  gath- 
ering and  many  favorable  comments  were  voiced 
relative  to  the  merits  of  the  individual  exhibits. 

Dr.  P.  A.  Davis,  chairman,  and  his  Akron  com- 
mittee which  woi'ked  faithfully  and  effectively  in 
arx-anging  for  the  Scientific  Exhibit,  received 
many  congratulations  on  the  lay-out  and  on  hav-- 
ing  succeeded  in  arranging  for  exhibits  of  such 
unusual  interest  and  educational  value.  Those 
who  assisted  Dr.  Davis  were  Dr.  R.  T.  Allison, 
Dr.  A.  E.  Davis,  Dr  P.  C.  Langan,  Dr.  R.  H. 
Max'kwith,  Dr.  A.  P.  Ormond,  Dr.  A.  S.  Robinson, 
Dr.  E.  L.  Saylor  and  Dr.  F.  A.  Smith. 

The  following  exhibits  were  shown: 

Intestinal  Obstruction — Dr.  Harry  Goldblatt 
and  Associates,  Cleveland.  An  exhibit  of  intesti- 
nal obstruction,  demonstrated  by  pictures,  X-ray 
plates  and  colox-ed  plates  in  an  illuminated  booth. 

Lung  Abscess  and  Gangrene — Dr.  B.  S.  Kline 
and  Associates,  Mt.  Sinai  Hospital,  Cleveland. 
This  was  portrayed  by  pictures,  slides,  charts, 
and  pathological  specimens  aixd  demon stx’ations. 

Dermatological  Exhibit — Dr.H.  N.  Cole  and  Dr. 
J.  R.  Driver,  Cleveland.  This  exhibit  was  pox-- 
trayed  by  excellent  pictures  and  demonstrated  by 
Dx\  Driver. 

Anatomic  Models  of  Nose  and  Throat  and  Can- 
cer of  Larynx.  These  wex-e  beautiful  models  in 


654 


The  Ohio  State  Medical  Journal 


October,  1933 


colors  and  were  made  in  such  planes  that  the  ob- 
servers could  readily  see  the  part  intended  to  be 
shown.  These  were  presented  by  Dr.  W.  V.  Mul- 
lin,  Cleveland  Clinic. 

Radiological  Exhibit — This  exhibit,  presented 
by  the  Cleveland  Radiological  Society,  consisted 
of  many  films  mounted  on  shadow  boxes  and  dem- 
onstrated several  rare  and  interesting  conditions. 

Complete  Filtration  Plant — F.  L.  Rollins,  Bar- 
bertain.  A complete  working  model  of  an  up-to- 
date  filtration  plant.  It  was  demonstrated  at  all 
times  and  proved  to  be  very  interesting. 

Glucose  Tolerance — Dr.  F.  A.  Smith,  Akron. 
This  was  a series  of  clinical  charts  showing  the 
glucose  tolerance,  and  the  effect  of  insulin  injec- 
tions on  arthritis. 

Blood  Studies  in  Anemias—  Cleveland  Clinic. 
This  exhibit  consisted  of  charts,  pictures,  instru- 
ments, and  models  of  red  blood  cells. 

Statistical  Exhibit — State  Department  of 

Health.  Charts,  pictures  and  A-ray  films  show- 
ing various  industrial  conditions  such  as  silicosis, 
lead  poisoning,  etc.,  were  shown. 

* * ❖ * 

One  of  the  most  elaborate  and  varied  programs 
of  medical  and  surgical  clinics  ever  given  in  con- 
nection with  an  annual  meeting  of  the  State  As- 
sociation was  presented  by  members  of  the  Akron 
profession  on  Wednesday,  September  6,  at  the 
different  Akron  hospitals.  Each  clinic  was  at- 
tended by  an  interested  group  of  out-of-town 
physicians  and  considerable  favorable  comment 
was  voiced  by  those  who  arrived  in  time  to  take 
in  this  excellent  additional  attraction  of  the  an- 
nual meeting. 

The  institutions  where  clinics  were  held  and 
those  who  presented  them  follow: 

Children’s  Hospital — J.  D.  Smith,  C.  R.  Steinke, 
H.  V.  Sharp,  H.  H.  Musser,  R.  F.  Thaw,  U.  D. 
Seidel,  E.  A.  Weeks,  J.  M.  Ulrich,  R.  S.  Friedley, 
J.  G.  Kramer,  W.  A.  Hoyt,  F.  B.  Roberts,  L.  E. 
Brown,  Jr.,  C.  E.  Krill. 

City  Hospital — C.  E.  Jelm,  H.  R.  Conn,  W.  A. 
Parks,  R.  V.  Luce,  J.  N.  Weller,  R.  E.  Pinkerton, 
Frederick  Smith,  John  H.  Weber,  C.  C.  Pinker- 
ton, L.  R.  C.  Eberhard,  Carl  R.  Steinke,  R.  H. 
Smith,  W.  A.  Hoyt,  L.  E.  Brown,  L.  A.  Witzeman, 
M.  J.  Pierson,  E.  L.  Saylor. 

People’s  Hospital — R.  H.  McKay,  J.  G.  Blower, 
J.  D.  Smith,  L.  L.  Bottsford,  Iv.  H.  Harrington, 
Samuel  Miller,  J.  R.  Shoemaker,  L.  A.  Witze- 
man, M.  F.  Bossart,  E.  B.  Dyson,  J.  C.  McClel- 
land, D.  D.  Daniels,  E.  R.  Stumpf,  C.  E.  Held,  E. 
L.  Voke,  F.  C.  Potter. 

St.  Thomas  Hospital — H.  R.  Conn,  C.  R.  Steinke, 
E.  C.  Banker,  H.  H.  Musser,  J.  H.  Weber,  A.  J. 
Devaney,  J.  E.  Monnig,  S.  Morgenroth,  F.  A. 
Smith,  P.  C.  Langan. 

Springfield  Lake  Sanatorium — W.  A.  Hoyt,  J. 


R.  Villani,  T.  B.  Bliss,  C.  R.  Steinke,  C.  L.  Hyde, 
assisted  by  sanatorium  staff. 

* * * * 

Varied  and  delightful  entertainment  was  ar- 
ranged by  wives  of  Akron  physicians  for  the 
wives  of  visiting  physicians  and  other  women 
guests.  On  Wednesday,  September  6,  a number  of 
the  visiting  women  golfed  and  attended  a luncheon 
at  the  Fairlawn  Country  Club,  arranged  by  their 
Akron  hostesses.  On  Thursday  noon,  many  of  the 
approximately  130  women  visitors  registered  at- 
tended a luncheon  given  in  their  honor  at  the 
Portage  Country  Club,  following  which  they  were 
taken  on  a tour  of  some  of  the  gardens  in  that 
vicinity  and  to  other  points  of  interest  in  the  city. 
On  Friday  morning,  about  50  women  visitors  took 
a ride  in  one  of  the  Goodyear  blimps  by  special 
arrangement  on  the  part  of  the  women’s  enter- 
tainment committee.  The  women  physicians  at- 
tending the  meeting  held  an  informal  luncheon  on 
Friday  noon  at  the  Mayflower  Hotel. 

Jp  % 

Praise  of  the  highest  order  is  due  C.  J.  Fitz- 
patrick, the  genial  manager  of  the  Mayflower 
Hotel,  Ralph  Balke,  his  hard-working  assistant 
and  master  of  details,  and  other  members  of  the 
hotel  staff  for  their  splendid  service.  Everything 
possible  for  the  convenience  and  accommodation 
of  the  visiting  physicians  was  done  by  the  hotel 
management.  Because  of  its  able  assistance  and 
cooperation,  the  committees  who  had  part  in 
handling  the  details  and  arrangements  for  the 
meeting  were  able  to  function  smoothly  and  it  was 
possible  to  carry  out  the  program  according  to 
schedule  and  without  a single  serious  hitch.  Mr. 
Fitzpatrick’s  well-trained  aides  saw  to  it  that 
every  detail  delegated  to  them  was  taken  care  of 
well  in  advance  of  the  opening  of  the  different 
sessions  and  the  speed  with  which  they  “changed 
the  scenes”  must  have  broken  all  records.  Only 
laudable  comment  regarding  the  hotel,  its  man- 
agement, its  staff,  and  last  but  not  least  its  chef 
and  his  assistants,  was  voiced  by  the  members. 
Akron  can  be  justly  proud  of  its  Mayflower  Hotel, 
one  of  the  finest-appointed  in  the  country  and  of 
those  at  the  helm  of  its  personnel. 

* * * * 

The  attractive  and  distinctive  annual  meeting 
badges  furnished  through  the  courtesy  and  kind- 
ness of  the  B.  F.  Goodrich  Company,  Akron, 
made  a big  hit  with  the  members  generally.  The 
unique  rubber  emblem,  adorned  with  a Silver- 
town  tire,  undoubtedly  will  be  kept  by  many  as 
souvenir  of  Akron  hospitality  and  one  of  the  best 
meetmgs  ever  held  by  the  State  Association.  Dr. 
Don  B.  Lowe  of  the  B.  F.  Goodrich  Company  en- 
gineered the  gift  badges. 

* * * * 

Splendid  coverage  of  the  two-days  meeting  was 
given  by  the  Akron  newspapers.  Accurate  and  de- 
tailed accounts  of  the  business  and  scientific  pro- 
ceedings were  carried  daily.  The  sentiment  of  the 


October,  1933 


Annual  Meeting 


655 


membership  generally  regarding  the  efficient  man- 
ner in  which  the  newspapers  handled  the  meeting 
was  expressed  by  the  House  of  Delegates  in  adopt- 
ing a motion  expressing  a vote  of  thanks  to  the 
papers  and  the  reporters  assigned  to  cover  the 
meeting. 

A number  of  class  and  fraternity  reunions  were 
held  during  the  two-days  meeting,  all  of  wnich 
were  well-attended.  The  “Quarter  of  Century  of 


Progress”  luncheon  held  Thursday  noon  by  the 
Class  of  1908  of  Western  Reserve  University,  Col- 
lege of  Medicine  is  reported  to  have  won  honors 
for  attendance  and  enthusiasm.  The  meeting  of 
the  class  was  arranged  by  Dr.  John  D.  Knox, 
Warren.  Among  those  who  attended  was  Dr. 
Courtland  L.  Booth,  Portland,  Oregon,  who  made 
the  long  trip  from  the  Pacific  coast  especially  to 
meet  some  of  his  old  classmates  and  to  attend  the 
annual  meeting. 


Ethics  and  Economics  Discussed  by  Dr,  Follansbee  at  the 
Annual  Organization  Luncheon  Held  in  Akron 


Over  180  attended  the  Organization  Luncheon 
held  on  the  first  day  of  the  87th  Annual  Meeting 
of  the  State  Association,  September  7 and  8,  at 
Akron,  in  honor  of  the  presidents,  secretaries, 
treasurers,  legislative  and  medical  defense  com- 
mitteemen of  the  component  county  medical  so- 
cieties and  academies  of  medicine,  members  of  the 
House  of  Delegates,  officers  of  the  Scientific  Sec- 
tions, officers  and  councilors  of  the  State  Associa- 
tion, and  members  of  the  standing  and  special 
committees  of  the  State  Association. 

Dr.  C.  L.  Cummer,  Cleveland,  the  incoming 
president,  presided  as  chairman  of  the  luncheon 
following  his  introduction  by  Dr.  H.  M.  Platter, 
Columbus,  the  retiring  president.  Seated  at  the 
speakers’  table  in  addition  to  Dr.  Platter  and  Dr. 
Cummer,  were  Dr.  Geo.  Edw.  Follansbee,  Cleve- 
land, chairman  of  the  Judicial  Council  of  the 
American  Medical  Association,  the  luncheon 
speaker,  Dr.  Olin  West,  Chicago,  secretary  and 
general  manager  of  the  American  Medical  Asso- 
ciation, who  addressed  the  banquet  session  in  the 
evening,  Dr.  J.  H.  J.  Upham,  Columbus,  chairman 
of  the  Board  of  Trustees  of  the  American  Medi- 
cal Association;  Dr.  Andrews  Rogers,  Columbus, 
chairman  of  the  Publication  Committee;  Dr.  C. 
W.  Stone,  Cleveland,  chairman  of  the  Committee 
on  Military  and  Veterans’  Affairs  and  a member  of 
the  Committee  on  Public  Policy;  Dr.  V.  C.  Row- 
land, Cleveland,  chairman  of  the  Committee  on 
Preventive  Medicine  and  Periodic  Health  Ex- 
aminations; Dr.  Ben  R.  McClellan,  Xenia,  chaii'- 
man  of  the  Committee  on  Medical  Education  and 
Hospitals;  Dr.  John  B.  Alcorn,  Columbus,  chair- 
man of  the  Committee  on  Public  Policy;  Dr.  J.  E. 
Tuckerman,  Cleveland,  chairman  of  the  Commit- 
tee on  Medical  Defense  and  Dr.  H.  S.  Davidson, 
Akron,  Councilor  of  the  Sixth  District  and  chair- 
man of  the  Council  Committee  on  Annual  Meet- 
ing Arrangements. 

Following  brief  introductions  of  those  at  the 
speakers’  table  by  Dr.  Cummer,  Dr.  Follansbee 
addressed  the  gathering,  discussing  some  of  the 
important  economic,  social,  and  professional  prob- 
lems confronting  the  medical  profession  at  the 
present  time. 

As  a prelude  to  his  discussion,  Dr.  Follansbee 


presented  a number  of  basic  principles  which,  he 
said,  should  under-lie  any  consideration  of  the 
broad  question  of  medical  economics. 

“The  growth  of  society  as  a whole,”  he  declared, 
“has  developed  a trend  toward  dividing  the  popu- 
lation into  various  groups  which  are  bound  to- 
gether within  themselves  by  a common  interest  or 
objective.  The  profession  of  medicine  is  one  of 
society’s  essential  units  and  this  unit  has  peculiar 
relationships  to  the  people  and  to  the  individuals 
comprising  society  not  present  in  any  other  group 
or  unit.  It  gives  a service  of  a personal  nature; 
because  of  its  confidential  relations  and  the  trust 
that  is  imposed  upon  it,  it  requires  the  highest 
integi’ity  in  these  relations;  it  is  obligated  to 
render  service  at  all  hours  and  without  regard  to 
remuneration;  the  welfare  of  the  people  is  its 
first  obligation,  its  own  economic  status  second- 
ary; its  ultimate  aim  is  to  annihilate  itself. 

“Because  of  these  peculiar  relationships  of 
medicine  to  the  public,  certain  principles  of  ethics 
govern  all  our  actions,  and  all  our  thinking,  plan- 
ning and  development  must  be  based  upon  these 
principles.  Economics  cannot  be  separated  from 
ethics  and  economics  not  ethically  sound  cannot 
receive  the  support  of  medical  organization.  This 
is  not  to  say  that  the  economic  standing  of  our 
members  is  not  of  popular  concern  to  them  in- 
dividually and  to  the  profession  as  a whole.  Be- 
cause in  most  instances  our  members  must  make 
a living  from  their  profession,  the  profession  is  to 
that  extent  a business  in  which  we  are  in  com- 
petition with  each  other,  and  our  ethics  require 
fair  competition.  We  cannot  exploit  the  public  or 
individuals  and  we  have  a right  not  to  allow  the 
public  or  individuals  to  exploit  us.  We  are  in- 
debted to  the  public  in  many.  ways.  We  should 
and  do  pay  that  debt  in  many  ways.  Underlying 
these  mutual  obligations,  our  professional  re- 
lations and  economic  problems  are  the  principles 
of  ethics  which  have  developed  from  century  to 
century  and  decade  to  decade,  and  have  in  general 
been  committed  to  writing  since  the  days  of  Hip- 
pocrates.” 

One  of  the  outstanding  problems  confronting 
the  profession,  Dr.  Follansbee  said,  is  the  proposal 
advanced  by  the  majority  report  of  the  Commit- 


656 


The  Ohio  State  Medical  Journal 


October,  1933 


tee  on  the  Costs  of  Medical  Care  for  the  establish- 
ment of  a new  system  of  medical  practice  whereby 
physicians  practicing  in  groups  would  render  a 
group  service  on  a group  payment  basis.  Such  a 
plan  is  impractical  and  would  lead  inevitably  to 
inefficient,  incompetent,  impersonal,  low-grade 
medical  service,  he  declared. 

The  effects  of  such  a plan  if  instituted  on  a 
large  scale  would  be  detrimental  to  the  individual 
physician,  the  medical  profession  as  a whole,  and 
the  health  and  welfare  of  the  public  at  lai-ge,  he 
said.  It  would  eliminate,  Dr.  Follansbee  said,  be- 
tween 40  and  50  per  cent  of  the  physicians  now  in 
practice  in  this  country,  citing  similar  results  of 
group  practice  programs  now  in  operation  in 
several  European  countries.  Such  a set-up  would 
require  that  each  group  or  unit  be  owned  by  one 
or  more  physicians  who  would  employ  other  phy- 
sicians to  render  the  service  given  by  the  unit,  he 
pointed  out.  This,  he  said,  would  result  in  loss  of 
initiative  on  the  part  of  the  employed  physicians, 
since  they  would  necessarily  be  required  to  obey 
the  instructions  of  their  employers,  render  the 
type  of  treatment  outlined  by  the  owners  of  the 
group,  work  a required  number  of  hours  under  a 
standardized  wage  scale,  see  a required  number 
of  patients  per  hour  or  per  day,  and  otherwise  be 
required  to  subordinate  their  own  judgment  and 
independence  to  the  wishes  of  their  physician-em- 
ployers. Moreover,  a mechanized  group-practice 
system  would  throttle  advancement  for  many 
practitioners,  Dr.  Follansbee  pointed  out,  since 
private  practice  would  be  restricted  to  only  a 
small  percentage  of  the  profession  and  those 
working  for  group  units  would  be  compelled  to 
accept  small  remunerations  or  give  way  to 
younger  men  who  in  order  to  get  started  in  active 
practice  would  be  willing  to  work  for  less  than 
adequate  and  equitable  compensation. 

Dr.  Follansbee  pointed  out  that  cut-throat  com- 
petition would  result  inevitably  from  such  an  im- 
practical, inequitable  system,  resulting  in  poor 
service  to  the  public  and  starvation  remuneration 
for  physicians.  Moreover,  he  said,  such  conditions 
would  result  in  a degeneration  of  the  medical  pro- 
fession as  a whole  and  seriously  retard  the  ad- 
vancement of  scientific  medicine.  With  the  pros- 
pects for  advancement  and  material  gain  elimi- 
nated, few  men  of  ability  and  initiative  would  en- 
roll in  medical  schools,  Dr.  Follansbee  declared, 
which,  of  course,  would  lower  the  standards  of 
the  profession  and  necessarily  the  standards  of 
the  service  rendered.  He  cited  the  fact  that  Ger- 
many has  failed  to  contribute  one  outstanding 
thing  to  scientific  medicine  since  the  inauguration 
of  socialized  medicine  in  that  country  whereas  for 
many  years  preceding  that  time  Germany  had 
been  a leader  in  the  field  of  medicine. 

Dr.  Follansbee  expressed  the  opinion  that  while 
the  report  of  the  Committee  on  the  Costs  of 
Medical  Care  has  been  forgotten  for  the  time 
being  by  many  in  the  profession  and  most  of  the 


public,  the  profession  should  not  overlook  the  fact 
that  well-organized  groups  with  adequate  finan- 
cial backing  still  are  carrying  on  a campaign  to 
arouse  public  sentiment  in  favor  of  the  recom- 
mendations of  the  majority  report  and  encourag- 
ing the  inauguration  of  the  plans  proposed  in  that 
report.  The  profession,  he  said,  must  familiarize 
itself  with  the  report  and  must  be  prepared  to 
discuss  its  recommendations  intelligently  and  with 
a thorough  understanding  of  what  the  practical 
results  of  the  schemes  proposed  would  be.  Dr. 
Follansbee  warned  that  the  profession’s  opposi- 
tion to  the  dangerous  schemes  proposed  for  revo- 
lutionizing medical  practice  must  be  based  on 
what  their  effect  would  be  on  the  people  in  general 
and  that  emphasis  must  be  placed  on  the  fact  that 
the  public  is  certain  to  suffer  unless  medicine  is 
maintained  on  its  present  high  plane  and  the 
independent,  professional,  personal  and  competi- 
tive aspects  of  medical  practice  are  preserved. 

In  discussing  briefly  some  of  the  various  plans 
for  furnishing  hospital  service  to  groups  for  a 
fixed  periodic  fee,  Dr.  Follansbee  urged  that  the 
profession  study  such  plans  carefully.  The  pro- 
fession should  maintain  cordial  and  cooperative 
relationships  with  hospitals  and  assist  them  in 
meeting  their  economic  and  administrative  prob- 
lems, he  said.  At  the  same  time,  he  declared,  the 
profession  should  insist  that  no  professional  ser- 
vice be  included  in  any  group  hospitalization  pro- 
grams instituted;  should  oppose  the  practice  of 
medicine  by  hospitals,  and  should  demand  that  the 
rights  of  the  profession  be  protected  by  hospitals 
in  all  their  activities. 

Dr.  Follansbee  urged  the  profession  to  devote 
greater  study  to  the  questions  of  dispensaries, 
part-pay  clinics  and  care  of  the  sick  poor,  urging 
that  whenever  possible  plans  should  be  worked 
out  with  public  officials  whereby  the  temporary 
indigent  could  be  given  medical  care  by  the  in- 
dividual physician  at  his  own  office  or  in  the 
patient’s  own  home.  Once  a patient  becomes  ac- 
customed to  visiting  a dispensary  or  clinic  he  may 
be  lost  forever  by  the  private  practitioner,  Dr. 
Follansbee  pointed  out,  warning  that  free  or  part- 
pay  clinics  are  but  the  first  step  toward  full-pay 
clinics  which  compete  with  the  private  prac- 
titioner and  over  which  the  profession  has  little  or 
no  control. 

In  conclusion  Dr.  Follansbee  declared  that  since 
the  various  general  movements  to  change  the 
existing  system  of  medical  practice  and  the  num- 
erous problems  arising  from  them  have  different 
angles  depending  on  local  conditions  and  the  way 
they  are  being  promoted  in  different  localities, 
each  should  be  given  careful  consideration  by 
medical  organization  in  each  community.  Because 
of  this,  he  said,  it  is  vital  that  each  county  medical 
society  and  academy  of  medicine  have  an  alert  and 
energetic  committee  on  medical  economics  to  in- 
quire into  various  schemes  being  promoted  locally, 
contact  other  groups  and  governmental  officials, 


October,  1933 


Annual  Meeting 


657 


and  keep  the  membership  of  the  county  society  in- 
formed on  local  developments  and  trends.  More- 
over, he  stated,  one  of  the  duties  of  such  a com- 
mittee should  be  to  keep  in  close  and  constant 
contact  with  the  Committee  on  Medical  Economics 
of  the  State  Association  for  the  purpose  of  inter- 
changing ideas  and  information  through  the 


Headquarters  Office  of  the  State  Association  and 
where  reports  of  local  activities  in  meeting 
medical  economic  questions  and  problems  can  be 
assembled  for  publication  in  The  Journal  so  that 
the  entire  membership  may  have  the  benefit  of  the 
work  being  done  by  the  various  local  committees. 


Splendid  Attendance  at  87tk  Annual  Meeting  in  Akron 


In  view  of  prevailing  economic  conditions  and 
the  fact  that  the  Akron  meeting  was  held  at  a 
time  which  conflicted  somewhat  with  late  Summer 
vacations,  the  attendance  at  the  Eighty-Seventh 
Annual  Meeting,  September  7 and  8,  in  the  Rub- 
ber City  was  remarkable.  It  was  especially 
splendid  when  compared  with  the  big  decline  in 
registration  at  similar  professional  and  business 
gatherings  throughout  the  state  and  nation  dur- 
ing the  past  few  years. 

Total  registration  at  Akron,  including  members 
of  the  State  Association,  guests  and  exhibitors 
was  1049. 

Members  who  attended  and  registered  at 
Akron  totaled  858,  a fine  showing  and  attesting 
to  the  loyalty  and  active  interest  of  members  in 
the  program  and  activities  of  medical  organiza- 
tion. 

The  registration  of  guests,  including  internes, 
medical  students  and  women  visitors  totaled  160. 

The  number  of  exhibitors  registered — 25 — was 
the  smallest  at  any  annual  meeting  held  in  the 
past  15  years.  Business  conditions  generally  and 
the  postponement  of  the  meeting  date  from  May 
to  September,  causing  some  conflict  in  the  ex- 
hibitors’ schedules,  undoubtedly  were  responsible 
for  the  decline  in  the  number  of  firms  exhibiting. 

The  following  tabulation  for  the  past  succeed- 
ing 15  annual  meetings  shows  by  comparison  the 
numbers  registered  in  attendance,  the  out-of- 
state  physicians,  the  number  of  guests,  exhibitors 
and  respective  totals: 


Year  and 
Meeting-  place 

Mem- 

bers 

Out-of-state 

Physicians 

Guests 

Exhi- 

bitors 

Total 

1919 

Columbus  

1173 

10 

284 

92 

1529 

1920 

Toledo  

810 

17 

105 

80 

1062 

1921 

Columbus  

1275 

28 

204 

96 

1503 

1922 

Cincinnati  

1066 

21 

184 

70 

1341 

1923 

Da.yton  

1117 

19 

202 

76 

1414 

1924 

Cleveland  

1301 

13 

180 

109 

1603 

1925 

Columbus  

1204 

17 

361 

107 

1689 

1926 

Toledo  

903 

19 

120 

83 

1125 

1927 

Columbus  

1320 

17 

286 

82 

1705 

1928 

Cincinnati  

916 

27 

92 

80 

1116 

1929 

Cleveland  

1231 

15 

249 

124 

1619 

1930 

Columbus  — 

1241 

13 

435 

86 

1775 

1931 

Toledo  

826 

13 

198 

50 

1087 

1932 

Dayton  

978 

2 

201 

45 

1226 

1933 

Akron  

858 

6 

160 

25 

1049 

MEMBERSHIP  REGISTRATION 
The  list  of  members  registered,  by  counties,  fol- 
lows : 

Adams  County — 0.  T.  Sproull.  Allen — R.  D. 
Doughty,  O.  E.  Harvey,  Burt  Hibbard,  A.  S. 
Rudy,  T.  R.  Thomas,  J.  R.  Tillotson.  Ashland — 
W.  E.  Emery,  G.  B.  Fuller,  E.  G.  Grover.  Ash- 
tabula— J.  Frank  Docherty,  R.  B.  Wynkoop. 

Athens — T.  A.  Copeland,  J.  L.  Henry,  C.  S. 
McDougall.  Auglaize — Charles  C.  Berlin,  E.  F. 
Heffner,  R.  C.  Hunter,  Guy  E.  Noble,  Harry  S. 
Noble.  Belmont — F.  R.  Dew,  C.  W.  Kirkland, 

D.  M.  Murphy,  P.  H.  Pettay,  D.  O.  Sheppard. 
Butler — W.  E.  Griffith. 

Champaign — D.  C.  Houser.  Clark — F.  P.  Anz- 
inger,  Roy  D.  Arn,  Delos  W.  Hogue,  S.  R.  Hutch- 
ings, J.  A.  Link,  J.  D.  Thomas.  Clermont — Allan 
B.  Rapp,  James  K.  Ashburn.  Clinton — Kelley 
Hale,  Elizabeth  Shrieves.  Columbiana — John  A. 
Fraser,  W.  N.  Gilmore,  J.  M.  King,  C.  R.  Larkins, 

E.  C.  Louthan,  J.  M.  McGeorge,  R.  E.  Smucker. 
Coshocton — J.  C.  Briner,  D.  M.  Criswell,  R.  E. 
Hopkins,  S.  B.  Kistler,  A.  P.  Magness,  J.  G. 
Smailes.  Crawford — K.  H.  Barth,  E.  C.  Brandt, 
R.  L.  Solt. 

Cleveland  and  Cuyahoga  County — W.  J.  Abbott, 
Fred  W.  Andreas,  N.  S.  Banker,  W.  R.  Barney, 
A.  Baumoel,  G.  I.  Bauman,  M.  A.  Blankenhorn, 
George  U.  Bennett,  Samuel  S.  Berger,  M.  E. 
Blahd,  W.  F.  Boukalek,  Ralph  M.  Bone,  A.  V. 
Boysen,  A.  B.  Bruner,  Wm.  Evans  Bruner,  A.  T. 
Bunts,  Charles  W.  Burhans,  H.  Van  Y.  Caldwell, 
Wm.  M.  Champion,  Frank  H.  Clark,  C.  D.  Chris- 
tie, H.  N.  Cole,  M.  B.  Cohen,  M.  Coplan,  A.  G. 
Cranch,  Clyde  L.  Cummer,  J.  H.  Davis,  John 
Dickenson,  A.  B.  Denison,  J.  R.  Driver,  H.  H. 
Drysdale,  Wm.  J.  Engle,  Ralph  W.  Elliott,  Harry 

L.  Farmer,  A.  C.  Ernstene,  Warren  C.  Fargo, 

M.  H.  Fineberg,  Geo.  W.  Fetzer,  Joseph  Fetter- 
man,  F.  W.  D.  Finke,  R.  W.  Finley,  Alan  D. 
Finlayson,  Harold  Feil,  Geo.  Edw.  Follansbee, 
Alexander  N.  Freed,  Maurice  D.  Friedman,  Wm. 
D.  Fullerton,  W.  James  Gardner,  Charles  H.  Gar- 
vin, T.  H.  George,  Henry  J.  Gerstenberger,  M. 
Garber,  Frank  S.  Gibson,  Otto  L.  Goehle,  Donald 
M.  Glover,  Harry  Goldblatt,  C.  Lee  Graber. 

Russell  L.  Haden,  Karla  T.  Hahn,  H.  J.  Hart- 
zell,  0.  L.  Hawk,  Willard  E.  Hauser,  F.  C.  Her- 
rick, C.  H.  Heyman,  Charles  C.  Higgins,  Charles 
H.  Hay,  Samuel  Hurwitz,  W.  J.  Irwin,  James  J. 
Joelson,  F.  F.  Jordan,  Louis  J.  Karnosh,  Delbert 
V.  Kechele,  J.  C.  Kloepfer,  Harold  J.  Knapp, 
Hubert  C.  King,  C.  E.  Kinney,  F.  T.  Kopstein, 
J.  B.  Klein,  E.  Klaus,  Paul  H.  Krebs,  J.  J.  Kur- 
lander,  Charles  B.  Lewis,  Carl  H.  Lenhart,  P.  R. 
Linsey,  Albert  Loveman,  R.  V.  May,  E.  P. 
McCullagh,  Theodore  Miller,  Myron  Metzenbaum, 
Paul  G.  Moore,  S.  H.  Monson,  M.  Paul  Motto, 
Allan  R.  Moritz,  Wm.  V.  Mullin,  Earl  W.  Nether- 
ton,  John  D.  Osmond,  Harry  V.  Paryzek,  C.  A. 
Pitkin,  Samuel  S.  Quittner,  Albert  T.  Ransone, 
Wm.  Rigelhaupt,  C.  G.  LaRocco,  H.  L.  Rockwood, 
G.  F.  Romig,  Rudolph  S.  Reich,  J.  A.  Rudolph, 


658 


The  Ohio  State  Medical  Journal 


October,  1933 


Lewis  Rubin,  Vernon  C.  Rowland,  Harry  C. 
Rosenberger,  Scott  C.  Runnels,  Albert  D.  Ruede- 
mann. 

R.  W.  Scott,  Henry  C.  Schumacher,  Geo.  D. 
Shaaber,  Marvin  D.  Shie,  O.  M.  Shirey,  A.  0. 
Sibila,  A.  J.  Skeel,  John  G.  Slade,  Harry  G.  Sloan, 
Frederick  A.  Snyder,  S.  W.  Smolik,  Torald  Soll- 
mann,  Walter  G.  Stern,  Charles  W.  Stone,  John 
A.  Filak,  E.  V.  Thiehoff,  John  A.  Toomey,  J.  E. 
Tuckerman,  John  Tucker,  R.  K.  Updegraff,  C.  F. 
Ulrich,  C.  E.  Ward,  Charles  T.  Way,  Claude  D. 
Waltz,  Guy  H.  Williams,  Robert  W.  Williams, 
Z.  T.  Wirtschafter,  James  N.  Wychgel,  C.  W. 
Wyckoff,  Irwin  E.  Yoelson,  Samuel  Yamshon. 

Darke  — W.  T.  Fitzgerald.  Defiance  — D.  J. 
Slosser.  Delaware  — W.  E.  Borden,  M.  W. 
Davies,  George  D.  Lowry.  Erie — R.  E.  Garn- 
hart.  Fairfield — A.  A.  Brown,  Frederick  W. 
James,  Ralph  H.  Smith,  W.  E.  Wiyiarch.  Fay- 
ette— James  F.  Wilson. 

Columbus  and  Franklin  County — John  B.  Al- 
corn, E.  H.  Baxter,  James  A.  Beer,  L.  L.  Bige- 
low, Wayne  Brehm,  Edward  E.  Campbell,  Ivor  G. 
Clark,  George  Curtis,  Charles  A.  Doan,  V.  A. 
Dodd,  H.  H.  Dorr,  John  Dudley  Dunham,  E.  J. 
Emerick,  R.  S.  Fidler,  Jonathan  Forman,  T.  R. 
Fletcher,  Albert  D.  Frost,  Emilie  C.  Gorrell,  S.  J. 
Goodman,  F.  W.  Gosnell,  F.  E.  Ginder,  George 
T.  Harding,  III,  Emery  R.  Hayhurst,  E.  D.  Hel- 
frich,  A.  T.  Hopwood,  E.  G.  Horton,  C.  D.  Hoy, 
Geo.  W.  Keil,  F.  L.  Keiser,  Roy  E.  Krigbaum, 

G.  P.  Lawrence,  F.  F.  Lawrence,  H.  E.  LeFever, 
W.  E.  Lloyd,  Louis  Mark,  E.  F.  McCampbell, 
Russel  G.  Means,  Link  M.  Murphy,  B.  E.  Neis- 
wander,  W.  E.  Obetz,  Claude  S.  Perry,  H.  M. 
Platter,  Wm.  H.  Pritchard,  R.  A.  Ramsey,  An- 
drews Rogers,  H.  M.  Sage,  D.  G.  Sanor,  Ernest 
Scott,  E.  R.  Shaffer,  C.  L.  Spohr,  M.  E.  Swine- 
hart,  Ralph  B.  Taylor,  Wells  Teachnor,  Sr.,  John 
M.  Thomas,  E.  A.  Thrall,  J.  H.  J.  Upham,  Thomas 
A.  Vogel,  James  H.  Warren,  Fred  H.  Weber, 
E.  H.  Wilson. 

Gallia — Mary  L.  Austin,  Leo  C.  Bean,  S.  L. 
Bossard.  Geauga  — C.  F.  Gilmore.  Greene — 
Marshall  M.  Best,  Ben  R.  McClellan,  Reyburn 
McClellan.  Guernsey — William  L.  Denny,  Fred 
W.  Lane,  H.  R.  Neeland,  George  F.  Swan,  A.  G. 
Ringer. 

Cincinnati  and  Hamilton  County — Mary  Knight 
Asbury,  J.  F.  Bateman,  John  A.  Caldwell,  A.  T. 
Childers,  Louis  Feid,  Jr.,  Albert  H.  Freiberg, 
Ralph  Wm.  Good,  J.  Victor  Greenebaum,  Samuel 
Iglauer,  D.  E.  Jackson,  Lloyd  B.  Johnston,  D.  A. 
Johnston,  Charles  E.  Kiely,  Robert  A.  Lyon,  Don- 
ald J.  Lyle,  A.  Graeme  Mitchell,  Dudley  W.  Pal- 
mer, George  Renner,  Jr.,  Robert  C.  Rothenberg, 
Otto  Seibert,  Cecil  Striker,  Derrick  T.  Vail,  Jr., 
Edward  A.  Wagner,  Samuel  Zielonka. 

Hancock — J.  M.  Firmin,  John  V.  Hartman,  A. 

E.  King,  0.  P.  Klotz,  W.  M.  Metzler.  Highland — 

H.  W.  Chaney,  W.  B.  Roads,  K.  R.  Teachnor. 
Holmes — A.  T.  Cole,  J.  E.  Elder.  Huron — Geo. 

F.  Linn,  R.  L.  Morse,  J.  C.  Steiner.  Jackson — 
J.  L.  Frazer,  A.  G.  Ray,  J.  J.  McClung.  Jefferson 
— Albert  E.  Weinstein,  John  Y.  Bevan,  S.  J. 
Podlewski,  E.  H.  Rea,  M.  H.  Rosenblum.  Knox — 
F.  C.  Anderson,  Robert  L.  Eastman,  James  F. 
Lee,  J.  M.  Pumphrey,  Julius  Shamansky.  Lake 
— Burt  T.  Church,  F.  J.  Dineen,  Wm.  P.  Ellis,  R. 
E.  Gardner,  V.  N.  Marsh.  Licking — H.  B.  Ander- 
son, C.  G.  Bozman,  Geraldine  H.  Crocker,  Carl 
J.  Dillon,  Carl  E.  Evans,  R.  W.  Jones,  R.  C. 
Mauger,  W.  H.  Morgan,  E.  A.  Moore,  Dale  E. 
Roth,  George  W.  Sapp,  W.  E.  Shrontz. 

Lorain — John  W.  Adrian,  Valloyd  Adair,  Waite 
Adair,  Russell  M.  Arnold,  S.  V.  Burley,  Beni. 
Carlson,  Robert  J.  Emslie,  R.  D.  A.  Gunn,  J.  M. 


Metcalf,  G.  Mynchenberg,  Henry  R.  O’Brien,  H. 
W.  Powers,  Georgia  Scharff,  A.  C.  Siddall,  F.  M. 
Sponseller,  John  L.  Sullivan,  L.  H.  Trufant,  H.  F. 
Vaughan,  C.  B.  Wiedman. 

Toledo  and  Lucas  County — A.  A.  Applebaum, 
T.  H.  Brown,  W.  W.  Brand,  Lewis  R.  Carr,  B.  H. 
Carroll,  I.  R.  Cohn,  Ralph  M.  Crumrine,  Louis 

R.  Effler,  Karl  D.  Figley,  John  Gardiner,  H.  C. 
Gerber,  Norris  Gillette,  E.  B.  Gillette,  Stanley  D. 
Giffen,  Barney  J.  Hein,  H.  F.  Howe,  A.  B.  John- 
son, L.  A.  Levison,  Charles  Lukens,  Edward  J. 
McCormick,  Malcolm  L.  Mclnnes,  Richard  A. 
Mills,  C.  S.  Mundy,  W.  A.  Neil,  C.  S.  Ordway, 
Geo.  B.  Parisen,  Walter  V.  Prentice,  Thomas  L. 
Ramsey,  S.  R.  Salzman,  A.  H.  Schade,  Walter 
H.  Synder,  C.  W.  Waggoner,  John  F.  Wright. 

Mahoning — Karl  W.  Allison,  M.  H.  Bachman, 
John  U.  Buchanan,  W.  H.  Bunn,  C.  H.  Camp- 
bell, C.  R.  Clark,  L.  G.  Coe,  Louis  S.  Deitchman, 
George  Y.  Davis,  W.  H.  Evans,  J.  L.  Fisher,  R. 
D.  Gibson,  M.  B.  Goldstein,  J.  P.  Harvey,  Charles 
D.  Hauser,  J.  A.  Heeley,  John  Heberding,  A.  V. 
Hinman,  0.  D.  Hudnutt,  P.  H.  Leimbach,  M.  P. 
Mahrer,  Anthony  C.  Montani,  R.  R.  Morrall, 
James  B.  Nelson,  Gordon  G.  Nelson,  Dean  Nes- 
bit,  Claude  B.  Norris,  David  B.  Phillips,  Guy  A. 
Parillo,  F.  F.  Piercy,  R.  B.  Poling,  J.  Rosenfeld, 
Wm.  M.  Skipp,  W.  X.  Taylor,  O.  J.  Walker,  C.  F. 
Yauman. 

Marion — E.  L.  Brady,  Bret  B.  Hurd,  J.  W. 
Jolley,  F.  E.  Mahla,  Sheridan  W.  Mattox,  E.  H. 
Morgan,  B.  D.  Osborn,  Carl  W.  Sawyer,  B.  H. 
Taylor.  Medina — E.  C.  Bell,  J.  L.  Beach,  C.  A. 
Boiich,  E.  L.  Crum,  James  K.  Durling,  R.  L.  Man- 
sell, M.  F.  Miller,  J.  R.  Moorehead,  H.  T.  Pease, 
Frank  C.  Reutter,  H.  P.  H.  Robinson,  Harry 
Street,  Roy  G.  Strong,  Jos.  G.  Whitacre.  Meigs — 

H.  M.  Crumley.  Mercer — L.  M.  Otis.  Miami — 
Berton  M.  Hogle,  Wm.  W.  Trostel,  Ralph  D. 
Yates,  E.  A.  Yates.  Monroe — H.  P.  Gillespie. 

Montgomei'y — S.  H.  Ashmun,  E.  E.  Bohlender, 
Wm.  B.  Bryant,  A.  W.  Carley,  C.  D.  Fife,  Robert 
D.  Hostetter,  W.  Richard  Hochwalt,  E.  M.  Hus- 
ton, J.  A.  Judy,  Mildred  E.  Jeffrey,  Albert  F. 
Kuhl,  P.  H.  Kilbourne,  Jos.  S.  Koehler,  R.  C. 
McNelly,  A.  0.  Peters,  Leo  Schram,  Clement  D. 
Smith. 

Morgan — C.  E.  Northrup.  Morrow — Frank  M. 
Hartsook. 

Muskingum — Edmund  R.  Brush,  S.  P.  Carter, 
W.  D.  Coffman,  0.  I.  Dusthimer,  Beatrice  T. 
Hagen,  Lester  Lasky,  A.  C.  Lawrence,  M.  A. 
Loebell,  Robert  S.  Martin,  John  M.  McCleery, 
C.  M.  Rarnbo,  R.  E.  Wells.  Ottawa — H.  J.  Pool, 
Cyrus  R.  Wood.  Perry — Harry  L.  Hite.  Pike — 

I.  P.  Seiler.  Portage — Ivor  Campbell,  J.  S.  Dey- 
ell, E.  M.  Kauffman,  S.  L.  McManigal,  R.  T.  Odell, 

S.  U.  Sivon,  George  J.  Waggoner,  Emily  J.  Wid- 
decombe.  Putnam — P.  D.  Bixel,  E.  Blackburn, 

J.  R.  Echelbarger. 

Richland — J.  F.  McHugh,  L.  C.  Nigh,  0.  H. 
Schettler,  S.  C.  Schiller,  J.  L.  Stevens,  R.  C.  Wise, 
J.  A.  Yoder.  Scioto — A.  R.  Moore,  Ross  M.  Gault. 
Seneca — R.  R.  Hendershott,  R.  E.  Hershberger, 
Paul  J.  Leahy,  W.  W.  Lucas,  V.  L.  Magers,  E. 
H.  Porter.  Shelby — Brent  A.  Welch. 

Stark — Edward  Arnold,  L.  E.  Anderson,  D.  F. 
Banker,  M.  M.  Bauer,  S.  B.  Berkley,  Ray  A. 
Bohl,  H.  H.  Bowman,  L.  A.  Buchman,  Elizabeth 
Brunton,  Allen  W.  Budd,  C.  N.  Clark,  Roy  H. 
Klunk,  0.  R.  Clovis,  J.  H.  Cooper,  J.  P.  DeWitt, 
S.  T.  Feingold,  E.  S.  Folk,  A.  A.  Fisher,  C.  E. 
Fraunfelter,  Verl  Z.  Garster,  H.  W.  Gauchat, 
Emerson  Gillespie,  Charles  S.  Greene,  G.  B. 
Haggart,  W.  P.  Hanna,  R.  E.  Hall,  Frank  E. 
Hart,  Henry  P.  Hart,  F.  C.  Hendrickson,  Anna 


October,  1933 


Annual  Meeting 


659 


R.  Hendrickson,  J.  D.  Holston,  Perry  F.  King, 

G.  L.  King,  Jr.,  George  L.  King,  Sr.,  L.  E.  Leav- 
enworth, A.  A.  Lichtblau,  W.  G.  Lyle,  E.  J. 
March,  W.  C.  Manchester,  W.  A.  McConkey,  John 

D.  O’Brien,  A.  R.  Olmstead,  P.  A.  Paulson,  G.  E. 
Paolazzi,  E.  B.  Pierce,  C.  A.  Portz,  W.  R.  Portz, 
J.  Edwin  Purdy,  Regin  J.  Pumphrey,  R.  K.  Ram- 
sayer,  Fred  L.  Rhodes,  K.  E.  Reighard,  H.  M. 
Schuffell,  Wylie  Scott,  M.  E.  Scott,  John  E.  Shorb, 

D.  D.  Shontz,  R.  L.  Slater,  Jos.  D.  Stires,  L.  D. 
Stoner,  G.  Otho  Thomposn,  Roy  Lee  Thompson, 

F.  S.  Van  Dyke,  J.  M.  Van  Dyke,  A.  W.  Warren, 
J.  B.  Walker,  George  N.  Wenger,  H.  Welland, 
0.  G.  Wilson,  Pauline  Zinninger,  George  F.  Zin- 
ninger. 

Summit — M.  D.  Ailes,  Paul  R.  Adams,  W.  C. 
Arthur,  C.  R.  Anderson,  R.  E.  Amos,  E.  L. 
Averell,  C.  H.  Bair,  John  Bakos,  Roy  Barnwell, 

H.  R.  Baremore,  Edw.  C.  Banker,  C.  L.  Baskin, 

C.  L.  Beatty,  F.  C.  Bissell,  J.  G.  Blower,  George 

E.  Black,  Henry  E.  Blass,  I.  R.  Birnbaum,  L.  L. 
Bottsford,  M.  F.  Bossart,  R.  A.  Breckenridge, 
E.  W.  Breyfogle,  J.  L.  Brickwede,  L.  E.  Brown, 
R.  H.  Cather,  G.  M.  Campbell,  C.  J.  Case,  J.  M. 
Canter.  Charles  M.  Clark,  H.  R.  Conn,  F.  H. 
Cook,  H.  Irving  Cozad,  M.  B.  Crafts,  D.  D.  Dan- 
iels, D.  W.  Davis,  Harry  S.  Davidson,  Mason 
Daughtery,  Adrian  E.  Davis,  Paul  A.  Davis, 
Roger  Q.  Davis,  Arthur  F.  Dorner,  Frank  V. 
Dunderman,  E.  B.  Dyson,  L.  R.  C.  Eberhard, 
A.  F.  Errington,  H.  A.  Finefrock,  George  A. 
Ferguson,  E.  B.  Foltz,  A.  H.  Franks,  Edson  A. 
Freeman,  R.  S.  Friedley,  F.  V.  Gammage,  G.  E. 
Gardner,  M.  J.  Gibans,  B.  H.  Gillespie,  E.  W. 
Grubb,  R.  A.  Gregg,  Horace  C.  Groom,  Stephen 
Greenfield,  Kent  H.  Harrington,  David  E.  Haw- 
thorne, Joseph  D.  Hayden,  H.  B.  Harper,  Charles 
E.  Held,  J.  F.  Henderson,  Carrie  A.  Herring, 
T.  C.  G.  Herwig,  W.  S.  Henderson,  C.  T.  Hill, 
E.  C.  Hinman,  A.  M.  Hoyer,  W.  A.  Hoyt,  W.  L. 
Hogue,  Jr.,  T.  D.  Hollingsworth,  I.  L.  Houghton, 
Clarence  L.  Hyde,  J.  A.  Van  der  Hulse,  Harris 

D.  Her,  R.  F.  Jolley,  W.  M.  Johnston,  Wm.  McD. 
Johnston,  W.  I.  Jenkins,  C.  E.  Jelm,  F.  A.  John- 
son, R.  F.  Jukes,  Morris  Kalmon,  D.  C.  Keller, 
A.  J.  Knapp,  A.  A.  Kohler,  Esther  Kojinsky, 
Erwin  J.  Kraker,  Carl  E.  Krill,  Frank  Kunz, 
James  G.  Kramer,  J.  LaCamera,  Paul  C.  Langan, 
J.  G.  Lemmon,  R.  M.  Lemmon,  P.  B.  Long,  George 
M.  Logan,  G.  A.  Lucas,  R.  V.  Luce,  C.  N.  Long, 
H.  G.  Long,  D.  B.  Lowe,  E.  S.  Lyon,  Wm.  D. 
Lyon,  V.  C.  Malloy,  E.  L.  Mather,  D.  T.  Matthias, 
R.  H.  Markwith,  J.  C.  McClelland,  W.  E.  Mc- 
Corkle,  A.  S.  McCormick,  J.  L.  MeEvitt,  D. 
McDonald,  R.  H.  McKay,  Samuel  E.  McMaster, 
L.  B.  Mehl,  S.  J.  Michael,  J.  S.  Millard,  G.  A. 
Miller,  Samuel  Miller,  J.  F.  Miller,  M.  M.  Miller, 
Frank  B.  Murphy,  Harvey  J.  Musser,  D.  H.  Mor- 
gan, T.  K.  Moore,  M.  C.  Morgan,  S.  Morgenroth, 
Cyril  E.  Myers,  Charles  R.  Newton,  Carl  C.  Nohe, 

G.  A.  Palmer,  G.  K.  Parke,  William  A.  Parks, 
Roy  G.  Pearce,  Dallas  Pond,  Charles  C.  Pinker- 
ton, Roger  E.  Pinkerton,  F.  C.  Potter,  C.  A. 
Raymond,  G.  C.  Radcliffe,  R.  M.  Rankin,  Fred  K. 
Read,  W.  A.  Rechsteiner,  John  Repasky,  Herbert 
A.  Rodenbaug'h.  A.  S.  Robinson,  Fowler  B.  Rob- 
erts, George  W.  Rockwell,  R.  L.  Ross,  E.  L. 
Saylor,  J.  Paul  Sauvageot,  S.  A.  Schlueter,  J.  H. 
Seiler,  John  H.  Selby,  U.  D.  Seidel,  H.  Vern 
Sharp,  George  R.  Seikel,  J.  R.  Shoemaker,  Jay 
D.  Smith,  Frederick  A.  Smith,  A.  R.  Spindler, 
J.  E.  Springer,  A.  H.  Stall,  G.  W.  Stauffer,  Carl 
R.  Steinke,  F.  W.  Steiner,  Fannie  R.  Stees, 
George  R.  Taylor,  R.  F.  Thaw,  Llewelyn  I. 
Thomas,  Ralph  B.  Tate,  A.  D.  Traul,  M.  C. 
Tuholske,  Joseph  M.  Ulrich,  C.  E.  Updegraff, 
R.  L.  Vioran,  R.  P.  Vivian,  Edw.  L.  Voke,  Joseph 
Warburton,  K.  D.  Way,  Geo.  R.  Wellwood,  Kurt 


Weidenthal,  Elizabeth  M.  Weaver,  John  H. 
Weber,  Edmund  A.  Weeks,  Cloyd  F.  Wharton, 
L.  Earl  Wharton,  Louis  A.  Witzeman,  H.  E. 
Woodbury,  Samuel  St.  John  Wright,  J.  P.  Weiss, 
Roy  G.  Werner,  J.  N.  Weller. 

Trumbull — E.  P.  Adams,  J.  H.  Caldwell,  John 

D.  Knox,  R.  H.  McCaughtry.  Tuscarawas — Jay 
W.  Calhoon,  H.  A.  Coleman,  W.  W.  H.  Cur- 
tiss, D.  H.  Downey,  M.  W.  Everhard,  R. 
J.  Foster,  Roy  D.  Hildebrand,  F.  B.  Larimore, 
B.  A.  Marquand,  James  A.  McCollam,  George  L. 
Sackett,  Howard  H.  Schwindt,  E.  B.  Shanley, 
J.  M.  Smith.  Union — John  Dean  Boylan,  Fred 
Callaway,  H.  G.  Southard.  Van  Wert — S.  A.  Ed- 
wards, Charles  Mowry,  J.  B.  Sampsell. 

Washington — W.  E.  Radcliffe,  W.  W.  Sauer. 
Wayne — Lyman  A.  Adair,  E.  R.  Alexander,  A.  C. 
Delaplane,  Bernard  M.  Foster,  G.  L.  Hardgrove, 
J.  W.  Irvin,  John  J.  Kinney,  H.  J.  Mitchell,  W. 

F.  Mitchell,  Wm.  A.  Morton,  R.  C.  Paul,  R.  G. 
Rhoten,  L.  E.  Seyler,  0.  J.  Shong,  Fred  B. 
Snyder,  0.  P.  Ulrich,  John  G.  Wishard,  L.  A. 
Yocum,  H.  M.  Yoder.  Wood — W.  W.  Mannhardt, 

E.  A.  Powell.  Wyandot — J.  Craig  Bowman,  R.  L. 
Garster. 


Annual  Health  Commissioners  Conference 
October  19  and  20 

An  interesting  and  instructive  program  is  being 
formulated  for  the  14th  Annual  Conference  of 
Ohio  Health  Commissioners  with  the  State  De- 
partment of  Health,  to  be  held  Thursday  and  Fri- 
day, October  19  and  20,  at  the  Deshler-Wallick 
Hotel,  Columbus. 

Registration  headquarters  for  the  conference 
will  be  located  on  the  ballroom  floor  of  the  hotel 
and  will  open  at  9 a.m.,  Thursday,  October  19. 

The  opening  session  of  the  gathering  will  start 
at  10  a.m.,  Thursday,  the  first  events  on  the  pro- 
gram being  an  address  of  welcome  by  Governor 
George  White  and  the  annual  address,  of  Dr.  H. 

G.  Southard,  state  director  of  health. 

At  noon  on  Thursday  there  will  be  a luncheon 
of  public  health  nurses  which  will  be  addressed 
by  Dr.  John  Dean  Boylan,  Milford  Center,  health 
commissioner  of  Union  County.  Dr.  Boylan  will 
speak  on  “Study  of  Nutrition  of  the  School  Child”. 

As  yet,  the  official  program  for  the  meeting  has 
not  been  drafted,  but  it  is  anticipated  that  the 
following  addresses  will  be  presented : 

Dr.  J.  H.  J.  Upham,  Columbus,  dean  of  the 
College  of  Medicine,  Ohio  State  University,  will 
discuss  post-graduate  work  in  public  health  work 
and  Attorney  General  John  W.  Bricker  will  re- 
view some  of  the  legal  angles  in  public  health  ad- 
ministration. 

“Where  Are  We  In  Public  Health  Administra- 
tion and  Where  Are  We  Going”,  will  be  the  sub- 
ject of  an  address  by  Dr.  H.  J.  Powell,  health 
commissioner  of  Bowling  Green  and  Wood  County. 
Dr.  J.  H.  Hayes,  acting-  chief  of  the  Bureau  of 
Child  Hygiene,  State  Department  of  Health,  will 
present  the  subject,  “Protection  of  Our  Children”. 

One  of  the  out-of-state  speakers  scheduled  to 
address  the  meeting  is  Dr.  Edward  S.  Godfrey, 
director  of  local  health  administration,  New  York 


660 


The  Ohio  State  Medical  Journal 


October,  1933 


State  Department  of  Health.  Dr.  Godfrey  will 
talk  on  “Modern  State  Health  Regulations”.  Ar- 
rangements also  are  being  made  by  Dr.  R.  W.  De- 
Crow,  chief  of  the  Bureau  of  Health  Organization, 
State  Department  of  Health,  who  is  in  charge  of 
arranging  the  program,  to  have  a representative 
of  the  United  States  Public  Health  Service  pres- 
ent to  discuss  progress  in  diphtheria  immuniza- 
tion in  recent  years. 

A resume  of  engineering  problems  under  the 
National  Recovery  Act  will  be  presented  by  P. 
H.  Waring,  chief  of  the  Division  of  Sanitary  En- 
gineering, State  Department  of  Health,  and  new 
state  legislation  relating  to  public  health  work 
will  be  reviewed  and  analyzed  by  J.  E.  Bauman, 
assistant  state  director  of  health. 

Dr.  William  B.  Wherry,  Cincinnati,  has  been 
invited  to  speak  on  “Newer  Developments  in  the 
Control  of  Communicable  Diseases”.  The  public 
health  aspects  of  the  new  state  law  governing  the 
milk  industry  will  be  reviewed  and  interpreted  by 
Charles  G.  McBride,  secretary  of  the  State  Milk 
Commission. 

One  session  of  the  meeting  will  be  addressed  by 


State  Representative  William  R.  Foss,  Mercer 
County,  who  will  speak  on  “What  Is  Wrong  With 
Our  Present  Health  Laws”.  A symposium  on  the 
subject,  “Records  and  Bookkeeping  in  Public 
Health  Administration”  has  been  arranged.  Dr. 
M.  C.  Hanson,  health  commissioner  of  Mansfield 
and  Richland  County,  will  discuss  the  subject 
from  the  standpoint  of  the  city  health  district; 
Dr.  James  F.  Wilson,  health  commissioner  of 
Washington  C.  H.  and  Fayette  County,  from  the 
standpoint  of  the  combined  city-county  health  dis- 
trict, and  Dr.  R.  H.  Markwith,  health  commis- 
sioner of  Summit  County,  from  the  standpoint  of 
the  county  health  district.  A review  of  the  spe- 
cial rural  health  project  now  being  carried  on  in 
Hocking  County  will  be  presented  by  Dr.  W.  B. 
Lacock,  health  commissioner  of  Logan  and  Hock- 
ing County. 

Additional  events  and  addresses  are  being 
planned  but  have  not  been  decided  upon  definitely. 
The  regular  annual  buiness  meeting  of  the  Ohio 
Federation  of  Public  Health  Officials  will  be  held 
at  7:30  p.m.,  Thursday. 


Dm  EL  P»  Belli,  Cleveland,  Leads  Field  oiF  Medical  Golfers  in 
• Thirteenth  Annual  Tournament  at  Akron  on  September  6 • 


The  Thirteenth  Annual  Tournament  of  The 
Ohio  State  Medical  Golfers’  Association  was  held 
at  the  Portage  Country  Club  on  Wednesday,  Sep- 
tember 6, 1933.  It  was  a perfect  day  for  golf,  with 
a cloudless  sky  and  a gentle  breeze  to  temper  the 
effect  of  a burning  sun.  The  beautiful  course 
nestled  amidst  gently  rolling  hills,  with  well- 
placed  bunkers  and  sand  traps  and  velvet  greens, 
lured  a field  of  over  110  golfers  for  the  day’s  play. 

Dr.  R.  P.  “Dick”  Bell  of  Cleveland,  is  the  new 
“king”  of  Ohio’s  physician  golfers.  He  corralled 
a 76  in  the  morning  and  added  a 78  for  the  after- 
noon play  to  make  a total  of  154  strokes  for  the 
36-hole  medal  play  competition.  As  his  score  in- 
dicates, Dr.  Bell  played  excellent  golf  to  win  the 
much  coveted  Championship  Trophy.  In  winning 
the  championship.  Dr.  Bell  dethroned  Dr.  L.  M. 
Otis,  Celina,  who  captured  the  title  last  year  at 
Dayton. 

Dr.  J.  J.  Marek  of  Cleveland,  took  second  place 
with  a gross  score  of  159,  while  third  place  went 
to  Dr.  E.  C.  Banker,  Akron,  with  a card  of  161 
for  the  36  holes  of  play.  Dr.  A.  K.  Buell,  Colum- 
bus, came  through  with  a score  of  166  to  take 
fourth  place. 

The  Association  Handicap  Trophy  for  the 
lowest  27-hole  net  score  was  won  by  Dr.  H.  M. 
Schuffell,  Canton,  who  was  tied  with  Dr.  J.  F. 
Wright,  Toledo,  both  scoring  104.  A coin  was 
flipped  to  decide  the  winner.  Third  place  went  to 
Dr.  T.  H.  Brown  of  Toledo,  with  a net  score  of 


105.  Dr.  A.  W.  Carley,  Dayton,  with  a score  of 

106,  took  fourth  place. 

The  President’s  Trophy,  presented  by  Dr.  J.  P. 
DeWitt,  and  awarded  for  the  low  net  score  for  the 
first  18  holes  of  play,  was  won  by  Dr.  A.  H.  Reed, 
Cleveland,  with  a score  of  69.  This  event  was 
limited  to  players  with  a handicap  of  18  or  under. 

Dr.  R.  W.  Nosker,  Columbus,  won  the  prize 
awarded  for  the  low  gross  score  for  the  first  18 
holes  of  play,  while  second  place  in  this  event 
went  to  Dr.  A.  V.  Boysen  of  Cleveland. 

The  Cleveland  golfing  delegation  won  the  team 
championship  and  the  Team  Championship 
Trophy  presented  by  Dr.  John  T.  Murphy,  Toledo, 
when  five  Cleveland  golfers  posted  the  lowest  ag- 
gregate low  gross  score  or  the  36  holes. 

Other  events  and  prize  winners  were  as  follows : 

Low  Net,  Second  18  Holes — (1.)  Dr.  Chas. 
Lukens,  Toledo;  (2.)  Dr.  R.  O.  Ruch,  Lima; 

Low  Gross,  Second  18  Holes — (1.)  Dr.  E.  Gil- 
lespie, Canton;  (2.)  Dr.  C.  A.  Hyer,  Columbus; 

Low  Net,  First  9 Holes — (1.)  Dr.  G.  H.  Lewis, 
Cleveland;  (2.)  Dr.  J.  P.  DeWitt,  Canton; 

Low  Gross,  First  9 Holes — (1.)  Dr.  F.  T.  Gal- 
lagher, Cleveland;  (2.)  Dr.  E.  E.  Gaver,  Co- 
lumbus; 

Low  Gross,  Second  9 Holes — (1.)  Dr.  R.  W. 
Hancock,  Elyria;  (2.)  Dr.  Wm.  A.  Welsh,  Youngs- 
town ; 

Low  Net,  Second  9 Holes — (1.)  Dr.  R.  H.  Mc  - 
Kay, Akron;  (2.)  Dr.  J.  B.  Morgan,  Cleveland; 


October,  1933 


Annual  Meeting 


661 


Low  Gross,  Third  9 Holes — (1.)  Dr.  L.  J.  Car- 
son,  Cleveland;  (2.)  Dr.  C.  S.  Palmer,  Beach  City; 

Low  Net,  Third  9 Holes — (1.)  Dr.  F.  C.  Ander- 
son, Mt.  Vernon;  (2.)  Dr.  G.  S.  Hackett,  Canton; 

Grand-Dad’s  Prize  (Low  Gross,  27  Holes, 
Players  over  50  Years  of  Age.)  — (1.)  Dr.  E.  C. 
Yingling,  Lima;  (2.)  Dr.  J.  B.  Sampsell,  Van 
W ert ; 

High  Gross  Championship,  27  Holes — (1.)  Dr. 
H.  H.  Dorr,  Columbus;  (2.)  Dr.  R.  E.  Amos, 
Akron;  (3.)  Dr.  E.  J.  Humel,  Cleveland; 

Most  7’s — Dr.  R.  E.  Amos,  Akron; 

Nearest  to  Hole  on  No.  17 — Dr.  E.  Gillespie, 
Canton ; 

Most  Strokes  on  No.  9 Hole— Dr.  G.  H.  Heller, 
Akron,  and  Dr.  H.  H.  Dorr,  Columbus; 

Nearest  to  Hole  on  No.  3 — Dr.  W.  E.  Dwyer, 
Cleveland. 

Officers  elected  for  the  coming  year  at  the  an- 
nual golf  banquet  are  as  follows:  President,  Dr. 
F.  C.  Haney,  Columbus;  First  Vice-President,  Dr. 
J.  F.  Wright,  Toledo;  Second  Vice-President,  Dr. 
C.  F.  Wharton,  Akron ; Third  Vice-President,  Dr. 
F.  C.  Anderson,  Mt.  Vernon;  Fourth  Vice-Presi- 
dent, Dr.  W.  E.  Dwyer,  Cleveland;  Fifth  Vice- 
President,  Dr.  E.  Gillespie,  Canton;  Secretary- 
Treasurer,  Dr.  J.  B.  Morgan,  Cleveland. 

In  many  respects  the  Akron  tournament  was 
one  of  the  best  in  the  history  of  the  Golfers’  As- 
sociation for  which  credit  is  due  Dr.  J.  L.  Mc- 
Evitt  and  his  active  Akron  committee  on  local 
arrangements;  Dr.  J.  P.  DeWitt,  Canton,  retiring 
president  of  the  Golfers’  Association;  Dr.  John  B. 
Morgan,  Cleveland,  perennial  secretary  of  the  or- 
ganization, and  Henry  Gerber,  executive  secretary 
of  the  Toledo  Academy  of  Medicine,  who  handled 
details  and  paper  work  in  connection  with  the 
tournament,  served  as  official  starter  and  scorer, 
and  general  handy-man  to  the  tournament  com- 
mittee. 

Following  are  the  gross  scores  and  handicaps 
of  the  players  participating  in  the  tournament: 


First 

Second 

Handi- 

Name 

Nine 

Nine 

Cap 

Dallas  Pond,  Akron  ...  ..  . 

. 56 

47 

20 

47 

56 

O.  H.  Schettler,  Mansfield 

. 46 

44 

19 

50 

47 

R.  C.  Wise,  Mansfield 

. 44 

48 

15 

47 

48 

T.  K.  Moore,  Akron  _ ..  

. 54 

51 

25 

52 

56 

John  S.  Lewis,  Jr.,  Youngstown .. 

. 48 

41 

9 

48 

45 

E.  C.  Goldcamp,  Youngstown  

. 48 

48 

17 

48 

47 

C.  F.  Wharton,  Akron 

. 44 

40 

12 

47 

44 

J.  F.  Docherty,  Conneaut  

. 48 

44 

12 

45 

45 

F.  E.  Mahla,  Marion 

. 50 

46 

12 

46 

47 

E.  L.  Brady,  Marion 

. 52 

43 

12 

54 

43 

E.  H.  Morgan,  Marion  

. 53 

55 

17 

51 

50 

Perry  King,  Alliance 

. 53 

47 

16 

56 

49 

M.  R.  Kellum,  Cleveland  

. 43 

49 

14 

49 

43 

L.  C.  Thomas,  Lima  ...  - 

. 43 

48 

14 

52 

41 

Frei  C.  Calloway,  Marysville  ....  

. 47 

44 

22 

48 

43 

First 

Second 

Name 

Nine 

Nine 

R.  B.  Wynkoop,  Ashtabula. 

44 

48 

52 

50 

J.  V.  Heimann,  Cleveland 

45 

44 

50 

44 

G.  T.  Bauman,  Cleveland...  . _ 

45 

46 

56 

51 

J.  E.  Talbott,  Lima 

51 

49 

49 

48 

R.  O.  Ruch,  Lima  ...  ...  ..  . 

45 

41 

45 

41 

E.  J.  Curtiss,  Lima..  ...  ..  . ..  .. 

48 

45 

46 

49 

C.  S.  Palmer,  Beach  City 

48 

43 

41 

46 

47 

42 

45 

46 

Chas.  Lukens,  Toledo 

50 

47 

48 

43 

A.  W.  Carley,  Dayton.  ....  . 

45 

48 

50 

45 

G.  L.  Sackett,  New  Philadelphia 

52 

49 

51 

46 

R.  J.  Foster,  New  Philadelphia 

54 

49 

56 

49 

M.  W.  Everhard,  New  Philadelphia 

48 

50 

53 

48 

D.  A.  Prendergast,  Cleveland ... 

53 

42 

49 

R.  L.  Solt,  Bucyrus.  .. 

54 

48 

46 

53 

R.  C.  Mauger,  Newark 

48 

43 

56 

48 

S.  Morgenroth,  Akron ...  . ...  . 

49 

44 

46 

43 

J.  L.  McEvitt,  Akron.. 

44 

43 

45 

45 

H.  V.  Paryzek,  Cleveland—  . 

52 

50 

57 

55 

G.  H.  Lewis,  Cleveland ..  ... 

44 

57 

54 

52 

J.  B.  Sampsell,  Van  Wert..  _ ... . . .. 

46 

44 

44 

46 

R.  P.  Bell.  Cleveland.  . 

38 

38 

39 

39 

A.  C.  Smith,  Wooster  ..  

52 

46 

t 

48 

45 

Allen  N.  Wiseley,  Lima 

47 

53 

56 

44 

E.  Gillespie,  Canton ...  . 

45 

48 

40 

40 

S.  B.  Berkley,  No.  Canton..  ...  .. 

39 

41 

43 

44 

L.  M.  Otis,  Celina .. 

43 

41 

44 

42 

E.  P.  McNamee,  Cleveland 

43 

43 

42 

48 

G.  S.  Hackett,  Canton 

49 

46 

43 

43 

J.  P.  DeWitt,  Canton ..  

47 

47 

46 

— 

C.  D.  Waltz,  Cleveland 

47 

44 

52 

46 

W.  E.  Dwyer,  Cleveland 

47 

46 

49 

50 

J.  R.  Ripton,  Cleveland  

53 

51 

59 

59 

Frank  Kunz,  Akron ....  

52 

52 

54 

54 

E.  M.  Kauffman,  Kent . 

49 

42 

49 

50 

John  D.  Knox,  Warren 

46 

44 

43 

45 

Valloyd  Adair,  Lorain 

52 

45 

49 

48 

Ed.  J.  Novotny,  Lorain 

45 

45 

45 

42 

D.  Thomas,  Lorain  . ....  — 

48 

46 

44 

43 

A.  K.  Buell,  Columbus 

43 

41 

41 

41 

L.  Mark,  Columbus _ — . . . 

51 

44 

48 

42 

R.  W.  Nosker,  Columbus . ...  . 

42 

41 

44 

44 

W.  W.  Sauer,  Marietta . . 

47 

43 

46 

44 

T.  R.  Fletcher,  Columbus  ... _ 

47 

56 

53 

46 

H.  H.  Dorr,  Columbus  ..  „ ...  . ...  -.. 

59 

61 

61 

57 

A.  H.  Reed,  Cleveland  ...  

45 

44 

44 

43 

J.  J.  Marek,  Cleveland  

41 

38 

43 

37 

R.  W.  Hancock,  Elyria  

45 

39 

50 

40 

E.  C.  Banker,  Akron 

39 

39 

41 

42 

H.  M.  Schuffell,  Canton  

44 

43 

41 

45 

Handi- 

cap 

IS 

15 

18 

18 

15 

16 
9 

10 

24 

20 

24 

16 

18 

16 

20 

18 

12 

10 

20 

20 

15 
2 

14 

19 
12 
10 
10 

8 

20 

24 
18 

16 

25 

24 
21 
16 

15 

14 

15 
7 

7 

10 

14 

25 
24 
18 

8 

13 

8 

1G 


H.  M.  Schuffell,  Canton 


662 


The  Ohio  State  Medical  Journal 


October,  1933 


First 

Second 

Handi- 

Name 

Nine 

In  me 

Cap 

49 

53 

26 

51 

47 

......  47 

46 

20 

52 

46 

55 

53 

28 

63 

52 

63 

49 

18 

58 

45 

50 

51 

18 

45 

49 

45 

49 

20 

.....  53 

43 

21 

54 

50 

25 

47 

.......  45 

43 

12 

47 

43 

46 

49 

16 

44 

45 

15 

48 

.....  56 

53 

26 

55 

54 

54 

25 

50 

47 

18 

A.  J.  Keeley,  Akron 

51 

46 

18 

G.  H.  Heller,  Akron 

57 

57 

26 

48 

68 

50 

47 

19 

50 

61 

25 

54 

51 

18 

54 

46 

47 

18 

48 

R.  V.  Luce,  Akron  — 

52 

51 

25 

L.  W.  King,  Salem 

54 

46 

18 

48 

42 

12 

49 

48 

18 

46 

53 

12 

Wm.  A.  Welsh,  Youngstown  

46 

40 

44 

40 

4 

S.  W.  Boesel,  Niles . — 

47 

46 

44 

40 

9 

60 

58 

25 

54 

53 

C.  A.  Hyer,  Columbus 

48 

38 

8 

44 

38 

42 

45 

12 

42 

48 

50 

42 

18 

47 

51 

44 

39 

10 

47 

40 

42 

45 

10 

43 

43 

46 

50 

41 

46 

10 

48 

51 

22 

43 

43 

42 

44 

10 

42 

43 

J.  F.  Wright,  Toledo 

50 

43 

26 

46 

49 

45 

46 

22 

47 

44 

42 

41 

6 

41 

38 

Northwestern  Ohio  Medical  Meeting, 
Tiffin,  October  3 

Annual  Meeting  of  the  Northwestern  Ohio 
Medical  Association  will  be  held  October  3 at 
Tiffin,  preceded  by  a golf  tournament  on  October 
2 at  the  Mohawk  Country  Club. 

The  morning  and  afternoon  sessions  of  the 
meeting  will  consist  of  scientific  addresses  pre- 
sented by  Dr.  Donald  Putnam  Abbott,  professor 
of  internal  medicine,  Rush  Medical  College;  Dr. 
John  W.  Carmack,  professor  of  otolaryngology, 
University  of  Indiana;  Dr.  George  M.  Curtis,  pro- 


fessor of  surgery,  Ohio  State  University;  Dr. 
Carol  S.  Wright,  professor  of  dermatology  and 
syphilology,  Temple  University;  Dr.  Phillip 
Lewin,  professor  of  orthopedics,  Northwestern 
University;  Dr.  D.  C.  McKenney,  professor  of 
proctology,  University  of  Buffalo;  and  Dr.  John 
D.  Camp,  department  of  roentgenology,  Mayo 
Clinic. 

Dr.  Geo.  Edw.  Follansbee,  Cleveland,  chairman 
of  the  Judicial  Council  of  the  American  Medical 
Association,  will  address  the  evening  session.  Dr. 
Follansbee  will  discuss  the  work  and  views  of  the 
Committee  on  the  Costs  of  Medical  Care. 

Reservations  for  the  golf  tournament  are  being 
handled  by  Dr.  R.  F.  Machamer,  Tiffin. 


Francis  L.  Landacre,  aged  66,  for  many  years 
chairman  of  the  department  of  anatomy,  Ohio 
State  University,  died  August  23  at  his  home  in 
Columbus.  Dr.  Landacre  graduated  from  Ohio 
State  University  in  1895  and  received  his  Ph.D. 
degree  from  the  University  of  Chicago  in  1914. 
He  was  a member  of  the  faculty  of  old  Starling 
Medical  College  and  also  had  taught  at  the  Uni- 
versity of  California.  Dr.  Landacre  had  written 
extensively  on  biology  and  was  a nationally  known 
anatomist.  He  was  president  of  the  Ohio  Acad- 
emy of  Science  from  1917  to  1919  and  was  a mem- 
ber of  Sigma  Xi,  American  Association  of  Anato- 
mists, American  Society  of  Zoologists  and  the 
American  Association  for  the  Advancement  of 
Science.  He  served  as  secretary  of  the  College 
of  Medicine  at  the  university.  His  widow,  two 
daughters  and  one  brother  survive. 


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Papers  prepared.  Experience  with  leading  medical  journals, 
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Wanted — Physician  at  Windsor,  Ohio.  Good  pay,  good 
roads.  Large  country  practice,  forty  miles  from  Cleveland. 
Address  L.  C.  A.,  care  Ohio  State  Medical  Journal. 


For  Sale — In  the  heart  of  Santa  Cruz  mountains,  a beauti- 
fully furnished  house  and  office  combined.  Wonderful  view 
of  adjoining  country ; lovely  garden  surrounds  this  well 
situated  place.  After  20  years  here,  retiring  because  of  age. 
Only  doctor  in  the  town.  Write  W.  A.  Phillips,  M.D.,  Ben 
Lomond,  California. 


Opportunity — Cedarville,  Ohio.  Established  practice  as- 
sured. College  town  of  1100  ; large  country  radius.  Rent  or 
buy  modern  residence  and  office  combined.  Present  physician 
will  specialize  in  another  town.  For  particulars  address  A. 
Winter,  10  Broadwell  Place,  Dayton,  Ohio. 


Wanted — Position  in  physician’s  office.  Two  years  train- 
ing in  hospital,  also  office  experience.  Good  references. 
Address,  W.  L.  M.,  care  Ohio  State 1 Medical  Journal. 


For  Sale — Northwestern  Ohio,  excellent  location.  Ownrr 
deceased.  Address  B.  M.,  care  Ohio  State  Medical  Journal. 


snsation  to 


State  amd  Local  Governments 


Under  the  recently  revised  Federal  Relief  Pro- 
gram which  authorizes  use  of  a part  of  Federal 
relief  funds  for  medical,  nursing  and  dental  care 
of  the  sick  and  destitute  unemployed  persons,  Ohio 
will  receive  Federal  funds  amounting  to  approxi- 
mately $167,000  maximum  per  month,  or  a con- 
templated total  of  $2,000,000  or  more  for  the  en- 
suing 12-months  period,  for  use  in  the  various 
political  subdivisions  to  compensate  physicians, 
nurses  and  dentists  who  render  services  to  those 
who  are  already  the  beneficiaries  of  other  “relief” 
benefits. 

Regulations  governing  the  expenditure  in  Ohio 
of  Federal  funds  for  medical,  nursing  and  dental 
care  have  been  formulated  by  the  Ohio  Relief 
Commission  and  are  based  for  the  most  part  on 
new  regulations  issued  by  Harry  L.  Hopkins, 
Federal  Emergency  Relief  Administrator. 

As  pointed  out  in  an  article  on  the  subject  of 
medical  care  for  the  indigent  sick  in  the  August, 
1933,  issue  of  The  Ohio  State  Medical  Journal,  the 
Ohio  Relief  Commission  has  been  cooperating 
with  the  State  Department  of  Health  and  officials 
of  the  Ohio  State  Medical  Association  in  an  effort 
to  devise  plans  for  compensation  to  physicians 
who  render  medical  and  surgical  services  to  those 
on  the  relief  rolls. 

The  newest  regulations  formulated  by  the  Ohio. 
Relief  Commission  to  govern  the  expenditure  of 
the  Federal  money  recently  allotted  to  Ohio  for 
the  medical  phases  of  poor  relief,  according  to 
official  announcement,  seek  to  improve  conditions 
of  service  for  the  unemployed,  the  professions, 
and  the  relief  officials  under  the  immediate  super- 
vision of  which  the  needy  sick  are  cared  for. 

Problems  and  details  peculiar  to  each  commu- 
nity are  expected  to  be  worked  out  jointly  by  local 
officials  with  representatives  of  the  county  medi- 
cal societies  and  academies  of  medicine,  based  on 
general  instructions  from  the  Ohio  Relief  Com- 
mission to  local  officials  and  local  relief  commit- 
tees. 

AVAILABLE  WHEN  LOCAL  FUNDS  EXHAUSTED 

The  plan  of  procedure  and  the  disbursements  in 
Ohio  of  Federal  funds  for  medical  care  contem- 
plate that  such  funds  are  not  to  be  used  for  medi- 
cal care  and  public  health  work  that  had  normally 
been  carried  on  by  the  counties  and  cities,  but 
that  the  Ohio  Relief  Commission  will  assume  that 
portion  of  the  expense  for  medical  care  within  the 
appropriations  and  distribution  permissible  to 
each  community  in  need  which  has  been  brought 
about  directly  as  a result  of  unemployment,  and 
then  only  where  local  funds  for  these  purposes 
have  been  exhausted. 


As  stated  in  the  August  issue  and  in  previous 
issues  of  The  Journal,  the  Ohio  Relief  Commis- 
sion believes  the  furnishing  of  medical  care  for 
the  indigents  is  an  obligation  and  function  of 
townships,  counties  and  cities  at  all  times,  even  in 
normal  periods,  and  that  adequate  local  provision 
must  be  made  for  such  activities  as  long  as  local 
funds  are,  or  can  be  made,  available.  Money  for 
such  relief  work  may  be  obtained  locally,  the  com- 
mission has  pointed  out,  from  the  general  revenue 
fund,  issuance  of  special  poor  relief  bonds,  the 
local  prroportion  of  excise  tax  on  public  utilities, 
and  diversion  of  gasoline  taxes. 

When  local  funds  have  been  exhausted  and  no 
additional  local  revenue  is  available  for  medical 
poor  relief  activities,  the  Ohio  Relief  Commission 
will  authorize,  in  communities  where  such  condi- 
tions exist,  the  use  of  Federal  funds  for  carrying 
on  such  activities.  The  state  administration  real- 
izes, the  commission  has  pointed  out,  that  the 
medical  profession  of  Ohio  has  been  carrying  an 
unfair  burden  in  this  emergency  of  widespread 
unemployment  and  is  entitled  to  compensation  for 
services  to  beneficiaries  of  other  “relief”  activi- 
ties. To  meet  this  situation  in  communities  where 
local  funds  have  been  exhausted,  the  commission 
will  permit  the  use  of  Federal  money  which  has 
now  been  made  available. 

HOME  AND  OFFICE  CALLS  COVERED 

Under  the  rules  and  regulations  drafted  by  the 
commission,  the  use  of  Federal  relief  money  for 
medical  care  is  limited  to  service  in  the  home  or 
office  call.  Federal  funds  cannot  be  used  to  pay 
hospital  bills  or  for  treatment  in  nursing  homes 
or  clinics.  Office  service  for  ambulatory  patients 
is  permitted,  on  the  understanding  that  it  shall 
not  supplant  the  services  of  clinics  already  pro- 
vided in  the  community. 

Proposed  standard  agreements  between  relief 
officials  and  physicians  under  the  regulations  pro- 
vide for  attendance  of  not  more  than  two  weeks 
or  ten  visits  in  cases  of  acute  illness  and  not 
more  than  one  visit  a week  for  a period  not  ex- 
ceeding two  or  three  months  in  chronic  cases. 
Cases  requiring  more  protracted  calls  of  greater 
frequency  will  be  subject  to  reinvestigation  by  the 
local  emergency  relief  administration. 

In  obstetrical  cases,  provision  is  made  for  pre- 
natal and  postnatal  care,  and  exercise  of  “due 
caution”  that  undue  risk  be  not  involved  to  pa- 
tients for  whom  hospital  care  may  be  imperative. 

Other  and  special  cases  and  medical  and  nurs- 
ing care,  not  included  in  the  standard  procedure, 
may  be  made  the  subject  of  special  agreements  in 


663 


664 


The  Ohio  State  Medical  Journal 


October,  1933 


harmony  with  the  general  policy  laid  down  by  the 
administration. 

GENERAL  POLICY  IS  OUTLINED 

The  “essence  of  such  a policy”  is  declared  to 
be,  on  the  part  of  the  relief  administration,  rec- 
ognition of  the  traditional  family  and  family- 
physician,  physician-nurse,  and  dentist-patient  re- 
lationship in  the  authorization  of  medical,  nurs- 
ing and  emergency  dental  care  of  indigent  per- 
sons in  their  homes,  and  agreement  by  the  physi- 
cian, nurse  and  dentist  to  “furnish  the  same  type 
of  service  as  would  be  rendered  to  a private  pa- 
tient, at  a minimum  consistent  with  good  profes- 
sional judgment,  and  an  agreed  rate  which  makes 
due  allowance  for  conservation  of  relief  funds”. 

“The  common  aim”,  the  regulations  state, 
“should  be  the  provision  of  good  medical  service 
at  a low  cost — to  the  mutual  benefit  of  indigent 
patient,  physician,  nurse,  dentist,  and  taxpayer”. 

In  the  application  of  the  new  regulations  gov- 
erning medical  relief  activities,  the  Ohio  Relief 
Commission  announces  that  the  same  general 
policy  will  apply  that  governs  the  use  of  all  state 
and  Federal  funds  for  emergency  relief,  includ- 
ing: 

(a)  Each  case  involved  must  he  entitled  to 
emergency  relief  based  upon  adequate  investiga- 
tion, and  in  no  case  does  this  service  apply  to  in- 
stitutional care  or  the  normal  health  program  of 
the  subdivision. 

(b)  Medical,  service  to  be  paid  from  state  or 
Federal  funds  must  be  limited  to  calls  of  the 
physician  in  the  office  or  the  home  of  the  family 
receiving  relief,  and  for  actual  medicine  and 
medical  supplies  for  the  family  receiving  relief. 

(c)  Where  the  subdivisions  have  regularly  em- 
ployed physicians  on  a salary  or  fee  basis,  state 
or  Federal  funds  cannot  be  used  to  replace  this 
service. 

FREE  CHOICE  OF  PHYSICIAN  PRESERVED 

The  plan  of  procedure,  with  the  purpose  of 
preserving,  as  far  as  possible,  the  free  choice  of 
physician  by  the  patient,  includes  the  following: 

(a)  The  County  Relief  Director,  or  if  a city  is 
disbursing  state  or  Federal  funds  independent  of 
the  county,  the  proper  city  official  should  an- 
nounce the  plan  to  the  county  medical  society. 
Each  local  physician  that  is  willing  to  serve  fam- 
ilies receiving  relief  shall  be  given  the  opportu- 
nity to  register  with  the  County  Relief  Director, 
or  the  proper  city  official. 

(b)  The  relief  office  will  issue  a medical  order 
blank  to  the  family,  and  the  family  will  be  per- 
mitted to  select  a physician  from  the  registered 
list  at  relief  headquarters.  Only  in  cases  of 
emergency  will  families  be  permitted  to  call  a 
physician  before  securing  a medical  order  blank 
from  relief  officials;  and  then  in  each  case  an 
order  must  be  secured  before  the  second  visit. 


(c)  Physicians  registering  must  agree  to  sub- 
mit itemized  bills  regularly  to  the  local  relief  offi- 
cials. 

SCHEDULE  APPLIES  ONLY  TO  U.  S.  FUNDS 

In  order  to  conserve  the  funds  made  available, 
the  regulations  provide  for  a standard  medical 
fee  schedule,  to  be  applied  only  where  the  expendi- 
ture of  Federal  funds  is  involved  and  is  not  in- 
tended to  supplant  present  financial  a7rangements 
between  relief  officials  and  physicians  in  commu- 
nities that  are  carrying  on  medical  relief  activi- 
ties suppo7’ted  by  local  funds. 

A differential  in  fees  between  home  and  office 
visit  is  established  in  the  fee  schedule  drafted  by 
the  Ohio  Relief  Commission.  All  fees  are  estab- 
lished, as  suggested  in  the  Federal  regulations 
governing  the  use  of  Federal  funds  for  medical 
care,  on  the  basis  of  an  appreciable  reduction 
from  the  prevailing  minimum  charges  for  similar 
services  in  the  state  and  local  communities  as  a 
part  of  the  emergency  relief  program  applying 
only  to  those  definitely  in  need  and  already  re- 
ceiving other  relief  benefits. 

In  this  connection  and  as  a part  of  the  inter- 
pretation by  the  Ohio  Relief  Commission  of  the 
rules  and  regulations  which  have  been  formulated, 
it  is  emphasized  that  the  fee  schedule  governing 
the  expenditure  of  Federal  funds  shall  apply  only 
in  those  cases  of  the  needy  sick  who  are  already 
receiving  other  benefits  from  relief  funds  and 
where  provision  has  not  been  made  otherwise 
locally  for  the  care  of  such  needy  sick;  and  that 
the  fees  are  not  intended  to  establish  such  low 
rates  in  ordinary  medical  practice.  In  other 
words,  the  commission  wants  it  clearly  under- 
stood that  in  setting  up  a fee  schedule  to  govern 
the  expenditure  in  Ohio  of  Fedei’al  funds  for 
medical  services,  it  is  not  intending  to  establish 
or  suggest  any  fee  schedule  for  ordinary  private 
practice  or  for  the  expenditure  of  local  medical 
relief  funds.  The  Ohio  Relief  Commission  states 
that  it  believes  the  fee-schedule  plan  will  insure 
certainty,  simplicity  and  promptness  in  the  pay- 
ment of  medical  bills  for  services  to  the  indigent 
and  that  the  fee  schedule,  while  inadequate,  should 
insure  some  compensation  to  physicians  who  have 
been  rendering  medical  care  to  the  needy  sick 
without  any  compensation. 

MINIMUM  FEES  PROVIDED  IN  SCHEDULE 

The  fee  schedule  formulated  by  the  Ohio  Relief 
Commission  for  the  expenditure  of  Federal  funds 
is  as  follows: 

(a)  For  all  office  calls,  the  rate  shall  not  ex- 
ceed fifty  cents  (50c)  per  call,  plus  the  actual  cost 
to  the  physician  of  supplies  used. 

(b)  For  all  house  calls  made  within  the  village 
or  city  limits,  the  rate  shall  not  exceed  one  dollar 
($1.00)  per  call. 

(c)  For  all  calls  outside  the  village  or  city 
limits,  the  rate  shall  be  one  dollar  ($1.00)  for  each 
call  plus  mileage  at  the  rate  of  twenty-five  cents 


October,  1933 


State  News 


665 


(25c)  per  mile  from  the  village  or  city  limits — 
the  maximum  charge  for  any  call  to  be  two  dollars 
($2.00),  including  mileage  allowance. 

(d)  To  eliminate  unnecessary  mileage,  calls 
must  be  grouped  by  days  and  trips.  This  applies 
to  all  calls  other  than  emergency  calls. 

(e)  All  medicine  and  medical  supplies  fur- 
nished by  the  attending  physician  shall  be  billed 
at  actual  cost  price  rather  than  by  prescription 
through  druggists. 

(f)  Obstetrics: 

1.  Normal  delivery — $20.00. 

2.  Instruments,  repairs  or  extra  time  ex- 
ceeding 12  hours — $5.00.  This  $5.00 
additional  for  any  one  or  all  of  the 
three,  but  not  for  more  than  one. 

(g)  Specialists: 

1.  In  all  emergencies  requiring  the  as- 
sistance of  a specialist,  such  as  eye, 
ear,  nose,  throat,  surgeon,  dentist  or 
nurse,  same  will  be  called  only  on  the 
recommendation  of  the  physician  in 
attendance  who  has  seen  the  patient 
in  his  home  or  at  the  physician’s  of- 
fice, 

(h)  Workmen’s  Compensation  Medical  Fee 

Schedule: 

1.  The  Ohio  Industrial  Commission  gen- 
eral and  special  fee  schedules  for 
medical  and  surgical  services  shall 
apply  in  cases  not  covered  by  ordinary 
house  calls  as  stipulated  above. 

(i)  Health  Departments: 

1.  Health  departments  shall  examine 
free  of  charge  all  relief  children  upon 
entering  school. 

(j)  The  above  schedule  on  the  allotment  of 
Federal  funds  will  be  followed  within  the  limits 
of  the  budget  allowed  each  subdivision  for  medi- 
cal service.  Each  political  subdivision  will  be 
allowed  medical  services  in  accordance  with  the 
schedule  in  an  amount  equal  to  not  more  than 
$1.00  per  family  per  month  of  the  total  case  load 
of  the  subdivision  in  accordance  with  the  regula- 
tions of  the  State  Relief  Commission. 

LOCAL  CONFERENCES  IMPERATIVE 

When  this  article  was  written,  and  before  the 
date  of  publication,  arrangements  were  already 
being  made  in  some  communities  for  conferences 
by  the  officials  of  the  county  medical  societies  and 
local  relief  officials  in  an  effort  to  work  out  prac- 
tical local  plans  in  accordance  with  the  general 
provisions  and  regulations. 

It  is  highly  important  that  the  officials  of  all 
county  medical  societies  and  academies  of  medicine 
familiarize  themselves  with  the  rules  and  regula- 
tions formulated  by  the  Ohio  Relief  Commission. 
These  will  be  in  printed  form  and  will  be  avail- 
able from  local  relief  administrators. 

Officers  of  all  county  medical  societies  should 
confer  with  local  relief  officials  in  drafting  a pro- 


gram to  meet  local  needs  and  situations  and 
should  insist  that  such  officials  give  due  consid- 
eration to  medical  ca/re  and  compensation  thereof, 
and  that  where  local  funds  have  been  exhausted 
for  this  purpose  they  should  arrange  apportion- 
ment of  the  Federal  funds  available  for  medical 
care. 

It  will,  of  course,  be  the  purpose  of  officers  of 
the  State  Medical  Association  and  the  headquar- 
ters office  to  keep  in  close  touch  with  the  Ohio 
Relief  Commission  and  the  State  Department  of 
Health  in  an  effort  to  make  general  suggestions 
and  to  straighten  out  difficulties  which  may  arise 
locally  and  which  might  require  solution  by  state 
or  Federal  authorities. 


Clarence  Beekley,  M.D.,  Cincinnati;  Miami  Med- 
ical College,  Cincinnati,  1901;  aged  56;  died  Sep- 
tember 11.  Dr.  Beekley  was  a native  of  Cincin- 
nati and  had  practiced  there  since  his  graduation 
from  medical  college.  He  served  as  a captain  in 
the  medical  corp  during  the  World  War  and  was 
a member  of  the  American  Legion  and  the  Knights 
of  Columbus.  Surviving  ai’e  two  smis. 

Henry  B.  Bertolette,  M.D.,  Shreve;  University 
of  Pennsylvania,  Medical  School,  1892;  aged  66; 
died  August  10  of  acute  indigestion.  Dr.  Berto- 
lette was  born  and  reared  at  Shreve.  He  was  a 
Spanish  War  veteran  and  during  the  World  War, 
he  served  overseas  with  the  37th  Division,  holding 
the  x*ank  of  lieutenant  colonel  in  the  medical 
corps.  He  was  a member  of  the  American  Legion 
and  various  masonic  bodies.  His  widow  and  one 
daughter  survive. 

Albert  M.  Bleile,  M.D.,  Columbus;  Starling 
Medical  College,  Columbus,  1876;  aged  77;  hon- 
orary member  of  the  Columbus  Academy  of 
Medicine;  died  August  17  of  heart  disease.  Dr. 
Bleile  was  professor  emeritus  of  physiology  at 
Ohio  State  University,  having  served  40  years  as 
head  of  that  department.  He  was  in  active  prac- 
tice 12  years  before  becoming  affiliated  with  the 
university.  Dr.  Bleile  was  a member  of  the 
American  Physiological  Society,  the  Association 
for  the  Advancement  of  Science,  the  Columbus 
Club  and  the  Maennerchor.  Two  daughters  sur- 
vive. 

Charles  A.  Bray,  M.D.,  Toledo  ; Medical  College 
of  Fort  Wayne,  Indiana,  1881;  aged  80;  died 
August  24  following  an  extended  illness.  Dr. 
Bray  was  born  at  Chagrin  Falls  and  practiced  for 
a time  at  Grover  Hill  before  locating  in  Toledo 
about  25  years  ago.  He  leaves  one  son  and  eight 
daughters. 

Harvey  H.  Carter,  M.D.,  Dayton;  Medical  Col- 


666 


The  Ohio  State  Medical  Journal 


October,  1933 


lege  of  Ohio,  Cincinnati,  1889;  aged  68;  former 
member  of  the  Ohio  State  Medical  Association  and 
the  American  Medical  Association;  died  August 
17  of  strangulated  hernia.  Dr.  Carter  practiced 
in  Cuba,  Ohio,  and  Hamilton  before  he  enlisted 
in  the  medical  corps  during  the  Spanish-American 
War.  Following  the  war  he  opened  an  office  in 
West  Alexandria,  and  later  in  Columbus,  moving 
to  Dayton  in  1914.  He  was  a member  of  the 
Masonic  Lodge  and  the  Knights  of  Pythias.  He 
leaves  one  daughter  and  one  brother,  Dr.  J.  L. 
Carter,  Dayton. 

Emory  L.  Dial,  M.D.,  Cleveland;  Western  Re- 
serve University,  School  of  Medicine,  1898;  aged 
67 ; died  August  25.  He  leaves  his  widow,  four 
sons,  Dr.  Robert  J.  and  Dr.  Ralph  S.  of  Cleveland; 
Dr.  Donald  E.  Dial,  of  New  Haven,  Conn.,  Dr. 
David  L.  Dial,  Lancaster,  Pa.,  and  one  daughter, 
Dr.  Elizabeth  Spreng,  Cleveland. 

Robert  B.  Drury,  M.D.,  Columbus;  Ohio  State 
University,  College  of  Medicine,  1908;  aged  65; 
member  of  the  Ohio  State  Medical  Association  and 
a Fellow  of  the  American  Medical  Association ; 
died  of  heart  disease,  August  19.  Dr.  Drury,  a 
native  of  Columbus,  was  for  15  years  chief  of 
staff  and  consulting  surgeon  at  the  Franklin 
County  Tuberculosis  Hospital.  At  the  time  of  his 
death,  he  was  chief  of  the  surgical  staff  at  Mt. 
Carmel  Hospital,  Columbus;  chief  of  staff  at  St. 
Ann’s  Hospital,  Columbus,  and  a member  of  the 
staffs  of  Grant,  White  Cross,  Mercy  and  St. 
Anthony’s  hospitals,  Columbus.  Dr.  Drury  was  a 
former  president  of  the  Columbus  Academy  of 
Medicine,  and  active  in  numerous  civic  organiza- 
tions. Thousands  of  his  former  patients  and 
friends  attended  the  funeral  services,  held  in  St. 
Joseph’s  Cathedral.  He  is  survived  by  his1  widow 
and  one  nephew,  Dr.  Paul  Scofield,  Columbus. 

Robert  Erskine,  M.D.,  Lowellville;  Kentucky 
School  of  Medicine,  1898;  aged  79;  died  August  30 
of  heart  disease.  Dr.  Erskine  engaged  in  the  mer- 
cantile business  for  17  years  before  entering 
medical  school.  He  served  two  terms  as  mayor  of 
his  home  town  and  also  served  on  the  board  of 
education  and  on  the  village  council.  Surviving 
are  one  daughter,  one  brother  and  two  half- 
brothers. 

Joseph  C.  Fahnestock,  M.D.,  Piqua;  New  York 
Homeopathic  Medical  College  and  Flower  Hos- 
pital, New  York  City,  1882;  aged  76;  died  August 
19  of  heart  disease.  Dr.  Fahnestock  had  practiced 
in  Piqua  since  graduation  from  medical  school. 
He  owned  a citrus  plantation  in  Florida  and 
spent  the  winter  months  there.  Surviving  are  his 
widow  and  one  brother,  Dr.  William  Fahnestock, 
Creede,  Colorado. 

Samuel  B.  Grimes,  M.D.,  Cincinnati;  Cincinnati 
College  of  Medicine  and  Surgery,  1890;  aged  66; 
died  August  14.  Dr.  Grimes  had  practiced  in  Cin- 
cinnati since  1896  and  was  house  physician  for 


several  Cincinnati  hotels.  He  was  a life  member 
of  the  Masonic  Lodge.  His  widow  survives. 

John  H.  Hanes,  M.D.,  Columbus;  Ohio  Medical 
University,  Columbus,  1897 ; aged  71 ; member  of 
the  Ohio  State  Medical  Association  and  of  the 
American  Medical  Association;  died  August  15 
of  heart  disease.  Dr.  Hanes  was  a former 
coroner  of  Franklin  County  and  was  national 
medical  director  for  the  American  Insurance 
Union.  He  leaves  his  widow,  one  son  and  one 
daughter. 

Carl  W.  Henderson,  M.D.,  Waynesville;  Starling 
Medical  College,  Columbus,  1897;  aged  64;  died 
August  9 of  tuberculosis.  The  son  of  the  late  Dr. 
George  W.  Henderson,  Dr.  Henderson  was  a 
native  of  Warren  County  and  had  practiced  in 
Waynesville  since  leaving  medical  school.  He  was 
president  of  the  village  council  and  active  in 
civic  affairs.  He  leaves  his  widow,  two  sons  and 
three  brothers. 

William  E.  Holmes,  M.D.,  Brownsville;  Medical 
College  of  Ohio,  Cincinnati,  1884;  aged  78;  died 
September  12.  Dr.  Holmes  had  practiced  at 
Brownsville  for  the  past  50  years. 

Arthur  A.  Hugg,  M.D.,  Middleport;  Jefferson 
Medical  College,  Philadelphia,  1883;  aged  71; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  September  2 of  cerebral  hemorrhage. 
Dr.  Hugg,  a native  of  Gallia  County,  practiced  in 
Oskaloosa,  Iowa,  until  1904  when  he  returned  to 
Middleport.  One  son  survives. 

Clifford  C.  Kennedy,  M.D.,  Cincinnati;  Uni- 
versity of  Cincinnati,  College  of  Medicine,  1910; 
aged  48;  died  August  15  following  a nervous 
breakdown.  He  was  born  at  Bethel  and  received 
his  pre-medical  education  at  Ohio  Wesleyan  Uni- 
versity. Dr.  Kennedy  was  former  assistant  super- 
intendent of  the  Cincinnati  Tuberculosis  Hospital 
and  during  the  World  War  was  a first  lieutenant 
in  the  medical  corps.  Surviving  are  his  widow  and 
three  sisters. 

James  F.  Madden,  M.D.,  Toledo;  Keokuk  Medi- 
cal College,  1892;  aged  64;  died  July  25  of  heart 
disease.  Dr.  Madden,  a native  of  Ireland,  had 
practiced  in  Toledo  since  1897.  Surviving  are  his 
widow,  two  sons,  one  sister  and  one  brother. 

Sample  B.  McKerrihan,  M.D.,  Portsmouth; 
Medical  College  of  Ohio,  Cincinnati,  1877 ; aged 
87 ; member  of  the  Ohio  State  Medical  Associa- 
tion and  the  American  Medical  Association;  died 
August  12  of  infirmities  of  age.  Dr.  McKerrihan 
located  in  Portsmouth  in  1884.  For  many  years 
he  was  medical  examiner  for  the  U.  S.  Pensions 
Bureau.  He  leaves  three  daughters,  one  son,  two 
sisters  and  one  brother. 

Harry  H.  Primm,  M.D.,  Ravenna;  Cleveland 
University  of  Medicine  and  Surgery,  1893;  aged 
64;  died  September  2 following  an  extended  ill- 


October,  1933 


State  News 


667 


Why  the  Parthenon 
is  an  outstanding 

MASTERPIECE 


Not  because  it  was  designed  by  great  archi- 
tects and  artists,  not  because  it  was  built 
on  a hill,  not  because  it  was  dedicated  to 
Athena,  not  because  it  was  situated  in 
Athens,  not  because  of  its  severe  simplicity 
and  perfect  technical  execution,  not  because 
it  was  planned  and  built  in  the  Age  of 
Pericles  ....  BUT  because  of  definite  and 
complete  specifications.  Its  delicate  refine- 
ment, its  meticulous  lines,  are  explainable 
in  no  other  way.  So,  too,  dependable  re- 
sults in  the  patient’s  well-being  can  be 
assured  by  a thorough  prescription.  The 
words  “Wagner’s  Vichy”  on  your  prescrip- 
tion slip  are  as  much  a guide  to  your  patient 
as  the  architect’s  specifications  are  to  the 
builder. 


WAGNER 

MEDICINAL  LABORATORIES 


The  W.  T.  Wagner's  Sons  Co. 

In  Cincinnati  since  1868 


WAGNER'S 

VICHY 

(artificial) 

for  alkalization 


668 


The  Ohio  State  Medical  Journal 


October,  1933 


ness.  Dr.  Primm  has  practiced  in  Ravenna  for 
the  past  30  years. 


First  District 

Clinton  County  Medical  Society  was  entertained 
August  8 at  the  summer  camp  of  Dr.  Frank  A. 
Peelle,  near  Wilmington.  A picnic  dinner  was 
enjoyed,  at  which  members  of  the  dental  profes- 
sion, their  wives  and  the  wives  of  the  physicians 
of  the  county  were  guests.  Following  the  dinner, 
the  program  was  presented  by  Dr.  A.  C.  Roberts, 
Wilmington,  and  Dr.  C.  A.  Tribbett,  Westboro. 
They  spoke  on  “The  Relationship  Between  Medi- 
cine and  Dentistry”. — News  Clipping. 

Warren  County  Medical  Society  met  September 
5 at  Harmon  Hall,  Lebanon.  The  guest  speaker 
was  Dr.  H.  Kennon  Dunham,  Cincinnati,  who  ad- 
dressed the  gathering  on  “The  Care  and  Treat- 
ment of  Tuberculosis.” — News  Clipping. 

Second  District 

Miami  Comity  Medical  Society  met  in  regular 
session  September  1 at  Memorial  Hospital,  Piqua. 
The  program  was  presented  by  Dr.  Roy  D.  Am, 
Springfield,  who  spoke  on  “Relief  of  Pain  by 
Neuro-Surgical  Measures,”  and  Dr.  Vernon  L. 
Hart,  Dayton,  who  read  a paper  on  “Fractures  of 
the  Elbow”.  Dinner  was  served  following  the 
meeting. — Bulletin. 


B.  W.  Travis  and  Dr.  E.  C.  Wurst,  both  of  Defi- 
ance, were  elected  to  membership,  and  Dr.  W.  E. 
McKee,  formerly  of  Fulton  County,  was  admitted 
to  membership  on  transfer.  The  program  con- 
sisted of  case  reports  made  by  Dr.  George  E. 
Winn,  Dr.  Slosser,  Dr.  Travis  and  Dr.  Wurst. — 
D.  J.  Slosser,  M.D.,  secretary. 

t Fifth  District 

ACADEMY  OF  MEDICINE  OF  CLEVELAND 

(C.  H.  Heyman,  M.D.,  Secretary) 

The  Cleveland  Academy  of  Medicine  held  its 
first  Fall  meeting  September  15  at  the  Medical 
Library  Auditorium.  The  guest  speaker  was  Dr. 
Frank  Lahey,  Boston,  who  addressed  the  meeting 
on  “Problems  in  Gastro-Intestinal  Surgery”. — 
Bulletin. 

Ashtabula  County  Medical  Society  held  its  an- 
nual outing  August  3 at  the  Ashtabula  Country 
Club  in  conjunction  with  the  annual  outings  of 
the  county  dental  society  and  the  county  bar  asso- 
ciation. About  60  members  of  the  societies  and 
their  wives  attended.  Following  the  dinner,  the 
guests  were  entertained  by  vocal  and  instrumen- 
tal selections.  After  the  musical  program,  dancing 
and  bridge  were  enjoyed. — A.  M.  Mills,  M.D.,  sec- 
retary. 

Medina  County  Medical  Society  held  a picnic 
on  September  3 near  LeRoy,  attended  by  about  50 
members  and  guests.  A sports  program  was  held 
in  the  afternoon  followed  by  a picnic  dinner.  Dr. 


CURDOLAC  FOODS 


New 

County  Sod 


-rom 

d Academies 


Third  District 

Hardin  County  Medical  Society  feted  two  of  its 
members  who  recently  completed  fifty  years  of 
active  practice  at  its  meeting  September  21  at 
Spring  Grove.  The  two  physicians  honored  were 
Dr.  W.  N.  Mundy,  Forest,  and  Dr.  J.  C.  Hedrick, 
Dunkirk.  An  illustrated  lecture  on  “Tibet”  was 
given  by  J.  D.  Peterson,  Indianapolis,  following 
the  dinner  and  recognition  services  for  Dr.  Mundy 
and  Dr.  Hedrick. — News  Clipping. 

Logan  County  Medical  Society  met  September  1 
at  Hotel  Ingalls,  Bellefontaine.  Dr.  A.  J.  Mc- 
Cracken, health  commissioner  of  Bellefontaine, 
and  Dr.  W.  H.  Carey,  former  health  commissione'r 
of  Logan  County,  addressed  the  meeting,  both  dis- 
cussing various  phases  of  public  health  adminis- 
tration.— News  Clipping. 

Marion  County  Academy  of  Medicine  was  ad- 
dressed by  Dr.  Fred  M.  Douglass,  Toledo,  at  its 
meeting  September  5 at  the  Marion  City  Hospital. 
Dr.  Douglass  spoke  on  “The  Management  and 
Treatment  of  Biliary  Infection,  Especially  in 
Common  Duct  Obstruction”. — Bulletin. 

Fourth  District 

Defiance  County  Medical  Society  met  August  17 
in  the  office  of  Dr.  D.  J.  Slosser,  Defiance,  secre- 
tary of  the  society.  At  the  business  session,  Dr. 


FULFILL  THE  A.  B.  C.’s  OF  THE 
DIABETIC  DIET  PERFECTLY  — 

Curdolac  Breakfast  Cereal 

Curdolac  Soya  Flour 

Curdolac  Wheat-Soya  Flour 

Curdolac  Soya  Cereal  Johnny  Cake  Flour 

Curdolac  Soya-Bran  Breakfast  Food 

Curdolac  Soya-Bran  Flour 

Adequate  in  nourishment 
Beautiful  to  the  sight 
Correct  in  food  value 

Samples  and  Literature  on  request 

CURDOLAC  FOOD  COMPANY 

Box  299  Waukesha,  Wis. 


LAUB’S 

QUALITY 

BREAD 


. . Tested  and  ac- 

cepted by  your  own 
official  body. 


The  Jacob  Laub  Bak- 
ing Co.,  Cleveland,  O. 


October,  1933 


State  News 


669 


Edward  Reinert 

Ph.G.,  M.D. 

247  East  State  Street  Columbus,  Ohio 

Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 

FRANK  GALLEN,  M.D.,  LEE  A.  HAYS,  M.D., 

Dermatology  Roentgenology 

Tel.  Main  1537  University  5842 


W.  H.  MILLER,  M.  D. 

328  East  State  St.  Columbus,  Ohio 

Office  Telephone,  MAin  3743  Residence,  EVergreen  5644 

Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

<LTH> 

Prompt  and  Full  Report 


670 


The  Ohio  State  Medical  Journal 


October,  1933 


C.  L.  Cummer,  Cleveland,  president-elect  of  the 
State  Association  and  former  councilor  of  the 
Fifth  District,  was  the  guest  of  honor.  Dr.  C.  A. 
Bolich,  Wadsworth,  was  in  charge  of  arrange- 
ments for  the  outing. — News  Clipping. 

Sixth  District 

Holmes  County  Medical  Society  met  August  29 
at  Smith  Hospital,  Millersburg.  At  a business 
session,  Dr.  Clyde  Bahler,  Walnut  Creek,  was 
elected  president  of  the  society  succeeding  Dr. 
Lawrence  Anderson,  Mt.  Hope,  resigned.  The 
society  voted  to  hold  regular  meetings  on  the  first 
Wednesday  in  each  third  month. — News  Clipping. 

Mahoning  County  Medical  Society  opened  its 
Fall  activities  with  a well-attended  meeting  Sep- 
tember 19  at  the  Youngstown  Club.  The  guest 
speaker  was  Dr.  George  M.  Curtis,  professor  of 
surgery,  Ohio  State  University,  who  spoke  on 
“The  Significance  of  the  Iodine  Content  of  Hu- 
man Blood”. 

The  anuual  picnic  and  clam  bake  of  the  society 
was  held  September  28  at  the  Squaw  Creek  Coun- 
try Club.  A golf  tournament  was  held  in  the 
afternoon. — Bulletin. 

Stark  County  Medical  Society,  at  its  meeting 
September  12  at  the  Elks’  Club,  Canton,  was  ad- 
dressed by  Dr.  Walter  C.  Hoyt,  Akron,  on  “The 
Hip  Joint”.  The  address  was  illustrated  with 
slides. — Bulletin. 

Eighth  District 

Athens  County  Medical  Society  held  an  outing 
on  September  4 at  the  farm  of  Dr.  T.  A.  Copeland, 
secretary  of  the  society.  Following  a basket-pic- 
nic and  a musical  program  by  the  Raccoon  Fid- 
dlers, the  society  was  addressed  by  “Dusty”  Mil- 
ler, Wilmington  humorist. — Bulletin. 

Guernsey  County  Medical  Society  at  its  lunch- 
eon meeting  August  31  at  the  Romance  Restaur- 
ant, Cambridge,  held  a round-table  discussion  of 
the  subject  “The  N.  R.  A.  in  Medicine”.  The  dis- 
cussion was  led  by  Dr.  A.  B.  Souders,  Cam- 
bridge. The  various  codes  developed  under  the 
N.  R.  A.  were  analyzed  and  compared  to  the  code 
of  ethics  which  has  governed  the  medical  profes- 
sion for  centuries. — News  Clipping. 

Muskingum  County  Academy  of  Medicine  held 
a dinner  meeting  September  13  at  the  Zane  Hotel. 
Dr.  Harlan  Wilson,  Columbus,  was  the  principal 
speaker,  discussing  various  phases  of  orthopedics. 
— Bulletin. 

Tenth  District 

COLUMBUS  ACADEMY  OF  MEDICINE 

(John  H.  Mitchell,  M.D.,  Secretary) 

The  Columbus  Academy  of  Medicine  held  its 
first  Fall  meeting  on  September  18  at  the  Colum- 
bus Public  Library.  The  program  consisted  of 
the  following  symposium  on  “Encephalitis  Leth- 
argica”;  “Ep’demiology”,  Leo  Ey,  director  of  the 
laboratory,  State  Department  of  Health;  “Signs 
and  Symptoms”,  Dr.  E.  J.  Emerick;  “Pathology”, 
Dr.  R.  S.  Fidler. 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 

LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Association. 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  B.S.,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Baughn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Conp,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


November,  1933 


Advertisements 


673 


THE  SAWYER  SANATORIUM 

WHITE  OAKS  FARM,  MARION,  OHIO 


Treats  Nervous 

and 

Mental  Diseases 


Kind,  efficient,  refined  and  experi- 
enced nursing  is  provided  for  the 
Nervous  and  Mental  patient  at  the 
Sawyer  Sanatorium. 


Send  for  Housebook 


Address,  Sawyer  Sanatorium,  White  Oaks  Farm,  Marion,  Ohio 


The  Ohio  State  Medical  Association 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year ; single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 
Andrews  Rogers.  M.D.,  Chairman  (1934 ) _ 
A.  B.  Denison,  M.D.  (1936)- 


.Columbus 

-Cleveland 

Portsmouth 


Gilbert  Micklethwaite,  M.D.  (1935)  — 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney —Advertising  Manager 


Officers  1933-1934 


PRESIDENT 

C.  L.  Cummer,  M.D 


-Cleveland 


PRESIDENT-ELECT 
John  A.  Caldwell,  M.D. 


TREASURER 

James  A.  Beer,  M.D 


-Cincinnati 

—Columbus 


EXECUTIVE  SECRETARY 

Don  K.  Martin Columbus 

ASS’T  EXECUTIVE  SECRETARY 
Charles  S.  Nelson Columbus 


State  Council 

First  District 

Park  G.  Smith,  M.D 


Second  District 
E.  M.  Huston,  M.D— 


Third  District 


O.  P.  Klotz,  M.D 

Fourth  District 

B.  J.  Hein,  M.D 

Fifth  District 

H.  V.  Paryzek,  M.D 

Sixth  District 
H.  S.  Davidson,  M.D— 


-Cincinnati 

Dayton 

Findlay 

Toledo 


-Cleveland 
Akron 


Seventh  District 

E.  B.  Shanley,  M.D New  Philadelphia 

Eighth  District 

E.  R.  Brush,  M.D — —Zanesville 

Ninth  District 

I.  P.  Seiler,  M.D — Piketon 

Tenth  District 

S.  J.  Goodman,  M.D Columbus 


Ex-Officio,  The  Ex-President 
H.  M.  Platter,  M.D — 


-Columbus 


674 


The  Ohio  State  Medical  Journal 


November,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 

Societies  President  Secretary 

First  District.., 

Adams L.  H.  Leonard,  Manchester O.  T.  Sproull,  West  Union —3d  Wednesday  in  April,  June,  Aug., 

Oct. 

Brown it.  B.  Hannah,  Georgetown Geo.  P.  Tyler,  Jr.,  Ripley 4th  Wednesday  in  Feb.,  May  and 

Nov. 

Butler H.  O.  Lund,  Middletown Walter  Roehl,  Middletown  — .2d  Wednesday,  monthly. 

Clermont J.  K.  Ashburn,  Batavia Allan  B.  Rapp,  Owensville  3d  Wednesday,  monthly. 

Clinton F.  A.  Peele,  Wilmington Wm.  L.  Regan,  Wilmington 1st  Tuesday,  monthly. 

Fayette S.  E.  Boggs,  Washington  C.  H J.  F.  Wilson,  Washington  C.H 1st  Thursday,  monthly. 

Hamilton Samuel  Iglauer,  Cincinnati _H.  F.  Downing,  Cincinnati Monday  evening  of  each  week. 

Highland  _„C.  C.  Cropper,  Lynchburg W.  B.  Roads,  Hillsboro 1st  Wednesday,  monthly. 

Warren J.  E.  Witham,  Waynesville —James  Arnold,  Lebanon 1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 

Second  District Cyril  Hussey,  Sidney — H.  R.  Huston,  Dayton 

Champaign  N.  M.  Rhodes,  Urbana JL.  A.  Woodburn,  Urbana 2d  Thursday,  monthly. 


.w. 

Greene 

H. 

Miami 

G. 

Mcmtgomery 

C.  D.  Smith,  Dayton 

Mi 

Preble  ... 

c. 

...  A. 

Third  District 

C.  E.  Hufford,  Toledo 

. ...j. 

Allen 

L. 

Auglaize 

-C. 

Hancock 

...  H. 

Hardin  

...  W. 

w. 

Marion 

...  J. 

Mercer 

—F. 

. R. 

Van  Wert 

..R. 

Wyandot 

B.  A.  Moloney,  Upper  Sandusky. 

...  W. 

and  August. 


H.  Marshall,  Findlay 
C.  Thomas,  Lima 


-3d  Tuesday,  monthly. 


C.  Berlin,  Wapakoneta 2nd  Thursday,  bi-monthly. 

O.  Crosby,  Findlay 1st  Thursday,  monthly. 

N.  Mundy,  Forest ,17th  of  each  month. 

H.  Carey,  Bellefontaine 1st  Friday,  monthly. 

W.  Jolley,  Marion  1st  Tuesday,  monthly. 

E.  Ayers,  Celina  .2d  Thursday,  monthly. 

E.  Hershberger,  Tiffin 3rd  Thursday,  monthly. 

H.  Good,  Van  Wert 1st  Tuesday,  monthly. 

L.  Naus,  Upper  Sandusky  1st  Thursday,  monthly. 


Fourth  District (With  Third  District  in  Northwestern  Ohio  District) 

Defiance S.  E.  DeMuth,  Hicksville  D.  J.  Slosser,  Defiance 3d  Thursday,  monthly,  except 

July,  August,  December. 

Fulton  P.  S.  Bishop,  Delta Geo.  McGuffin,  Pettisville .2nd  Thursday,  monthly. 

Henry  T.  P.  Delventhal,  Napoleon  F.  M.  Harrison,  Napoleon  ... 1st  Wednesday,  monthly. 

Lucas L.  R.  Effler,  Toledo ...A.  P.  Hancuff,  Toledo Friday,  each  week. 

Ottawa. R.  A.  Willett,  Elmore Cyrus  R.  Wood,  Port  Clinton 2d  Thursday,  monthly. 

Paulding C.  E.  Houston,  Paulding Gaile  L.  Doster,  Paulding 3d  Wednesday,  monthly. 

Putnam  _E.  Blackburn,  Kalida W.  B.  Light,  Ottawa  1st  Tuesday,  monthly. 

Sandusky  D.  W.  Philo,  Fremont J.  C.  Boyce,  Fremont .Last  Thursday,  monthly. 

Williams  ....  „„B.  C.  Bly,  Bryan H.  R.  Mayberry,  Bryan 3d  Thursday,  monthly. 

Wood  F.  L.  Sterling,  Bowling  Green  R.  N.  Whitehead,  Bowling  Green 3d  Thursday,  monthly. 


Fifth  District  H.  V.  Paryzek,  Councilor 

Ashtabula J.  F.  Docherty,  Conneaut 

Cuyahoga  ...  _..  H.  V.  Paryzek,  Cleveland 

Erie J . C.  Kramer,  Sandusky 

Geauga H.  E.  Shafer,  Middlefield 

Huron W.  W.  Lawrence,  Norwalk 

Lake G.  O.  Hedlund,  Painesville .... 

Lorain Herman  Campbell,  Elyria 

Medina Harry  Streett,  Litchfield 

Trumbull E.  P.  Adams,  Warren....— 


Chrm.  Com.  on  Arrangements .Cleveland. 

A.  M.  Mills,  Ashtabula 2nd  Tuesday,  monthly. 

Clarence  H.  Heyman,  Cleveland 3d  Fri.  Feb.,  March,  May,  Sept., 

Nov.,  Dec. 

G.  A.  Stimson,  Sandusky Last  Wednesday,  monthly,  except 

July,  Aug.,  Sept. 

Isa  Teed-Cramton,  Burton -Last  Wednesday,  Apr.  to  Oct. 

Geo.  F.  Linn,  Norwalk 3d  Tuesday,  February,  May, 

August,  Nov. 

B.  T.  Church,  Painesville 4th  Tuesday,  monthly. 

W.  E.  Hart,  Elyria .2d  Tuesday,  monthly. 

J.  K.  Durling,  Wadsworth 1st  Thursday,  monthly. 

R.  H.  McCaughtry,  Warren 3d  Thursday,  monthly*  except 

June,  July,  August. 


November,  1933 


The  Ohio  State  Medical  Journal 


675 


Societies  President  Secretary 

Sixth  District A.  E.  Brant,  Youngstown J.  H.  Seiler,  Akron 

Ashland H.  M.  Gunn,  Ashland ..Paul  E.  Kellogg,  Ashland  ... 

Holmes Clyde  Bahler,  Walnut  Creek _.C.  T.  Bahler,  Walnut  Creek  . 

Mahoning — J.  P.  Harvey,  Youngstown W.  M.  Skipp,  Youngstown  . 

Portage _S.  U.  Sivon,  Ravenna — E.  J.  Widdecombe,  Kent 

Richland — C.  H.  Bell,  Mansfield  Mabel  Emery,  Mansfield  ... 

Stark H.  Welland,  Canton __._F.  S.  VanDyke,  Canton  .... 

Summit — ...J,  H.  Selby,  Akron A.  S.  McCormick,  Akron  ..... 

Wayne  W.  A.  Morton,  Wooster  R.  C.  Paul,  Wooster 


2d  Wed.,  Jan.,  April  and  Oct. 

.2nd  Friday,  Sept,  to  May. 

1st  Tuesday,  quarterly,  Jan.,  April, 

July,  October. 

-3d  Tuesday,  monthly. 

—1st  Thursday,  monthly. 

Last  Thursday,  monthly. 

2d  Tuesday,  monthly. 

.1st  Tuesday,  monthly. 

2d  Tuesday,  monthly. 


Seventh  District  .... 

Belmont :.G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire  —1st  Thurs.,  monthly,  4 p.  m., 

except  July  and  August. 

Carroll (With  Stark  Co.  Society) 

Columbiana J.  W.  Robinson,  Lisbon  ..John  Fraser,  East  Liverpool __2d  Tuesday,  monthly. 

Coshocton Floyd  Craig,  Coshocton  J.  D.  Lower,  Coshocton Last  Thursday,  monthly. 

Harrison  .A.  C.  Grove,  Jewett W.  C.  Wallace,  Hopedale 3d  Wednesday,  monthly. 

Jefferson S.  A.  Harris,  Steubenville  . John  Y.  Bevan,  Steubenville .Last  Thursday,  monthly. 

Monroe _G.  W.  Steward,  Woodsfield A.  R.  Burkhart,  Woodsfield 2d  Wednesday,  monthly. 

Tuscarawas F.  B.  Larimore,  New  Phila G.  L.  Sackett,  New  Phila.  2d  Thursday,  monthly. 


Eighth  District 


Athens C.  E.  Welch,  Nelsonville 

Fairfield JE.  B.  Roller,  Lithopolis 

Guernsey C.  C.  Headley,  Cambridge 

Licking Geo.  W.  Sapp,  Newark 

Morgan D.  G.  Ralston,  McConnelsville 

Muskingum C.  M.  Rambo,  Zanesville 

Noble 

Perry James  Miller,  Corning  .. 

Washington W.  WT.  Sauer,  Marietta 


_T.  A.  Copeland,  Athens  1st  Monday,  monthly. 

C.  W.  Brown,  Lancaster .2d  Tuesday,  monthly. 

E.  F.  Hunter,  Cambridge 1st  and  3rd  Thursday  each  month. 

.G.  A.  Gressle,  Newark Xast  Friday,  monthly. 

C.  E.  Northrup,  McConnelsville 3d  Wednesday,  monthly. 

Beatrice  T.  Hagen,  Zanesville 1st  Wednesday,  monthly. 

F.  J.  Crosbie,  New  Lexington  . ..3d  Monday,  monthly. 

.G.  M.  James,  Marietta .2d  Wednesday,  monthly. 


Ninth  District 

Gallia O.  A.  Vornholt,  Gallipolis JVlilo  Wilson,  Gallipolis 

Hocking H.  M.  Boocks,  Logan -M.  H.  Cherrington,  Logan... 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 

Lawrence. Cosper  Burton,  Ironton ..Anne  D.  Marting,  Ironton  .... 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 

Pike L.  E.  Wills,  Waverly It.  T.  Leever,  Waverly 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth 

Vinton O.  S.  Cox,  McArthur _H.  S.  James,  McArthur 


...1st  Wed.,  Feb.,  May,  Sept,  and  Dec. 
.Quarterly. 

2nd  Tuesday,  monthly. 

..  .1st  Thursday,  monthly. 

...3d  Thursday,  bi-monthly. 

...1st  Monday,  monthly. 

,._.2d  Monday,  monthly. 

3d  Wednesday,  monthly. 


Tenth  District 


Crawford E.  C.  Brandt,  Crestline  .— —JR.  L.  Solt,  Bucyrus 1st  Monday,  monthly. 

Delaware Geo.  D.  Lowry,  Delaware —J.  G.  Parker,  Delaware 1st  Tuesday,  monthly. 

Franklin Jonathan  Forman,  Columbus John  H.  Mitchell,  Columbus Every  Monday,  8 : 30  p.  m. 

Knox S.  O.  Gantt,  Centerburg .JR.  L.  Eastman,  Mt.  Vernon Xast  Thursday,  monthly. 

Madison R.  S.  Postle,  London  G.  C.  Scheetz,  West  Jefferson 4th  Wednesday,  monthly. 

Morrow F.  M.  Hartsook,  Cardington. .T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly. 

Pickaway C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville 1st  Friday,  monthly. 

Ross Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 1st  Thursday,  monthly. 

Union E.  J,  Marsh,  Broadway ....Angus  Maclvor,  Marysville 2d  Tuesday,  monthly. 


676 


Advertisements 


November,  1933 


THE  ORCHARD  SPRINGS  SANITARIUM 
near  DAYTON,  OHIO 

A Private  Hospital  For  Mental  and  Nervous  Diseases  Established  in  1911 

This  institution,  with  its  modern  facilities,  its  delightful  and  restful  suburban  location,  and 
its  well-trained  efficient  organization,  has  for  15  years  been  in  a splendid  position  to  render 
skilled  beneficial  service  at  reasonable  rates. 


E.  C.  FISCHBEIN,  M.D. 

JAMES  L.  SAGEBIEL,  M.D. 

Medical  Directors. 

Dayton.  Ohio 

MRS.  GEORGE  V.  SHERIDAN, 
President-Treasurer. 

1645  Ridgeway  Place,  Columbus,  Ohio 


For  detailed  information,  address 

NAOMI  VOGE,  R.  N. 

Resident  Superintendent 

R.  F.  D.  No.  13,  Dayton,  Ohio 
Telephone:  Taylor  4011,  Dayton  City  Exchange 


Windsor  Hospital 

The  Windsor  Hospital  and  Sanitarium  is 
completely  equipped  with  all  the  best  appa- 
ratus for  giving  Hydrotherapy,  Occupa- 
tional Therapy,  and  other  treatments  for 
all  types  of  Nervous  disorders,  acute  and 
chronic. 

John  H.  Nichols,  M.D. 

Medical  Director 

Phone  Chagrin  Falls  360 
CHAGRIN  FALLS,  OHIO 

ESTABLISHED  35  YEARS 


A MODERN  ETHICAL  HOSPITAL 

Rates:  $25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alcohol,  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  Not  limited  as  to  the  quantity 
used  but  can  give  the  patient  as  much  whiskey  as  his  condition  requires. 

NERVOUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoscine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  that  their  own 
home  affords. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 

tal. Female  attendants  only ; absolute  privacy ; com- 
fortable, well-appointed  ladies’  lounge. 

Cherokee  Road  (Long  Distance  Phone  East  1488) 

THE  STOKES  SANATORIUM 

Louisville,  Ky.  27  Years  Treating  Nervous  Patients. 


THE  OXFORD  RETREAT 

Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . . . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 


FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


Undoubtedly,  every  Ohio  physician  has  by  this 
time  received  notification  that  a new  edition  of 
the  American  Medical  Directory  is  now  being  com- 
piled by  the  Ameri- 
can Medical  Asso- 
ciation and  will  be 
issued  early  in  1394 
— the  first  complete 
Medical  Directory 


For  Early  Payment 
of  1934  Dues 


issued  since  1931. 

Receipt  of  the  information  card  from  the  head- 
quarters office  of  the  American  Medical  Associa- 
tion from  which  data  for  the  Directory  is  ob- 
tained should  emphasize  in  the  mind  of  each 
physician  the  necessity  for  and  value  of  member- 
ship in  medical  organization. 

It  is  particularly  important  that  all  eligible 
physicians  be  included  in  the  new  A.M.A.  Direc- 
tory as  members  of  medical  organization.  As 
physicians  know,  this  Directory  is  used  officially 
not  only  by  the  medical  profession,  but  by  in- 
surance companies,  railroads,  industries,  hospitals, 
public  officials  and  a host  of  other  agencies  and 
organizations  for  identification  of  physicians  and 
to  determine  their  professional  affiliations. 

Every  physician  should  understand  that  in 
order  to  appear  as  a member  of  medical  organiza- 
tion in  the  forthcoming  1934  Directory,  he  must 
pay  his  1934  annual  dues  in  the  Ohio  State  Medi- 
cal Association  promptly  so  that  proper  certifica- 
tion may  be  made  from  the  State  Headquarters 
Office  and  through  it  to  the  American  Medical 
Association  by  December  15,  1933. 

It  is  to  be  hoped  that  the  secretaries  of  all 
county  medical  societies  and  academies  of  medi- 
cine will  promptly  emphasize  these  facts  to  the 
members  of  local  societies  and  make  a special 
effort  to  secure  the  reinstatement  of  delinquent 
members  and  the  affiliation  in  medical  organiza- 
tion of  all  eligible  physicians  who  are  not  at 
present  members  of  their  county  medical  societies. 

Although  this  is  but  one  of  numerous  im- 
portant reasons  why  every  eligible  physician  in 
Ohio  should  belong  to  medical  organization,  it  is 
of  such  importance  at  this  time  that  it  deserves 
particular  emphasis  to  the  membership  at  large 
and  should  stimulate  energetic  activity  on  the 
part  of  the  secretaries  and  other  officers  of  all 
component  county  societies. 

Every  physician  who  can  qualify  for  member- 
ship in  medical  organization  should  be  impressed 
with  the  increasing  necessity  for  cohesion  and 


unity  in  the  medical  profession  which  at  the 
present  time  is  confronted  with  innumerable  ser- 
ious situations  that  must  be  met  by  alert,  col- 
lective activity  on  the  part  of  the  profession 
which  can  only  be  carried  on  through  the  medium 
of  medical  organization. 


In  his  presidential  address  at  the  recent  annual 
meeting  of  the  Indiana  State  Medical  Association, 
Dr.  J.  H.  Weinstein,  Terre  Haute,  made  some 
pertinent  observations  relative 
to  the  present-day  “world- 
wide experimentation  in  human 
destiny”  and  the  revolutionary 
changes  which  have  taken 
place  during  the  past  two  de- 
cades to  impress  upon  his  listeners  the  necessity 
for  alertness  and  aggressiveness  on  the  part  of 
the  medical  profession  to  meet  the  problems  of 
our  ever-changing  social  and  governmental  struc- 
ture. 

Of  particular  interest  was  an  analysis  by  Dr. 
Weinstein  of  the  platforms  adopted  in  1912  by 
the  National  Socialist  and  the  National  Progres- 
sive parties.  As  quoted  by  Dr.  Weinstein,  these 
platforms  called  for: 

1.  Federal  loans  to  states. 

2.  Public  work  to  relieve  unemployment. 

3.  Federal  employment  bui’eaus. 

4.  A shorter  work  day  and  week  to  keep  pace 
with  production. 

5.  Old  age  pensions. 

6.  Health  insurance. 

7.  Workmen’s  compensation  laws. 

8.  Abolition  of  child  labor. 

9.  Ban  on  interstate  shipment  of  convict  labor. 

10.  Minimum  wage  laws. 

11.  Graduated  income  tax. 

12.  High  inheritance  tax. 

13.  Reforestation. 

15.  Equal  suffrage. 

15.  Curbing  the  power  to  issue  labor  injunc- 
tions. 

Commenting  on  this  thought-provoking  observa- 
tion, he  said: 

“Many  of  the  medical  profession  are  lying  back 
in  smug  complacency  with  a sense  of  security  in 
the  thought  that  there  is  no  danger  of  state  medi- 
cine being  established. 

“When  you  feel  inclined  to  dismiss  the  pos- 
sibility of  the  imminent  advent  of  state  medicine, 
bear  in  mind  that  out  of  the  fifteen  liberal  ob- 


Moderm 

Social 

Program 


689 


690 


The  Ohio  State  Medical  Journal 


November,  1933 


jectives  set  forth  20  years  ago,  two  alone  remain 
as  unaccomplished  in  a nation-wide  scale — old 
age  pensions  and  health  insurance.” 

To  amplify  Dr.  Weinstein’s  explanation  it  may 
be  added  that  a number  of  states  have  old-age 
pension  systems  and  that  health  insurance 
schemes  are  being  experimented  with  in  some 
states,  although  yet  without  governmental  sup- 
port. 

What  the  next  20  years  will  produce  in  the  way 
of  additional  social  and  governmental  changes  is 
something  worthy  of  conjecture.  At  any  rate,  it 
is  quite  certain  that  “smug  complacency”  will  not 
be  of  material  assistance  to  the  medical  profession 
in  solving  critical  pi'oblems  that  are  bound  to 
arise  in  the  future,  perhaps  with  greater  rapidity 
than  in  the  past  few  years. 


Resumption  of  medical  schools  throughout  the 
country  for  the  1933-34  academic  year  at  a time 
when  the  medical  profession  is  confronted  with 
the  most  critical  period  in  its 
history  should  impress  those 
in  charge  of  medical  educa- 
tion activities  with  the  im- 
portance of  their  responsi- 
bility. 

Aside  from  the  fact  that  the  modem  medical 
school  is  expected  to  provide  the  best  possible 
training  and  scientific  opportunities  for  those 
who  will  become  the  physicians  of  the  future  so 
that  they  can  render  effective  service  to  the  pub- 
lic, medical  institutions  should  feel  obligated  to 
give  to  students  more  than  a mere  smattering  of 
information  and  knowledge  concerning  some  of 
the  economic,  social,  ethical,  professional,  gov- 
ernmental, and  legal  problems  which  confront  the 
present-day  physician. 

At  the  1933  meeting  of  the  American  Medical 
Association,  the  House  of  Delegates  instructed  the 
Council  on  Medical  Education  and  Hospitals  to 
give  serious  consideration  to  this  question  and  to 
actively  assist  in  “devising  a course  of  lectures 
and  demonstrations  related  to  medical  ethics, 
economics,  office  and  practice  business  details,  re- 
lationship of  physician  to  patient  and  public,  and 
the  fundamental  purposes  and  activities  of  county, 
state  and  national  organizations,  and  causing 
their  inclusion  in  curriculums  of  approved  col- 
leges”. 

Undoubtedly,  the  A.M.A.  Council  on  Medical 
Education  has  already  drafted  a program  of  ac- 
tion to  stimulate  such  work  in  medical  schools,  or 
will  do  so  in  the  near  future.  However,  it  should 
not  seem  necessary  for  any  medical  school  to 
await  suggestions  from  that  official  body  or  to 
delay  before  adopting  its  curriculum  to  include 
such  discussions.  Some  medical  schools  have  been 
giving  instruction  on  these  questions ; others  have 
signified  their  intention  to  do  so.  It  is  imperative 
that  all  do  so  as  early  as  possible. 


No  approved  medical  school  is  so  situated  that 
it  does  not  have  available  plenty  of  talent  among 
the  practicing  profession  to  carry  on  the  teaching 
end  of  such  courses.  The  experiences  of  many 
men  now  in  active  practice  are  in  themselves,  if 
properly  presented,  sufficient  to  give  the  medical 
neophyte  valuable  information  concerning  some 
of  the  ups  and  downs  of  active  practice  and  pre- 
pare him  to  meet  some  of  the  problems  he  will 
encounter  after  graduation. 

As  a matter  of  fact,  such  questions  should  be 
discussed  frequently  and  fi’eely  at  medical  society 
meetings.  The  business  aspects  of  medical  pra- 
tice  have  not  received  sufficient  emphasis  in  the 
past.  The  physician  in  active  practice  as  well  as 
the  medical  student  needs  education  along  these 
lines.  This  is  one  practical  way  to  produce  a more 
alert  and  more  aggressive,  as  well  as  better  pre- 
pared and  better  informed  medical  profession  in 
ensuing  years. 


Every  physician  who  has  given  careful  con- 
sideration to  published  accounts  of  discussions  of 
veterans’  relief  problems  at  the  recent  annual 
convention  of  the  Amer- 
IPreseiit  Policy  ican  Legion  in  Chicago 
^ t no  doubt  has  been  im- 

OH  Veterans  pressed  with  the  fact 

Benefits  that  this  question  con- 

tinues to  be  one  of  the 
most  important  from  many  angles  confronting  the 
nation  today  and  one  of  direct  concern  to  the 
medical  profession  generally. 

The  address  of  President  Roosevelt  before  the 
convention  was  a frank  statement  of  the  policy  of 
the  present  Federal  Administration  the  principal 
tenet  of  which  is  that  adequate  benefits  should  be 
provided  by  the  Federal  government  for  those 
suffering  from  disabilities  incurred  in  or  result- 
ing from  war  service,  but  that  ex-service  men 
whose  disabilities  are  not  due  to  war  service 
should  be  treated  just  as  other  disabled  citizens. 

The  action  of  the  Legion  in  adopting  the  four- 
point  relief  program  drafted  by  the  organization’s 
rehabilitation  committee  indicates  that  the  Fed- 
eral Administration  will  be  subjected  to  con- 
siderable pressure  to  modify  that  part  of  its 
policy  dealing  with  the  hospitalization  of  ex-ser- 
vice men  to  permit  free  hospitalization  for  any 
ex-service  men  at  any  time  and  for  any  cause. 

The  present  policy  of  the  Federal  Government 
in  holding  the  care  of  ex-service  men  whose  dis- 
abilities are  not  due  to  war  service  as  primarily 
the  obligation  of  local  communities  and  that  only 
after  local  and  state  help  is  exhausted  should  they 
become  the  charge  of  the  Federal  Government,  is 
in  line  with  the  long-established  policy  of  medical 
organization  which  has  repeatedly  objected  to  the 
gigantic  and  costly  hospital  building  program  that 
has  been  carried  on  by  the  Federal  government 
and  the  extensive  system  of  governmental  medi- 
cal service  which  provided  medical  and  hospital 


Education 

In 

Economics 


November,  1933 


Editorial 


691 


care  not  only  for  deserving  and  eligible  ex-service 
men  but  also  for  those  whose  disabilities  were  not 
received  in  or  the  result  of  actual  war  service. 

Obviously,  the  policy  of  the  Federal  Govern- 
ment as  established  by  the  National  Economy 
Act  will  be  put  to  a severe  test  during  the  en- 
suing months.  It,  undoubtedly,  will  be  modified 
when  necessary  to  insure  equitable  and  just  treat- 
ment for  deserving  veterans  and  the  dependents 
of  veterans  killed  in  or  who  died  as  a result  of 
war  service.  However,  unless  public  sentiment 
changes  materially,  it  will  remain  as  the  basis  for 
dealing  with  the  veterans  question  and  will  con- 
sequently provide  the  fullest  justice  for  truly  de- 
serving ex-service  men,  but  will  prohibit  many  of 
the  abuses  and  fallacies  that  existed  under  the 
old  program  which  permitted  Federal  aid  for  all 
classes  of  veterans,  regardless  of  the  nature  of 
their  disabilities  or  their  economic  status. 

As  emphasized  in  a resolution  adopted  by  the 
House  of  Delegates  at  the  recent  Annual  Meeting 
of  the  State  Association,  the  cooperation  and  sup- 
port of  the  medical  profession  of  Ohio  should  be 
given  to  the  government  in  administering  the  new 
veterans  regulations  and  to  the  fundamental 
principles  underlying  the  present  policy  of  the 
Federal  Administration  on  this  matter. 


Frederick  Shelton,  Washington  observer  for 
Nation’s  Business,  offers  considerable  food  for 
thought  in  recent  comment  regarding  the  radical 
changes  which  are  taking 
place  daily  in  government 
and  governmental  func- 
tions. 

Writing  in  a recent  issue 
of  that  publication,  Mr.  Shelton  said: 

“Regardless  of  failure  of  certain  experiments 
now  being  tried  you  can  depend  upon  it  that  the 
next  step  will  be  further  toward  collectivism. 
How  can  the  ‘little  fellow’  protect  himself?  Ob- 
viously, he  will  need  trade  associations,  cham- 
bers of  commerce,  protective  societies,  consumers’ 
cooperative  clubs,  labor  unions,  and  other  or- 
ganizations able  to  take  mass  action.  He  espe- 
cially will  need  to  take  a serious  part  in  politics, 
parties,  elections  and  all  the  activities  which  af- 
fect the  course  of  governmental  policies.” 

In  this  prediction  there  are  two  important  facts 
which  the  medical  profession  must  recognize. 

First,  to  protect  itself  and  the  principles  of 
medicine,  the  medical  profession  must  be  pre- 
pared to  take  collective  action  when  the  need  for 
organized  action  presents  itself.  Such  concerted 
activity  can  be  and  will  be  forthcoming  providing 
medical  organization  is  maintained  at  the  highest 
possible  degree  of  efficiency  and  has  the  support 
of  every  eligible  physician. 

Second,  to  play  an  effective  role  in  directing  the 
future  course  of  governmental  activity,  the  medi- 
cal profession,  individually  and  collectively,  must 
take  an  increasing  active  interest  in  governmental 


Problems  of 
Collectivism 


and  political  affairs  and  make  their  influence  felt 
in  all  functions  having  a direct  bearing  on  medical 
and  health  matters. 

The  question  has  been  asked:  Will  the  regi- 
mentation of  industry  be  followed  by  an  attempt 
at  a regimentation  of  the  medical  profession? 

What  the  future  holds  for  the  medical  pro- 
fession and  medical  practice  none  can  foretell. 
However,  it  behooves  the  profession^  to  give  ser- 
ious thought  to  eventualities.  It  must  be  pre- 
pared for  future  contingencies  by  maintaining  its 
present  organization  at  the  peak  of  usefulness 
and  strength.  It  must  use  its  collective  initiative 
and  ability  in  an  effort  to  mold  public  opinion; 
command  public  respect,  and  direct  all  activities 
about  which  it  is  best  informed  and  best  able  to 
carry  on. 

As  one  leader  of  organized  medicine  has  sum- 
marized the  question:  “Medicine  still  has  the  con- 
fidence of  the  public;  and  if  we  can  hold  it 
through  this  crisis  we  will  make  our  profession 
the  supreme  social  influence  in  all  the  world. 
Medicine  has  never  before  had  such  an  oppor- 
tunity to  take  leadership  of  all  health  agencies 
in  the  distribution  of  its  services  as  it  has  in  this 
crisis.  * * * The  services  of  medicine  must  be 
distributed  by  methods  under  the  control  of  the 
profession  itself,  and  the  profession  must  remain 
master  in  its  own  house.” 


Of  Education 


In  a recent  issue  of  the  monthly  publication  of 
one  of  the  better  known  national  service  clubs, 
there  appeared  two  articles  written  by  two 
physicians. 

One  advocated  more 
extensive  use  of  group 
medical  practice  as  a 
means  of  reducing  the 
costs  of  medical  care.  The  other  exposed  the 
shortcomings  of  the  large-unit  scheme  and  warned 
against  over-organization  of  medical  services. 

Although  the  arguments  presented  were  not 
new  to  the  well-read  physician,  they  undoubtedly 
were  interesting  and  instructive  to  the  lay  reader 
of  the  publication,  the  editors  of  which  are  to  be 
congratulated  on  the  fact  that  they  gave  an 
opportunity  for  a free  discussion  of  both  sides  of 
this  controversial  question. 

We  mention  this  incident  merely  to  emphasize 
to  members  of  the  medical  profession  the  im- 
portance of  constant  and  close  contact  with  in- 
dividuals and  groups  outside  the  profession  who 
are  interested  in  the  problems  confronting  phy- 
sicians and  have  at  their  command  ways  of  pass- 
ing on  to  the  public  information  on  medical  and 
health  questions. 

Discussions  of  medical  problems  are  appearing 
in  the  lay  press  with  increasing  frequency.  Medi- 
cal and  health  topics  are  frequently  the  principal 
subjects  for  discussion  at  meetings  of  civic  clubs 
and  similar  organizations.  The  public,  at  least  the 
thinking  portion  of  it,  appears  to  be  sincerely  in- 


692 


The  Ohio  State  Medical  Journal 


November,  1933 


terested  in  these  questions  and  is  seeking  in- 
formation about  them. 

Obviously,  it  is  extremely  important  that  those 
soliciting  information  of  this  kind  be  accurately 
informed  and  that  they  be  given  an  opportunity 
to  know  all  the  facts. 

Physicians,  individually  or  through  their  local 
medical  organizations,  can  do  much  to  insure  that 
the  laity  is  correctly  and  fully  informed  about 
problems  relating  to  health  and  medical  matters. 
Physicians  who  are  members  of  luncheon,  service, 
civic  clubs,  etc.,  should  make  it  a point  to  keep  in 
close  contact  with  the  program  committee  of  these 
groups.  If  a discussion  of  medical  and  health 
questions  is  contemplated,  they  should  see  to  it 
that  qualified  speakers  are  selected  and  that  an 
opportunity  will  be  had  for  a fair  and  accurate 
presentation  of  the  facts. 

Through  its  committee  on  public  relations,  the 
county  medical  society  can  assist  and  advise  lay 
groups  in  arranging  for  programs  of  this  kind. 
One  of  the  most  important  functions  of  medical 
organization,  especially  at  this  time,  is  to 
strengthen  the  belief  of  the  public  that  it  (medi- 
cal organization)  is  the  one  authoritative  source 
of  information  on  medical  and  health  questions. 
This  cannot  be  done  unless  physicians,  individ- 
ually and  collectively,  take  an  active  part  in  the 
civic,  social  and  political  affairs  of  their  com- 
munities. The  public  is  confronted  with  the  danger 
of  being  grossly  misinformed  on  medical  and 
health  matters  unless  the  medical  profession  gives 
it  the  benefit  of  its  judgment  and  assists  it  in 
finding  the  propel*  sources  of  information. 


A state-wide  warning  concerning  racketeering 
by  certain  unscrupulous  insurance  companies  was 
broadcast  recently  by  State  Insurance  Commis- 
sioner Warner  who  urged 
citizens  of  this  state  to  exer- 
cise extreme  caution  in  pur- 
chasing policies  and  by  all 
Rackets  means  to  ascertain  whether 

or  not  the  companies  contact- 
ing them  are  licensed  to  write  insurance  in  Ohio. 

The  attention  of  the  membership  is  called  to 
this  warning  inasmuch  as  most  physicians  are  in- 
surance enthusiasts  and  because  of  the  hazards 
of  the  profession  carry  more  insurance  than  al- 
most any  other  group  of  citizens. 

Moreover,  experience  has  shown  that  a con- 
siderable number  of  physicians  each  year  are 
victimized  by  racketeering  insurance  salesmen  or 
have  fallen  prey  to  certain  types  of  casualty  com- 
panies that  make  a practice  of  soliciting  business 
by  mail.  Repeated  warnings  concerning  the  pur- 
chase of  insurance  policies  from  unknown  com- 
panies or  from  salesmen  lacking  the  proper 
credentials  have  been  published  in  The  Journal , 
yet  some  physicians  have  either  failed  to  read 
these  warnings  or  have  paid  no  attention  to  them. 


Court  Muling 


Splittini 


Considerable  publicity  has  been  given  to  a 
novel  case  recently  decided  in  the  Surrogate’s 
Court  of  New  York  County,  New  York,  in  which 
the  division  of  fees  by 
physicians  was  involved. 

The  case  arose  from  a 
provision  in  the  will  of 
the  late  Henry  Sterne 
which  established  trusts 
for  the  benefit  of  the  Montefiore  Hospital  and  the 
Hospital  for  Joint  Diseases,  New  York  City,  but 
provided  that  to  become  eligible  the  two  institu- 
tions must  “make  a binding  rule  to  the  effect  that 
any  and  all  physicians  at  any  time  practicing  for 
remunei’aUon  in  the  said  respective  institutions 
shall  be  required  to  and  shall  pay  toward  the 
maintenance  and  support  of  the  said  institution 
a sum  of  money  equal  to  10  per  cent  of  the  gross 
fees  which  shall  at  any  time  be  received  by  such 
physician  respectively  for  services  performed  by 
them  in  the  said  institutions”. 

A protest  against  this  provision  of  the  will  was 
filed  in  the  Surrogate’s  Court  by  the  two  hos- 
pitals, the  petition  stating  that  the  condition  im- 
posed upon  them  a rule  of  conduct  which  was  in 
violation  of  public  policy,  compelled  the  division 
of  fees  by  physicians,  and  would  impair  the  effi- 
ciency of  the  hospital. 

In  deciding  the  case  in  favor  of  the  hospitals 
and  striking  the  provision  from  the  will,  the 
court  declared: 

“It  is  immaterial  whether  the  division  of  medi- 
cal fees  occurs  between  a physician  or  a layman, 
or  a physician  and  a physician  in  cases  pro- 
hibited by  the  canons  of  ethics,  or,  as  in  the  • 
situation  here,  between  a physician  and  a hospital. 
Inevitably  such  a method  of  division  would  lead 
to  deterioration  in  the  medical  staffs  of  hospitals 
with  attendant  injury  to  the  public.  It  would  like- 
wise subject  some  physicians  to  the  temptation  of 
overcharging  their  patients  to  meet  the  require- 
ments of  the  hospital  rule. 

“Although  the  difficulty  in  enforcing  the  con- 
dition might  not  of  itself  be  a ground  for  a de- 
termination of  invalidity,  where,  as  here,  it  is 
nrngled  with  a requirement  that  is  unreasonable, 
unethical  and  in  volation  of  public  policy,  the 
court  cannot  sustain  it.” 

This  attitude  of  the  New  York  court  is  en- 
couraging. It  is  possible  it  may  blaze  the  trail 
for  similar  settlements  of  bad  situations  else- 
where, where  division  of  fees  is  not  necessarily 
involved,  but  where  commercialized  ventures  in 
supplying  medical  services  are  flourishing. 

It  may  become  necessary  for  those  familiar 
with  the  dangers  of  many  medical  and  hospital 
service  schemes  to  turn  to  the  court  to  protect 
the  public.  It  is  easy  to  imagine  the  short  work 
which  could  be  made  of  some  medical  rackets 
were  the  projects  taken  to  court  for  judgment  on 
their  merits  in  the  light  of  public  policy  and  pub- 
lic benefit. 


Acute  and  Chronic  Intussusception* 

Charles  W.  Mayo,  M.D.,  Rochester,  Minnesota 


IT  is  the  purpose,  in  this  paper,  to  point  out 
certain  fundamental  differences  between 
acute  and  chronic  intussusception  and  to  con- 
sider surgical  treatment  in  relation  to  these  dif- 
ferences. One  must  be  mindful  that  there  are  no 
hard  and  fixed  rules  in  medicine,  and  that  there 
has  been,  is,  or  will  be  the  exceptional  case  to  dis- 
prove any  rule. 

Interest  in  my  subject  has  been  fostered  by  re- 
cent reviews  of  thirty-three  cases  of  acute  in- 
tussusception, and  forty  cases  of  chronic  intussus- 
ception observed  at  The  Mayo  Clinic,  and  by  the 
subsequent  perusal  of  the  literature.  Although 
both  types  of  intussusception  may  occur  at  any 
point  in  the  gastrointestinal  tract,  they  are  so  un- 
like from  the  standpoint  of  age,  sex,  etiology, 
symptoms,  and  the  type  of  operation  that  should 
be  employed,  that  comparison  seems  merited. 

AGE  AND  SEX  INCIDENCE 
One  of  the  most  outstanding  facts  is  in  relation 
to  age.  Approximately  80  per  cent  of  the  cases  of 
acute  intussusception  affect  children  less  than  two 
years  of  age  and  further,  50  per  cent  occur  among 
children  between  the  fifth  and  ninth  months  of 
life.  After  puberty,  the  acute  form  is  rare.  In  my 
series  of  cases  of  chronic  intussusception,  one 
patient  was  aged  three  and  a half  years  and  one 
ten  years,  but  the  majority  were  in  the  fourth  or 
fifth  decade  of  life.  The  sex  ratio  in  the  acute 
cases  was  two  males  to  one  female;  in  the  chronic 
cases,  three  males  to  one  female. 

ETIOLOGY 

Acute  intussusception. — It  is  unusual  to  find  a 
pathologic  cause  in  a case  of  acute  intussusception. 
A few  cases  have  been  reported  in  the  literature 
in  which  Meckel’s  diverticulum  has  been  the  ex- 
citing factor;  however,  the  explanation  is  usually 
only  theoretical. 

There  are  two  logical  conclusions  with  reference 
to  the  cause  of  the  condition:  first,  in  the  infant 
the  ileocecal  valve  projects  3/8  inch  (about  1 cm.) 
into  the  cecum,  the  terminal  portion  of  the  ileum 
is  surrounded  by  a rich  lymphatic  supply.  Due  to 
the  digestive  disturbances  which  are  more  likely 
to  occur  after  the  fifth  month,  when  changes  in 
diet  are  usually  made,  these  structures  become 
swollen,  the  projecting  valve  acts  as  an  irritant, 
and  peristalsis  increases.  Acute  intussusception 
is  notoriously  a disease  affecting  formerly  healthy 
children,  and  a majority  of  the  intussusceptions 
are  of  the  ileocolic  type.  The  second  explanation 
is  that  the  condition  is  purely  neurogenic.  Inco- 
ordinated  nervous  impulses  contracting  the  in- 
testines here  or  there,  and  stimulating  peristalsis 

Division  of  Surgery,  The  Mayo  Clinic,  Rochester,  Minn. 

*Read  before  the  Four  County  Medical  Society,  Wauseon, 
Ohio,  June  16,  1933. 


or  antiperistalsis  above  or  below  the  contracted 
part,  might  easily  lead  to  telescoping  of  the  seg- 
ment and  explain  the  rare  cases  of  retrograde  or 
even  multiple  intussusception. 

There  is  good  reason  to  believe  that  the  cases  of 
severe  colic  observed  among  young  children  may 
be  explained  on  the  basis  of  intussusception  and 
self-reduction.  Experimentally,  it  is  difficult  to 
keep  induced  intussusception  in  place. 

Chronic  intussusception — In  cases  of  the  chronic 
form  of  intussusception,  it  is  usual  to  find  a path- 
ologic cause.  Of  twenty-four  cases  of  intussus- 
ception in  the  small  bowel  and  ileocecal  region, 
eighteen  were  definitely  due  to  tumors  and  sixteen 
of  these  were  malignant.  All  of  twelve  cases  in 
which  the  intussusception  involved  the  transverse 
colon  and  sigmoid,  were  caused  by  tumors  and 
eleven  were  malignant.  In  other  words,  in  more 
than  85  per  cent  of  the  forty  cases  studied,  in- 
cluding four  cases  of  intussusception  of  the  ap- 
pendix, the  condition  was  due  to  definite  changes 
and  in  67  per  cent  of  these,  to  malignant  changes. 

SYMPTOMS 

Judging  from  the  age  incidence,  from  the 
etiologic  factors  involved,  and  from  the  descrip- 
tive terms,  acute  and  chronic,  it  is  obvious  that 
there  is  a wide  variation  in  the  symptoms  of  the 
two  forms.  There  is  also  considerable  variation 
among  the  cases  in  each  group,  depending  on  the 
situation  of  the  intussusception,  its  duration,  its 
extent,  and  the  degree  of  obstruction  present.  It 
is  well  to  remember  also  that  the  chronic  type 
may  progress  to  the  acute  type. 

Rather  than  attempt  a detailed  comparison  of 
symptoms,  I prefer  to  cite  illustrative  cases,  and 
then  to  describe  the  operations  employed. 

Case  I. — A boy,  aged  eighteen  months,  was 
brought  to  the  clinic  with  the  history  of  having 
had  excellent  health  until  twenty  hours  previously, 
at  which  time  he  suddenly  had  been  seized  with 
severe  pain  in  the  abdomen.  The  pain  passed 
away  for  a time  (a  few  moments)  but  returned 
intermittently,  but  with  fair  regularity.  The 
child  assumed  the  knee-chest  position  in  bed  and 
appeared  to  strain  as  at  stool  during  the  seizures. 
Vomiting  developed  after  a dose  of  castor  oil 
which,  fortunately,  was  not  retained.  Later, 
bloody  mucus  stools  were  passed,  with  little  fecal 
matter. 

The  child  appeared  to  be  in  a state  of  shock. 
He  was  pale  and  perspiring.  Hyperperistalsis 
was  observed  over  the  abdomen;  a mass  could  be 
palpated  through  the  abdominal  wall  on  the  right 
side  and  also  by  rectum.  Such  a mass,  it  should 
be  noted,  is  not  always  found  and  may  be  con- 
sidered,merely  as  a supplementary  factor,  not  one 
necessary  to  diagnosis. 

The  diagnosis  before  operation  was  acute  in- 
tussusception. 

Case  II. — A boy,  aged  three  and  a half  years, 
was  brought  to  the  clinic  with  the  history  of 


693 


694 


The  Ohio  State  Medical  Journal 


November,  1933 


having  had  severe  colic  at  the  age  of  three 
months,  after  which  he  had  been  well  except  for 
constipation  requiring  frequent  enemas,  until  five 
weeks  before  admission.  At  that  time  he  had  be- 
gun to  be  troubled  with  intermittent  stomach  ache, 
distention,  and  increasing  constipation;  there  was 
no  fever.  The  stomach  ache  and  distention  had 
increased,  and  about  two  and  a half  weeks  before 
admission  he  had  begun  to  vomit  at  night,  usually 
at  about  2:00  a.  m.  The  vomitus  had  consisted 
chiefly  of  mucus,  rarely  of  food,  and  the  emesis 
had  become  projectile.  There  had  been  no  loss  of 
weight,  and  no  hematemesis  or  melena.  The 
patient  had  become  progressively  weaker,  and  the 
pain  more  constant  and  chiefly  epigastric.  He  had 
whimpered  and  moaned,  but  had  not  cried  out- 
right. He  had  begun  to  vomit  during  the  day  as 
well  as  at  night  and  his  food  had  to  be  entirely 
liquid. 

The  child  appeared  to  be  fairly  well  developed 
and  nourished.  It  was  difficult  to  examine  him. 
All  signs  were  negative  except  for  distention  of 
the  abdomen  graded  3.  The  distention  was  more 
marked  in  the  upper  half.  There  was  slight,  gen- 
eralized tenderness.  Loops  of  bowel  were  pal- 
pable, but  a mass  could  not  be  felt  except  by 
rectum.  Palpating  in  this  way,  a suggestion  of  a 
mass  was  detected  in  the  anterior  part  of  the 
right  lower  quadrant. 

The  preoperative  diagnosis  was  chronic  partial 
intestinal  obstruction. 

SURGICAL  CONSIDERATION 

The  surgeon  must  always  fight  morbidity  and 
mortality.  Before  the  days  of  aseptic  surgery 
there  was  ample  excuse  for  medical  treatment  of 
intussusception  by  means  of  water,  oil,  air  or 
barium  given  by  rectum  under  pressure,  but  the 
excuse  no  longer  exists  except  in  rare  instances. 
The  treatment  of  acute  or  chronic  intussusception 
is  surgical,  and  the  most  important  factor  is  the 
element  of  time.  Particularly  is  this  true  if  in- 
tussusception is  acute,  because  on  it  depends  the 
choice  of  surgical  procedure. 

Study  of  the  thirty-three  cases  of  acute  intus- 
susception observed  at  the  clinic,  and  of  the  re- 
ports in  the  literature,  would  seem  to  suggest  that 
if  a patient  is  seen  within  the  first  twenty-four 
hours,  and  usually  within  thirty-six  hours,  the  in- 
tussusception itself  may  be  attacked  safely,  with 
the  object  in  view  of  reduction  and  fixation  to 
prevent  recurrence.  The  manipulation  must  be 
gentle,  and  the  fixation  usually  is  accomplished 
by  attaching  the  reduced  bowel  to  the  mesocolon 
near  the  cecum,  to  the  cecum  itself,  or  to  the 
peritoneum  of  the  anterior  abdominal  wall. 

The  high  mortality  rate  in  the  surgical  treat- 
ment of  acute  intussusception  occurs  in  cases  in 
which  operation  is  performed  after  thirty-six 
hours  and  is  due  to  two  principal  factors.  The 
first  factor  is  resection,  which  carries  a deplorably 
high  mortality  rate  in  these  cases;  it  is  fair  to 
estimate  that  an  average  mortality  rate  gleaned 
from  the  literature  is  85  per  cent.  The  second 
factor  is  attempt  at  reduction  after  fixation  of  the 
intussusception,  with  resulting  trauma  and  tear- 
ing into  the  wall  of  the  bowel  and  futile  repair 


of  already  necrotic  tissue.  Death  in  all  cases  is 
due  either  to  shock,  peritonitis  or  both. 

Rather  than  attempt  reduction  and  fixation,  or 
rather  than  attempt  resection,  I would  suggest, 
whenever  possible,  fixation  to  prevent  progres- 
sion, and  ileocolostomy  around  the  involved  por- 
tion, or  else  consideration  of  extraperitoneal- 
ization. 

In  the  thirty-three  cases  of  the  acute  form  of 
intussusception,  resection  was  performed  in  three, 
with  two  deaths.  The  operative  mortality  rate  for 
the  series  was  21.2  per  cent. 

Treatment  of  chronic  intussusception,  usually 
diagnosed  before  operation  as  partial  intestinal 
obstruction,  is  also  always  surgical.  In  contra- 
distinction to  the  acute  type  of  intussusception, 
reduction  should  rarely  be  attempted,  regardless 
of  duration.  Resection  should  always  be  the  pro- 
cedure of  choice,  because  in  as  large  a proportion 
as  67  per  cent,  the  condition  is  caused  by  a 
malignant  lesion. 

The  type  of  resection  will  depend  on  the  case. 
It  may  be  advisable  to  perform  it  in  two  stages 
or  in  one  stage;  the  situation  of  the  lesion  and 
the  condition  of  the  patient  will  be  the  deciding 
factors. 

In  Case  II  in  which  the  symptoms  were  of 
chronic  intussusception,  at  operation  April  3, 
1933,  intussusception  of  the  ileum  into  the  cecum, 
and  part  way  up  the  ascending  colon,  was  found. 
There  was  considerable  inflammatory  reaction  in 
the  immediate  vicinity  of  the  trouble,  and  for 
several  inches  up  the  ileum,  and  it  was  necessary 
to  resect  about  22  cm.  of  ileum,  along  with  the 
appendix,  cecum,  and  ascending  colon.  Because  of 
the  chronicity  of  the  obstruction,  the  small  bowel 
was  hypertrophied  and  distended,  and  it  was  pos- 
sible to  make  an  end-to-end  anastomosis  between 
the  ileum  and  the  splenic  flexure  of  the  transverse 
colon,  protecting  the  suture  line  with  omentum. 

Unfortunately,  but  as  might  have  been  sus- 
pected in  chronic  intussusception,  regardless  of 
the  age  of  the  patient,  the  change  causing  the  con- 
dition proved  to  be  sarcoma.  The  obstruction  was 
relieved,  however,  and  the  patient  has  passed  two 
stools  a day  by  rectum  since.  In  June,  fluid  ap- 
peared in  the  right  side  of  the  thorax,  which  on 
tapping,  indicated  metastasis.  At  the  time  of 
writing,  the  patient  is  still  alive,  although  not 
well,  and  is  being  treated  by  deep  roentgen  rays. 

SUMMARY 

It  may  be  said  that  there  are  fundamental  dif- 
ferences between  the  acute  and  the  chronic  forms 
of  intussusception,  and  that,  surgically,  the  ele- 
ment of  time  is  most  important.  In  the  acute 
form,  the  procedure  of  reduction  and  fixation  is 
usually  safely  done  within  thirty-six  hours.  After 
that,  fixation  to  prevent  progression,  and  a short- 
circulating  procedure,  are  safer  than  resection  or 
an  inadvisable  attempt  at  reduction. 

Resection  is  always  the  procedure  of  choice  in 
the  chronic  form  of  intussusception. 


H.  G.  Southard,  M.D.,  Columbus,  Ohio 


IN  searching  through  a large  volume  dealing 
thoroughly  with  the  progress  of  civilization 
in  apparently  every  aspect,  only  one  men- 
tion was  made  of  medicine,  viz. : That  the  ancient 
Athenian  cities  were  limited  in  size  because  no 
adequate  system  of  sanitation  had  been  developed. 

The  author  could  have  told  how  Babylon  had 
established  a sewerage  system  and  brought  its 
drinking  water  from  a far  distant  supply;  how 
Jei’usalem  effectively  disposed  of  its  garbage,  how 
ancient  Persians  boiled  all  their  drinking  water, 
and  how  Roman  aqueducts  supplied  the  city, 
which  had  a sewerage  system  that  even  today  is 
in  use. 

No  mention  was  made  of  Hippocrates,  who, 
2,300  years  ago  taught  that  disease  originated 
from  natural  causes,  and  associating  sickness  with 
ignorance  rather  than  blaming  it  to  a wrathful 
God. 

No  time  history  of  civilization  can  ignore  medi- 
cal science;  without  it  there  could  be  no  civiliza- 
tion. 

The  unrivalled  supremacy  of  the  Greek  intellect 
degenerated  because  man  was  then  helpless 
against  the  ravages  of  malaria,  and  the  mosquitoes 
of  the  Pontine  marshes  contributed  more  to  the 
downfall  of  Rome  than  did  the  onslaught  of  bar- 
barian tribes. 

PHYSICIAN  ON  THE  PROW  OF  THE  SHIP 
President  A.  Lawrence  Lowell,  of  Harvard,  in 
summarizing  the  progress  of  civilization,  said: 
“It  is  hardly  an  exaggeration  to  summarize  the 
history  of  four  hundred  years  by  saying  that  the 
leading  idea  of  a conquering  nation  in  relation 
to  the  conquered  was  in  1600  to  change  their  re- 
ligion; in  1700,  to  change  their  laws;  in  1800,  to 
change  their  trade  ; and  in  1900,  to  change  their 
drainage.  May  we  not  say  that  on  the  prow  of 
the  conquering  ship  in  these  four  hundred  years 
first  stood  the  priest,  then  the  lawyer,  then  the 
merchant,  and  finally  the  physician.” 

If  this  tribute  be  true,  that  there  stands  today 
the  physic’an  on  the  prow  of  the  ship  of  civiliza- 
tion, then  why  do  not  historians  in  their  written 
pages  give  medical  science  the  pre-eminence  which 
it  deserves?  Why  do  they  not  come  forward 
frankly  with  the  full  truth,  that  civilization  is  not 
only  based  upon  modern  medical  science,  but  made 
possible  by  modem  medical  science,  says  Haggard 
in  “The  Lame,  The  Halt  and  The  Blind”. 

Without  the  knowledge  of  Walter  Reed  and  his 
associates  (1900)  the  Panama  Canal  would  be- 
long to  France, — and  suppose  that  without  that 

Read  before  the  Section  on  Public  Health  and  Preventive 
Medicine,  Ohio  State  Medical  Association  at  the  87th 
Annual  Meeting,  Akron,  Sept.  7 and  8,  1933. 


knowledge  the  Canal  had  been  built;  it  would  lie 
idle  today.  For  if  yellow  fever  still  existed  there 
as  it  once  did,  every  port  in  the  world  would  be 
closed  to  a ship  that  passed  that  way. 

PROGRESS  OF  MEDICAL  SCIENCE  HAS  BEEN  SLOW 

It  is  true  that  the  progress  of  medical  science 
has  been  a slow  and  halting  one  down  the  corridor 
of  time.  So,  too,  has  been  the  progress  of  civiliza- 
tion, but  within  the  past  fifty  years  more  advance- 
ment has  been  made  in  medicine  than  in  all  the 
ages  past,  and  90  per  cent  of  this  has  been  along 
the  line  of  prevention. 

Following  the  return  of  the  Crusaders,  Europe 
was  devastated  with  many  diseases  and  plagues, 
before  scarcely  known.  Cholera,  bubonic  plague 
and  smallpox  decimated  large  populations,  and 
hideously  deformed  lepers  crouched  begging  by 
nearly  every  wayside  shrine.  Then,  too,  from  the 
East  came  a revival  of  Galen’s  herb  medication 
which  dominated  European  medicine  for  many 
succeeding  centuries,  for  the  returning  Crusaders 
brought  cloves,  cinnamon,  aloes,  carroway  seed, 
nutmeg,  pepper  and  other  spices  which  were 
eagerly  grasped  by  the  physicians  of  that  day  as 
cures  for  all  human  ailments. 

The  rivalry  of  the  countries  of  Europe  in  ob- 
taining supplies  of  these  valuable  spices  estab- 
lished the  “years  of  discovery”,  during  which 
hardy  mariners  sought  easier,  shorter  and  less 
dangerous  routes  by  which  they  might  be  pro- 
cured. 

FROM  TRAFFIC  IN  DRUG  TRADE  EMERGED  THE  BRITISH 
EMPIRE  AND  THE  DISCOVERY  OF  AMERICA 

Thus  it  was  that  Christopher  Columbus,  seek- 
ing a shorter  route  for  the  drug  trade,  discovered 
America,  and  from  this  cause  emerged  the  far- 
flung  extent  of  the  British  Empire. 

Then  America  began  to  be  peopled  from  Europe, 
and  along  a narrow  border  of  the  Atlantic  shore 
of  our  present  United  States  little  settlements 
arose  and  multiplied,  and,  as  population  increased, 
restless  numbers  moved  farther  inland,  and  it  is 
thus  that  Ohio  was  originally  settled  by  a varied 
people  of  Anglo-Saxon  blood  who  emigrated  from 
a fringe  of  the  Atlantic  slope  extending  from  Vir- 
ginia to  New  England. 

Driven  by  that  pioneering  spirit  of  unrest  that 
has  always  pointed  westward,  they  came  in  ever 
increasing  numbers  year  after  year.  They  found 
a land  rich  of  soil;  a land  of  hill  and  plain,  teem- 
ing with  game  and  savage  beasts,  and  still  more 
savage  men;  a land  of  vast  forests,  of  crystal 
streams  and  of  wide-spread,  pestilential  swamps. 
Many  of  these  early  arrivals  soon  filled  an  un- 
timely grave  in  the  wilderness,  for  this  young 
Ohio  was  no  place  for  the  weakling  or  the  physi- 
cally unfit. 


Director  of  Health,  State  of  Ohio. 


695 


696 


The  Ohio  State  Medical  Journal 


November,  1933 


OHIO  ONE  HUNDRED  YEARS  AGO 

At  the  age  of  twenty-seven, — one  hundred  years 
ago, — Ohio  had  a population  of  937,903  living  in 
numerous  backwoods  settlements  or  in  isolated 
little  individual  clearings.  Cincinnati,  the  metro- 
polis, could  boast  of  a population  of  24,831;  Day- 
ton  had  2,954  inhabitants ; Columbus,  2,437 ; 
Cleveland,  1,100;  and  it  was  hot  until  1840  that 
Toledo  reached  the  1,300  mark. 

The  savage  red  man  had  long  ceased  to  be  a 
menace,  and  daugerous  wild  animals,  the  wolf,  the 
bear  and  the  catamount  were  rapidly  dwindling  in 
numbers,  but  there  was  one  foe  by  far  more 
deadly  than  all  these  had  ever  been  that  still  con- 
tinued to  annually  reap  an  appalling  harvest  of 
death.  This  was  disease.  Cholera  and  virulent 
smallpox  periodically  swept  the  State;  malaria 
and  typhoid  fever  devastated  whole  settlements; 
milk  sickness,  mysterious,  deadly,  slaughtered  en- 
tire families;  diphtheria,  diarrhea  and  enteritis, 
and  other  ailments  of  early  childhood  killed  al- 
most one-fourth  of  all  babies  before  their  first 
year  had  passed.  The  new-born  babe  had  a life 
expectancy  of  about  25  years. 

MEDICAL  DISCOVERIES 

Almost  1700  years  after  the  Christian  Era, 
Leuwenhoek,  a Dutch  scientist  and  lens  maker, 
discovered  what  he  called  “animalculae”  in  the 
tartar  from  teeth,  and  what  we  now  know  as  pro- 
tozoa in  diarrheal  stools,  by  means  of  a micro- 
scope of  his  own  construction. 

In  1849  a village  doctor  on  the  Rhine,  peering 
through  a crude  compound  miscroscope,  found 
red-like  bodies  in  the  blood  of  animals  sick  with 
anthrax,  and  was  unable  to  find  them  in  the  blood 
of  healthy  animals.  The  science  of  bacteriology 
was  born. 

Louis  Pasteur  must  be  credited  with  building 
the  foundation  upon  which  the  exact  systemic 
knowledge  of  the  causal  agents  of  disease  is  based. 
He  over-threw  the  ancient  doctrine  of  the  spon- 
taneous generation  of  the  lower  forms  of  life  by 
his  work  with  fermentation ; he  proved  that  these 
lower  forms  of  life  breed  true,  so,  there  being  a 
special  organism  for  each  variety  of  fermentation, 
why  not  a specific  organism  for  each  disease? 
Many  of  these  have  now  been  found.  He  showed 
that  sufficient  heat  to  kill  these  organisms  ar- 
rested fermentation, — from  this  came  steriliza- 
tion; he  demonstrated  putrefaction  to  be  due  to 
bacterial  growth, — this  led  to  our  present  aseptic 
surgery;  he  found  that  by  attenuation  of  bacterial 
strains  vaccines  might  be  prepared  that  would 
give  immunity. 

Pasteur’s  work  was  amplified  by  that  of  Robert 
Koch,  undoubtedly  the  outstanding  bacteriologist 
of  all  time.  Koch’s  solid  media  and  bacterial 
strains  have  made  the  growth,  separation  and 
identification  of  bacteria  comparatively  easy,  and 
energetic  workers  in  all  lands  have  “carried  on” 
and  are  gradually  conquering  these  invisible  foes. 


SHOULD  ONE  OF  OUR  CITIZENS  OF  ONE  HUNDRED 
YEARS  AGO  RETURN 

Should  one  of  our  citizens  of  one  hundred  years 
ago  return,  he  would  be  told  that  cholera  had 
been  unknown  in  Ohio  for  many  years;  that  cases 
of  malaria  are  so  infrequent  that  many  of  our 
physicians  have  never  seen  one;  that  typhoid 
fever  and  diphtheria  are  now  preventable  and 
that  when  cases  occur  they  are  due  to  careless- 
ness, negligence  or  ignorance;  that  few  deaths 
occur  from  smallpox  (we  would  be  ashamed  to 
mention  the  number  of  cases  each  year) ; that 
only  five  per  cent  of  the  babies  born  in  our  day 
fail  to  reach  one  year  of  age,  and  that  the  new- 
born babe  now  has  a life  expectancy  of  fifty-eight 
years. 

We  could  tell  him  of  many  complete  recoveries 
from  tuberculosis;  we  could  tell  him  how  public 
health  is  protected  by  supervision  of  water  and 
milk  supplies;  how  the  traveling  public  may  be 
assured  of  health  protection  in  inspected  tourist 
camps,  and  of  safe  drinking  water  where  signs  of 
the  Ohio  Department  of  Health  appear.  Of  the 
constant  guardianship  of  both  city  and  rural  com- 
munities by  local  health  departments;  of  the  in- 
vestigation and  checking  of  local  outbreaks  of 
communicable  diseases;  of  the  inspection  of  school 
children  that  epidemics  may  not  occur,  and  of  the 
examination  of  younger  children  that  defects  may 
be  corrected  by  physicians  or  dentists  before  the 
child  enters  school. 

We  could  tell  of  great  reduction  of  maternity 
death  rates  since  his  day,  due  to  prenatal  and 
postnatal  care,  and  we  would  tell  of  the  instruc- 
tion of  children  in  the  care  of  the  body,  that  they 
may  reach  manhood  and  womanhood  physically  fit. 

IF  CIVILIZATION  WERE  DEPRIVED  OF  MEDICAL 
SCIENCE 

If  civilization  were  deprived  of  medical  and 
sanitary  science,  pestilences  would  return,  epi- 
demics would  run  rampant  and  large  sections  of 
the  world  would  soon  become  uninhabitable.  Many 
of  us  remember  when  the  mortality  rate  for  chil- 
dren under  one  year  of  age  was  113  (now  it  is 
59)  ; when  tetanus  and  rabies  infection  meant 
certain  death ; when  diphtheria  was  nearly  always 
fatal;  when  water  and  milk  supplies  were  unpro- 
tected and  typhoid  raged  uncontrolled,  and  when 
a diagnosis  of  tuberculosis  was  regarded  as  a 
death  sentence. 

In  fact,  the  advance  of  medicine  has  been  be- 
yond the  mental  absorption  of  the  people  as  a 
whole;  so,  while  research  and  discovery  occupy 
the  minds  and  time  of  our  men  of  science,  we 
must  not  forget  that  there  is  now  available  suffi- 
cient medical  information  to  revolutionize  the 
health  conditions  of  all  nations,  could  the  general 
public  be  educated  to  utilize  what  they  have. 


November,  1933  Public  Health  Administration — Southard 


697 


ECONOMY  AND  HEALTH 

Any  undue  retrenchment  in  health  work  is 
bound  to  be  paid  for  in  dollars  and  cents  as  well 
as  in  impairment  of  the  people’s  health  generally, 
according  to  Dr.  Wm.  H.  Welch,  Dean  of  Ameri- 
can Medicine,  as  quoted  in  the  New  York  Times. 
“We  can  demonstrate  convincingly  that  returns  in 
economic  and  social  welfare  from  expenditures 
for  public  health  service  are  far  in  excess  of  their 
costs.” 

“Suicidal”  was  the  word  used  by  Dr.  Kendall 
Emerson  to  describe  the  cutting  of  government 
health  department  budgets  to  the  extent  of  im- 
pairing their  service, — “We  must  separate  the  es- 
sential from  the  non-essential.” 

“If  we  people  but  knew  the  risk  of  decreased 
health  protection,  we  would  approve  reduction  in 
every  other  department  * * * before  impairing 
the  service  that  watches  with  unslumbering  vigi- 
lance over  our  comfort,  our  health,  and  our  chil- 
dren’s lives.” 

A GREAT  SAVING  IN  LIFE  RECORDED  SINCE  THE 
HUGHES-GRISWOLD  LAW 

During  the  past  thirteen  years  the  population 
in  Ohio  increased  17.8  per  cent:  Of  this  gain  10.7 
per  cent  was  due  to  births  reported  over  the  num- 
ber of  deaths,  and  7.1  per  cent  was  the  excess  of 
immigration  over  emigration.  With  this  increase 
of  one  million  in  population  during  the  past  thir- 
teen years  we  find  only  3.4  per  cent  more  deaths 
filed  in  the  year  1932  than  in  1920,  the  year  be- 
fore our  present  health  laws  became  operative. 

Let  us  analyze  the  results  of  the  health  and 
medical  efforts  in  the  State  for  this  period  of 
time. 

In  1920  every  128th  mother  was  sacrificed  in 
childbirth ; in  1932  every  188th  mother  paid  this 
supreme  sacrifice.  A great  saving  of  lives  was 
recorded  in  children  under  one  year  of  age.  Every 
12th  child  bora  in  1920  never  lived  to  have  a 
birthday;  today  every  17th  child  bora  dies  during 
the  first  year  of  life. 

Every  12th  death  that  occurred  in  the  State  in 
1920  was  due  to  tuberculosis,  and  in  1932  every 
21st  death  was  caused  by  some  form  of  this 
malady.  Forty-two  per  cent  of  all  deaths  in  the 
State  in  1920  were  among  school  children  between 
the  ages  of  five  to  nineteen  years;  in  1932  only  27 
per  cent  of  the  deaths  were  in  this  group. 

I want  to  discuss  only  five  more  causes  of  death 
that  are  very  familiar  to  the  citizens  of  Ohio.  In 
1920  in  this  group  there  were  3,013  deaths,  and 
in  1932  only  1,085, — a decrease  of  64  per  cent. 
The  names  and  percentages  of  decreases  are  as 
follows:  Typhoid  fever,  66  per  cent;  scarlet  fever, 
40  per  cent;  diphtheria,  65  per  cent;  measles,  76 
per  cent ; and  whooping  cough,  58  per  cent. 

Along  the  hazardous  road  of  life  this  cannot  be 
said  to  be  a mere  coincidence,  but  is  the  result  of 
cooperation  of  the  family  physician  and  a well- 
rounded  health  program  in  each  general  health 


district,  which  includes  sanitation,  immunization, 
control  of  communicable  diseases  and  education. 


WHAT  IS  THE  DIVIDEND  ON  OUR  HEALTH 
INVESTMENT? 

What  is  the  dividend  on  our  health  investment? 
To  answer  we  must  have  an  estimate  of  the  money 
value  of  a human  life  (Age  25-29  years,  $18,000). 

“The  Money  Value  of  a Man”,  by  Dublin  and 
Lotka,  (from  School  Health  Bureau,  1932,  Metro- 
politan Life  Insurance  Company)  has  thrown  a 
flood  of  light  upon  the  subject,  and  has  given  us  a 
basis  for  making  the  calculation  that  we  need. 

What  was  the  economic  value  of  lives  saved  in 
Ohio  during  the  year  1932  by  the  reduction  of 
death  rate  for  ages  under  35  years? 

A comparison  of  the  death  rate  for  1920  and 
1932  in  this  age  group  revealed  last  year  the 
saving  of  10,540  lives,  and  that  the  persons  saved 
were  equivalent  to  a total  saving  in  money  capital 
of  One  Hundred  Eleven  Million,  One  Hundred  and 
Eighty-two  Thousand  Dollars  ($111,182,000), 
with  an  actual  expenditure  of  Three  Million  Dol- 
lars ($3,000,000)  for  public  health  services.  The 
economic  value  of  lives  saved  in  Ohio  since  the 
Hughes-Griswold  Act  became  operative  during  the 
past  thirteen  years,  in  the  age  group  under  35 
years,  was  Eight  Hundred  and  Seventy-four  Mil- 
lion, Six  Hundred  and  One  Thousand  Dollars 
($874,601,000). 


EXPENDITURES  FOR  PUBLIC  HEALTH  SERVICE— 1932 
For  the  fiscal  year  1932  there  was  expended  for 
public  health  service  in  General  Health  Dis- 
tricts   $ 703,058.32 

In  City  Health  Districts  1,791,268.73 

Total  expenditure,  including  the  State  of  Ohio’s 
contribution  in  form  of  State  Subsidy  reim- 
bursement   2,494,327.06 

Total  expenditure,  State  Department  of  Health  467,264.04 

Total  expenditure  for  Public  Health 2,961,591.09 

Per  capita  cost  for  Rural  Health  Service .28 

Per  Capita  Cost  for  City  Health  Service .254 

Average  per  capita  cost  for  State .364 

Average  cost  to  taxpayer,  for  State  as  a whole, 

per  $1,000  property  valuation  .234 

Furthermore,  63.8  per  cent  of  the  rural  popula- 
tion is  under  the  direction  of  full-time  public 
health  administration. 


STATE  TAX  DOLLAR—1932 

Highways  and  Grade  Crossings 

Education  

Welfare  

General  Administration  

Public  Debt  

State  Office  Building  

Miscellaneous  ( 

Public  Works  5 
Military  ] 

Judiciary  f — 

Legislative  J 

Health  - - 


.4851 

.224 

.1228 

.0669 

.034 

.0213 


.0207 

.0188 


.0063 


EXPENDITURES  OF  STATE,  CITY  AND  COUNTY 
HEALTH  DISTRICTS 


State  i $ 467,264.04  Part  of  Tax  Dollar .0063 

City  1,791,268.73  Part  of  Tax  Dollar .....  .017 

County  703,058.32  Part  of  Tax  Dollar 036 


Total  .0593 

The  State  spent  for  Health  in  1930  $652,823.00 

1931  567.237.61 

1932  486,044.06 

Or,  only  .00630  of  the  tax  dollar  for  health  in  1932. 

For  1933  we  have  been  allotted 381,583.35 


But  even  this  small  amount  may  not  be  available. 

There  is  needed  in  Ohio  for  the  purchase  of 
Biologies,  $25,000. 

In  1931,  $8,000  was  granted  by  the  U.  S.  Gov- 


698 


The  Ohio  State  Medical  Journal 


November,  1933 


ernment,  through  the  U.  S.  Public  Health  Service, 
for  biologies  for  the  drought  area,  only. 

Immunization  and  vaccination  in  1932  practi- 
cally ceased,  due  to  lack  of  funds  to  purchase 
biologies.  The  same  condition  exists  in  1933. 

Through  the  U.  S.  Public  Health  Service,  aid 
was  furnished  to  five  (5)  health  districts,  amount- 
ing to  $8,550.  This  was  discontinued  on  June  15, 
1933,  causing  a loss  of  nursing  service  to  these 
five  districts;  also,  a sanitary  officer  in  one  dis- 
trict. 

The  State  Subsidy  was  reduced  50  per  cent, 
which  means  an  approximate  loss  to  each  health 
district  in  the  State  of  $1,000. 

This  means  that  some  of  our  full-time  health 
commissioners  will  revert  to  part-time  service, 
and  many  nurses  will  be  on  part-time. 

In  42  full-time  county  health  districts,  76  per 
cent  of  budgets  were  decreased  on  an  average  of 
$2,500 — amounting  to  $80,000. 

In  29  full-time  city  health  districts,  66  per  cent 
of  budgets  were  decreased  on  an  average  of 
$13,700 — amounting  to  $260,300  or  a loss  in  health 
service  for  full-time  units  of  $340,000. 


The  114  part-time  health  units  are  decreased  in 
like  amounts.  This  means  a proportionate  crip- 
pling of  health  service  throughout  the  State. 

CONCLUSION 

If  we  can  place  glasses,  that  the  children  may 
see;  if  we  can  prevent  throat  and  ear  trouble,  that 
the  children  may  hear;  if  we  can  make  cripples 
walk;  if  we  can  have  fewer  mentally  sick;  if  we 
can  instill  in  the  children  a desire  and  ability  to 
serve;  if  we  can  lengthen  the  span  of  life,  that 
men  and  women  may  meet  their  responsibility,  the 
Cost  of  Public  Health  will  have  saved  millions  in 
pain  and  suffering,  and  many  more  millions  in 
dollars  and  cents. 

The  Cost  of  Public  Health  should  be  measured 
in  dividends  of  the  millions  who  can  “carry  on”, 
for  countries  have  fallen  and  have  been  peopled 
by  a stronger  race  when  they  disregarded  the  pro- 
tection of  preventive  medicine,  or  Public  Health. 


Penetrating  Wound  of  Heart  and  Lung  With  Successful 
Surgical  Memoval  of  Foreign  Body 

Bernard  J.  Dreiling,  M.D.,  Youngstown,  Ohio 


REPORT  OF  CASE 

Mrs.  G.  S.,  white,  female,  age  27,  entered 
St.  Elizabeth’s  Hospital,  Youngstown,  Ohio,  with 
a history  of  attempted  suicide. 

Family  Plistory — Essentially  Negative. 

Personal  History — Patient  has  enjoyed  good 
health.  No  history  of  trauma  or  surgery.  Appetite 
usually  good.  Patient  has  been  dieting  of  late  and 
worrying  because  she  had  lost  her  appetite 
whereas  her  weight  remained  constant.  A growth 
of  hair  on  her  face  added  to  her  mental  distress. 
Has  been  married  twelve  years.  No  children. 

History  of  Present  Illness — About  five  days 
previous  to  entry  patient  tried  to  commit  suicide 
by  passing  a large  darning  needle  through  the 
fifth  left  intercostal  space  into  the  heart. 

Chief  Complaint — Pain  in  lower  left  breast 
aggravated  on  slightest  exertion. 

Physical  Examination — Presents  a well  nour- 
ished, white  female  who  does  not  co-operate  with 
history  or  physical  examination.  Face  shows 
moderate  growth  of  hair  and  has  acromegalic  ap- 
pearance. Thorax  symmetrical.  Greater  expansion 
on  right  side.  Normal  resonance;  no  rales.  Breath 
sounds  normal.  Breasts — right  is  normal.  Left 
shows  a very  slightly  contused  area.  No  object 
felt  on  palpation  beneath  left  breast  in  inframam- 
mary region.  Abdomen — normal  tone.  No  masses 
or  tenderness  elicited. 

X-ray  report — Indicates  the  presence  of  the 
needle  in  a direct  antero-posterior  line,  vertical 
angle  of  thirty  to  forty  degrees,  point  elevated. 
(Figs.  1 and  2).  Fluoroscopically  the  needle  was 
seen  to  move  synchronously  with  the  heart. 

Operation  was  decided  upon. 

Operation — Under  Nitrous  Oxide-Oxygen  Ether 
anesthesia  an  incision  was  made  beginning  at  the 
third  rib  in  the  midline  extending  downward  and 
lateralward  over  the  sixth  rib.  The  muscle  and 
fascia  were  dissected  free  and  turned  laterally 
due  to  the  large  mammary  gland,  exposing  the 
fourth,  fifth,  and  sixth  ribs.  The  fourth  and  fifth 
ribs  were  cut  about  three  inches  from  the  sternum 


and  retracted  medially  over  the  cartilages.  The 
pericardium  and  pleura  were  exposed  and  an  ad- 
hesion found  between  them  was  freed  following 
which  the  needle  was  felt.  The  needle  was  pushed 
into  the  lung  in  order  to  free  it  from  the  heart 
and  pericardium,  the  end  grasped,  and  the  needle 
removed.  The  ribs  were  put  back  in  place  and 
sutured  with  chromic  catgut.  The  muscle  flap  was 
brought  over  and  sutured  and  the  incision  closed 
with  clips.  The  duration  of  the  operation  was 
thirty-seven  minutes. 

Progress  notes — On  the  day  following  operation 
the  patient  complained  of  pain  and  weakness  in 
the  chest;  pulse  120  per  minute  and  temperature 
101.8.  Four  days  after  operation  the  patient’s 
general  condition  was  favorable  though  she  com- 
plained of  pain  in  the  chest  on  deep  inspiration. 
The  pulse  volume  was  good.  The  skin  clips  were 
removed  on  the  sixth  post-operative  day.  The  in- 
cision was  clean  and  healing  by  primary  intention. 
Fourteen  days  after  operation  the  patient  was 
discharged  having  been  up  and  about  the  hospital 
for  several  days  with  no  unfavorable  reactions. 
The  patient  was  seen  again  two  weeks  after  dis- 
charge at  the  office  and  at  that  time  recovery  was 
complete. 

COMMENT 

Thoracic  surgery  is  still  in  its  infancy  although 
the  first  successful  operation  on  the  chest  was 
done  by  Rehn  thirty-seven  years  ago  for  the 
suture  of  a cardiac  wound,  and  it  is  this  writer’s 
opinion  that  each  new  successful  case  adds  a mile- 
stone towards  the  time  when  this  procedure  will 
be  as  commonplace  as  abdominal  surgery  is  today. 

The  operative  technique  since  Rehn’s  time  has 
proceeded  more  towards  simplification  and  reduc- 
ing the  amount  of  lung  exposed  rather  than  to- 
wards changing  the  method.  Rehn1  in  1914  de- 
scribed an  operation  consisting  of  an  incision  from 
the  second  left  costal  cartilage  to  the  xiphoid  pro- 


November,  1933 


Penetrating  Wound  Heart  and  Lung — Dreiling 


699 


cess,  cutting  deep  and  splitting  the  muscles  and 
then  retracting  the  ribs  and  sternum  thereby 
gaining  full  exposure  of  the  chest.  Herringhanr 
in  1917  simplified  this  procedure  in  that  only  a 
costal  flap  over  the  area  in  which  the  missile  was 
lodged  was  turned  back.  Allen3  used  the  “Trap 
Door  Flap”  which  is  similar  to  Herringham’s 
technique  and  a modification  of  which  was  used  in 
the  case  described  above.  Every  operator,  though, 
takes  especial  pains  to  make  it  clear  that  the 
pleura  is  not  to  be  handled  more  than  is  absolutely 
necessary  and  the  wound  is  to  be  closed  without 
drainage,  if  clean,  to  prevent  post-operative  in- 
fection. 

The  prognosis  in  heart  injuries  is  dependent 
upon  the  chamber  affected,  the  thicker  the  mus- 
culature the  greater  the  chance  for  self-closure. 
Vance*  states  that  injury  to  the  left  ventricle 
presents  the  most  favorable  prognosis,  the  right 
ventricle  the  next  most  favorable,  and  the  auricles 
least  since  they  are  the  thinnest  walled.  As  men- 
tioned above,  the  prognosis  of  the  chest  wounds 
themselves  is  dependent  upon  two  factors: — first, 
avoidance  of  manipulation,  so  far  as  possible,  of 
the  pleura,  and  second,  closure  of  the  wound  with- 
out drainage  provided  infection  is  not  present. 


Fig.  1.  Antero-posterior  view  of  chest  showing  needle 
(arrows)  penetrating  heart  and  lung. 


Most  of  the  thoracic  surgery,  of  course,  was 
performed  during  the  years  1914-1918  of  the 
World  War  and  even  then  surgeons  were  optimis- 
tic of  their  results  if  infection  were  avoided,  de- 
spite the  fact  that  they  did  not  see  the  patient 
until  two  to  three  days  following  the  injury.  Ac- 
cording to  Bradford5  the  most  frequent  cause  of 
death  during  the  war  was  septic  infection  of  a 
hemothorax;  other  complications  being  purulent 
bronchitis,  pneumonia,  pleurisy,  collapse  of  the 
lung,  and  pericarditis.  In  civilian  practice  where 
the  patient  is  usually  seen  within  an  hour  or  two 
following  the  injury  and  the  chances  for  infection 
are  so  much  reduced,  there  is  certainly  cause  for 
optimism  as  regards  the  prognosis. 


Fig.  2.  Lateral  view  of  chest  Full  length  of  needle 
(arrows)  seen  distinctly. 


As  to  treatment  of  a hemothorax  and  infected 
chest  wound  Bradford5  believes  that  aspiration  of 
the  fluid  with  replacement  by  oxygen  and  free 
drainage  of  the  chest  wound  is  to  be  recommended. 

In  the  words  of  Milton"  . then  it  may  certainly 
be  true  that  “if  once  a safe  route  is  established  a 
great  field  for  surgical  interference  lies  open. 
That  the  lungs  are  amenable  to  surgical  inter- 
ference has  been  frequently  proved,  and  many 
surgical  procedures,  from  the  removal  of  a for- 
eign body  from  the  bronchus  to  the  extirpation  of 
the  whole  lung,  may  some  time  or  other  be  classed 
amongst  established  operations.  Heart  surgery  is 
still  quite  in  its  infancy,  but  it  requires  no  great 
stretch  of  fancy  to  imagine  the  possibility  of 
plastic  operations  in  some,  at  all  events,  of  its 
valvular  lesions.  That  the  heart  is  tolerant  of 
wounds  and  injuries  has  been  proved  over  and 
over  again,  and  I see  no  reason  why  it  should  not 
be  tolerant  of  a deftly  guided  scalpel.  Not  only 
will  the  anterior  mediastinum  with  its  not  uncom- 
mon growths,  innocent  and  malignant,  lie  open  to 
us,  but  also  the  median  and  the  posterior,  and 
operations  on  the  esophagus,  the  thoracic  duct  and 
great  nerve  trunks  of  the  pneumogastric  and 
sympathetic  may  come  within  our  range.  Briefly 
stated  . . . the  last  great  cavity  of  the  body  and 
its  contents  lie  open  to  the  surgeon’s  hand  and 
knife.” 

SUMMARY 

1.  Report  of  a case  of  attempted  suicide  by 
lodging  a large  darning  needle  in  the  thoracic 
cavity  with  successful  surgical  removal. 

2.  Discussion  of  different  types  of  operations 


700 


The  Ohio  State  Medical  Journal 


November,  1933 


employed  for  entering  the  thorax  and  prognosis  of 
thoracic  surgery. 

604-605  Central  Tower. 

REFERENCES 

1.  Rehn,  “The  Interpleural  Exposure  of  the  Heart  by 
Means  of  Longitudinal  Section  of  the  Sternum.”  Trans. 
Am.  Surg.  As.,  xxxii,  697,  1914. 

2.  Herringham,  W.,  “Penetrating  Wounds  of  the  Chest 


at  the  Casualty  Clearing  Stations.”  Brit.  Med.  J.,  p.  721, 
June  2,  1917. 

3.  Allen,  C.  W.,  “Removal  of  Bullet  From  Walls  of 
Heart  and  Report  of  Stab  Wound  of  Heart.”  New  Orleans 
M.  & S.  J.,  80,  458. 

4.  Vance,  B.  M.,  “Three  Unusual  Cases  of  Bullet 
Wounds  of  the  Heart  Showing  Attempts  at  Healing.”  Am. 
J.  Med.  Sci.  clxix,  6,  872,  June,  1925. 

5.  Bradford,  Brit.  Med.  J.,  p.  141,  Aug.  4,  1917. 

6.  Milton,  H.,  “Mediastinal  Surgery.”  The  Lancet, 
March  27,  1897. 


General  Paralysis  and  the  Malarial  Treatment 

Fred  L.  Rhodes,  M.D.,  Massillon,  Ohio 


GENERAL  Paralysis  is  a nonsuppurative  in- 
flammation of  the  parenchyma  of  the  cere- 
brum characterized  in  its  chronic  stage  by 
degeneration  and  organic  or  functional  destruc- 
tion of  the  cortical  neurons,  and  due  to  the  direct 
presence  of  the  spirochaeta  pallida  and  its  liber- 
ated toxins.  It  is  tertiary  syphilis  in  which  the 
brain  cells  become  involved  by  the  invasion  and 
final  localization  of  the  microorganisms. 

My  interpretation  of  this  obstinate  disease 
herewith  presented  is  a result  of  study  during  my 
twelve  years  of  service  as  assistant  superin- 
tendent of  the  Massillon  State  Hospital.  It  is  ob- 
vious that  this  grave  disorder  can  be  properly 
studied  only  in  a hospital  where  such  cases  are 
segregated. 

General  paralysis  will  probably  occur  in  about 
10  per  cent  of  the  cases  of  conti-acted  syphilis. 
The  percentage  may  be  higher.  There  is  at 
present  no  possible  means  of  exact  determination. 
Theoretically  a similar  percentage  of  tertiary 
lues  may  occur  in  any  one  of  certain  other  organs, 
and  in  such  cases  the  brain  escapes  from  the  bac- 
terial invasion.  Here  we  are  concerned  with  the 
cerebral  involvement  which  produces  a multi- 
tudinous array  of  diversified  symptoms  and  prob- 
lems. The  prevalency  of  the  condition  and  its 
resistance  to  ordinary  therapy  is  well  understood. 

Unfortunately  many  of  the  paresis  cases  arrive 
at  the  state  hospitals  after  the  pathological  pro- 
cess has  reached  the  point  of  brain  cell  destruc- 
tion. The  exceptions  consist  of  the  acute  forms 
of  the  disease  in  which  the  actual  destruction  of 
the  neurons  has  not  as  yet  taken  place,  but  are 
merely  in  a state  of  toxic  stimulation  or  irritation, 
and  the  resulting  psychotic  manifestations  are  not 
very  unlike  the  excited  or  manic  phase  of  manic 
depressive  psychoses.  These  are  the  cases  in 
which  the  malarial  treatment  is  especially  in- 
dicated, and  does  much  good,  whether  permanently 
or  in  a palliative  manner. 

It  can  hardly  be  denied  that  every  case  of 
general  paralysis  means  that  there  was  inade- 
quate treatment  instituted,  or  none  at  all,  after 
the  initial  infection.  In  some  cases  a history 
would  reveal  that  the  chancre  was  “dried  up”  with 
powder.  The  lesion  healed  (after  running  its 
course)  and  for  one  or  more  reasons  the  patient 


considered  himself  cured,  and  it  was  his  belief 
that  he  “got  it”  just  in  time.  It  may  be  men- 
tioned here  that  the  secondary  manifestations  of 
lues  may  be  so  slight  that  the  condition  is  un- 
noticed or  not  diagnosed.  Fifteen  or  twenty 
years  ago  some  patients  were  “cured”  with  one 
injection  of  salvarsan,  and  the  technic  of  adminis- 
tration was  a highly  complicated  one.  Other  cases 
gave  a history  of  receiving  insignificant  courses 
of  treatment  consisting  of  two  to  five  “shots”  in 
the  arm  or  buttocks.  Some  took  mercury  by 
mouth.  Self  medication  was  resorted  to  in  some 
cases.  In  many  cases  which  did  receive  a fair 
number  of  intravenous  treatments,  we  found  that 
the  dosages  were  so  small  that  no  benefits, 
should  have  been  expected.  Our  experience 
does  not  bear  out  the  contention  of  some 
that  small  dosages  should  be  given  in  syphilis 
involving  the  central  nervous  system.  In 
all  phases  of  syphilis  we  used  usually  the  stand- 
ard maximum  arsenical  dosages,  which  in  the  case 
of  neoarsphenamin  is  .9  gram.  We  did  not  use 
any  smaller  doses  unless  the  patient  showed  some 
special  pathology  in  which  this  maximum  dose 
might  be  contraindicated,  or  possibly  in  cases  of 
some  women  patients.  In  some  cases  1.8  grams 
of  neosalvarsan  has  been  given  at  one  dose  intra- 
venously and  without  a single  one  of  these  show- 
ing any  reaction  whatever.  These  facts  were 
checked  by  careful  clinical  and  laboratory  study. 
While  such  dosage  is  not  to  be  recommended  at 
this  time,  yet  it  may  help  to  confirm  the  fallacy 
of  unreasonably  small  doses  in  either  blood 
syphilis  or  neurosyphilis.  It  is  to  be  conceded 
that  a psychotic  person  is  not  prone  to  manifest 
subjective  reactions  or  symptoms.  Paretics  are 
usually  somewhat  insensible  to  severe  pain  and 
their  mental  faculties  are  not  normal.  There  is  no 
ability  to  permit  the  occurrence  of  a reaction  from 
a psychic  standpoint.  While  in  our  out-patient 
department  we  had  an  occasional  reaction  follow- 
ing intravenous  injection  of  arsenicals  of  the 
ordinary  dosage,  we  did  not  believe  that  the 
size  of  the  dose  had  much  to  do  with  causation 
of  reactions  in  most  cases.  Nor  in  our  experience 
was  the  weight  of  the  adult  patient  important.  In 
fact  the  more  obese  individuals  were  given 
arsenicals  with  more  precaution,  they  being  more 


November,  1933 


General  Paralysis — Rhodes 


701 


prone  to  a reaction  fi-om  a maximum  dosage. 
Rather  than  the  weight  of  the  patient,  we  were 
more  concerned  with  the  existence  of  any  glandu- 
lar pathology,  metabolic  or  endocrine  disturbances, 
and  cases  of  plethora.  We  believe  that  many  re- 
actions could  be  avoided  by  more  careful  technic 
in  the  administration  of  intravenous  medication. 
The  procedure  certainly  should  not  be  made  diffi- 
cult. It  is  believed  that  reactions  may  occur  when 
the  distilled  water  is  contaminated  by  protein 
bodies,  and  in  some  cases  probably  a reaction  may 
occur  from  an  inferior  product.  Arsenical  rash 
(dermatitis  medicamentosa)  happens  occasionally 
and  is  probably  due  to  an  idiosyncrasy.  It  may 
follow  an  initial  small  dose. 

While  this  paper  is  not  intended  to  deal  with 
the  first  and  second  stages  of  syphilis,  it  seems 
well,  however,  to  emphasize  the  importance  of 
proper  and  adequate  treatment  in  these  stages, 
thereby  preventing  insofar  as  possible  the  oc- 
currence of  paresis  or  tertiary  syphilis  of  other 
organs.  Rigid  therapy  is  essential  for  the  pro- 
phylaxis of  general  paralysis.  The  treatment  of 
general  paralysis  is  not  unlike  that  of  any  other 
stage  of  syphilis  except  that  the  malarial  therapy 
is  included  in  the  former  now  almost  universally. 
Unfortunately,  however,  its  use  in  some  hospitals 
is  carried  on  in  such  a haphazard  fashion,  that 
due  credit  cannot  be  given  in  these  instances  to 
this  new  form  of  therapy.  The  improper  applica- 
tion of  this  therapy  is  contrasted  by  a study  of 
its  proper  use,  as  we  endeavored  to  observe  at  the 
Massillon  State  Hospital,  since  its  introduction 
there  in  1924.  I might  mention  here  that  there 
seems  to  be  no  logical  reason  why  malarial 
therapy  could  not  be  used  with  benefit  in  any  stage 
of  syphilis,  and  my  theory  of  the  therapeutic 
action  of  malaria  would  support  this  contention. 
In  fact  we  have  used  it  in  cases  of  so-called  blood 
syphilis  and  with  satisfactory  results. 

From  a comparative  viewpoint,  the  condition 
known  as  cerebral  syphilis  might  be  mentioned 
here.  Such  cases  are  classified  differently  from 
paresis  and  occur  usually  sooner  after  the  initial 
infection  than  does  general  paralysis.  The  average 
length  of  time  between  the  infection  and  the  de- 
velopment of  general  paralysis  is  ten  or  eleven 
years,  although  I have  seen  cases  in  which  there 
was  an  interval  of  only  one  year,  and  the  other 
extreme  was  thirty-two  years.  These  extremes 
consisted  of  three  cases  only.  Cerebral  syphilis 
differs  from  paresis  in  that  the  former  is  not  a 
true  parenchymatous  involvement  except  possibly 
in  the  case  of  gumma.  The  three  types  of  cerebral 
syphilis  are:  (1)  Meningitic,  or  syphilitic  menin- 
gitis which  may  be  acute  or  chronic;  (2)  En- 
darteritic  or  inflammation  of  the  vascular  system 
of  the  brain;  and  (3)  Gummatous.  All  three  of 
these  pathological  processes  may  of  course  occur 
at  the  same  time,  and  the  first  two  in  conjunction 
with  the  pathology  of  paresis,  although  this  is 
rare. 


The  symptoms  of  cerebral  syphilis  are  some- 
times very  obscure,  and  there  are  usually  no 
psychotic  manifestations  except  possibly  slight 
mental  confusion  in  some  cases,  and  in  the  acute 
meningitic  form  there  may  be  delirium.  There 
may  be  involvement  of  the  cranial  nerves  most 
especially  in  the  cases  of  meningeal  form. 
In  the  cases  of  gumma  there  may  be  expected 
to  be  a paralysis  of  some  portion  of  the  body, 
usually  of  course  unilateral.  In  any  type  of 
cerebral  syphilis  there  are  few  if  any  mental 
symptoms.  The  Wassermann  and  Kahn  should 
of  course  be  made  on  the  blood  and  spinal 
fluid,  also  a spinal  fluid  cell  count  and  globulin, 
although  the  findings  may  not  differentiate  be- 
tween this  condition  and  general  paralysis,  except 
in  the  cases  of  a severe  acute  meningitic  involve- 
ment in  cerebral  syphilis  when  the  cell  count  is 
exceedingly  high.  In  these  latter  cases  the  ma- 
larial therapy  should  not  be  administered  until 
after  a course  of  intravenous  treatments. 

PATHOLOGY  OF  GENERAL  PARALYSIS 

The  reiteration  of  the  pathology  of  general 
paralysis  may  be  unnecessary  here ; however,  some 
mention  will  be  made  of  it  in  view  of  the  Apparent 
alleviation  of  the  pathological  process  itself  by 
the  introduction  of  the  malarial  therapy.  Micro- 
pathological  studies  confirm  this  as  evidenced  by 
Wilson’s  extensive  study  and  his  subsequent  re- 
port in  Histopathological  Changes  Following  Ma- 
larial Treatment  of  General  Paralysis  which  ap- 
peared in  Vol.,  51/4,  1928,  of  the  Brain,  and 
which  study  was  made  in  the  University  Psychia- 
tric Clinic  of  Hamburg-Friedrichsberg  with  Pro- 
fessor Dr.  Jakob.  The  cortex  of  the  cerebrum  is 
the  seat  of  the  bacterial  invasion  and  localization, 
and  the  frontal  and  parietal  lobes  show  the  most 
extensive  tissue  pathology.  Due  to  the  inflam- 
matory products  the  neurons  and  the  layers  of  the 
cortex  show  much  distortion.  There  is  usually  a 
pronounced  perivascular  infiltration  of  the  nerve 
tissue  with  extension  of  this  process  in  some  in- 
stances to  the  meninges.  The  neurons  are  altered 
in  shape  and  size  and  show  much  proliferation. 
The  neurogliar  histology  is  greatly  disarranged. 
Lymphatic  infiltration  is  marked.  The  process  in 
general  is  diffuse. 

The  picture  is  one  of  confusion  and  disorganiza- 
tion among  the  tissue  cells  brought  about  by  the 
aggressiveness  of  the  invading  spirochaete  and  its 
toxins.  As  previously  stated  micropathological 
study  carried  on  in  cases  which  have  been  treated 
with  malaria  show  a much  milder  picture,  and 
with  evidence  of  healing  and  reconstruction  of  all 
tissue  elements  concerned.  And  these  cases  have 
shown  an  absence  or  a marked  reduction  of  the 
presence  of  the  bacteria  in  the  nerve  tissue.  These 
studies  were  made  in  comparison  with  cases  which 
never  underwent  the  malarial  therapy.  Where  the 
disease  has  progressed  to  the  point  of  marked 
brain  cell  destruction,  the  therapeutic  destruction 


702 


The  Ohio  State  Medical  Journal 


November,  1933 


of  the  spirochaete  could  only  arrest  the  progress 
of  general  paralysis,  and  could  not  cure  any  ex- 
isting neurological  abnormalities  and  handicaps 
which  are  due  to  the  organic  destruction  of 
neurons  in  the  nucleus  of  origin.  To  be  sure  even 
the  arrest  of  the  progress  is  to  be  desired,  but  an 
absolute  cure  is  the  ultimate  goal  is  cases  of  gen- 
eral paralysis,  therefore,  the  importance  in  in- 
stituting prompt  treatment  in  all  cases. 

It  is  almost  needless  to  state  that  in  syphilis 
of  the  central  nervous  system  we  expect  to  find 
always  a positive  Wasserman  and  Kahn  reaction 
upon  the  spinal  fluid,  also  a pleocytosis  and  posi- 
tive globulin.  We  expect  the  cell  count  to  be 
greatly  increased  when  the  pathological  process 
is  very  active  and  of  recent  onset,  and  not  greatly 
increased  if  the  case  is  an  old  one  and  in  its 
chronic  phase.  The  cell  count  is  also  high  when 
the  meninges  are  involved.  In  the  cases  im- 
proved by  treatment  and  when  the  cell  count  has 
become  about  normal,  the  positive  globulin  may 
persist  for  a while,  and  even  after  the  spinal  fluid 
has  become  negative  to  the  Wasserman  test.  The 
disappearance  of  positive  reactions  in  the  course 
of  treatment  usually  occur  in  the  order  named — 
The  Wasserman,  The  Kahn,  and  the  globulin; 
the  globulin  being  undoubtedly  a derivative  of 
the  inflammatory  exudates  which  of  course  may 
persist  in  the  brain  for  some  length  of  time.  For 
one  or  more  reasons  which  are  not  always  un- 
derstood, the  blood  is  sometimes  negative  in  un- 
treated cases  of  syphilis,  especially  general  paraly- 
sis. This  may  possibly  be  solved  by  the  biochem- 
ist, and  may  be  due  to  the  existence  of  a natural 
antigen  in  the  blood  stream  with  a resulting  for- 
mation of  antibodies  which  for  some  reason  their 
action  does  not  materialize  in  the  brain  and  spinal 
fluid;  therefore,  the  unreliability  of  a negative 
Wasserman  or  Kahn  on  the  blood.  At  a certain 
point  in  the  course  of  treatment  the  blood  is  ren- 
dered negative,  yet  the  patient  still  has  syphilis. 
In  our  experience  it  was  comparatively  easy  to 
secure  a negative  Wasserman  on  the  blood  after 
a brief  but  rigid  course  of  treatment.  Additional 
and  prolonged  therapy  is  of  course  obvious,  if  a 
cure  is  to  be  expected  in  any  case  of  syphilis.  It 
is  not  believed  that  a negative  Wasserman  on 
the  blood  has  any  value  whatever  unless  secured 
at  least  a month  following  the  cessation  of  all 
treatment,  and  we  have  sometimes  thought  that 
the  presence  of  accumulated  arsphenamine  in  the 
body  may  sometimes  cause  a pseudo-negative 
reaction. 

SYMPTOMS  OF  GENERAL  PARALYSIS 

Even  those  experienced  in  psychiatry  may  find 
it  somewhat  difficult  to  outline  in  a systematized 
and  clear  manner  the  diversified  symptoms  and 
singular  manifestations  found  in  patients  with 
general  paralysis.  The  psychiatrist  is  well  ac- 
quainted with  all  of  them,  but  needs  a very  few 
indeed  to  establish  the  diagnosis,  and  invariably 


he  makes  the  diagnosis  before  the  results  of  the 
laboratory  tests  are  reported,  and  which  are 
merely  to  confirm  the  diagnosis  already  made. 
Of  course  there  are  exceptions.  The  history  of 
the  case  is  of  little  or  no  value,  unless  for  con- 
jugal reasons.  If  the  patient’s  findings  are  posi- 
tive and  he  is  a manned  man,  then  naturally  a 
professional  interest  should  be  manifested  in  the 
wife’s  condition,  especially  that  of  recurrent  mis- 
carriages. A clinical  history  is  more  important 
with  women  patients  so  many  of  which  contract 
syphilis  and  have  no  means  of  knowing  such. 
Disturbances  of  pregnancy  are  very  important 
incidences  to  note. 

In  arriving  at  a diagnosis  the  objective  symp- 
toms of  general  paralysis  are  most  important, 
and  include  those  found  upon  a careful  neuro- 
logical examination.  Any  abnormality  of  the 
patient’s  gait  is  to  be  noted  as  he  enters  the  ex- 
amining room.  It  may  or  may  not  be  impaired, 
but  if  it  is  then  this  will  be  of  value  along  with 
other  positive  findings.  There  may  be  mental 
confusion  which  in  some  cases  is  slight  or  hardly 
noticeable.  The  mood  may  be  that  of  marked 
euphoria,  or  just  the  reverse — depression.  The 
latter  class  would  be  more  prone  to  voluntarily 
seek  medical  aid.  Usually  it  is  best  to  permit  the 
patient  to  tell  his  story,  and  in  this  manner  his 
line  of  thought  is  secured,  and  the  abnormal  mani- 
festations become  apparent.  The  onset  of  general 
paralysis  is  generally  slow,  and  those  about  him 
may  notice  that  he  is  doing  some  “peculiar” 
things,  and  eventually  his  behavior  will  become 
erratic  to  a marked  degree.  On  the  other  hand 
there  are  a few  cases  with  sudden  onset  which 
is  accompanied  by  great  mental  excitement,  and 
he  may  become  uncontrollable,  the  condition 
simulating  the  excited  phase  of  manic  depressive 
psychoses.  These  cases  especially  are  the  ones 
which  promptly  respond  to  malarial  therapy  inas- 
much as  the  cortical  cells  are  merely  in  a state 
of  sudden  stimulation  from  the  bacterial  toxins, 
and  as  yet  have  not  undergone  organic  destruc- 
tion which  would  eventually  occur  in  untreated 
cases. 

These  acute  cases  present  a picture  of  mental 
upset,  and  not  that  of  a physical  illness.  The 
course  of  the  disease  is,  however,  usually  slow 
with  the  gradual  development  of  increased  mental 
and  physical  symptoms  which  may  include  gen- 
eral weakness,  mental  depression,  or  more  often 
euphoria,  in  the  latter  cases  of  which  there  may 
be  manifested  an  abnormal  feeling  of  well  be- 
ing. The  patient’s  ideas  are  usually  of  the  grandi- 
ose type.  He  may  have  great  plans  for  the  fu- 
ture. He  may  have  the  common  delusion  of  great 
wealth,  and  the  figures  generally  run  into  millions 
of  dollars.  These  symptoms  are  considered  prac- 
tically pathognomonic  of  general  paralysis.  As 
previously  stated  the  symptoms  from  a subjective 
standpoint  may  be  greatly  diversified,  and  may 
even  simulate  those  of  most  any  psychosis.  It  is 


November,  1933 


General  Paralysis — Rhodes 


703 


to  be  noted  that  there  are  few  cases  which  do  not 
exhibit  any  mental  symptoms  whatever,  but  for 
some  reason  or  another  they  notice  that  they  do 
not  seem  to  have  the  strength  or  initiative  force 
to  carry  on  their  work  to  which  they  have  been 
accustomed.  There  may  or  may  not  be  a history 
of  amnesia.  Some  do  not  give  a history  of  in- 
fection, usually  because  they  do  not  remember  or 
purposely  deny  such.  Insight  may  be  present  or 
lacking.  The  neurological  examination  is  very 
important  in  the  proper  diagnosis.  The  Romberg 
sign  is  usually  present,  but  not  always. 

In  progressed  cases  there  is  motor  incoordina- 
tion as  revealed  by  the  usual  tests.  The  reaction 
of  the  pupils  is  practically  always  impaired — 
Argyle  Robertson.  In  many  cases  they  are  un- 
equal in  size,  and  a few  show  irregularity  of  the 
pupillary  margin.  There  may  be  fundus  involve- 
ment, but  more  often  this  is  to  be  found  in 
cerebral  syphilis,  when  there  may  be  optic  neu- 
ritis or  atrophy,  or  more  rarely  partial  or  com- 
plete amaurosis,  the  latter  of  which  may  also  veiy 
rarely  occur  in  general  paralysis  when  there  is 
involvement  of  the  cortical  visual  center.  Opthal- 
moscopy  should  be  made  when  possible.  Speech 
defect  or  the  inability  to  articulate  is  a common 
manifestation,  and  may  be  demonstrated  by  the 
usual  test  phrases.  The  patellar  reflexes  are  in- 
creased greatly  or  moderately.  In  taboparesis 
or  when  the  spinal  cord  is  involved  the  patellar 
reflexes  are  absent.  Further  neurological  tests 
seem  unnecessary  for  the  diagnosis  of  general 
paralysis.  Convulsions  are  fairly  common  in  a 
few  cases  and  probably  due  to  inhibited  capillary 
circulation  with  resulting  anoxemia  and  edema 
of  cortical  tissue.  They  are  usually  clonic  in 
type.  In  a few  cases  they  may  be  repeatedly  per- 
sistent, there  being  an  interval  of  one-half  to  one 
minute  between  the  seizures.  If  not  checked, 
death  is  promptly  inevitable.  In  these  paretic 
convulsions,  it  is  not  at  all  uncommon  for  the  un- 
fortunate to  be  perfectly  conscious,  yet  he  cannot 
express  his  thoughts  in  words.  His  mental  an- 
guish is  obvious.  The  attacks  are  rare  during 
the  course  of  the  malarial  treatment,  which  fact 
may  assist  in  proclaiming  the  merits  of  this 
therapy  in  paresis. 

TREATMENT  OF  GENERAL  PARALYSIS 

The  history  of  the  malarial  treatment  is  well 
known  and  therefore  it  is  unnecessary  to  repeat 
that  phase  of  it  here.  There  have  been  attempted 
substitutes  for  malaria  for  the  production  of  thera- 
peutic fever,  which  heretofore  has  been  the  prin- 
cipal theory  of  the  mode  of  action  of  malaria  upon 
cases  of  general  paralysis.  It  is  believed  that  the 
elevation  of  body  temperature  does  have  spiro- 
cheticidal  tendencies,  as  in  any  infectious  disease 
the  fever  has  bactericidal  tendencies.  But  unfor- 
tunately a fever  does  not  occur  in  conjunction 
with  the  activity  of  the  spirochaete  in  general 
paralysis.  I believe  that  the  principal  and  most  im- 


portant therapeutic  action  of  malaria  against  the 
pathological  process  in  paresis  is  a result  of  the 
production  of  antigens.  These  are  in  the  form 
of  one  of  the  proteins — probably  toxalbumen  and 
is  formed  by  the  malarial  parasites  themselves 
or  in  conjunction  with  the  disintegrated  red  blood 
cells.  Antibodies  naturally  form  as  a result  of  the 
presence  of  antigens. 

Needless  to  state  that  cases  for  treatment 
should  if  possible  be  confined  to  a hospital.  At 
least  they  should  be  so  located  where  they  could 
be  under  the  constant  observation  of  a nurse  who 
could  be  in  communication  with  the  physician  at 
any  time.  However,  in  properly  selected  case* 
with  the  use  of  the  quotidian  type  of  malaria,  un- 
favorable complications  or  alarming  symptoms 
are  rather  rare.  The  quotidian  malaria  does  not 
seem  to  produce  the  virulent  effects  as  may  be 
noted  in  the  tertian  type,  yet  its  ability  to  pro- 
duce antibodies  would  seem  greater. 

Sometimes  there  are  cases  of  general  paralysis 
in  which  the  malarial  treatment  is  desired  but 
for  some  reason  it  is  inconvenient  to  take  them 
away  for  the  inoculation.  Here  I might  say  that 
the  citrated  malarial  blood  can  be  transported  in 
an  ordinary  sterile  Wasserman  tube,  and  the  para- 
sites will  remain  active  for  four  to  six  hours. 
If  kept  at  a body  temperature  this  time  may  be 
extended  to  twenty-four  to  thirty-six  hours. 

Sometimes  in  any  infectious  disease  treatment 
may  be  of  no  avail  if  instituted  at  a late  stage. 
The  same  is  true  of  the  malarial  treatment  in  gen- 
eral paralysis.  There  is  no  use  to  apply  this 
therapy  to  an  advanced  paretic  where  there  are 
general  enfeeblement,  signs  of  prolonged  paraly- 
sis, and  loss  of  all  mental  faculties.  These  condi- 
tions are  the  result  of  extensive  brain  cell  de- 
struction, and  the  normal  histology  of  the  brain 
tissues  cannot  again  exist  even  though  the  spiro- 
chaetes  are  destroyed.  With  the  careful  selection 
of  cases  and  the  application  of  rigid  treatment 
negative  serological  tests  have  been  effected  and 
the  patients  have  become  normal  mentally  and 
physically.  When  we  first  began  to  use  the  ma- 
larial treatment  in  1924  our  methods  and  technic 
were  somewhat  clumsy,  but  we  perfected  them, 
and  finally  were  securing  remarkable  results  with 
its  proper  administration. 

Before  the  treatment  is  applied  it  is  impor- 
tant to  become  acquainted  with  the  physical  and 
laboratory  findings  in  each  case.  If  the  treat- 
ment is  not  contraindicated,  the  patient  is  in- 
oculated intravenously  with  2 or  3 cc.  of  malarial 
blood  which  is  taken  immediately  before  from  a 
patient  with  active  malaria.  The  incubation 
period  is  from  two  to  twelve  days,  after  which 
there  will  occur  daily  paroxysms  of  chills  and 
fever.  The  number  of  paroxysms  the  patient  is 
permitted  to  have  depends  of  course  upon  his 
general  condition  from  day  to  day.  He  should  be 
confined  to  his  bed  at  all  times.  Twelve 
paroxysms  is  the  average,  when  the  patient  should 


704 


The  Ohio  State  Medical  Journal 


November,  1933 


receive  quinine  suphate  grains  5,  three  times  daily 
for  about  six  days.  Intravenous  arsenical  treat- 
ment should  be  started  on  the  same  day  that  the 
first  dose  of  quinine  is  given.  This  is  exceedingly 
important,  but  sadly  neglected  in  some  instances. 
The  spirochaetes  are  greatly  devitalized  by  the 
malarial  process,  and  this  is  the  opportune  time 
to  take  advantage  of  the  bactericidal  power  of 
intravenous  medication.  If  neoarsphenamine  is 
used  it  should  be  given  in  .9  gram  dosage  once 
weekly.  After  a month  bismuth  is  then  started 
in  conjunction  with  the  neoarsphenamine  treat- 
ments, and  is  given  intramuscularly,  the  dosage 
of  this  depending  upon  the  patient’s  tolerance. 

At  the  end  of  about  six  months,  a rigid  course 
of  mercury  intramuscularly  may  be  substituted 
for  the  neoarsphenamine  and  bismuth.  A spinal 
fluid  examination  should  then  be  made.  If  the 
Wasserman  is  still  positive  or  the  cell  count  is 
above  normal,  the  intravenous  and  bismuth  treat- 
ment should  be  repeated.  In  obstinate  cases  we 
did  not  hesitate  to  administer  .9  gram  neoar- 
sphenamine twice  weekly.  In  some  cases  we 
gave  a rigid  course  of  potassium  or  sodium  iodide 
in  addition  to  the  above  therapy.  Antisyphilitic 
treatment  should  continue  for  a reasonable  time 
even  after  obtaining  negative  laboratory  find- 
ings. The  main  point  in  the  treatment  is  to  push 
the  drug  to  the  point  of  tolerance  or  therapeutic 
effect.  The  disease  is  surely  fatal  without  ade- 
quate treatment.  Insignificant  fragmentary 
dosages  or  a delayed  interval  between  individual 
treatments  may  be  disastrous.  From  time  to  time 
during  antisyphilitic  therapy  the  patient’s  gen- 
eral condition  should  be  determined  by  physical 
and  laboratory  examinations.  The  necessity  for 
proper  food  during  and  following  malaria,  is  ob- 
vious. Existing  anemia  will  gradually  disappear, 
also  the  emaciation.  We  have  used  all  of  the 
other  arsenicals,  but  find  that  the  neoarsphena- 
mine preparation  is  quite  satisfactory. 

As  to  possible  complications  during  the  course 
of  intravenous  treatments,  dermatitis  medica- 
mentosa or  arsenical  rash  may  be  mentioned.  Its 
treatment  consists  of  withdrawing  arsenical  medi- 
cation, and  the  intravenous  administration  of 
sodium  thiosulphate  grams  one  in  5 to  10  cc. 
sterile  distilled  water.  This  is  given  daily  for 
three  to  five  days.  Commercal  concerns  may  sup- 
ply this  dosage  in  crystal  form  and  in  sealed  am- 
pules ready  for  solution.  Fortunately  the  com- 
plication is  rare.  Another  rare  complication  of 
arsenical  therapy  is  jaundice  which  may  be  due  to 
a temporary  hepatitis.  However,  the  arsenical 
may  be  merely  a contributory  factor  in  the  pro- 
duction of  this  condition,  as  it  may  occur  in 
paretics  who  have  had  no  treatment.  The  with- 
drawal of  the  arsenical  and  the  substitution  of 
bismuth  is  probably  indicated.  There  may  be 
subjective  reactions,  either  real  or  psychic,  and 
which  usually  prove  to  be  of  no  serious  conse- 
quences. 


As  previously  stated,  convulsions  are  rather 
common  in  a few  cases  of  general  paralysis.  They 
do  not  usually  occur  during  the  active  malaria. 
One  or  two  occasional  seizures  require  no  treat- 
ment, but  when  they  occur  in  series  and  have  a 
tendency  to  persist  it  becomes  necessary  to  check 
them  to  prevent  death.  Probably  the  best  drug 
for  this  purpose  is  sodium  amytal  given  intra- 
venously or  intramuscularly  in  the  dosage  of  one 
gram,  or  when  the  attacks  are  not  so  severe  one- 
half  gram  only.  Morphine  even  in  maximum 
doses  will  not  stop  a paretic  convulsion. 

CONCLUSIONS 

The  treatment  in  any  stage  of  syphilis  demands 
prompt,  rigid,  and  persistent  procedures,  and  es- 
pecially in  general  paralysis.  The  grave  prog- 
nosis of  this  disease  without  adequate  therapy 
should  be  borne  in  mind.  The  therapeutic  value 
of  the  malarial  treatment  is  definitely  established, 
but  the  application  of  its  use  in  conjunction  with 
other  treatment  must  be  systematized. 

As  to  the  theories  regarding  the  therapeutic 
action  of  malaria,  it  seems  that  the  production  of 
fever  is  secondary,  and  so  far  there  has  been  no 
satisfactory  substitute  for  the  malarial  treatment 
in  general  paralysis. 

Micropathological  studies  seem  to  show  that 
malaria  has  a direct  therapeutic  action  upon 
the  pathological  process  in  the  brain  tissue. 

The  symptoms  of  general  paralysis  are  greatly 
diversified,  especially  the  mental  manifestations. 
However  there  are  a few  pathognomonic  symp- 
toms and  which  include  certain  neurological  find- 
ings. Spinal  fluid  examination  is  important. 

General  paralysis  cases  not  hospitalized  are 
by  no  means  uncommon.  These  may  have  few  or 
no  psychotic  symptoms,  and  hospitalization  has 
not  been  considered.  Any  possible  complaints 
may  be  obscure,  and  perhaps  a diagnosis  has  not 
been  made. 

The  treatment  is  of  no  avail  in  the  late  stages 
of  this  disease  or  when  there  is  extensive  brain 
cell  destruction,  except  possibly  the  arrest  of  the 
pathological  process.  Intelligent  selection  of 
cases  is  important. 

The  malaria  is  easily  controlled  by  quinine, 
and  any  danger  from  the  treatment  is  rather  re- 
mote in  properly  selected  cases  and  which  are 
carefully  observed  each  day.  Intravenous 
therapy  should  be  started  immediately  after  the 
malaria  is  checked. 

Some  reactions  which  may  occur  following  in- 
travenous medication  do  not  necessarily  warrant 
the  cessation  of  such  procedure.  However,  if  there 
is  a probability  of  additional  severe  reactions, 
then  mercury  or  bismuth  may  be  substituted,  and 
the  arsenicals  tried  out  again  at  a later  period. 

Paretic  convulsions  may  occur  in  a few  cases 
of  this  disease,  but  they  are  usually  of  no  seri- 
ous consequence  unless  they  occur  in  series.  They 
are  promptly  checked  by  proper  therapy, 


November,  1933 


Genetics  and  Medicine — Snyder 


705 


Any  satisfactory  substitute  for  the  malarial 
treatment  will  undoubtedly  be  an  introduced  an- 
tigen capable  of  causing  the  hematopoietic  sys- 
tem to  produce  spirocheticidal  antibodies.  Such 
antigen  will  probably  be  one  of  the  several  pro- 
teins, and  would  be  given  in  more  frequent  and 
larger  doses  to  establish  possibly  a degree  of  tox- 
emia equal  to  that  which  is  produced  by  malaria. 
Malaria  produces  a marked  toxemia,  and  natur- 
ally this  condition  stimulates  antibody  produc- 
tion in  the  hematopoietic  system.  These  anti- 
bodies are  spirocheticidal.  The  toxic  protein 
which  occurs  through  destruction  of  the  blood  ele- 
ments by  the  malaria,  is  toxalbumen  which  acts 
in  the  roll  of  the  antigen.  It  is  possible  that  an 
introduced  antigen  even  in  the  form  of  potent 
vaccines  would  be  a fairly  satisfactory  agent  if 


administered  in  larger  doses  which  would  produce 
the  degree  of  toxemia  which  occurs  in  malaria. 

Each  case  of  general  paralysis  is  indicative  of 
the  fact  that  there  has  been  either  inadequate 
antisyphilitic  treatment,  or  none  at  all.  Small 
fragmentary  doses  of  arsphenamines  are  worth- 
less in  most  cases  of  syhpilis  in  the  adult.  Syphi- 
lis of  the  central  nervous  system  does  not  contra- 
indicate the  use  of  the  maximum  dosage  of  the 
arsphenamines,  mercury,  or  bismuth.  The  degree 
of  tolerance  in  such  cases  is  high. 

Serological  tests  should  be  made  at  least  a 
month  following  the  cessation  of  medication,  es- 
pecially with  the  arsphenamines.  Treatment 
should  extend  over  a period  of  at  least  a year  re- 
gardless of  laboratory  findings. 

510-511  Ohio  Merchants  Trust  Bldg. 


Genetics  and  Medicine 

Lawrence  H.  Snyder,  Sc.D.,  Columbus,  Ohio 


IN  RECENT  years  there  has  been  accumulated 
a considerable  body  of  knowledge  on  the  sub- 
ject of  human  heredity.  Progress  is  being 
made  rapidly  at  present  and  will  be  made  even 
more  rapidly  in  the  near  future.  It  is  therefore 
of  advantage  to  the  medical  student  to  become 
familiar  with  the  present  knowledge  of  human 
heredity,  incomplete  though  it  may  be,  in  order  to 
be  able  to  evaluate  the  statements  and  articles  of 
the  future  as  they  may  appear. 

Even  in  our  present  state  of  knowledge,  an  un- 
derstanding of  the  hereditary  factor  in  various- 
human  conditions  can  be  of  very  practical  value 
to  the  physician.  Such  a knowledge  may  be  ap- 
plied in  various  ways: 

(1)  It  may  be  of  aid  in  diagnosis,  especially 
early  diagnosis.  Macklin1  has  recorded  instances 
of  telangiectasis,  orthoglycemic  glycosuria,  spina 
bifida  and  others  where  the  diagnosis  was  facili- 
tated by  a knowledge  of  heredity  on  the  part  of 
the  physician.  In  a recent  case  on  the  Research 
Service  at  the  University  Hospital,  involving  an 
excess  of  red  blood  corpuscles,  physicians  who  had 
seen  the  patient  prior  to  admission  were  unwilling 
to  make  a diagnosis  of  polycythemia  vera,  because 
of  certain  atypical  elements  in  the  syndrome.  The 
finding  of  an  unusually  high  red  cell  count  and 
hemoglobin  (7,000,000  R.  B.  C.,  17  gms.  hemoglo- 
bin per  100  cc.  of  blood),  and  myelocytes  among 
the  white  cells  in  the  father,  however,  who  was  an 
active,  florid  individual,  helped  decidedly  in  the 
establishment  of  the  diagnosis  of  polycythemia 
vera  in  the  daughter.  Following  these  findings, 
further  investigation  into  the  family  history  re- 

Professor  of  Medical  Genetics,  Ohio  State  University 
College  of  Medicine. 

1.  Mackin,  M.  T.  1932.  Jour.  Assn.  Amer.  Med.  Coll., 
November. 


vealed  data  strongly  suggesting  a tendency  to 
erythremia  in  the  grandfather. 

(2)  It  may  be  of  seiwice  in  outlining  preventive 
measures.  The  individual  with  a family  history 
of  hypertension  should  be  warned  and  watched, 
given  regular  examinations  for  urine  albumen  and 
blood  pressure,  and  when  necessary,  advised  to 
change  the  tempo  of  his  life.  Likewise  the  in- 
dividual with  a strong  family  history  of  cancer 
would  do  well  to  avoid  all  the  known  extrinsic 
agents  associated  with  the  etiology  of  cancer  and 
should  not  marry  into  a cancer  family. 

A recent  case  of  hemolytic  icterus  provides  an 
interesting  example  of  the  possibility  of  pre- 
ventive measures  on  the  basis  of  genetics.  The 
patient  showed  both  clinical  symptoms  and  labora- 
tory signs  of  the  disease.  A splenectomy  was 
done  with  good  results.  When  seen  at  the  age  of 
55,  the  patient  had  been  suffering  for  a number  of 
years  from  the  incapacities  of  the  disease,  which 
had  been  unrecognized  as  the  cause  of  his  chronic 
invalidism.  Had  splenectomy  been  performed 
earlier  he  would  have  been  saved  to  economic  in- 
dependence which  he  now  has  regained.  Because 
of  the  hereditary  nature  of  the  condition,  labora- 
tory tests  were  run  on  the  seven  sons  of  the  pa- 
tient, none  of  whom  presented  marked  clinical 
symptoms.  Five  of  them,  however,  showed  one 
or  more  of  the  laboratory  signs,  including  micro- 
cytosis, increased  fragility,  increased  number  of 
reticulocytes  and  secondary  anemia.  These  sons 
are  now  undergoing  recurrent  examination  look- 
ing to  the  possible  need  of  a splenectomy.  Thus 
the  knowledge  of  the  hereditary  aspect  of  this 
disease  may  facilitate  early  treatment  in  other 
members  of  the  family  and  prevent  chronic  in- 
validism. 

(3)  It  may  be  applied  in  medico-legal  cases. 


706 


The  Ohio  State  Medical  Journal 


November,  1938 


The  careful  study  of  the  inheritance  of  the  blood 
groups  has  resulted  in  laws  applicable  to  cases  of 
disputed  paternity,  mixed  infants  in  hospitals,  and 
similar  cases  (Snyder)2 3.  Wiener3  has  recently  re- 
corded the  solving  of  such  a case  on  the  basis  of 
the  new  M-N  reaction  where  the  orthodox  blood 
groups  failed  to  give  positive  information. 

(4)  It  may  furnish  the  basis  for  advice  on  pro- 
spective marriages.  In  a recent  case,  a hemo- 
philic patient  with  a positive  family  history  stated 
that  his  three  daughters  had  not  been  told  the  na- 
ture of  his  affliction,  nor  were  they  to  be  told. 
Yet  when  these  daughters  marry,  half  of  their 
sons  will  be  hemophilic.  In  another  case  a girl, 
blind  from  aniridia,  was  amazed  to  learn  shortly 
before  her  marriage  that  at  least  half  of  her  chil- 
dren would  be  expected  to  have  the  abnormality. 

(5)  It  may  furnish  the  basis  for  advice  on  pro- 
spective pregnancies.  A young  man  recently 
came  to  us  for  advice  on  a family  history  of  psori- 
asis. His  father  and  grandfather  had  the  disease 
as  did  several  brothers  and  sisters  and  some  nieces 
and  nephews.  The  young  man's  wife  was  then 
pregnant.  After  becoming  pregnant  she  had 
learned  of  and  seen  the  skin  affliction  of  her  hus- 
band’s relatives,  which  in  the  case  of  the  girls 
and  women,  prevented  the  wearing  of  sleeveless 
or  low-necked  gowns.  The  young  wife  became 
obsessed  with  the  idea  that  her  child  would  have 
psoriasis.  It  preyed  on  her  mind  to  such  an  ex- 
tent that  she  was  in  danger  of  a psychosis.  Close 
examination  of  this  family  history  revealed  that 
the  psoriasis  never  appeared  in  a child  unless  one 
of  the  parents  had  it.  When  one  parent  had  the 
affliction,  about  half  of  the  children  showed  it.  It 
was  apparently  behaving  as  a dominant  character. 
Since  the  young  man  in  question  was  entirely 
free  from  the  disease,  it  was  possible  to  assure 
his  wife  that  there  was  no  danger  of  the  child’s 
inheriting  the  condition. 

(6)  It  may  provide  the  necessary  information 
for  setting  up  eugenic  and  euthenic  programs  for 
the  protection  of  society,  a problem  in  which  every 
physician  should  be  able  to  take  an  intelligent 
part,  based  upon  experimental  data,  not  on  opin- 
ions, prejudices,  or  the  exaggeration  of  the  uncer- 
tainties. 

The  study  of  human  heredity  must  of  necessity 
be  based  primarily  on  the  experimental  analysis 
of  other  organisms.  It  is  assumed,  on  adequate 
grounds,  that  most  of  the  great  fundamental  prin- 
ciples of  heredity  are  now  known.  The  work  of 
the  past  thirty  years  on  a large  variety  of  ani- 
mals and  plants  has  resulted  in  the  establishment 
and  understanding  of  these  principles.  It  is  now 
imperative  to  apply  these  principles  to  the  vari- 
ous morphological,  physiological,  and  pathological 
conditions  in  human  beings,  to  test  their  validity 
in  such  conditions. 

2.  Snyder,  L.  H.  1929.  Blood  Grouping  in  Relation  to 
Clinical  and  Legal  Medicine,  xii  + 153  pp.  Baltimore,  The 
Williams  and  Wilkins  Co. 

3.  Wiener,  A.  S.  1931.  Amer.  Jour.  Med.  Sci.  181 :603. 


The  carefully  controlled  experiments  in  labora- 
tory animals  and  plants  have  carried  heredity  far 
beyond  the  old  and  well-known  simple  laws  of 
Mendel.  These  laws  stand  today  just  as  sound 
and  basic  as  ever,  but  many  additions  and  modi- 
fications have  been  made.  Improvements  in 
methods  of  investigation  have  l-esulted  in  bring- 
ing a wide  range  of  seemingly  inexplicable  phe- 
nomena under  a unified  set  of  hereditary  laws, 
which  while  considerably  more  extensive  and  in- 
clusive than  Mendel’s  original  laws,  are  yet  fun- 
damentally simple  and  orderly. 

No  longer  does  the  familiar  3:1  ratio  cover  the 
major  portion  of  the  field  of  heredity.  As  a mat- 
ter of  fact,  ratios  of  the  sort  found  in  the  F> 
generations  of  animals  and  plants  are  not  ob- 
servable as  such  in  a man.  No  single  human 
family  is  large  enough,  as  a rule,  to  provide  a 
valid  ratio  in  any  generation.  And  when  groups 
of  families  are  lumped  together  for  analysis,  aber- 
rant ratios  are  obtained  because  it  is  usually  im- 
possible to  separate  homozygous  parents  from 
heterozygous  parents.  This  leads  to  a radically 
different  type  of  analysis  of  human  pedigrees,  the 
study  of  the  frequencies  of  the  factors  concerned. 
This  method  of  analysis  promises  far-reaching 
benefits  to  medicine  in  the  future. 

Even  though  we  could  isolate  definite  Men- 
delian  ratios  in  man,  the  simple  3:1  ratios  and 
others  equally  obvious  would  not  suffice  to  explain 
the  whole  of  human  heredity.  At  least  a dozen 
major  kinds  of  hereditary  behavior  are  known, 
and  the  combinations  and  interactions  of  these  in- 
crease the  number.  A specific  hereditary  charac- 
ter may  be  the  result  of  the  substitution  of  one  or 
more  factors  (genes)  for  allelomorphs  of  these 
genes.  The  kind  of  genes  which  may  be  involved 
in  the  substitution  include  dominant  unit  factors, 
recessive  unit  factors,  blending  factors,  multiple 
allelomorphs,  sex-linked  factors,  sex-influenced 
factors,  sex-limited  factors,  factors  with  epistatic 
relationships,  duplicate  factors,  multiple  factors, 
modifying  factors,  lethal  factors,  etc. 

The  various  kinds  of  hereditary  behavior  result- 
ing from  such  gene  substitutions  have  been  scien- 
tifically established  in  animals  and  plants.  Hu- 
man beings,  in  so  far  as  they  have  been  studied, 
appear  to  obey  the  same  laws  of  heredity  as  other 
organisms.  The  only  essential  difference  is  that 
human  beings  are  capable  to  a large  extent  of  con- 
trolling their  own  environment.  This  may  pro- 
foundly modify  the  expression  of  a hereditary  fac- 
tor, but  it  neither  obviates  the  fact  of  the  genetic 
nature  of  any  hereditary  condition,  nor  changes 
in  the  least  the  potentiality  or  the  mode  of  its 
transmission. 

The  various  kinds  of  hereditary  characters  now 
known  are  complicated  enough,  then,  that  their 
understanding  requires  a certain  amount  of  study. 
This  means  that  no  one  is  justified  in  stating  on 
his  own  responsibility  that  a given  condition  is  or 
is  not  conditioned  by  hereditary  factors  unless: 


November,  1933 


Genetics  and  Medicine — Snyder 


707 


(1)  He  is  thoroughly  familiar  with  all  the 
known  kinds  of  hereditary  behavior. 

(2)  He  is  familiar  with  the  condition  under  dis- 
cussion in  all  its  varying  manifestations. 

(3)  He  has  carefully  investigated  the  condi- 
tion in  a scientific  manner  from  a genetic  stand- 
point. 

As  in  other  sciences  any  hypothesis  of  heredity, 
besides  accounting  for  the  facts  at  hand,  must 
stand  the  acid  test  of  predictive  value. 

In  order  to  apply  a knowledge  of  heredity  to 
medical  practice,  certain  fundamental  conclusions 
must  be  granted,  and  certain  common  misconcep- 
tions correctly  understood.  Among  the  conclu- 
sions taken  for  granted  in  the  application  of 
genetics  to  medicine  are  the  following: 

(1)  The  biological  basis  for  the  dozen  or  more 
kinds  of  hereditary  behavior  has  been  adequately 
established  by  experimentation. 

(2)  Hereditary  factors  ar-e  associated  with  the 
chromosomes.  The  evidence  for  this  now  amounts 
to  what  is  practically  a complete  proof. 

(3)  Man  fulfills  the  biologic  requirements  for 
being  subject  to  the  same  laws  of  heredity  as 
other  organisms.  (Among  these  requirements  are 
sexual  reproduction,  a chromosome  mechanism 
undergoing  meiosis,  physiologic  processes  similar 
to  those  of  other  organisms,  etc.) 

(4)  Mental  traits  have  their  basis  in  physico- 
chemical structure,  and  thus  may  be  susceptible 
to  the  same  laws  of  heredity  as  other  characters. 

(5)  Heredity  and  environment  are  cooperative 
in  the  production  of  any  finished  character.  One 
or  the  other  influence  may  in  certain  circumstances 
appear  negligible,  but  the  dual  nature  may  al- 
ways be  demonstrated.  This  point  deserves  a 
litle  amplification.  We  may  arrange  characters 
roughly  in  a series  depending  on  the  relative  im- 
portance of  heredity  and  environment  in  their  pro- 
duction. At  one  end  would  be  those  in  which  en- 
vironment is  the  major  influence,  heredity  being 
so  similar  in  all  the  individuals  involved  as  to  play 
no  part  in  observed  variations.  Such  a character 
would  be  syphilis,  for  example,  in  regard  to  which 
everyone  so  far  as  we  know  inherits  a suscepti- 
bility, so  that  whether  or  not  a person  contracts 
syphilis  depends  entii’ely  on  the  environmental 
contact  with  the  causative  agent.  At  the  other  ex- 
treme would  be  characters  in  which  heredity  is 
the  major  influence,  no  environment  of  sufficient 
potency  to  alter  the  expression  of  the  heredity  be- 
ing readily  available  at  present.  Such  a char- 
acter would  be  migraine,  for  instance,  where  a 
person  develops  the  condition  regardless  of  en- 
vironmental influences  if  he  inherits  the  factor 
for  it,  and  where  migraine  does  not  develop  if  the 
factor  is  not  inherited ; the  inheritance  in  this  case 
being  directly  from  one  or  the  other  parent. 

Between  these  two  extremes  lie  the  great  ma- 
jority of  characters,  in  the  production  of  which 
heredity  and  environment  play  more  or  less  equal 
roles.  The  determination  of  the  exact  part  played 


by  heredity  or  by  environment  in  the  production 
of  any  character  is  one  of  the  most  difficult  prob- 
lems in  the  study  of  human  heredity.  We  have 
become  accustomed  to  speaking  of  a character  as 
“hereditary”  when  variations  in  the  character  are 
caused  mainly  by  differences  in  the  genetic 
make-up.  While  this  is  the  common  use  of  the 
word,  it  must  be  idealized  that  “hereditax’y”  is  a 
relative  term,  all  characters,  as  stated,  being 
components  of  hereditary  and  environmental  in- 
fluences. 

There  is  no  fundamental  distinction  between 
(a)  the  case  of  a person  who  through  inheritance 
has  a normal  structure  of  the  cochlea,  the  eighth 
nerve,  etc.,  and  so  has  the  ability  to  hear,  and  who 
through  disease  becomes  deaf,  and  thus  patho- 
logical, and  (b)  the  case  of  a person  who  through 
inheritance  has  hemophilia,  a pathological  condi- 
tion, and  who  through  recurrent  preventive  trans- 
fusions at  regular  intervals  fails  to  exhibit  the 
bleeding,  and  thus  becomes  essentially  normal. 
In  the  case  of  acquired  deafness,  the  original 
hereditary  normal  structures  will  be  transmitted 
in  spite  of  the  adventitious  deafness,  and  in  the 
case  of  the  hemophiliac  who  because  of  preventive 
transfusions  never  bleeds  abnormally,  the  original 
hereditary  hemophilic  condition  will  be  transmit- 
ted, in  spite  of  its  lack  of  manifestation. 

Among  the  misconceptions  which  are  commonly 
met  with,  and  which  must  be  recognized  as  mis- 
conceptions, are  the  following: 

(1)  The  students  of  heredity  believe  and  are 
anxious  to  prove  that  all  characters  are  rigidly 
determined  by  heredity. 

(2)  That  if  a character  were  conditioned  by 
heredity  it  could  not  be  modified  by  the  environ- 
ment. 

(3)  That  if  a hereditary  basis  were  demon- 
strated for  any  particular  condition,  medical  re- 
search on  that  condition  could  not  or  would  not 
make  further  progress. 

(4)  That  because  a causative  agent  is  known 
for  a disease,  heredity  can  play  no  part  in  its 
manifestation. 

(5)  That  heredity  or  “constitution  basis”  is  a 
catch-all  for  the  things  about  which  nothing  is 
really  known. 

(6)  That  a condition  can  not  be  hereditary  un- 
less it  presents  a clear  “family  history.” 

(7)  That  “congenital”  and  “hereditary”  mean 
the  same  thing. 

(8)  That  because  in  many  cases  we  do  not 
know  just  how  a hereditary  factor  or  set  of  fac- 
tors brings  about  the  production  of  the  finished 
characters,  the  mere  fact  of  heredity  is  mean- 
ingless. 

None  of  the  eight  statements  listed  above  is 
true. 

It  would  be  misleading  to  conclude  these  gen- 
eral statements  without  pointing  out  that  in  the 
bringing  together  of  medicine  and  human  heredity, 
the  science  of  heredity  may  expect  to  receive 


708 


The  Ohio  State  Medical  Journal 


November,  1933 


great  benefit  from  the  association.  Much  of  hu- 
man heredity  is  still  to  be  investigated,  and  much 
of  this  investigation  depends  on  the  interest  and 
cooperation  of  the  physician.  Adequate  family 
histories  must  be  available,  and  in  many  instances 
these  are  only  obtainable  by  the  physician.  Medi- 
cine may  be  hoped  to  give  aid  in  the  solving  of 
problems  as  yet  almost  untouched,  among  the  most 
important  of  which  are  the  precise  meaning  of 
“susceptibility”  in  various  diseases  and  the  in- 
heritance of  these  susceptibilities,  the  mode  of 
action  of  hereditary  factors  in  the  production  of 
finished  characters,  and  the  construction  of 
chromosome  maps  for  human  beings. 

With  the  above  considerations  in  mind,  and  in 
full  sympathy  with  the  views  of  Dr.  Macklin,  who 
has  reiterated  in  frequent  publications  the  need 
for  such  a course  in  the  medical  curriculum,  a 
course  in  Medical  Genetics  has  been  established 
at  the  Ohio  State  University  College  of  Medicine. 
The  course  is  required  for  all  sophomores,  in  the 
spring  quarter.  Thus  it  is  presented  parallel  with 
the  introductory  work  in  normal  physical  examina- 
tion, and  emphasizes  the  importance  of  the  care- 
ful taking  of  family  histories.  A premedical 
course  in  elementary  genetics  is  at  present  listed 
as  a desirable  prerequisite,  but  it  is  hoped  to  make 
such  a course  a required  prerequisite  in  the  near 
future. 

At  present  the  course  in  Medical  Genetics  con- 
sists of  twelve  one-hour  lectures,  with  an  abun- 
dance of  clinical  material,  brought  in  by  mem- 
bers of  the  medical  staff,  for  demonstration.  The 
course  will  be  extended  in  scope  as  the  technical 
development  of  medical  genetics  warrants  such 
extension.  The  twelve  lectures  at  present  em- 
brace the  following  topics: 

1.  General  considerations. 

2.  Medico-legal  applications  (Blood  groups, 
M-N  reactions,  etc.) 

3.  Diseases  of  the  eye  and  ear. 

4.  Diseases  of  the  skin. 

5.  Skeletal  and  muscular  abnormalities. 

6.  Diatheses  (hemophilia,  allergies,  cretinism, 
hypei’tension,  diabetes,  hemolytic  icterus,  heart 
troubles,  goiter,  etc.) 

7.  Susceptibility  to  infectious  diseases  (diph- 
theria, tuberculosis,  scarlet  fever,  etc.) 

8.  Cancer. 

9.  Nervous  disorders  (Friedreich’s  ataxia,  Hun- 
tington’s chorea,  Myotonia,  stammering,  etc.) 

10.  Insanities  and  psychopathies  (Feeble-mind- 
edness, dementia  praecox,  amaurotic  juvenile 
idiocy,  epilepsy,  etc.). 

11.  Linkage;  marriage  of  relatives;  advice  to 
families;  need  for  and  possibilities  of  research. 

12.  Family  histories:  how  to  take  them  and 

how  to  interpret  them. 

Specific  examples  of  the  practical  applications 
of  a knowledge  of  human  heredity  to  diagnosis, 
preventive  measures,  advice  to  families,  etc.,  are 
brought  out  during  the  course. 


Mimeographed  material  on  certain  phases  of 
the  subject  not  covered  in  the  lectures  is  pre- 
sented to  the  students.  This  includes  a summary 
of  the  evidence  that  hereditary  factors  are  asso- 
ciated with  the  chx-omosomes,  a summaxy  of  the 
major  kinds  of  hereditary  behavior,  a series  of 
definitions  of  genetic  terms,  and  an  outline  of  the 
methods  of  genetic  investigation,  including  the 
newer  mathematical  analyses  of  gene  frequencies, 
linkage  probabilities,  etc.  Current  literature  is  re- 
ferred to  constantly,  and  outside  reading  is  as- 
signed in  Baur,  Fischer  and  Lenz’  “Human 
Heredity”. 

The  success  of  a new  course  such  as  this  de- 
pends considerably  upon  the  cooperation  of  the 
rest  of  the  staff  of  the  College  of  Medicine,  and 
this  has  been  given  fi’eely  in  the  present  case. 
Especially  are  we  in  close  cooperation  in  experi- 
mental work  with  the  Department  of  Medical  and 
Surgical  Research. 


New  Books  Received 

Stedman’s  Medical  Dictionary,  12th  Revised 
Edition,  by  Thomas  Lathrop  Stedman,  M.D.,  con- 
taining about  1,000  new  titles  and  several  hun- 
dred sub-titles ; a useful  compilation  of  words 
used  in  medicine  with  their  derivation  and  pro- 
nunciation, including  dental,  veterinary,  chemical, 
botanical,  electrical,  life  insurance  and  other 
special  terms;  anatomical  tables  of  the  titles  in 
general  use,  the  terms  sanctioned  by  the  Basle 
Anatomical  Convention  and  those  suggested  by 
the  Nomenklatur-Kommission ; pharmaceutical 
preparations,  and  a comprehensive  list  of  syno- 
nyms; William  Wood  and  Company,  Baltimore,, 
publishers;  price,  $7.00,  plain  edge;  $7.50,  thumb 
indexed. 

Obstetrical  Nursing,  by  Carolyn  Conant  Van. 
Blarcom,  R.  N.,  former  assistant  superintendent 
in  obstetrical  nursing  and  the  care  of  infants 
at  Johns  Hopkins  Hospital,  Training  School  for 
Nurses;  a text  book  on  the  nursing  care  of  the 
expectant  mother,  the  woman  in  labor,  the  young 
mother  and  her  baby;  The  MacMillan  Company,. 
60  Fifth  Avenue,  New  York,  publishers;  price, 
$3.00. 

Gastric  Anacidity,  by  Arthur  L.  Bloomfield, 
M.D.,  professor  of  medicine,  Stanford  University, 
and  W.  Scott  Polland,  M.D.,  instructor  in  medi- 
cine, Stanford  University;  a monograph  on  the 
subject  of  defective  gastric  secretion  in  relation 
to  disease;  Macmillan  Company,  60  Fifth  Avenue, 
New  York  City,  publishers;  price,  $2.50. 

The  Technic  of  Local  Anesthesia,  by  Arthur  E. 
Hertzler,  M.D.,  professor  of  surgery,  University 
of  Kansas;  The  C.  V.  Mosby  Company,  3523  Pine 
Boulevard,  St.  Louis;  price,  $5.00. 

Public  Health  Nursing  in  Industry,  Violet  H- 
Hodgson,  R.N.,  assistant  director  of  the  National 
Organization  for  Public  Health  Nursing;  The 
Macmillan  Company,  60  Fifth  Avenue,  New  York 
City;  price,  $1.75. 


The  Presidents  P<yqe 


A Personal  Communication  to  the  Membership  from 

C.  L.  Cummer,  M.D.,  President,  Cleveland,  Ohio 


Our  annual  meeting-  has  come  and  gone.  In  attendance,  interest,  and  the  quality  of  the  scien- 
tific papers  it  was  most  successful.  The  econom'c  phases  of  medical  practice  were  given  much 
consideration  because  of  their  growing  important.  Whether  or  not  we  desire  to  think  of  the 
economic  side  of  the  practice  of  medicine,  we  are  forced  to  do  so;  every  day  brings  evidence  that 
many  agencies  outside  our  profession  feel  that  thsy  have  been  given  the  right  to  direct  our  future. 
The  questions  of  insurance  practice,  hospital  group  insurance,  socialized  medicine,  state  medicine, 
and  others  of  similar  nature  are  forced  upon  us. 

The  need  for  unity  within  our  ranks  was  the  burden  of  Dr.  Olin  West’s  address  at  Akron.  In 
establishment  of  general  policies,  the  American  Medical  Association  has  taken  the  guiding  hand. 
As  to  this  state,  our  Association  has  done  likewise,  but  the  battle  for  the  principles  which  it 
enunciates  must  be  made  by  the  county  societies.  Whether  we  doctors  continue  to  practice  in  the 
manner  in  which  we  think  the  public  is  best  served,  or  whether  we  practice  according  to  plans 
formulated  for  us  by  theorists  outside  our  ranks,  will  depend  upon  the  actions  and  activities  of  the 
many  county  societies  in  this  broad  land  of  ours. 

The  Ohio  State  Medical  Association  therefore  calls  upon  each  county  society  to  inform  itself 
of  the  general  policies  which  have  been  establish?d  by  your  representative  governing  bodies,  the 
House  of  Delegates  and  the  Council  of  this  Association,  and  to  support  them. 

To  accomplish  this  end,  each  county  society  should  designate  a committee  on  Medical  Econom- 
ics, composed  of  members  who  are  willing  to  read,  study,  and  assimilate  the  pertinent  reports 
which  have  been  or  will  be  issued  from  time  to  time.  This  duty  cannot  be  assumed  by  the  officers 
alone,  for  each  year  brings  some  change  in  personnel,  new  officers  who  may  not  be  familiar  with 
precedent  and  prior  actions  of  the  parent  bodies,  while  a committee  can  be  set  up  with  overlapping 
terms  for  its  members,  so  that  it  will  be  continuous  in  its  functions.  Active  and  interested  workers 
can  be  retained  on  the  committee  at  the  expiration  of  their  terms.  In  the  smaller  units,  the  duty 
may  be  designated  to  a single  member.  In  this  way,  each  society  will  have  the  benefit  of  con- 
tinuity in  knowledge  and  consistency  in  policy.  The  task  is  a most  vital  one,  and  those  responsible 
for  it  should  keep  themselves  fully  informed  as  to  general  policies  and  the  trend  of  the  times. 

How  many  of  our  members  read  the  annual  reports  of  the  standing  committees?  For  fear 
that  some  may  have  failed  to  do  so,  I am  quoting  from  the  annual  report  of  the  Committee  on 
Medical  Economics  of  this  Association: 

“In  its  consideration  of  medico-social  questions  during  the  past  year,  the  Committee  * * * 
has  been  greatly  impressed  with  the  necessity  for  increased  local  activity  and  more  extensive 
study  of  these  questions  on  the  part  of  the  medical  profession  generally.  * * * 

“ * * * Every  society  should  have  a special  committee  whose  duty  is  to  assist  the  officers  of 
the  society  in  disseminating  such  information  to  the  membership  and  in  arranging  programs  for 
the  discussion  of  economic  questions.  * * * 

“Every  county  medical  society  should  provide  itself  with  strong  leadership  with  the  courage 
to  face  impending  problems  and  possessing  those  attributes  which  will  command  the  respect  of  the 
community  and  stimulate  interest  and  activity  on  the  part  of  the  membership.  The  leaders,  in  fact, 
the  entire  membership,  of  all  county  societies  should  realize  that  local  problems  are  best  met  by 
local  action.  * * * 

“Varying  situations  must  be  met  by  local  activity.  The  challenge  to  local  initiative,  enterprise 
and  keen  appraising  judgment  by  the  members  of  organized  medicine  has  never  been  greater.  In 
concerted  and  vigorous  local  application  of  fundamental  policies  and  principles  lies  our  salvation.” 

Coming  at  the  time  of  commencing  the  activities  for  fall  and  winter,  this  is  a call  to  the 
counties  for  efficient  and  far-seeing  organization.  The  battle  will  be  on  your  home  soil  and  you 
will  have  to  organize  your  own  Minute  Men. 


709 


Problems  and  Developments  in  Plans  for  Medical  Care  to 
the  Needy  Unemployed  Through  Federal  Funds,  With 
Emphasis  on  Local  Activity  in  Addition  to 
Local  Legal  Mesponsibility 


PROBLEMS  of  administration  in  providing 
medical  care  for  the  needy  unemployed  con- 
tinued to  multiply  locally  since  the  Federal 
Emergency  Relief  Administration  formulated  and 
announced  its  Rules  and  Regulations  No.  7 gov- 
erning medical  care  to  be  provided  in  the  home 
to  recipients  of  unemployment  relief  and  follow- 
ing the  plans  announced  by  the  State  Relief  Com- 
mission to  the  local  relief  officials,  referred  to  in 
detail  in  last  month’s  issue  of  The  Journal.,  pages 
663  to  665,  inclusive. 

In  some  instances  through  misunderstanding 
on  the  part  of  local  relief  officials  as  to  the  in- 
tent and  purport  of  the  federal  regulations,  a num- 
ber of  questions  have  arisen.  It  was  the  inten- 
tion of  the  Federal  Relief  Administration  in  this 
program,  following  the  availability  of  federal 
funds  in  Ohio  through  the  State  Relief  Commis- 
sion, to  have  organized  in  each  county  a local 
medical  advisory  committee  to  work  out  harmo- 
niously problems  which  are  peculiarly  local. 

It  was  also  the  intention  of  the  State  Relief 
Commission  that  such  local  advisory  committee 
consist  of  an  official  group  from  the  county  medi- 
cal society  or  academy  of  medicine ; if  no  standing 
committee  is  appropriate  for  this  purpose  and  if 
a special  committee  has  not  been  officially  cre- 
ated for  this  purpose,  that  the  president  and 
secretary,  together  with  a third  member  selected 
by  those  two,  should  represent  the  county  medi- 
cal society. 

In  order  to  clarify  the  procedure  on  this  mat- 
ter, the  regulations  applying  to  the  fee  schedule 
as  announced  by  the  State  Relief  Commission  are 
set  forth  as  follows: 

(a)  The  county  relief  director,  or  if  a city  is 
disbursing  state  or  federal  funds  independent  of 
the  county,  the  proper  city  official,  should  an- 
nounce the  plan  to  the  county  medical  association. 
Each  local  physician  who  is  willing  to  serve  fami- 
lies receiving  relief  shall  be  given  the  opportunity 
to  register  with  the  county  relief  director,  or  the 
proper  city  official. 

(b)  The  relief  office  will  issue  a medical  order 
blank  to  the  family,  and  the  family  will  be  per- 
mitted to  select  a physician  from  the  registered 
list  at  relief  headquarters.  Only  in  cases  of 
emergency  will  families  be  permitted  to  call  a 
physician  before  securing  a medical  order  blank 
from  relief  officials;  and  then  in  each  case  an 
order  must  be  secured  before  the  second  visit. 

(c)  Physicians  registering  must  agree  to  sub- 
mit itemized  bills  regularly  to  the  local  relief 
officials. 


SOME  OF  THE  OBJECTIONS  TO  PLAN 

Some  of  the  complaints  and  objections  to  the 
plan  and  fee  schedule  so  far  raised  by  members 
and  county  medical  societies  may  be  summarized 
as  follows: 

A.  Objection  to  a standardized  schedule 
for  the  state,  particularly  on  such  a ma- 
terially reduced  basis. 

B.  The  attitude  of  recipients  of  relief,  re- 
lief administrators  and  welfare  workers  to 
insist  later  that  the  inadequate  schedule  be 
applied  generally. 

C.  A belief  that  this  entire  plan  is  one 
more  long,  forward  step  toward  state  or  so- 
cialized medicine. 

D.  Inequities  in  a general  application  of  a 
standardized  procedure  and  fee  schedule. 

It  has  been  apparent  with  the  increasing  un- 
employment and  the  gradually  increased  amount 
of  medical  charity  during  recent  years,  that  the 
income  of  the  medical  profession  was  not  only 
being  drastically  reduced,  but  that  it  was  being 
called  on  to  render  a proportionately  multiplied 
amount  of  free  service.  In  fact  not  only  the 
public  but  public  officials  charged  with  the  duty 
of  providing  necessities  of  life  to  the  indigents 
in  normal  times  and  to  the  increased  number 
of  needy  unemployed  at  this  time,  were  failing  to 
make  adequate  provision  even  under  statutory  re- 
quirements to  furnish  medical  care. 

For  these  reasons  there  has  developed  in  the 
medical  profession  a growing  belief  and  insistence 
that  provision  should  be  made,  in  the  distribu- 
tion of  governmental  funds,  to  include  medical 
service  to  the  needy  unemployed. 

In  many  communities  local  officials  had  failed 
to  make  either  adequate  or  proper  legal  provision 
for  the  payment  of  medical  fees  as  provided  by 
state  statutes.  (1)  Even  before  federal  funds 
became  available  for  medical  relief  there  were  sev- 
eral sources  of  funds  open  to  city,  township  and 
county  officials  as  follows:  (2) 

A.  That  part  of  the  general  revenue  fund 
of  the  subdivision  set  aside  for  poor  relief 
work,  including  medical  care. 

B.  Issuance  of  special  poor  relief  bonds. 

C.  The  local  proportion  for  this  purpose 
of  the  excise  tax  on  public  utilities. 

D.  Diversion  of  the  subdivision’s  portion 
of  the  gasoline  tax. 

1.  Statutes  and  regulations  for  local  medical  relief  ana- 
lyzed March,  1932,  issue  of  The  Journal , pages  203  to  207. 

2.  These  were  analyzed  in  detail,  pages  257-258  of  the 
April,  1933,  issue  of  The  Journal. 


710 


November,  1933 


Medical  Poor  Relief 


711 


CONTRACT  PLANS  FOUND  IMPRACTICAL 

In  some  communities  an  inequitable  plan  had 
been  developed  whereby  local  physicians  were 
asked  to  “bid”  on  furnishing  medical  care  to  the 
needy  sick,  and  even  in  some  instances  the  func- 
tions of  the  local  health  department  had  been 
expanded  to  include  such  service.  In  some  in- 
stances this  competitive  bidding  contract-arrange- 
ment resulted  not  only  in  woefully  inadequate 
compensation  to  those  who  accepted  the  contract, 
but  it  still  placed  on  the  shoulders  of  the  medi- 
cal profession  generally  in  the  community  the 
burden  of  continuing  its  medical  service  to  those 
who  were  unable  to  pay  and  with  no  provision 
for  compensation  through  public  funds  or  public 
officials. 

In  conjunction  with  officials  of  the  American 
Medical  Association,  the  Federal  Emergency  Re- 
lief Administration  formulated  rules  and  regu- 
lations recently  announced,  referred  to  in  the  last 
issue  of  the  Journal  and  fully  set  forth  in  the 
Journal  of  the  American  Medical  Association.  (3) 
As  set  forth  in  those  regulations,  it  was  the  in- 
tention of  the  Federal  Emergency  Relief  Admin- 
istration to  relieve  the  unfair  burden  placed  on 
the  medical  profession  generally,  by  making  it 
possible  for  all  eligible  physicians  in  the  com- 
munity who  so  desired,  to  care  for  such  cases 
when  called,  to  preserve  the  “free  choice”  by  the 
unemployed  sick  and  their  families  in  the  selec- 
tion of  their  physicians  and  to  preserve  the  “tra- 
ditional family  and  family-physician  relation- 
ship”, and  to  augment  and  render  more  ade- 
quate facilities  already  existing  in  local  com- 
munities for  the  provision  of  medical  care  to 
those  who  were  unable  to  provide  it  for  them- 
selves at  “an  agreed  rate  which  makes  due  allow- 
ance for  the  conservation  of  relief  funds”  at  a 
“reduction  from  the  usual  minimum  fee  schedule 
for  such  services”. 

SCHEDULE  NOT  APPLYING  TO  LOCAL  FUNDS 

It  was  the  thought  of  the  public  officials  in 
charge  of  the  administration  of  this  relief  that 
while  the  amount  available  and  the  fees  that 
could  be  allowed  were  minimized,  that  it  would 
provide  some  compensation  to  many  physicians  in 
their  practice  who  had  been  rendering  much 
service  to  their  needy  unemployed  patients  with 
no  compensation  whatever. 

It  was  further  the  intention  of  the  federal  re- 
lief officials  that  “this  schedule  (fee  schedule) 
shall  only  apply  where  the  expenditure  of  federal 
funds  is  involved  and  shall  not  preclude  the  pay- 
ment of  additional  amounts  from  local  funds” , 
as  specifically  set  forth  under  paragraph  (g)  of 
Rules  and  Regulations  No.  7. 

Therefore,  the  fee  schedule  announced  by  the 
State  Relief  Commission  as  a pattern  for  local 
consideration  is  the  subject  of  negotiation  and 
modification  by  local  relief  administrators  after 

3.  Issue  of  September  23,  1933,  J.  A.  M.  A.,  pages  1026 
and  1027. 


conferences  with  the  proper  medical  advisory 
committee  representing  the  local  medical  pro- 
fession and  subject,  of  course,  to  the  general 
rules  and  regulations  governing  the  expenditure 
of  federal  funds. 

Officials  of  the  Ohio  State  Medical  Association 
for  a number  of  months  have  been  in  contact 
and  conference  with  officials  of  the  State  Relief 
Commission  and  the  State  Department  of-  Health 
on  these  problems,  and  as  indicated  heretofore, 
have  insisted  that  where  public  funds  are  avail- 
able to  furnish  other  necessities  of  life  to  the 
needy  unemployed,  provision  should  be  made  to 
include  medical  service. 

As  soon  as  it  became  known  that  a definite 
amount  of  federal  funds  would  be  apportioned, 
at  least  temporarily,  in  Ohio  as  a part  of  the 
relief  program  to  provide  medical  service  to  the 
needy  unemployed  and  in  an  effort  to  make  these 
funds  available  promptly,  the  State  Relief  Com- 
mission proceeded  with  a plan  and  fee  schedule 
which  were  announced  about  the  time  the  federal 
regulations  on  this  matter  were  issued  and  pre- 
liminary to  the  organization  of  a medical  advisory 
committee  as  contemplated  in  the  federal  plan. 

Officials  of  the  State  Medical  Association  and 
the  State  Medical  Association  headquarters,  in 
this  problem  as  in  all  other  problems  affecting  the 
practicing  profession,  are  endeavoring  to  repre- 
sent the  interest  of  physicians,  and  as  indicated 
previously,  they  are  anxious  to  have  comments, 
suggestions  and  requests  from  the  membership 
through  the  county  medical  societies. 

It  should  be  borne  in  mind  and  emphasized 
that  the  plan  of  medical  relief  to  the  needy  un- 
employed, particularly  in  the  use  of  federal-state 
funds  as  distinguished  from  the  constant  legal 
responsibility  of  local  officials  to  provide  medical 
care  for  the  indigent  even  in  normal  times,  is  a 
part  of  “ temporary  emergency  relief”.  The  plan 
or  the  fees  involved  are  not  intended  in  any  man- 
ner to  be  a pattern  for  normal  times  or  for  those 
who  are  able  financially  to  employ  their  own  medi- 
cal service.  This  was  pointed  out  specifically  in 
the  regulations  issued  by  the  State  Relief  Com- 
mission in  these  words:  “These  fees  are  not  in- 
tended to  establish  such  low  rates  in  ordinary 
pi'actice”. 

ADJUSTMENTS  IN  PLAN  ANTICIPATED 

Moreover,  the  entire  plan  must  necessarily  be 
subject  to  general  and  local  adjustments  and  modi- 
fications to  meet  unanticipated  problems.  If  the 
preliminary  “temporary”  plan  is  found  to  require 
modification,  it  may  be  possible  that  the  funds 
available,  irrespective  of  the  standard  fee  sched- 
ule, might  be  apportioned  to  each  county  or  politi- 
cal subdivision  to  which  they  are  available  in  pro- 
portion to  the  needy  population.  Or  as  another 
possible  alternative,  the  minimum  fee  schedule  for 
the  expenditure  of  federal  funds  might  be  aug- 
mented by  local  funds,  thus  providing  an  addi- 
tional amount  to  establish  a more  adequate  fee 


712 


The  Ohio  State  Medical  Journal 


November,  1933 


basis,  subject,  of  course,  to  administrative  au- 
thorization and  to  agreement  by  the  local  relief 
officials  and  officials  of  the  county  medical  society. 

While  there  are  many  valid  arguments  relative 
to  the  danger  that  an  agreement  by  physicians 
to  accept  reduced  fees  for  care  of  the  indigent 
sick  will  encourage  those  able  to  pay  the  cus- 
tomary fee  to  expect  physicians  to  reduce  the 
fee  to  them  also;  and  to  the  inequitableness  of  a 
plan  which  expects  medical  service  to  be  rendered 
indigents  at  a comparatively  lower  rate  of  com- 
pensation than  that  paid  for  other  types  of  re- 
lief, other  arguments  in  explanation  of  the  pro- 
posed plan  also  have  been  advanced. 

It  has  been  pointed  out  that  physicians  will  not 
be  expected  in  the  “emergency”  plan  to  render 
an  exhaustive  type  of  service  unless  absolutely 
necessary;  that  the  patient  who  can  and  expects 
to  pay  for  medical  service  does  not  care  to  be 
placed  in  a pauper  classification  and  therefore 
will  pay  the  regular  fee  of  the  physician;  that 
those  supplying  services  or  materials  in  other 
types  of  relief  are  expected  to  take  but  a small 
profit,  if  any;  that  the  reduced  fee,  while  small 
and  obviously  inadequate,  will  be  paid  promptly 
and  will  be  for  work  for  which  physicians  have 
in  most  instances  been  receiving  no  compensa- 
tion whatever,  and  that  the  proposed  set-up  calls 
for  the  personal  choice  of  physician  by  the  pa- 
tient, a factor  which  is  being  precluded  under 
other  methods  of  procedure,  such  as  the  ques- 
tionable contract  for  in  digents’  service. 

Some  members  have  raised  the  pertinent  ques- 
tion that  the  medical  profession  as  a group  in 
society  contributes  through  taxation  and  other- 
wise to  public  funds  and  that  since  other  neces- 
sities of  life — food,  clothing,  etc. — are  furnished 
to  the  needy  unemployed  and  purchased  at  a 
normal  price,  that  medical  service  for  such  needy 
persons  should  also  be  purchased  at  public  er- 
pense  at  a normal  fee.  Relief  officials,  however, 
point  out  that  in  many  instances  the  other  “neces- 
sities” have  been  purchased  on  “bids”  and  that 
it  is  the  further  intention  of  the  administration 
to  set  up  a wholesale  purchasing  and  distributing 
system  to  eliminate  all  profit  for  necessities  fur- 
nished to  the  needy;  these  to  apply  particularly 
to  food  and  clothing.  It  is  further  pointed  out 
that  the  plan  even  in  effect  heretofore  has  not 
provided  the  normal  amount  figured  for  rent  and 
housing  for  the  needy. 

LOCAL  PLANNING  AND  INITIATIVE  ESSENTIAL 

Necessarily  the  State  Relief  Commission  can  only 
view  the  question  of  medical  poor  relief  in  a gen- 
eral and  detached  way  and  from  a state-wide 
point  of  view.  It  is  not,  and  can  not  be  expected 
to  be,  entirely  familiar  with  the  numerous  definite 
local  problems  and  situations. 

For  this  reason,  it  is  imperative  that  each 
county  medical  society  be  represented  by  an  alert 
and  aggressive  committee  on  public  relations  or 
medical  poor  relief  which  should  meet  as  soon  and 


as  frequently  as  possible  with  local  relief 
officials  to  discuss  local  needs  and  local  procedure. 
If  possible,  an  agreement  relative  to  the  most 
practical  plan  in  each  community  should  be  formu- 
lated. This  plan,  together  with  pertinent  infor- 
mation concerning  the  local  situation,  may  then 
be  submitted  to  the  State  Relief  Commission  so 
that  a composite  picture  may  be  had  by  the  state 
commission  of  the  medical  relief  problems  of  the 
state  as  a whole,  and  which  may  be  used  as  a 
basis  for  modification  or  local  adjustment  of  the 
suggested  state  program  so  as  to  permit  greater 
freedom  to  local  relief  agencies  in  working  out 
more  satisfactory  or  augment  by  local  funds  medi- 
cal relief  methods;  eliminating  any  unfeasible 
features  of  the  plan  which  has  been  suggested, 
and  adjusting  medical  fees  in  relief  cases  in  an 
equitable  manner. 

FEDERAL  REGULATIONS  QUOTED 

In  order  that  there  may  be  a definite  under- 
standing of  the  policy  and  procedure  proposed  by 
the  Federal  Relief  Administration,  the  following 
excerpts  are  quoted  from  Rules  and  Regulations 
No.  7 governing  medical  care  to  recipients  of  un- 
employment relief  through  federal  funds: 

The  following  regulations,  governing  the  pro- 
vision in  the  home  of  medical  care  (includes 
“medicine,  medical  supplies  and/or  medical  at- 
tendance”) to  persons  eligible  for  unemployment 
relief,  are  hereby  established. 

1.  Policy. — A uniform  policy  with  regard  to 
the  provision  of  medical,  nursing,  and  dental  care 
for  indigent  persons  in  their  homes,  shall  be  made 
the  basis  of  an  agreement  between  the  relief  ad- 
ministration and  the  organized  medical,  nursing, 
and  dental  professions,  state  and/or  local.  The 
essence  of  such  a policy  should  be: 

(a)  An  agreement  by  the  relief  administration 
to  recognize  within  legal  and  economic  limitations, 
the  traditional  family  and  family-physician  re- 
lationship in  the  authorization  of  medical  care  for 
indigent  persons  in  their  homes;  the  traditional 
physician-nurse  relationship  in  the  authorization 
of  bedside  nursing  care;  the  traditional  dentist- 
patient  relationship  in  the  authorization  of 
emergency  dental  care;  and 

(b)  An  agreement  by  the  physician,  nurse  (or 
nursing  organization),  and  dentist  to  furnish  the 
same  type  of  service  to  an  indigent  person  as 
would  be  rendered  to  a private  patient,  but  that 
such  authorized  service  shall  be  a minimum  con- 
sistent with  good  professional  judgment,  and  shall 
be  charged  for  at  an  agreed  rate  which  makes  due 
allowance  for  the  conservation  of  relief  funds. 

jJj  ;js 

The  policy  adopted  shall  be  to  augment  and 
render  more  adequate  facilities  already  existing 
in  the  community  for  the  provision  of  medical 
care  by  the  medical,  nursing,  and  dental  profes- 
sions to  indigent  persons.  It  shall  imply  con- 
tinuance in  the  use  of  hospitals,  clinics,  and  medi- 
cal, dental,  and  nursing  services  already  estab- 
lished in  the  community  and  paid  for,  in  whole  or 
in  part,  from  local  and/or  state  funds  in  accord- 
ance with  local  statutes  or  charter  provisions. 
Federal  emergency  relief  funds  shall  not  be  used 
in  lieu  of  local  and/or  state  funds  to  pay  for  these 
established  services. 

The  phrase  “in  their  homes”  shall  be  inter- 
preted to  include  office  service  for  ambulatory 


November,  1933 


Medical  Poor  Relief 


713 


patients,  with  the  understanding  that  such  office 
service  shall  not  supplant  the  services  of  clinics 
already  provided  in  the  community. 

2.  Proecedure. — A uniform  procedure  for  au- 
thorization of  medical,  nursing,  and  dental  care 
in  the  home  shall  be  established  by  each  state 
and/or  local  emergency  relief  administration. 
This  procedux-e  shall  not  be  in  conflict  with  the 
following  requirements: 

(a)  Written  order. — All  authorizations  for 
medical,  nui-sing,  and  dental  care  shall  be  issued 
in  writing  by  the  local  l’elief  officer,  on  the  regular 
relief  order  blank,  prior  to  giving  such  care;  ex- 
cept that  telephone  authorization  shall  immedi- 
ately be  followed  by  such  a written  oi-der;  and 
provided  that  authorizations  for  bedside  nursing 
care  shall  be  based  on  a recommendation  by  the 
attending  physician,  in  cases  where  a physician  is 
in  attendance,  who  shall  cex-tify  to  the  need  for 
nui-sing  sex-vice  as  part  of  the  medical  cax-e.  Au- 
thorizations for  medicine  and  medical  supplies 
shall  also  be  issued  in  wx’iting  axxd,  in  general, 
such  authorizations  shall  ixot  be  issued  except 
upon  written  x'equest  of  the  physician  authox'ized 
to  attend  the  person  for  whose  use  they  are  de- 
sired. * * * * 

(e)  Special  services. — Medical  and  nux'sing  ser- 
vices not  covex-ed  above  shall  be  authorized  on  axx 
individual  basis,  subject  to  the  general  provisions 
of  the  agreement  made  under  regulation  1.  Spe- 
cial dental  sex-vice  shall  be  subject  to  a similar 
procedure. 

Medical  care  shall  not  oi'dinarily  be  authox'ized 
by  relief  administrations  for  conditions  that  do 
not  cause  acute  suffering,  interfere  with  earxxing 
capacity,  endanger  life,  or  thx'eaten  some  perma- 
nent new  handicap  that  is  preventable  when  medi- 
cal care  is  sought.  * * * 

(g)  Fee  schedule. — The  agx-eement  between  the 
state  and/or  local  relief  administration  axxd  the 
organized  professional  groups  of  physicians, 
nurses,  and  dentists,  state  and/or  local,  established 
under  x-egulatioxx  1,  shall  include  a fee  schedule 
covex-ing  the  basic  axxd  special  sex'vices  outlined  in 
sections  (b)  to  (f),  inclusive,  of  this  regulation. 
In  the  interests  of  simplified  accouxxtixxg  it  is  sug- 
gested: That  a flat  rate  be  established,  on  a per 
visit  basis  for  the  usual  care  given  to  acute  and 
chi'onic  illness  (sections  (b)  and  (c)  above),  fox- 
attendance  at  confinement  (section  (d)  above), 
for  emergency  extractions  (section  (f)  above), 
and  for  a bedside  nursing  visit  (section  (f) 
above)  ; and  that  all  special  services  (medical, 
nursing,  or  dental)  be  covei'ed  by  an  agreed  re- 
duction from  the  usual  minimum  fee  schedule  for 
such  sex-vices  with  an  agreed  max-mum  fee.  A 
recognized  diffex-ential  in  fee  shall  be  established 
between  a home  and  an  office  visit.  All  fees 
shall  be  established  on  the  basis  of  an  ap- 
preciable reduction  from  the  prevailing  mini- 
mum charges  for  similar  services  in  the  state  and 
local  communities,  with  due  recognition  of  the  cex-- 
tainty,  simplicity  and  promptness  of  payment  that 
authorization  fx*om  the  local  x-elief  administration 
insures. 

This  schedule  shall  only  apply  where  the  ex- 
penditure of  federal  x-elief  funds  is  involved  and 
shall  not  px-eclude  the  payment  of  additional 
amounts  from  local  funds.  * * * * 

(h)  Bills. — Physicians,  nurses  (or  nursing  ox-- 
ganizations) , and  dentists  who  are  providing 
authoiized  medical  care  to  indigent  persons  in 
their  homes  shall  submit  to  the  local  relief  official, 
monthly  (within  10  days  after  the  last  day  of  the 
calendar  month  in  which  such  medical  care  was 
provided),  an  itemized  bill  for  each  patient.  Each 


bill  shall  be  chronologically  arranged  and  shall 
contain  at  least  enough  information  to  permit 
proper  audit  (i.e.,  name,  age,  and  address  of 
patient;  general  nature  of  illness  or  diagnosis; 
whether  home  or  office  treatment;  dates  of  ser- 
vice; and  status  of  case  at  end  of  month — cured, 
sent  to  hospital,  dead,  needs  further  care,  etc.) 
Bills  for  medical  care  shall  be  accompanied  by  the 
original  written  order  for  such  care,  except  for 
cases  in  which  medical  service  under  an  authoriza- 
tion has  not  texminated  during  the  calendar  month 
covered  by  the  bill,  in  which  cases  the  bill  shall 
show,  in  addition  to  the  details  requix-ed  above,  the 
date  and  sei’ial  number  of  the  outstanding  ox-der. 
Retx'oactive  authoxfizations  shall  not  be  issued  or 
honored  for  payment. 

* * * * 

In  addition  to  the  citations  contained  in  the 
foregoing  article  as  a background  and  history 
of  the  medical  relief  px-oblems  in  Ohio,  readers 
of  The  Journal  will  be  interested  in  referring  to 
the  August,  1933,  issue  of  The  Journal,  pages 
516  to  518;  as  well  as  the  introduction  to  the 
recent  annual  report  of  the  Committee  on  Medi- 
cal Economics,  page  563  of  the  September,  1933. 
Journal. 


Tributes  to  Late  Dr.  Probst  Read  at 
T.  B.  Conference 

An  all-day  conference  on  tuberculosis  was  held 
at  the  State  Tuberculosis  Sanatorium,  Mt.  Ver- 
non, on  October  18.  The  program  was  dedicated 
to  the  late  Dr.  Charles  O.  Probst,  Columbus,  for 
many  years  a leader  in  public  health  activities 
of  the  state. 

Dr.  Probst’s  work  during  his  long  and  active 
cax-eer  was  summarized  in  three  aspects  at  the 
morning  session.  “Dr.  Probst  and  Health  Work 
in  Ohio”  was  the  subject  of  a talk  by  James  E. 
Bauman,  assistant  state  director  of  health.  Dr. 
H.  M.  Platter,  Columbus,  discussed  “The  Medi- 
cal Aspects  of  Dr.  Probst’s  Work”,  and  W.  H. 
Dittoe,  chief  engineer  of  the  Mahoning  Valley 
Sanitary  District  and  former  chief  engineer  in 
the  State  Department  of  Health,  spoke  on  “The 
Sanitary  Engineering  Phase  of  Dr.  Probst’s 
Work”. 

A syixxposiuixx  on  the  medical  aspects  of  tuber- 
culosis was  held.  Dr.  Charles  A.  Doan,  Colum- 
bus, presented  a paper  on  “The  Tubercle  Bacil- 
lus and  Tuberculous  Disease;  the  Newer  Bac- 
terial Chemistry  and  Its  Immunological  Implica- 
tions”. Dr.  B.  K.  Wiseman,  Columbus,  discxxssed 
“The  Relationship  of  the  Cells  of  the  Blood  to 
Diagnosis,  Prognosis  and  Treatment  in  Tubex-- 
culosis”. 

In  the  afternoon,  a paper  relating  to  the  sur- 
gical aspects  of  tuberculosis  was  presented  by 
Dr.  George  M.  Curtis,  Columbus,  entitled  “Col- 
lapse Therapy  for  Pulmonary  Tubex-culosis”.  A 
pathological  exhibit  was  presented  by  Dr.  Ernest 
Scott,  Columbus,  and  axx  M-ray  exhibit  by  Dr. 
Louis  Mark,  Columbus. 


Hospital  Group  Payment  Plans  Proposed  by  the  Cleveland 


SOME  time  ago  among  other  proposals  for  hos- 
pital group  payment  plans,  the  Cleveland 
Hospital  Council  submitted  to  the  State  In- 
surance Commission  of  Ohio  a detailed  outline  of 
a proposal. 

It  was  contemplated  that  groups  or  individuals 
would  be  solicited  to  participate  in  a plan  where- 
by, through  payments  of  so  much  per  year,  they 
would  be  entitled  to  hospital  service.  This  ques- 
tion was  then  submitted  by  the  State  Department 
of  Insurance  to  the  Attorney  General  for  an 
opinion. 

The  syllabus  of  the  opinion  issued  by  the  At- 
torney General  under  date  of  September  26,  reads 
as  follows: 

“By  virtue  of  the  provisions  of  Section  699  of 
the  General  Code,  none  of  the  laws  of  this  state 
regulating  or  pertaining  to  insurance  applies  to 
contracts  for  the  furnishing  of  hospital  service  to 
the  general  public,  individuals  or  groups,  for  a 
certain  stipulated  charge  per  year,  so  long  as  such 
contracts  are  made  only  with  persons  for  whom 
such  service  is  to  be  rendered  who  are  residents 
of  the  county  where  the  hospitals  or  sanitoriums 
in  which  such  service  is  to  be  furnished  are  lo- 
cated”. 

In  the  submission  of  the  question  from  the 
State  Superintendent  of  Insurance  to  the  Attor- 
ney General,  it  was  pointed  out  that  a group  of 
men  from  Cleveland  and  Akron  had  submitted  a 
proposition  for  selling  hospital  service  to  the  gen- 
eral public  or  to  groups,  and  with  the  question  of 
whether  or  not  such  a plan  would  come  within  the 
provisions  of  the  state  insurance  statutes. 

In  his  opinion  the  Attorney  General  stated  that: 
“Under  this  plan  the  hospitals  represented  by  the 
Cleveland  Hospital  Council  propose  to  offer  to  the 
general  public  a program  of  group  hospitalization. 
It  is  proposed  that  a corporation  not  for  profit  be 
organized  and  that  contracts  be  entered  into  be- 
tween such  corporation,  as  agent  for  said  hospi- 
tals, and  persons  purchasing  such  hospital  serv- 
ice, whereby  such  persons  will  be  entitled,  upon 
the  payment  of  an  annual  charge,  to  hospital  serv- 
ice in  any  of  the  participating  hospitals  for  a 
period  not  to  exceed  a certain  number  of  days  in 
the  year  for  which  such  charge  is  made.  The  pro- 
posed contoact  provides  that  this  hospital  service 
shall  include  board  and  bed  in  a semi-private  room 
or  ward,  general  nursing  service,  X-ray  service, 
operating  room  service,  and  ordinary  drugs,  dress- 
ings and  medicine,  but  does  not  include  hospitali- 
zation for  contagious  diseases,  mental  diseases, 
maternity  cases,  or  injuries  or  diseases  for  which 
hospitalization  is  available  without  cost  to  the 
patient  under  any  laws.  This  service  shall  be 
available  only  to  employed  persons  in  groups  of 
ten  or  more,  all  of  which  persons  in  each  group 
shall  be  employed  by  the  same  employer. 


“Sections  665,  666  and  669,  General  Code  of 
Ohio,  read  as  follows: 

“Section  665. 

‘No  company,  corporation,  or  association, 
whether  organized  in  this  state  or  elsewhere,  shall 
engage  directly  or  indirectly  in  this  state  in  the 
business  of  insurance,  or  enter  into  any  contracts 
substantially  amounting  to  insurance,  or  in  any 
manner  aid  therein,  or  engage  in  the  business  of 
guaranteeing  against  liability,  loss  or  damage,  un- 
less it  is  expressly  authorized  by  the  laws  of  this 
state,  and  the  laws  regulating  it  and  applicable 
thereto',  have  been  complied  with.’ 

“Section  666. 

‘No  company,  corporation  or  association  en- 
gaged in  the  business  of  providing  for  the  pay- 
ment of  the  funeral,  burial  or  other  expenses  of 
deceased  members,  or  certificate  holders  therein 
or  engaged  in  the  business  of  providing  any  other- 
kind  of  insurance  shall  contract  to  pay  or  pay 
such  insurance  or  its  benefits  or  any  part  of  either 
to  any  official  undertaker  or  to  any  designated  un- 
dertaker or  undertaking  concern  to  any  particular 
tradesmen  or  business  man,  so  as  to  deprive  the 
representative  or  family  of  the  deceased  from,  or 
in  any  way  to  control  them  in,  procuring  and  pur- 
chasing such  supplies  and  services  in  the  open 
market  with  the  advantages  of  competition,  unless 
expressly  authorized  by  the  laws  of  this  state  and 
all  laws  regulating  such  insurance  or  applicable 
thereto  have  been  complied  with.’ 

“Section  669. 

‘No  law  of  this  state  pertaining  to  insurance 
shall  be  construed  to  apply  to  the  establishment 
and  maintenance  by  individuals,  associations  or 
corporations,  of  sanatoriums  or  hospitals  for  the 
reception  and  care  of  patients  for  the  medical, 
surgical  or  hygienic  treatment  of  any  and  all  dis- 
eases, or  for  the  instruction  of  nurses  in  the  care 
and  treatment  of  diseases  and  in  hygiene,  or  for 
any  and  all  such  purposes,  nor  to  the  furnishing 
of  any  or  all  services,  care  or  instruction  in  or  in 
connection  with  any  such  institution,  under  or  by 
virtue  of  any  contract  made  for  such  purposes, 
with  residents  of  the  county  in  which  such  sana- 
torium or  hospital  is  located.” 

It  is  significant  that  the  substance  of  Section 
669  of  the  General  Code  on  which  this  opinion  was 
based  was  enacted  by  the  Ohio  General  Assembly 
and  became  a law  in  1904,  almost  thirty  years  ago. 

In  summarizing  his  opinion,  the  Attorney  Gen- 
eral pointed  out  that  from  “the  three  sections 
quoted,  which,  in  substantially  the  same  language, 
were  formerly  contained  in  Section  289  of  the  Re- 
vised Statutes,  that  while  contracts  of  this  nature 
which  provide  for  the  payment  of  funeral,  burial 
or  other  expenses  of  deceased  persons,  or  the  pay- 
ment of  any  of  the  benefits  of  any  other  kind  of 
insurance  to  any  designated  undertakers,  trades- 
men or  business  men,  so  as  to  deprive  the  repre- 
sentative or  family  of  the  deceased  of  procuring 
and  purchasing  such  supplies  and  services  in  the 
open  market,  as  well  as  all  other  contracts  sub- 
stantially amounting  to  insurance,  are  prohibited 


714 


November,  1933 


State  News 


715 


unless  expressly  authorized  by  statute  and  unless 
all  laws  applicable  thereto  are  complied  with,  the 
legislature  expressly  provided  that  neither  Sec- 
tions 665  and  666,  General  Code,  nor  any  other 
laws  pertaining  to  insurance  are  to  be  construed 
to  apply  to  the  furnishing  of  hospital  seiwice  in 
hospitals  or  sanatoriums  under  or  by  virtue  of 
any  contract  therefor  so  long  as  such  contracts 
are  made  with  residents  of  the  county  in  which 
such  hospitals  or  sanatoriums  are  located.  In 
view  of  the  provisions  of  Section  669,  General 
Code,  it  is  unnecessary  to  determine  whether  such 
contracts  constitute  insurance”. 

In  his  conclusion  the  Attorney  General  stated, 
“I  am  of  the  opinion  therefore  that,  by  virtue  of 
the  provisons  of  Section  669,  of  the  General  Code, 
none  of  the  laws  of  this  state  regulating  or  per- 
taining to  insurance  applies  to  contracts  for  the 
furnishing  of  hospital  service  to  the  general  pub- 
lic, individuals  or  groups,  for  a certain  stipulated 
charge  per  year,  so  long  as  such  contracts  are 
made  only  with  persons  for  whom  such  service  is 
to  be  rendered  who  are  residents  of  the  county 
where  the  hospitals  or  sanatoriums  in  which  such 
service  is  to  be  furnished  are  located.” 

* * * 

WHAT  THE  “PLAN”  INCLUDES 

The  proposed  “Cleveland  plan”  for  group  hos- 
pital payment  or  an  insurance  basis  as  formu- 
lated by  the  Cleveland  Hospital  Council  represents 
fifteen  local  hospitals  in  the  proposal,  and  accord- 
ing to  the  prospectus  and  plan  “contemplates  the 
sale  of  two  types  of  service.  Ward  service  will 
be  offered  at  $7.20  per  year,  and  semi-private 
room  service  at  $9.00  per  year.  For  this  sum,  the 
purchaser  will  be  entitled,  in  addition  to  hoard 
and  bed  in  a hospital,  to  general  nursing  and 
medical  care,  use  of  X-ray,  operating  room  and 
laboratory  facilities,  and  other  benefits.  The  serv- 
ice will  be  limited  to  twenty-one  days  in  any  one 
year”. 

The  stipulation  for  “general  nursing  and  medi- 
cal care ” is  not  very  clearly  defined  even  in  the 
proposed  agency  contract  to  be  signed  by  the  sub- 
scriber or  participant,  but  which,  under  Article  1 
of  the  contract  covenant,  construes  “hospital  serv- 
ice to  mean  receiving  a subscriber  into  a partici- 
pating hospital  and  furnishing  to  him  or  her 
board  and  bed,  either  in  a semi-private  room  or  a 
ward,  general  nursing  service,  technical  X-ray 
service,  operating  room  service,  anaesthesia,  rou- 
tine laboratory  service,  and  ordinary  drugs,  dress- 
ings and  medications,  for  not  to  exceed  twenty-one 
days  in  any  one  year.  It  shall  not  include  hospi- 
talization for  the  treatment  of  contagious  dis- 
eases, mental  diseases,  maternity  cases,  or  in- 
juries or  diseases  for  which  hospitalization  is 
available  without  cost  to  the  patient  under  any 
laws  enacted  by  the  legislatures  of  any  of  the 
states  or  the  Congress  of  the  United  States.  It 
also  shall  not  include  ambulatory  seiwice,  so- 
called,  which  is  defined  to  mean  seiwice  rendered 


to  one  who  does  not  occupy  a hospital  bed  for  a 
period  of  at  least  twelve  hours.  A semi-private 
room  is  defined  to  be  a room  containing  not  more 
than  three  beds.  A ward  is  defined  to  be  a room 
containing  four  or  more  beds.  The  terms  ‘hospi- 
tal service  in  a semi-private  room’  and  ‘hospital 
service  in  a ward’,  whenever  used  herein,  shall 
convey  the  particular  meanings  ascribed  to  such 
terms  in  this  paragraph”. 

ESTIMATED  HOSPITAL  COSTS 

Under  conditions  and  limitations  in  the  agree- 
ment it  is  stipulated  that  “hospital  service  will 
be  rendered  to  a subscriber  only  upon  the  recom- 
mendation of  a physician  or  surgeon  who  is 
licensed  to  practice  medicine  by  the  State  of 
Ohio  and  who  is  acceptable  to  the  participating 
hospital  to  which  such  recommendation  is  di- 
rected, and  only  during  such  time  as  the  sub- 
scriber is  under  the  treatment  and  care  of  such 
a physician  or  surgeon. 

“Hospital  service  will  not  be  rendered  to  a 
subscriber  after  notice  to  the  participating  hos- 
pital rendering  such  service,  by  the  physician  or 
surgeon  attending  the  subscriber,  that  further 
hospitalization  is  unnecessary.  The  subscriber 
must  pay  to  the  participating  hospital  the  estab- 
lished charges  of  such  hospital  for  all  services 
rendered  after  such  notice”. 

It  is  proposed  that  the  fifteen  Cleveland  hos- 
pitals, and  perhaps  others  to  be  admitted  later, 
will  form  “The  Cleveland  Hospital  Service  Asso- 
ciation, Inc.”,  an  incorporation  not  for  profit, 
and  the  contract  stipulates  that  it  is  executed 
by  the  Service  Association  solely  as  agent  of  the 
participating  hospitals. 

In  the  general  prospectus  under  this  proposed 
plan,  hospital  service  is  proposed  to  be  offered  to 
the  general  public  without  discrimination  and 
subject  only  to  “such  limitations  as  are  neces- 
sary to  the  sound  operation  of  the  program”  on 
“an  annual  rate”  basis. 

THE  INCOME  CONTEMPLATED 

The  prospectus  further  provides  that  “at  the 
outset,  seiwice  will  be  available  only  to  employed 
persons,  and  only  in  groups  of  ten  or  more  such 
persons,  all  of  whom  are  employed  by  the  same 
employer.  If  the  employer  regularly  employs 
twenty  persons  or  less,  all  employes  must  be 
members  of  the  group.  If  the  employer  regularly 
employs  more  than  twenty  persons,  sixty  per  cent 
of  the  employes  must  be  members  of  the  group”. 

The  funds  collected  by  the  agency  from  contract 
purchases  are  proposed  to  “be  distributed  among 
the  participating  hospitals  in  proportion  to  the 
number  of  days  of  seiwice  furnished  by  each  hos- 
pital”. The  announcement  on  this  point  states  that 
“for  convenience  in  accounting,  $4.50  per  day  will 
be  allowed  for  ward  service  and  $6.00  per  day  for 
semi-private  room  service,  these  figures  repre- 
senting roughly  the  actual  cost  of  such  services 
to  the  hospital”. 


716 


The  Ohio  State  Medical  Journal 


November,  1933 


While  apparently  the  plan  would  not  confine 
subscribers  to  any  income  group  or  economic 
status,  the  brief  submitted  by  the  Hospital  Coun- 
cil to  the  Department  of  Insurance  and  the  Attor- 
ney General  states  that  “it  should  be  recognized 
that  the  object  of  group  hospitalization  is  neither 
charity  nor  profit”  and  that  “the  per  diem  return 
to  the  hospitals  on  a cost  basis  will  be  somewhat 
less  than  the  customary  per  diem  rate  for  the 
same  class  of  service”.  The  brief  further  states 
that  “to  the  hospitals  themselves,  the  plan  broad- 
ens the  base  of  hospital  support,  reduces  the  vol- 
ume of  gratuitous  service,  and  increases  the  num- 
br  of  paying  patients.  By  reducing  the  volume 
of  charity  service,  the  hospital  is  placed  in  the  po- 
sition to  reduce  the  rates  charged  by  it  for  all 
other  classes  of  service. 

❖ 5^  ^ 

PROBLEMS  AND  POLICIES  INVOLVED 

In  view  of  the  opinion  by  the  Attorney  General 
and  the  intention  of  a number  of  Ohio  hospitals  to 
inaugurate  group  hospitalization,  it  has  become 
increasingly  imperative  that  the  medical  profes- 
sion in  each  section  of  Ohio  give  serious,  thorough 
and  analytical  consideration  to  the  question  of 
group  hospitalization,  or  hospital  insurance  as 
such  hospitalization  programs  are  commonly 
called. 

During  the  past  year  a considerable  number  of 
hospitals  in  communities  throughout  the  country 
have  embarked  on  hospital  insurance  plans  with 
a view  to  solving  their  financial  problems.  From 
time  to  time,  various  aspects  of  the  question  of 
group  hospitalization  have  been  discussed  in  The 
Journal.  Much  data  on  plans  now  in  operation  or 
proposed  have  been  collected  by  the  Bureau  of 
Medical  Economics  of  the  American  Medical  As- 
sociation and  published  in  The  Journal  of  the 
American  Medical  Association,  together  with  edi- 
torial comment  and  analysis.  The  Council  on  Com- 
munity Relations  and  Administrative  Practice  of 
the  American  Hospital  Association  has  issued  a 
brochure  concerning  group  hospitalization  and 
lists  certain  fundamental  principles  upon  which  it 
thinks  such  plans  should  be  based. 

Authoritative  information  that  has  been  col- 
lected shows  that  many  hospitals  throughout  the 
nation  are  confronted  with  serious  financial  diffi- 
culties and  that  some  groups  of  society  are  unable 
to  protect  themselves  against  unanticipated  large 
hospital  expenses. 

On  the  other  hand,  the  data  indicates  that  some 
of  the  plans  which  have  been  proposed  to  meet 
these  problems  are  questionable  and  quite  likely 
to  cause  problems  more  serious  than  those  they 
are  intended  to  solve. 

Without  reference  at  that  time  to  the  plan  pro- 
posed from  Cleveland  or  those  in  operation  or  con- 
templated in  other  communities,  it  may  be  said  as 
a matter  of  record,  as  The  Journal  of  the  Ameri- 
can Medical  Association  has  pointed  out,  that  the 
medical  profession  generally  has  hesitated  to  give 


its  blanket  approval  to  group  hospitalization  be- 
cause of  the  inherent  dangers  apparent  in  some 
of  the  plans  now  in  effect  or  proposed. 

GENERAL  CONSIDERATIONS 

It  has  been  pointed  out  that  some  group  hospi- 
talization plans  fail  to  provide  for  complete  par- 
ticipation of  most  if  not  all  of  the  recognized  hos- 
pitals in  the  community  and  for  complete  partici- 
pation of  all  reputable  physicians.  In  some  in- 
stances, the  data  shows,  the  free  choice  of  physi- 
cian and  hospital  by  the  patient  is  precluded. 

The  danger  of  exploitation  of  such  plans  by 
commercial  interests  which  charge  excessively  for 
selling  the  service  or  promoting  it  and  which  fre- 
quently have  insufficient  financial  backing  to  carry 
responsibility  has  been  repeatedly  emphasized. 
Even  should  the  direction  of  activities  in  group 
hospitalization  plans  remain  in  the  hands  of  a 
non-profit  organization  representing  hospitals,  it 
has  been  pointed  out,  there  still  is  an  opportunity 
for  solicitation  of  patients  and  competitive  under- 
bidding on  the  part  of  hospitals,  either  of  which 
are  a menace  to  competent  service  and  the  whole- 
some organization  of  this  important  phase  of 
medical  care. 

As  the  editor  of  the  A.  M.  A.  Journal  has  em- 
phasized, some  of  the  plans  advanced  by  hospital 
officials  “are  fraught  with  danger  in  placing  hos- 
pitals on  a competitive  basis  for  patients,  offering 
services  at  prices  lower  than  warranted  with  sub- 
sequent skimping  of  the  services,  and  most  serious 
of  all,  disruption  of  medical  organization  and  of 
the  whole  institution  of  medicine”. 

Another  angle  of  the  question  of  hospital  insur- 
ance which  apparently  has  not  been  given  as 
careful  thought  by  some  hospital  executives  as  it 
merits,  is  the  economic  soundness  of  many  of  the 
group  hospitalization  schemes  upon  which  some 
hospitals  have  embarked. 

INSURANCE  ANGLES 

Pertinent  comment  on  this  phase  of  the  ques- 
tion was  made  by  Dr.  Samuel  C.  Harvey  in  his 
presidential  address  to  the  New  Haven  (Conn.) 
County  Medical  Society  which  was  published,  in 
part,  in  the  A.  M.  A.  Journal.  Concerning  insur- 
ance generally,  Dr.  Harvey  said: 

“There  are  certain  essentials  in  providing  any 
insurance.  One  is  to  limit  the  scope  of  the  insur- 
ance to  a field  sufficiently  narrow  so  that  accurate 
figures  may  be  obtained  from  wh'ch  the  actuari- 
ans  may  estimate  the  probable  losses  with  a con- 
siderable degree  of  certainty.  A second  is  the 
setting  up  of  sufficient  reserves  to  cover  with  com- 
plete safety  any  possible  eventualities,  and  this 
requires  capital.  A third  is  that  the  insurer  does 
not  enter  into  the  business  of  replacing  losses.  An 
insurance  company  does  not  rebuild  a house  de- 
stroyed by  fire,  for  this  would  mean  entering  into 
an  entirely  foreign  field  of  activity  which  can  be 
more  efficiently  and  satisfactorily  done  by  those 
already  engaged  within  it.  A fourth  is  that  some 
mechanism  be  provided  by  which  the  insurance  is 
sold  with  knowledge  and  skill  so  that  it  may  be 
adapted  to  the  needs  of  the  individual  concerned. 
A fifth  is  a sufficient  spread  of  the  field  of  the  in- 


November,  1933 


State  News 


717 


sured  so  that  disaster  to  any  one  group  will  not 
destroy  the  reserves  of  the  insurer. 

“Taking  all  these  things  into  consideration,  it 
seems  absurd  to  suppose  that  amateurs  can  off- 
hand enter  into  the  field  of  insurance  and  accom- 
plish something  that  the  professional  organiza- 
tions have  not  yet  found  themselves  able  to  do.  A 
customary  statement  is  to  the  effect  that  removing 
the  profit  from  insurance  would  enable  this  to  be 
done  with  less  cost,  but  unfortunately  this  also 
removes  the  expert  in  insurance  matters,  with  the 
result  that  the  gain  by  abolition  of  profit  is  more 
than  balanced  by  the  loss  in  efficiency.  I believe, 
then,  that  if  insurance  is  to  be  developed  to  cover 
the  costs  of  medical  care  it  must  be  done  by  those 
who  are  experienced  in  this  activity,  and  that  in 
practice  means  by  reputable  insurance  organiza- 
tions already  in  existence.  Any  other  attempt 
will  lead  to  subsidy  by  taxation,  and  where  the 
state  spends  its  funds  it  controls.  There  then 
grow  up  bureaus  which  contain  within  themselves 
the  incentive  to  further  growth,  the  only  restraint 
being  the  exhaustion  of  the  taxpayer.  And  the 
consumer  always  pays,  but  then  by  taxation 
through  an  intermediate  body  which  necessarily 
abstracts  from  his  dollar  so  that  by  the  time  it 
reaches  the  producer  its  purchasing  value  is  sadly 
reduced. 

“With  these  reservations  in  mind,  it  would  seem 
advisable  to  attempt  to  pick  out  some  part  of  the 
costs  of  medical  care  which  might  be  susceptible 
of  insurance.  Inasmuch  as  the  largest  factor  in 
the  serious  illness  is  the  cost  of  hospitalization, 
this  would  seem  the  logical  point  of  attack.  This 
has,  of  course,  been  long  recognized  and  various 
attempts  are  being  made  by  hospitals  and  groups 
of  individuals,  some  of  which  are  organized  as 
corporations  to  provide  insurance.  None  of  these 
complies  with  the  indications  which  have  been 
stated  above  and  therefore  I believe  they  are 
essentially  unsound  and  doomed  to  failure  with- 
out they  obtain  subsidy  from  philanthopy  or  the 
state. 

“That  professional  insurance  organizations 
should  study  this  problem  in  conjunction  with 
hospitals  and  representatives  of  the  medical  pro- 
fession seems  obvious.  The  answer  would  seem 
to  be  in  general  along  the  lines  of  coverage,  not 
complete  but  approximating  acual  hospital  costs, 
for  the  use  of  plant  and  in  addition  limited  cover- 
age for  professional  fees,  the  disbursement  to  be 
made  to  the  patient,  the  hospital  and  physician 
having,  however,  a primary  lien  upon  such 
monies.  With  these  limitations,  it  should  be  pos- 
sible to  write  an  insurance  the  cost  of  which 
would  fall  under  normal  circumstances  within  the 
scope  of  the  present  average  budget  of  the  ma- 
jority of  families.” 

ECONOMIC  FACTORS 

Critical  analysis  of  a number  of  group  hospi- 
talization plans  now  in  effect  in  scattered  parts  of 
the  country  by  the  Bureau  of  Medical  Economics 
of  the  American  Medical  Association  emphasizes 
the  following  present  and  prospective  defects: 

1.  The  adoption  of  such  a plan  by  a single  hos- 
pital or  a group  of  hospitals  in  a locality  creates  a 
division  within  the  hospital  field  and  the  medical 
profession,  and  a feeling  that  such  a plan  by  cre- 
ating an  artificial  monopoly  through  salesmanship 
and  compulsion  by  employers  is  apt  to  exert  “un- 
fair competition”  on  those  hospitals  outside  the 
scheme.  This  encourages  the  formation  of  rival 
groups  and  solicitation  of  patients,  underbidding 
and  consequent  deterioration  of  service.  Free 
choice  of  physicians  and  hospitals  is  destroyed  for 


as  large  a section  of  the  population  as  are  induced 
to  become  contributors. 

2.  Such  plans  tend  to  extend  hospital  care  be- 
yond its  natural  scope.  Patients  who  would  ordi- 
narily be  cared  for  by  a family  physician  at  home 
will  insist  on  going  to  the  hospital  where  they 
feel  they  have  already  paid  for  care. 

3.  The  employment  of  salesmen,  especially  on 
commission,  introduces  all  the  elements  of  com- 
mercial competition,  including  flamboyant  ad- 
vertising, exaggerated  promises,  misrepresenta- 
tion, etc. 

4.  The  tendency  to  extend  the  scope  from  hos- 
pitalization to  general  medical  care  through  a 
plan  over  which  the  medical  profession  has  no 
control  and  contrary  to  the  best  considered 
opinions  of  the  organized  medical  profession. 

5.  Confining  the  scope  of  the  service  to  em- 
ployed wage-workers  leaves  a large  section  of  the 
population  most  in  need  of  hospital  care  without 
protection.  Restricting  of  the  plan  to  the  em- 
ployed means  that  a worker  who  contributes  to 
such  a scheme  for  years  becomes  ineligible  for 
benefits  the  moment  he  loses  a job. 

6.  There  usually  is  no  security  that  the  scheme 
is  sound  financially  or  the  funds  so  safeguarded 
that  in  case  of  failure  of  the  insured  who  has 
contributed  for  future  care  might  not  be  left  with- 
out recourse. 

7.  The  control  of  county  medical  societies  over 
medical  practice  is  lessened  thus  decreasing  the 
effectiveness  of  the  most  important  form  of  pro- 
fessional control  of  standards  and  ethics. 

8.  The  hospital  is  made  a preferred  creditor 
over  physicians.  Many  patients  would  be  led  to 
believe  that  their  contributions  cover  all  expense 
during  hospitalization. 

9.  Increases  the  control  of  hospital  manage- 
ment by  lay  organizers  and  executives  of  pro- 
moting organizations. 

10.  Raises  numerous  legal  questions  involving 
contracts,  etc. 

These  criticisms  of  some  group  hospitalization 
programs  now  in  operation  or  contemplated  in- 
dicate the  necessity  for  careful  study  of  all  such 
proposals  not  only  by  hospital  organizations  but 
by  all  medical  societies.  As  has  been  pointed  out 
before  in  The  Journal,  the  medical  profession 
should  not  permit  itself  to  be  disarmed  by  the  fal- 
lacious argument  that  any  program  involving 
changes  in  the  relationship  between  a hospital 
and  its  patients  does  not  directly  concern  the  med- 
ical profession  or  that  questions  arising  incidental 
thereto  are  not  medical  questions  and  deserving 
of  serious  consideration  by  the  profession.  There 
are  numerous  serious  medical  problems  involved 
in  all  plans  for  group  hospitalization  about  which 
the  medical  profession  should  be  deeply  concerned 
and  accurately  informed  in  order  that  it  may  be 
prepared  through  the  county  medical  societies  to 
meet  problems  which  have  arisen,  or  may  arise, 
in  various  communities. 


A member  of  a board  of  health  of  a general 
health  district  is  not  prohibited  by  statute  from 
voting  for  or  participating  in  the  making  of  a 
contract  of  employment  with  his  daughter  or  any 
other  member  of  his  family  as  public  health  nurse, 
according  to  an  opinion  rendered  recently  by  At- 
torney General  John  W.  Bricker. 


Interesting  Comparative  Data  on  Nursing  Education  Has 
Just  Been  Announced  for  Ohio 


Steadily  rising  standards  in  the  nursing  care 
of  the  sick  in  Ohio  are  anticipated  by  the  Com- 
mittee on  the  Grading  of  Nursing  Schools,  a 
national  body  now  concluding  its  seventh  and 
final  year  of  study,  on  the  basis  of  information 
obtained  by  the  committee  in  a survey  of  54  of 
Ohio’s  70  accredited  schools  of  nursing.  Approxi- 
mately 1400  schools  of  nursing  throughout  the 
country  were  studied  by  the  committee. 

Even  during  the  period  of  severest  depression, 
Ohio  nursing  schools  made  many  advances  in  the 
educational  requirements  of  student  and  graduate 
nurses,  the  Grading  Committee  has  reported  to 
Dr.  H.  M.  Platter,  Columbus,  secretary  of  the 
State  Medical  Board  and  State  Board  of  Nurse 
Examiners. 

How  Ohio  schools  of  nursing  compare  with 
schools  in  the  other  states  and  in  the  nation  as  a 
whole  is  indicated  in  the  statistics  which  were 
gathered  in  1929  and  again  in  1932.  During  that 
three-year  period,  surprising  progress  was  made, 
but  practically  all  nursing  schools  in  the  United 
States  have  a long  road  to  travel  before  they  at- 
tain the  goals  set  for  them  by  the  Grading  Com- 
mittee, it  is  pointed  out. 

The  Ohio  State  Nurses’  Association,  of  which 
Marguerite  E.  Fagen,  R.N.  of  Cincinnati,  is 
president  and  Mrs.  Elizabeth  P.  August,  R.N., 
85  E.  Gay  Street,  Columbus,  is  general  secretary, 
has  been  a financial  contributor  to  this  nation- 
wide survey  of  nursing  education  and  nursing 
service,  through  its  affiliation  with  the  American 
Nurses’  Association. 

Mrs.  August,  in  commenting  on  the  report  of 
the  Grading  Committee  on  Ohio  schools  of  nurs- 
ing, stated  that  it  was  regretted  that  not  all  of 
Ohio’s  accredited  schools  had  taken  part  in  the 
committee’s  study  since  all  had  advanced  during 
the  past  five  years  and  the  records  of  those  not 
participating  undoubtedly  would  have  increased 
the  standing  of  Ohio  in  the  national  rating. 

Since  1929  the  admission  standards  for  students 
entering  nurses’  training  have  risen  in  Ohio,  98 
per  cent  of  the  students  being  high  school  grad- 
uates at  the  time  of  the  Grading  Committee’s 
latest  study.  Ohio  surpasses  most  other  states  in 
the  nation  in  this  respect,  as  in  the  country  as  a 
whole  90  per  cent  of  the  students  in  accredited 
schools  of  nursing  are  high  school  graduates.  The 
national  nurses’  associations  and  the  Grading 
Committee  urge  schools  to  admit  only  those  whose 
standing  while  in  high  school  was  above  the  gen- 
eral average.  In  Ohio,  53  per  cent  of  the  student 
nurses  enjoy  this  distinction. 

One-quarter  of  the  nursing  schools  in  the 
United  States  were  without  a single  full-time 
instructor,  the  Grading  Committee  finds.  In  other 


schools  instruction  is  given  by  nurses  who  must 
also  help  run  the  nursing  service  of  the  hospital. 
In  Ohio,  92  per  cent  of  the  schools  have  one  or 
more  full-time  nurse  instructors.  The  situation  is 
improving  in  nearly  every  state,  it  is  said,  and 
even  during  the  depression  years,  when  money  for 
additional  salaries  was  scarce,  the  number  of 
regular  full-time  instructors  has  increased.  So 
far  only  27  per  cent  of  these  instructors  have 
finished  college,  but  it  is  hoped  that  in  the  near 
future  college  graduation  will  be  a requirement 
for  all  teaching  positions  in  nursing. 

Eighty-one  per  cent  of  the  schools  in  Ohio  give 
three  weeks  or  more  vacation  to  the  student 
during  the  year.  In  this  respect  the  state  stands 
ahead  of  the  country’s  average,  which  is  43  per 
cent  of  schools  giving  at  least  a three  week  an- 
nual holiday. 

Almost  no  hospital  is  able  to  give  training  in 
all  clinical  services  to  student  nurses,  the  Grading 
Committee  found.  Consequently,  schools  that  do 
not  provide  for  added  experience  by  sending  their 
students  to  other  hospitals  for  affiliation  cannot 
hope  adequately  to  prepare  students  for  practice, 
the  Committee  states.  In  this  state,  64  per  cent 
of  the  schools  send  their  students  away  for  some 
part  of  their  training,  as  against  57  per  cent  for 
the  country  as  a whole.  Ohio  ranks  nineteenth  in 
this  respect  among  the  states. 

Hospitals  conducting  nursing  schools  in  Ohio 
work  their  nurses  fairly  long  hours — too  long,  in 
the  opinion  of  the  Grading  Committee.  On  this 
point  other  states  are  equally  culpable,  it  is 
found. 

“Students  should  not  be  full-time  workers,” 
the  Committee  declares.  “The  forty-eight  hour 
week  of  hospital  service,  where  classes  and  study- 
ing are  not  included,  is  itself  too  long  for  stu- 
dents. More  than  a forty-eight  hour  week  should 
be  unthinkable.” 

Eleven  per  cent  of  the  nursing  schools  in  Ohio 
work  their  students  as  little  as  forty-eight  hours 
in  a week.  Ohio  ranks  fourteenth  from  the  top 
among  the  states  in  respect  to  reasonable  working 
hours  for  its  student  nurses,  according  to  the 
report. 

On  night  duty,  the  student  nurse  is  expected  to 
work  more  than  fifty-six  hours  a week  in  most 
states.  The  Grading  Committee  regards  such 
long  hours  as  detrimental  to  the  health  of  stu- 
dents and  to  the  welfare  of  patients.  Ohio  ranks 
eighth  from  the  top  in  the  list  of  states  giving 
reasonable  hours  for  student  night  duty. 


Cincinnati — Dr.  Eben  B.  Shewman  has  been 
elected  dean  of  the  faculty  of  the  Eclectic  Medi- 
cal College,  succeeding  the  late  Dr.  R.  L.  Thomas. 


718 


Naif's  From 

Academies 


First  District 

ACADEMY  OF  MEDICINE  OF  CINCINNATI 

(Harold  P.  Downirg,  M.D.,  Secretary) 

September  25 — General  Session.  Academy 
Auditorium.  Annual  reports  of  standing  commit- 
tees. Presidential  address  by  Dr.  Parke  G.  Smith, 
retiring  president.  Inaugural  address  by  Dr. 
Samuel  Iglauer,  incoming  president.  Introduc- 
tion of  new  secretary,  Dr.  Harold  F.  Downing. 

October  2 — General  Session.  Program:  “The 
Value  of  Early  Operations  in  Acute  Cholecy- 
stitis”, Dr.  M.  M.  Zinninger;  discussion  by  Dr. 
Charles  E’.  Langdale  and  Dr.  B.  N.  Carter;  “Anti- 
rabic  Inoculation  with  Spinal  Cord  Complica- 
tions”, Dr  Charles  E.  Kiely;  discussion  by  Dr. 
Lee  Foshay  and  Dr.  Stanley  E.  Dorst. 

October  9 — General  Session.  Program:  Physi- 
ology of  the  Upper  Respiratory  Tract  in  the 
Light  of  Some  New  Research  Developments”,  Dr. 
Anderson  Hilding,  Duluth,  Minn. 

October  16 — General  Session.  Program:  “En- 
cephalography”, Dr.  William  J.  Bleckwenn,  Mad- 
ison, Wis. 

October  23 — General  Session.  Program:  “Acute 
Appendicitis  and  the  Weather”,  Dr.  C.  A.  Mills; 
“Otorhinolaryngological  Problems  in  General 
Practice”,  Dr.  Ben  L.  Bryant;  discussion  by  Dr. 
C.  C.  Fihe  and  Dr.  M.  F.  McCarthy. 

October  30 — General  Session.  Program:  “Aids 
in  the  Diagnosis  and  Treatment  of  Tularemia”, 
Dr.  Lee  Foshay;  discussion  by  Dr.  Stanley  E. 
Dorst  and  Dr.  Merlin  Cooper. 

Butler  County  Medical  Society  opened  its  Fall 
activities  with  a meeting  on  September  28  at  the 
Fort  Hamilton  Hospital,  Hamilton.  The  program 
was  presented  by  Dr.  H.  L.  Stitt  and  Dr.  C.  E. 
Wooding,  both  of  Cincinnati.  They  delivered  il- 
lustrated lectures  on  “The  Treatment  of  Non- 
Tubercular  Diseases  of  the  Chest”. — News 
Clipping. 

Clinton  County  Medical  Society,  in  session  Oc- 
tober 3 at  Wilmington,  was  addressed  by  Dr. 
Robert  Conard,  Wilmington,  on  “The  Distribution 
of  Medical  Care — Our  Local  Problems”.  During 
the  round-table  discussion  which  followed  inter- 
esting comments  were  made  by  Drs.  V.  E. 
Hutchens,  C.  A.  Tribbett,  T.  E.  Craig,  H.  E. 
Gibson,  W.  K.  Ruble  and  Kelley  Hale. — News 
Clipping. 

Warren  County  Medical  Society  was  addressed 
by  Dr.  Edward  O.  Bauer,  Middletown,  on  “Ap- 


pendicitis”, at  its  regular  meeting  October  3 at 
Harmon  Hall,  Lebanon. — News  Clipping. 

Second  District 

Greene  Coxmty  Medical  Society  met  in  regu- 
lar session  October  5 at  Xenia.  Dr.  Roy  Arn, 
Springfield,  was  the  guest  speaker,  presenting  a 
paper  on  the  subject,  “Treatment  of  Skull  Frac- 
tures and  Internal  Damage”.  He  ably  de- 
scribed the  more  common  types  of  skull  fractures, 
the  damage  usually  resulting  and  the  treatment 
of  such  cases. 

On  September  15,  the  society  was  addressed  by 
Dr.  G.  I.  Nelson,  Columbus,  who  discussed  the 
subject,  “Cardio-Vascular  Diseases”. — H.  C. 
Shick,  M.D.,  Secretary. 

Miami  County  Medical  Society  held  a dinner 
meeting  October  6 at  the  Memorial  Hospital, 
Troy.  The  program  was  presented  by  Dt.  Rus- 
sell Gardner,  Troy,  and  Dr.  W.  C.  Breidenbach, 
Dayton.  Dr.  Gardner  discussed  “Some  New 
Blood  Count  Considerations”.  Dr.  Breidenbach 
presented  a paper  on  “Progress  of  the  Modern 
Trend  in  the  Treatment  of  Tuberculosis”. — 
Bulletin. 

Montgomery  County  Medical  Society  was  ad- 
dressed on  October  6 by  Dr.  W.  E.  Elder,  as- 
sistant chief  medical  examiner  of  the  State  In- 
dustrial Commission,  who  explained  the  procedure 
in  the  handling  of  industrial  commission  claims 
and  interpi'eted  the  recently-revised  rules  and 
regulations  relating  to  medical  care  of  injured 
workmen.  The  question  of  medical  poor  relief 
was  discussed  at  the  business  session.  The  mat- 
ter of  drafting-  a local  program  for  medical  care 
of  the  poor  for  submission  to  local  relief  officials 
was  referred  to  the  Committee  on  Public  Rela- 
tions for  study  and  recommendation. — Bulletin. 

At  a meeting  of  the  society  on  October  20,  the 
following  symposium  on  “Intestinal  Obstruction” 
was  presented:  “Clinical  Symptoms  and  Diag- 

nosis”, Dr.  R.  L.  Johnston;  “Pathological  Physi- 
ology”, Dr.  H.  D.  Cassel;  “From  a Pediatrician’s 
Point  of  View”,  Dr.  R.  D.  Hostetter,  and  “Sur- 
gical Treatment”,  Dr.  R.  C.  Austin.  The  papers 
were  discussed  by  Dr.  R K.  Finley  and  Dr.  A.  W. 
Carley. — -Bulletin. 

Auglaize  County  Medical  Society  met  in  regu- 
lar session  on  Thursday  evening,  October  12,  at 
St.  Mary’s  with  a good  attendance.  The  feature 
of  the  program  was  a paper  by  Dr.  0.  P.  Klotz, 
Findlay,  councilor  of  the  Third  District  on  the 
subject,  “ Thro mbo- Angitis  Obliterans”  (Burgers 
Disease).  Excellent  repoi’ts  of  the  Akron  meet- 
ing of  the  State  Association  were  given  by  Dr. 


719 


720 


The  Ohio  State  Medical  Journal 


November,  1933 


Guy  E.  Noble  and  Dr.  R.  C.  Hunter.  A resolution 
of  respect  and  condolence  relative  to  the  death 
of  Dr.  R.  A.  Rulmann,  Minster,  a former  presi- 
dent of  the  society  and  a member  of  the  Board  of 
Censors,  was  adopted.  An  animated  discussion 
with  regard  to  the  social  and  economic  conditions 
confronting  the  medical  profession  was  held  by 
the  membership  after  a summary  of  some  of  the 
px-oblems  by  Dr.  Klotz. — C.  C.  Berlin,  M.D.,  secre- 
tary. 

Third  District 

Marion  County  Academy  of  Medicine  met  on 
October  5 at  the  Marion  City  Hospital.  The  pro- 
gram was  presented  by  Dr.  Carl  W.  Sawyer  who 
read  a paper  on  “Some  Observations  on  De- 
mentia Praecox”. — Bulletin. 

Seneca  County  Medical  Society  held  a dinner 
meeting  September  21  at  the  Mohawk  Club  near 
Tiffin.  Fifty-two  members,  wives  of  members 
and  physician  guests  from  surrounding  counties 
attended  and  listened  to  two  interesting  addresses 
by  Dr.  E.  J.  McCormick  and  Dr.  Thomas  L.  Ram- 
sey, both  of  Toledo.  Dr.  McCormick  spoke  on 
“Medical  E'thics”  and  Dr  Ramsey  on  “History  of 
Medicine”.  Preceding  the  meeting  a golf  tourna- 
ment was  held  and  a bridge  party  was  held  for 
the  women  guests. — -News  Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO  AND 
LUCAS  COUNTY 

(A.  P.  Hancuff,  MMX,  Secretary) 

October  6 — General  Session.  Program:  “The 
Developmental  Health  Examination  for  Children”, 
Dr.  T.  Wingate  Todd,  Cleveland. 

October  13 — Section  of  Pathology,  Experi- 
mental Medicine  and  Bacteriology.  Program : 
“Manifestations  of  Streptococcus  Viridans  in  Cu- 
taneous Disease”,  Dr.  C.  E.  Price;  “Streptococcus 
Viridans  in  Heart  Disease”,  Dr.  F.  C.  Clifford. 

October  20 — Medical  Section.  Program:  “Head- 
ache— Diagnostic  Outline”,  Dr.  Charles  Lukens; 
discussants,  Drs.  R.  E.  Boice,  S.  H.  Patterson, 
Carll  S.  Mundy  and  L.  A.  Miller. 

October  27 — -Surgical  Section.  Program:  “Pye- 
litis of  Pregnancy”,  Dr.  N.  B.  Muhme;  discus- 
sant, Dr.  A.  R.  Klopfenstein;  “Maternal  Mor- 
tality in  the  City  of  Toledo”,  Dr.  B.  H.  Carroll. 

Wood  County  Medical  Society  was  addressed 
by  Dr.  L.  A.  Levison,  Toledo,  at  its  meeting  Sep- 
tember 21  at  Bowling  Green.  Dr.  Levison  spoke 
on  “Diseased  Peripheral  Circulation”.  The  meet- 
ing was  held  at  the  General  Hospital  following  a 
dinner. News  Clipping. 

Fifth  District 

CLEVELAND  ACADEMY  OF  MEDICINE 

(C.  H.  Heyman,  M.D.,  Secretary) 

October  k — Obstetrical  and  Gynecological  Sec- 
tion. Program:  “Myomectomy — As  a Means  of 
Preserving  the  Reproductive  Function  of  the 


Uterus”,  Dr.  C.  T.  Hemmings;  discussion  opened 
by  Dr.  Theodore  Miller;  “A  Case  Report  of  an 
Unusual  Type  of  Uterine  Anomaly”,  Dr.  Wil- 
liam H.  Weir;  discussion  opened  by  Dr.  Marion 
Douglass;  “The  Treatment  of  Acute  and  Chronic 
Pelvic  Infection”,  Dr.  Scott  C.  Runnels;  discus- 
sion opened  by  Dr.  J.  C.  Wood. 

October  6 — Clinical  and  Pathological  Section. 
Program:  “Molar  Pregnancy”,  Dr.  Theodore  Mil- 
ler; “Physiologic  Harelip  Repair”,  Dr.  Donald  M. 
Glover;  “Lactic  Acid  Stricture  of  the  Esophagus”, 
Dr.  Charles  E.  Kinney;  “Bronze  Diabetes”,  Dr. 
Charles  T.  Way;  “Difficulties  in  the  Diagnosis  of 
Primary  Malignancy  of  the  Liver”,  Dr.  Rafael 
Dominguez;  “Renal  Rickets”,  Dr.  W.  C.  Fargo. 

October  11 — Section  on  the  Practice  of  Medicine. 
Program:  “Simple  Hypochromic  Anemia”,  Dr.  R. 
L.  Haden;  “Various  Forms  of  Treatment  of  Per- 
nicious Anemia”,  Dr.  H.  H.  Brittingham;  “The 
Cost  of  Various  Treatments  for  Pernicious 
Anemia”,  Dr.  Harley  Williams. 

October  13 — Experimental  Medicine  Section. 
Program:  “Studies  in  Repair  of  Bone”,  Dr.  Wil- 
bert H.  McGaw;  “Hypoglycemia  Accompanying 
Pancreatic  Tumors”,  Dr.  Lloyd  I.  Ross;  “Con- 
tusions of  the  Heart”,  Dr.  Claude  S.  Beck;  “Func- 
tional Pathology  of  Intrapericardial  Lesions”,  Dr. 
E.  H.  Cushing  and  Dr.  Claude  S.  Beck;  “Electro- 
cardiographic Changes  Accompanying  Trauma  to 
the  Heart  and  Pericardium”,  Dr.  Harold  Feil; 
“Roentgen  Diagnosis  of  the  Pick  Syndrome”,  Dr. 
David  Steel;  “Cardiac  Output  Studies  as  Applied 
to  the  Surgery  of  the  Heart”,  Dr.  R.  M.  Hosier, 
Dr.  F.  R.  Mautz  and  Dr.  John  Williams;  “Cardiac 
Output  in  the  Pick  Syndrome”,  Alice  B.  Maltby, 
A.M.,  (by  invitation). 

October  2k — Section  on  Military  Medicine. 
Symposium  on  the  Civilian  Conservation  Corps. 
Principal  discussions  by  Major  G.  D.  Holland  and 
Major  Ross  B.  Bretz. 

October  25 — Pediatric  Section.  Program:  “Ma- 
laria in  the  Newborn”,  Dr.  J.  W.  Epstein;  “The 
Types  of  Human  Hypersensitiveness — Their  Re- 
lationship to  the  Liability  to  Serum  Reactions”, 
Dr.  J.  A.  Rudolph;  “Observations  on  the  In- 
fluence of  Alkalies  on  the  Albumin  Content  of  the 
Urine  as  Determined  by  Heat  and  Esbach  Meth- 
ods”, Dr.  C.  E.  Zeithaml  and  Dr.  H.  J.  Gersten- 
berger. 

October  27 — Ophthalmological  and  Oto-laryngo- 
logical  Section.  Dinner  meeting  at  University 
Club.  Pi'ogram:  “Frontal  Sinus  Infection  Fol- 

lowing Swimming”,  Dr.  W.  B.  Chambeidin;  dis- 
cussion opened  by  Dr.  C.  E.  Pitkin;  “Pathology 
of  the  Central  Retina”,  Dr.  Paul  Moore;  discus- 
sion opened  by  Dr.  W.  E.  Bruner;  “Vasomotor 
Rhinitis  in  Relation  to  Allergy”,  Dr.  H.  V.  Phelan; 
discussion  opened  by  Dr.  J.  R.  Breitbart. 

Erie  County  Medical  Society  met  September  28 
at  Sandusky  for  a business  session.  The  principal 


November,  1933 


State  News 


721 


matter  taken  up  was  relative  to  having  the  society- 
join  the  Merchants’  Retail  Credit  Bureau.  The 
matter  was  referred  to  a committee  which  will 
report  at  a later  meeting. — News  Clipping. 

Sixth  District 

Portage  County  Medical  Society  met  on  October 

4 at  the  home  of  Dr.  L.  W.  Prichard,  Ravenna. 
Following  a report  on  the  1933  annual  meeting 
of  the  State  Association  by  Dr.  George  J.  Wag- 
goner, an  address  on  ‘'Communicable  Diseases” 
was  made  by  Dr.  Gerald  S.  Shibley,  Cleveland. — 
Bulletin. 

Richland  County  Medical  Society,  at  its  meeting 
September  21  at  the  Mansfield-Leland  Hotel, 
Mansfield,  was  addressed  by  Dr.  William  Brad- 
ford, a member  of  the  medical  faculty  at  the  Uni- 
versity of  Rochester.  Dr.  Bradford  discussed  the 
subject,  “Scarlet  Fever”.  Dr.  Dwight  Weir  and 
Dr.  Erling  Smedal,  both  of  Mansfield,  were  ad- 
mitted to  membership. — News  Clipping. 

Summit  County  Medical  Society  in  regular  ses- 
sion October  3 at  the  Mayflower  Hotel,  Akron,  was 
addressed  by  George  Massig,  relief  administrator 
of  Summit  County,  on  “The  Care  of  the  Indigent 
Sick  in  the  Home”.  An  interesting  discussion  of 
the  subject,  “The  Doctor  in  Court”  was  presented 
by  Dr.  Walter  G.  Stem,  Cleveland. — Bulletin. 

Seventh  District 

Belmont  County  Medical  Society  met  on  October 

5 at  the  Belmont  Hills  Country  Club.  The  guest 
speaker  was  Dr.  Jonathan  Forman,  Columbus, 
who  spoke  on  “Allergy  in  General  Practice”.  Din- 
ner was  served  after  which  the  various  aspects  of 
medical  poor  relief  were  discussed. — Bulletin. 

Columbiana  County  Medical  Society,  in  session 
October  10  at  the  Whist  Club,  Lisbon,  was  ad- 
dressed by  Dr.  P.  C.  Hartford  on  “The  Evolution 
of  Medicine  During  the  Past  Half  Century”.  In- 
teresting discussions  of  the  subject  were  presented 
by  Drs.  Hobbs,  Heck  and  Bookwalter. — Bulletin. 

Coshocton  County  Medical  Society  was  ad- 
dressed by  Dr.  Ward  Coffman,  Zanesville,  on 
“Cancer”  at  its  regular  meeting  on  September  28 
at  Coshocton.  Dr.  E.  R.  Brush,  Zanesville,  mem- 
ber of  the  State  Association  Council  was  a guest 
at  the  meeting. — News  Clipping. 

Eighth  District 

Athens  County  Medical  Society  was  addressed 
by  Dr.  George  J.  Heer,  Columbus,  at  its  meeting 
October  2 at  Nelsonville.  Dr.  Heer  discussed 
“Surgical  Diagnosis”.  A discussion  of  medical 
poor  relief  problems  was  held  following  a talk  by 
Ray  Noble,  county  relief  administrator. — Bulletin. 

Guernsey  County  Medical  Society  at  its  meeting 
September  21  at  Cambridge,  heard  a report  on  the 
recent  annual  meeting  of  the  State  Association. 
The  report  was  presented  by  Dr.  H.  R.  Neeland, 
official  delegate  of  the  society.  Dr.  C.  D.  Hoy, 


Columbus,  the  scheduled  guest  speaker,  was  un- 
able to  attend  because  of  illness. — News  Clipping. 

Licking  County  Medical  Society  met  in  regular 
session  September  29  at  the  Warden  Hotel,  New- 
ark, when  special  business  was  transacted. — News 
Clipping. 

Perry  County  Medical  Society  held  a duck 
luncheon  September  18  at  the  Park  Hotel,  New 
Lexington.  The  principal  speaker  was  Dr.  Robert 
Martin,  Zanesville,  who  discussed  “Diseased  Con- 
ditions of  the  Eye  As  Met  by  the  General  Prac- 
titioner and  Treatment  of  the  Same”.  Dr.  E.  R. 
Brush,  Zanesville,  councilor  of  the  Eighth  Dis- 
trict, was  present  and  spoke  briefly. — News  Clip- 
ping. 

Washington  County  Medical  Society,  in  session 
October  11  at  the  Marietta  Memorial  Hospital, 
was  addressed  by  Dr.  Howard  L.  Stitt  and  Dr. 
C.  E.  Wooding  both  of  Cincinnati,  on  “Bronchial 
Lavage”.  The  discussions  were  illustrated  with 
slides  and  demonstrations  of  technique  were  pre- 
sented.— Bulletin. 

Ninth  District 

Scioto  County — The  Hempstead  Academy  of 
Medicine  met  on  October  9 at  the  Recreational 
Hall,  Nurses’  Home.  The  guest  speaker  was  Dr. 
Frank  Davis,  Columbus,  who  discussed  “Eclamp- 
sia”, A buffet  supper  was  served  after  the  meet- 
ing. 

On  September  21,  the  Academy  held  its  annual 
golf  tournament  at  the  Raven  Rock  Golf  Club 
after  which  dinner  was  served  at  the  Hurth 
Hotel. — Bulletin. 

Tenth  District 

COLUMBUS  ACADEMY  OF  MEDICINE 

(John  H.  Mitchell,  M.D.,  Secretary) 

September  25 — General  Practitioners’  Section. 
Program:  “The  Periodic  Health  Examination 

Movement”,  Dr.  Louis  Jentgen;  “Preventive 
Phases  of  Gynecology  and  Obstetrics,  Including 
Cancer”,  Dr.  Roy  Krigbaum,  Dr.  S.  J.  Goodman, 
Dr.  W.  D.  Inglis,  and  Dr.  P.  J.  Reel. 

October  2 — General  Session.  Program:  “How 
We  Inherit  Disease”,  L.  H.  Snyder,  professor  of 
medical  genetics,  Ohio  State  University. 

October  9 — General  Session.  Program:  “Pre- 
ventive Medicine  for  Young  Adults”,  Dr.  J.  S. 
Wilson,  Dr.  M.  F.  Osborn  and  Dr.  J.  M.  Foley. 

October  16 — General  Session.  Program:  “New 
Phase  in  Chronic  Cystic  Mastitis”,  Dr.  J.  W. 
Means. 

October  23 — General  Session.  Program:  “Sur- 
gery of  the  Arterial  System”,  Dr.  V.  A.  Dodd; 
“Surgery  of  Varicose  Ulcers”,  Dr.  J.  M.  Dunn. 

October  30 — General  Practitioners’  Session. 
Program:  “The  Art  of  Bedside  Diagnosis”,  Dr. 
Leslie  M.  Lisle;  discussions  by  Dr.  Ralph  Taylor, 
Dr.  C.  C.  Ross  and  Dr.  E.  C.  Beam. 


722 


The  Ohio  State  Medical  Journal 


November,  1933 


Legislation  Provides  Reimbursement  to 
Some  Hospitals  for  Services  to  In- 
digents Injured  in  Auto  Accidents 

Between  $250,000  and  $300,000  in  state  funds 
will  be  available  during  the  next  12  months  for 
distribution  to  some  hospitals  of  the  state  as  re- 
imbursement for  expenses  incurred  by  such  insti- 
tutions for  the  care  of  indigent  persons  injured 
in  motor  vehicle  accidents  in  accordance  with  the 
terms  of  legislation  (House  Bill  No.  80)  enacted 
by  the  90th  Ohio  General  Assembly  and  which  be- 
came effective  October  9. 

Only  Ohio  hospitals  “organized,  and  operated  not 
for  profit’’  will  benefit  under  the  act  which  was 
sponsored  and  promoted  by  the  Ohio  Hospital  As- 
sociation and  introduced  in  the  Legislature  by 
Representatives  S.  A.  Hesse,  Cleveland.  A con- 
siderable number  of  privately-owned  hospitals  and 
institutions  will  be  excluded  from  participation 
in  the  fund  because  of  the  “non-profit”  require- 
ment of  the  act. 

The  measure  had  a stormy  career  in  the  Leg- 
islature and  was  not  enacted  until  the  closing  mo- 
ments of  the  session  because  of  objections  raised 
by  some  members  of  the  General  Assembly.  At 
that  time  it  was  pointed  out  by  some  legislators 
that  the  act  discriminated  between  hospitals  and 
that  it  provided  for  the  use  of  a specific  state  fund 
designated  for  other  purposes.  Moreover,  doubt 
was  raised  as  to  the  fundamental  policy  of  com- 
pensation for  one  particular  type  of  injuries  and 
as  to  the  soundness  of  the  policy  of  having  the 
state  finance  such  activities  which  are  not  strictly 
emergency  poor  relief  activities. 

To  save  the  bill  from  defeat,  its  backers  con- 
sented to  an  amendment  which  limits  its  opera- 
tion and  effect  until  March  1,  1935. 

Under  the  act,  each  hospital  able  to  qualify  un- 
der the  terms  of  the  act,  will  be  entitled  to  reim- 
bursement from  the  State  Maintenance  and  Re- 
pair Fund,  raised  by  the  annual  automobile  license 
tag  fees,  for  the  care  of  persons  injured  in  motor 
vehicle  accidents  who  are  unable  to  pay  for  hos- 
pitalization. 

The  sum  to  be  taken  from  the  Maintenance  and 
Repair  Fund  for  reimbursement  to  hospitals  is 
allotted  by  setting  aside  19  cents  for  each  motor 
vehicle  registered  in  the  state  for  the  years  1933, 
1934  and  1935  prior  to  March  1,  1935. 

Hospitals  permitted  to  share  in  the  fund  will 
be  paid  on  a per  diem  basis  for  the  hospitaliza- 
tion of  indigent  victims  of  motor  vehicle  accidents. 
The  per  diem  rate  is  to  be  the  same  as  the  per 
diem  amount  paid  to  each  hospital  by  the  State 
Industrial  Commission. 

As  defined  in  the  act,  an  “indigent  person  is 
one  who  has  suffered  a motor  vehicle  injury,  is 
received  and  cared  for  in  a hospital,  is  unable  to 
pay  for  the  cost  of  such  care  and  whose  account 
therefore  remains  unpaid  at  the  expiration  of  90 
days  after  the  termination  of  such  care.” 

The  act  excludes  an  employe  suffering  from  a 


motor  vehicle  injury  with  respect  to  which  he  is 
entitled  to  the  benefits  of  the  workmen’s  com- 
pensation act.  A person  injured  by  the  operation 
of  a motor  vehicle  is  deemed  unable  to  pay  hos- 
pital charges  if  it  appears  that  should  an  action 
be  brought  and  judgment  secured  for  the  payment 
of  the  hospital  bill  against  him  or  against  any 
other  person  legally  responsible  for  his  care,  exe- 
cution thereon  is  unavailing. 

The  State  Registrar  of  Motor  Vehicles  is 
charged  with  administration  of  the  act  and  with 
approval  and  payment  of  claims  filed  by  hos- 
pitals. Hospitals  entitled  to  the  benefits  of  the 
act  and  desiring  to  take  advantage  of  it  are  re- 
quired to  make  monthly,  detailed  reports  to  the 
registrar,  setting  forth  all  the  facts  in  the  case 
for  which  payment  is  requested.  If  the  registrar 
of  motor  vehicles  disapproves  any  claim,  the 
claimant  hospital  is  entitled  to  a hearing  before 
him  to  press  its  claim.  The  decision  of  the  reg- 
istrar in  all  claims  is  final. 

In  case  a patient  for  whom  a hospital  has  been 
reimbursed  by  the  registrar  should  become  able 
to  pay  for  his  hospitalization,  the  hospital  is  ex- 
pected to  collect  from  him  the  amount  of  his  hos- 
pital bill.  Should  the  amount  of  the  bill  be  col- 
lected, the  registrar  of  motor  vehicles  is  author- 
ized to  deduct  such  amount  from  future  claims 
submitted  by  the  hospital.  In  event  reimburse- 
ment to  the  state  cannot  be  collected  in  this  man- 
ner, the  act  authorizes  suit  against  the  hospital 
by  the  attorney  general. 


Jurisdiction  of  Health  Officers 

In  answer  to  an  inquiry  from  Dr.  H.  G.  South- 
ard, state  director  of  health,  relative  to  the  juris- 
diction of  local  health  departments  over  the  build- 
ings and  lands  occupied  by  state  institutions  in 
matters  affecting  the  public  health  and  general 
sanitation,  Attorney  General  John  W.  Bricker  has 
ruled  that  neither  local  district  boards  of  health 
nor  local  health  commissioners  have  any  general 
jurisdiction  over  state-owned  property  in  their 
political  subdivisions. 

“Since  state-owned  institutions  are  not  ex- 
pressly included  nor  by  necessary  implication  in- 
cluded in  the  general  health  statutes  relating  to 
city  district  boards  of  health,  it  is  my  opinion”, 
Mr.  Bricker  stated  in  his  opinion,  “that  such 
boards  have  no  jurisdiction  over  the  state-owned 
buildings  or  grounds.  It  was  evidently  the  intent 
of  the  Legislature  to  leave  the  health  regulations 
of  state-owned  buildings  and  grounds  to  the  state 
officers  having  supervision  of  such  property,  ex- 
cept those  quarantine  and  sanitary  rules  and 
regulations  adopted  by  the  state  board  of  health.” 


Strasburg — Offices  have  been  opened  here  by 
Dr.  Chester  A.  Bennett,  formerly  connected  with 
the  staff  of  the  Massillon  State  Hospital,  and 
Dr.  L.  Brooks  Mehl,  a graduate  of  the  Ohio  State 
University,  College  of  Medicine. 


November,  1933 


State  News 


723 


Osteopath  Ineligible  As  Medical  Witness 
in  Lunacy  Proceedings 

An  osteopathic  physician  is  not  a registered 
physician  having  at  least  three  years’  experience 
in  the  practice  of  medicine  within  the  meaning 
of  Section  1956  of  the  General  Code  of  Ohio, 
and  is  therefore  not  qualified  to  act  as  a medical 
witness  in  lunacy  proceedings  held  pursuant  to 
Section  1954,  et  seq.,  of  the  General  Code,  ac- 
cording to  an  opinion  rendered  recently  by  At- 
torney General  John  W.  Bricker. 

Mr.  Bricker  in  upholding  the  rulings  made  by 
former  attorney  generals,  pointed  out  that  Sec- 
tion 1274  of  the  General  Code  authorizes  one  type 
of  practitioner  to  practice  medicine  and  surgery 
while  Section  1288,  General  Code,  authorizes  the 
other  type  to  practice  osteopathy  and  surgery. 

“Such  fact,  together  with  the  additional  fact 
that  osteopathic  physicians  are  not  authorized  to 
prescribe  or  administer  drugs,  except  anesthetics 
and  antiseptics,  would  tend  to  indicate  a legis- 
lative intent  not  to  consider  osteopathic  phy- 
sicians as  having  the  same  qualifications  of  a 
doctor  of  medicine,”  he  declared. 

“I  am  informed,”  he  pointed  out,  “that  osteo- 
pathic physicians  have  not  yet  adapted  their 
method  of  treatment  to  brain  disorders  and  that 
neither  the  statute  nor  the  Ohio  State  Medical 
Board  has  adopted  or  laid  down  any  rule  of  ad- 
mission to  practice  such  vocation  which  would 
require  such  applicants  for  certificates  either  to 
be  educated  in  the  diagnosis  or  treatment  of  brain 
or  nervous  disorders.  I am  further  informed 
that  osteopathic  physicians  are  not  examined  in 
the  diagnosis  or  treatment  of  brain  or  nerve  dis- 
orders as  a condition  precedent  to  the  issuance  of 
their  license  by  the  medical  board.  Since  the  cer- 
tificate evidencing  the  license  of  an  osteopathic 
physician  does  not  purport  to  authorize  him  to 
practice  medicine  and  further,  since  the  medical 
board  has  not  required  an  applicant  for  an  oseo- 
pathic  physician’s  license  to  be  examined  as  to 
his  knowledge  of  mental  and  nerve  disorders  or 
the  general  practice  of  medicine,  I am  not  per- 
suaded that  the  opinion  of  my  predecessor  is  in- 
correct.” 


Health  Commissioners  Meet 

Fourteenth  Annual  Conference  of  Ohio  Health 
Commissioners  with  the  State  Department  of 
Health  was  held  Thursday  and  Friday,  October 
19  and  20,  at  the  Deshler-Wallick  Hotel,  Colum- 
bus. An  interesting  and  instructive  program  was 
presented  at  the  well-attended  gathering.  A de- 
tailed account  of  the  meeting  will  be  carried  in 
the  December  issue  of  The  Journal. 


Norwood — Dr.  John  S.  Meserve  has  announced 
his  candidacy  for  the  nomination  for  mayor  of 
Norwood  on  the  Republican  ticket.  He  has  been 
vice  mayor  of  the  city  for  three  terms. 


Tiffin  Host  to  Northwestern  Ohio 
Medical  Gathering 

Eighty-Ninth  Meeting  of  the  Northwestern 
Ohio  Medical  Association  was  held  at  the  Junior 
High  School  Auditorium,  Tiffin,  on  Tuesday,  Oc- 
tober 3. 

At  the  business  session  of  the  meeting,  Dr. 
C.  E.  Hufford,  Toledo,  was  elected  president;  Dr. 
H.  K.  Mouser,  Marion,  vice  president;  Dr.  J.  H. 
Marshall,  Findlay,  secretary,  and  Dr  E.  L. 
Brady,  Marion,  treasurer. 

At  the  dinner  session,  the  principal  address 
was  made  by  Dr.  Geo.  Edw.  Follansbee,  Cleve- 
land, chairman  of  the  Judicial  Council  of  the 
American  Medical  Association.  Dr.  Follansbee 
spoke  on  “Medicine — A Profession  or  a Trade” 
in  which  he  discussed  various  phases  of  the  im- 
portant medico-social  questions  confronting  the 
profession. 

The  scientific  program  was  presented  by  the 
following:  “The  Differential  Diagnosis  and 

Treatment  of  Diarrhea”,  Dr.  Donald  P.  Abbott, 
Rush  Medical  College;  “Sinusitis  in  Children”,  Dr. 
John  W.  Carmack,  University  of  Indiana,  School 
of  Medicine;  “The  Iodine  Metabolism  in  Goiter”, 
Dr.  George  M.  Curtis,  Ohio  State  University, 
College  of  Medicine;  “The  General  Treatment  of 
Syphilis”,  Dr.  Carroll  S.  Wright,  Temple  Uni- 
versity, School  of  Medicine;  “Arthritis”,  Dr. 
Phillip  Lewin,  Northwestern  University  Medical 
School ; “Some  Ano-rectal  Problems  in  Everyday 
Practice — Their  Management”,  Dr.  D.  C.  Mc- 
Kenney,  University  of  Buffalo,  School  of  Medi- 
cine; “Roentgenological  Findings  in  the  Less 
Common  Lesions  of  the  Upper  Gastro-Intestinal 
Tract”,  Dr.  John  D.  Camp,  Mayo  Clinic,  Rochester, 
Minn. 


Impostor  Nabbed  in  Columbus 

Ernest  Donald  Roberts,  arrested  in  Columbus 
recently  on  a charge  of  planning  to  defraud  a 
Columbus  bank  by  depositing  bogus  checks,  is,  ac- 
cording to  the  Bureau  of  Investigation  of  the 
American  Medical  Association,  an  alleged  im- 
postor who  has  victimized  banks  and  physicians 
in  various  parts  of  the  country  by  scattering  bad 
checks  among  them. 

Roberts,  the  Bureau  of  Investigation  points 
out,  has  posed  as  “Dr.  A.  L.  (Jerry)  Castle”,  “Dr. 
Gwyn  Chadwick”,  “Dr.  John  Bellinger”,  and  “Dr. 
George  Neville”.  He  speaks  foreign  languages, 
has  a good  knowledge  of  medical  terms,  is  grac- 
ious and  polite  and  a smooth  way  of  convincing 
his  acquaintance  that  he  is  a profesisonal  man  of 
a prominent  English  family.  Roberts  is  now  in 
the  custody  of  Atlanta,  Ga.,  police,  awaiting  trial 
on  a worthless  check  charge. 


Hamilton — Dr.  Earl  C.  Leyrer,  graduate  of 
Hahnemann  Medical  College  and  until  recently 
an  interne  at  Miami  Valley  Hospital,  Dayton, 
has  opened  offices  here. 


Ulysses  M.  Bachman,  M.D.,  Cleveland;  Cleve- 
land College  of  Physicians  and  Surgeons,  1907 ; 
aged  53;  former  member  of  the  Ohio  State  Medi- 
cal Association  and  former  Fellow  of  the  Ameri- 
can Medical  Association;  died  September  14.  Dr. 
Bachman  was  one  of  the  organizers  of  Polyclinic 
Hospital  and  a member  of  its  staff  at  the  time  of 
his  death.  During  the  World  War,  he  served  as  a 
captain  in  the  medical  corps.  Dr.  Bachman  was 
associated  with  the  Hoover  American  Relief  Ad- 
ministration and  attended  the  Paris  Peace  Con- 
ference in  an  official  capacity.  He  was  a member 
of  the  American  Legion  and  the  Masonic  Lodge. 
His  widow  and  one  son  survive. 

John  M.  C.  Cook,  M.D.,  Weston;  Long  Island 
College  of  Medicine,  Brooklyn,  1887;  aged  74; 
died  September  10  of  heart  disease.  Dr.  Cook  re- 
tired from  active  practice  two  years  ago  and  had 
resided  with  a daughter  in  Huntington,  West  Vir- 
ginia. He  was  visiting  in  Weston  at  the  time  of 
his  death.  He  had  served  on  the  board  of  edu- 
cation for  20  years  and  was  active  in  civic  affairs. 
He  was  affiliated  with  the  Masonic  Lodge.  Sur- 
viving are  two  sons  and  two  daughters. 

Ira  0.  Denman,  M.D.,  Bowling  Green;  Hahne- 
mann Medical  College  and  Hospital,  Chicago, 
1897;  aged  61;  member  of  the  Ohio  State  Medical 
Association  and  a Fellow  of  the  American  Medi- 
cal Association;  died  September  28  of  heart  dis- 
ease. Dr.  Denman  was  stricken  while  playing  golf 
at  the  Heather  Downs  Country  Club,  near  Toledo. 
He  had  practiced  medicine  in  Toledo  for  many 
years  until  three  years  ago  when  he  moved  to 
Bowling  Green.  Dr.  Denman  was  former  chief  of 
staff  at  Toledo  Hospital  and  was  oculist  for  sev- 
eral railroads.  He  was  a member  of  the  American 
College  of  Surgeons,  American  Academy  of 
Ophthalmology  and  Laryngology  and  American 
Board  of  Otolaryngology.  His  widow,  two  daugh- 
ters and  one  son  survive. 

William  C.  Doughty,  M.D.,  Dayton;  Ohio  Medi- 
cal University,  Columbus,  1901;  aged  58;  member 
of  the  Ohio  State  Medical  Association  and  the 
American  Medical  Association;  died  October  9 
following  an  extended  illness.  Dr.  Doughty  had 
been  in  general  practice  at  Dayton  for  the  past 
25  years,  having  practiced  at  West  Milton  prev- 
ious to  moving  to  Dayton.  He  was  a member  of 
the  Masonic  Lodge  and  the  Montgomery  County 
Fish  and  Game  Club.  His  widow,  one  daughter, 
and  his  mother  survive. 

Louis  E.  Eddy,  M.D.,  Port  Clinton;  Louisville 
Medical  College,  1893;  aged  72;  died  September 


28  of  cardiac  asthma.  Dr.  Eddy  had  practiced  at 
Port  Clinton  for  the  past  32  years,  being  the  fifth 
generation  of  physicians.  Surviving  are  a sister 
and  two  brothers. 

J.  Tressler  Ellis,  M.D.,  Warrensville;  Pulte 
Medical  College,  Cincinnati,  1880;  aged  76;  died 
September  24  following  a stroke  of  paralysis. 
Dr.  Ellis  located  at  Warrensville  soon  after  grad- 
uating from  medical  school.  He  was  an  active 
member  of  the  Grange  and  the  Masonic  Lodge. 
He  leaves  one  daughter,  two  sons,  one  brother  and 
three  sisters. 

Chauncey  B.  Forward,  M.D.,  Urbana;  Cleve- 
land Medical  College,  1893;  aged  72;  died  Sep- 
tember 28  of  heart  disease.  Dr.  Forward  had  not 
engaged  in  active  practice  for  many  years,  de- 
voting most  of  his  time  to  the  development  of  an 
oil  cracking  process.  He  was  active  in  civic  affairs 
and  a member  of  the  Kiwanis  Club  and  the  Meth- 
odist Episcopal  Church.  His  widow,  two  sons  and 
one  daughter  survive. 

Arnold  F.  Furrer,  M.D.,  Cleveland;  Harvard 
University  School  of  Medicine,  1902;  aged  58; 
member  of  the  Ohio  State  Medical  Association  and 
a Fellow  of  the  American  Medical  Association; 
died  September  12.  Dr.  Furrer,  a native  of  Lon- 
don, England,  was  an  active  member  and  secre- 
tary of  the  Milk  Commission  of  the  Cleveland 
Academy  of  Medicine.  He  served  in  the  World 
War  as  a captain  in  the  medical  corps.  Dr.  Fur- 
rer was  a member  of  the  Central  States  Pediatric 
Society  and  had  written  several  books  on  pre- 
vention of  rickets.  Surviving  are  his  widow,  one 
son  and  one  daughter. 

Simon  B.  Hildt,  M.D.,  Bolivar;  Miami  Medical 
College,  Cincinnati,  1874;  aged  83;  died  October  3 
of  heart  disease.  Dr.  Hildt  had  practiced  in 
Bolivar  since  graduation  from  medical  school  un- 
til two  years  ago  when  he  retired  from  active 
practice.  He  was  a member  of  the  Masonic  and 
Odd  Fellows  lodges.  One  son  survives. 

Robert  S.  Hxibbard,  M.D.,  Bedford;  University 
of  Wooster  Medical  Department,  Cleveland,  1877; 
aged  79;  died  September  27  of  heart  disease.  Dr. 
Hubbard  was  active  in  civic  and  political  affairs. 
He  leaves  his  widow,  three  daughters,  two  broth- 
ers and  one  sister. 

Frank  L.  Kinsey,  M.D.,  Fremont;  Medical  Col- 
lege of  Ohio,  Cincinnati,  1882;  aged  73;  member 
of  the  Ohio  State  Medical  Association  and  the 
American  Medical  Association;  died  September  8 
of  peritonitis  following  a ruptured  appendix. 
Born  in  Galion,  Dr.  Kinsey  had  practiced  at  Fre- 


724 


November,  1933 


State  News 


725 


mont  for  more  than  40  years.  He  leaves  his 
widow,  one  son,  and  two  sisters. 

Arnos  C.  Knestrick,  M.D.,  Wooster;  Long  Island 
College  of  Medicine,  Brooklyn,  1887;  aged  82; 
died  September  24  following  an  extended  illness. 
He  had  practiced  in  Canaan  and  Creston  before 
moving  to  Wooster  many  years  ago.  Dr.  Knes- 
trick belonged  to  the  Masonic  Lodge  and  the 
Lutheran  Church.  His^  widow  survives. 

Frank  Light,  M.D.,  Ottawa;  Columbus  Medical 
College,  1883 ; aged  72 ; member  of  the  Ohio  State 
Medical  Association  and  a Fellow  of  the  Ameri- 
can Medical  Association;  died  September  27  fol- 
lowing a stroke  of  paralysis.  Dr.  Light  practiced 
in  Leipsic  and  Chicago  before  moving  to  Ottawa 
in  1892.  He  was  a member  of  the  board  of  edu- 
cation, former  county  health  commissioner  and  a 
member  of  the  Kiwanis  Club,  Masonic  Lodge  and 
Presbyterian  Church.  During  the  World  War,  he 
was  a member  of  the  county  draft  board.  Surviv- 
ing are  his  widow,  two  daughters  and  three  sons, 
one  of  whom  is  Dr.  Wilbur  Light,  Ottawa. 

Oscar  M.  Main,  M.D.,  Custar;  Kentucky  School 
of  Medicine,  Louisville,  1893 ; aged  67 ; former 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died  Sep- 
tember 11;  Dr.  Main  had  practiced  in  Toledo  for 
25  years,  moving  to  Custar  three  years  ago.  Prior 
to  practicing  in  Toledo  he  had  resided  in  Holland 
and  Maumee.  He  was  a member  of  the  Masonic 
Lodge.  Surviving  are  his  widow  and  two  sons. 

Thomas  A.  Mitchell,  M.D.,  Owensville;  Medical 
College  of  Ohio,  Cincinnati,  1876;  aged  82;  former 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died  Sep- 
tember 25  of  heart  disease.  Dr.  Mitchell  was  a 
native  of  Owensville  and  had  practiced  there 
since  leaving  medical  school.  Dr.  Mitchell  was 
active  in  the  Masonic  Lodge.  Two  daughters  sur- 
vive, one  of  whom  is  the  wife  of  Dr.  Allan  B. 
Rapp,  Owensville. 

Rudolph  A.  Rulmann,  M.D.,  Minster;  Medical 
College  of  Ohio,  Cincinnati,  1881;  aged  73;  mem- 
ber of  the  Ohio  State  Medical  Association  and  a 
Fellow  of  the  American  Medical  Association;  died 
October  7 following  an  extended  illness.  Dr. 
Rulmann  was  a native  of  Germany,  coming  to 
America  with  his  parents  at  the  age  of  eight 
years.  He  located  in  Minster  in  1882,  one  year 
after  his  graduation  from  medical  school.  Dr. 
Rulmann  was  a former  president  of  the  Auglaize 
County  Medical  Society  and  a member  of  the 
Board  of  Censor’s  at  the  time  of  his  death.  He 
had  served  on  the  county  health  board  and  was 
active  in  civic  affairs.  He  belonged  to  the  Eagles 
Lodge  and  Knights  of  St.  John.  His  widow  and 
four  sons  survive. 

Rienzi  R.  Shank,  M.D.,  Medical  College  of  Ohio, 
Cincinnati,  1900;  aged  64;  member  of  the  Ohio 
State  Medical  Association  and  the  American  Med- 
ical Association;  died  September  14  of  heart  dis- 


ease. Dr.  Shank  had  practiced  in  Trotwood  for 
the  past  33  years.  He  was  a Spanish  War  veteran 
and  was  a member  of  the  Masonic,  Odd  Fellows 
and  Knights  of  Pythias  lodges.  He  was  the  fourth 
generation  of  physicians.  Surviving  are  his 
widow,  two  sons,  Dr.  Peter  J.  Shank,  Dayton, 
and  John  Shank,  a medical  student  at  George 
Washington  University,  two  daughters  and  one 
brother. 

Edwin  A.  Steely,  M.D.,  Anna;  Medical  College 
of  Ohio,  1873;  aged  82;  died  October  2.  Dr.  Steely, 
a native  of  Anna,  retired  from  active  practice 
several  years  ago.  His  widow  and  one  sister  sur- 
vive. 

Robert  Putnam,  M.D.,  Millersburg;  University 
of  Wooster  Medical  Department,  Cleveland,  1872; 
aged  81;  died  August  10  following  an  extended 
illness.  Dr.  Putnam  practiced  at  Brinkhaven  for 
50  years,  retiring  from  active  practice  about  10 
years  ago.  Surviving  are  one  brother  and  three 
nephews. 

KNOWN  IN  OHIO 

Thompson  B.  Wright,  M.D.,  Pasadena,  form- 
erly of  Circleville;  Columbus  Medical  College,  Co- 
lumbus, 1886;  aged  69;  died  August  22  of  cerebral 
hemorrhage.  Dr.  Wright  left  Circleville  in  1917 
after  many  years  of  practice  there.  He  was  a 
Spanish-American  war  veteran.  His  widow,  two 
daughters,  two  brothers  and  one  sister  survive. 


Nation’s  Mortality  Rate  in  1932  is 
Lowest  Ever  Recorded 

The  Bureau  of  the  Census  has  announced  that 
in  1932  in  the  death  registration  area  of  conti- 
nental United  States  (exclusive  of  the  State  of 
Utah)  there  were  1,304,109  deaths  from  all 
causes,  representing  a mortality  rate  of  10.9  per 
1,000  estimated  population.  This  is  the  lowest 
rate  since  the  annual  collection  of  mortality  sta- 
tistics was  begun  in  1900.  It  is  estimated  that 
96.3  per  cent  of  the  total  population  of  the  United 
States  was  included  in  the  registration  area  for 
the  year  1932.  Because  of  the  failure  of  the 
State  of  Utah  to  furnish  the  Bureau  with  death 
certificates  for  the  year  1932,  no  data  for  that 
State  are  included  in  the  summary.  However, 
even  if  the  number  of  deaths  which  occurred  in 
Utah  were  included,  the  total  death  rate  for 
each  of  the  three  years  would  remain  practically 
unchanged. 

Of  the  18  groups  of  causes  of  death  tabulated, 
13  showed  decreases  in  the  total  number  of 
deaths,  while  only  three  groups  had  increases,  and 
two  remained  practically  the  same.  The  groups 
which  show  decreases  include  infectious  and  para- 
sitic diseases,  chronic  poisonings  and  intoxica- 
tions, diseases  of  the  nervous  system,  of  the  res- 
piratory system,  of  the  digestive  system,  and  of 
pregnancy,  childbirth  and  the  puerperal  state. 
Of  particular  interest  is  the  decrease  in  certain 
causes  of  death  such  as  typhoid  fever,  measles, 


726 


The  Ohio  State  Medical  -Journal 


November,  1933 


diphtheria,  tuberculosis,  malaria,  diarrhea  and  en- 
teritis under  two  years  of  age,  and  some  others. 
The  large  decrease  of  over  9,000  deaths  from  tu- 
berculosis (all  forms),  and  the  drop  in  the  death 
rate  from  71.7  in  1930  to  63.0  in  1932  is  note- 
worthy. The  smaller  number  of  deaths  from  dis- 
eases of  the  respiratory  system  may  be  accounted 
for  largely  by  the  decrease  in  both  broncho  pneu- 
monia and  lobar  pneumonia.  Influenza  showed  a 
decided  increase,  though  the  rate  of  increase  for 
1932  over  1931  was  much  less  than  from  1930  to 
1931.  The  decrease  in  diseases  of  pregnancy, 
childbirth,  and  the  puerperal  state  was  approxi- 
mately the  same  from  1931  to  1932,  as  from  1930 
to  1931,  and  is  due  in  a large  measure  to  the  lesser 
number  of  deaths  from  puerperal  albuminuria 
and  eclampsia,  and  puerperal  septicemia. 

The  smaller  number  of  violent  and  accidental 
deaths  is  due,  principally,  to  the  decreased  num- 
ber of  deaths  from  motor  vehicles,  as  shown  in 
the  supplemental  table.  The  number  of  suicides 
increased  for  the  three-year  period,  and  the  num- 
ber of  homicides  was  more  for  1932  than  for 
1930,  though  less  than  in  the  year  1931. 

The  outstanding  groups  in  which  large  in- 
creases were  shown  were  cancers  and  other  ma- 
lignant tumors  and  diseases  of  the  circulatory 
system.  The  number  of  deaths  due  to  cancer  and 
other  malignant  tumors  continues  to  increase 
from  year  to  year,  and  practically  every  title  to 
which  deaths  due  to  this  cause  are  allocated  shows 
an  increase  in  number,  if  not  in  actual  rates. 
Of  the  total  number  of  deaths  assigned  to  this 
title,  25,802  were  of  the  stomach  and  duodenum, 
14,871  of  the  uterus,  11,863  of  the  breast,  and 
10,420  of  the  liver  and  biliary  passages. 

Deaths  due  to  diseases  of  the  circulatory  sys- 
tem increased  numerically  from  280,403  in  1930 
to  294,596  in  1932,  equivalent  to  death  rates  of 
237.5  and  246.2,  respectively.  This  large  increase 
was  due,  principally,  to  diseases  of  the  myocardium 
and  of  the  coronary  arteries,  angina  pectoris ; 
chronic  endocarditis,  valvular  diseases  being  the 
only  cause  in  this  group  for  which  there  was  a 
considei-able  decrease  in  1932  from  1930. 


Centennial  Celebration  of  the  College  of 
Medicine,  Ohio  State  University 

Plans  are  well  under  way  for  the  celebration  on 
March  3,  1934,  of  the  100th  anniversary  of  the 
founding  of  what  is  now  the  College  of  Medicine, 
Ohio  State  University. 

Members  of  the  faculty  of  the  College  of  Medi- 
cine and  a committee  representing  the  medical 
alumni  ai’e  at  work  arranging  for  the  events 
which  will  be  held  on  the  campus  and  which,  it  is 
hoped,  will  attract  to  Columbus  hundreds  of 
graduates  of  the  schools  which  were  merged  at 
different  times  during  the  past  100  years  to  make 
up  the  present  medical  school. 

In  commemoration  of  the  centennial  anniver- 
sary a One  Hundred  Year  Book  will  be  published 


under  the  auspices  of  the  medical  college  faculty 
and  the  alumni  committee.  The  publication,  ma- 
terial for  which  is  now  being  assembled,  will 
present  in  narrative  form  the  historical  facts  and 
records  of  every  important  event  and  person  con- 
nected with  the  growth  and  development  of  the 
college,  the  oldest  medical  school  west  of  the 
Appalachian  Mountains  from  the  standpoint  of 
continuous  operation.  The  book  will  contain  the 
names  of  all  members  of  the  graduating  classes, 
biographical  notes  of  the  faculty,  several  hun- 
dred cuts,  and  other  interesting  and  informative 
data  concerning  the  school. 

Each  person  subscribing  to  the  publication 
fund  will  be  entitled  to  one  copy  of  the  One  Hun- 
dred Year  Book.  Subscriptions,  costing  $10.00, 
are  now  being  received  by  sponsors  of  the  pub^ 
lication.  Subscriptions  also  may  be  sent  to  the 
College  of  Medicine,  Ohio  State  University,  which, 
moreover,  will  be  glad  to  furnish  additional  in- 
formation concerning  the  celebration  and  the  book 
upon  request. 

The  College  of  Medicine,  Ohio  State  University, 
according  to  official  records,  is  the  dii’ect  successor 
in  continuous  descent  of  five  earlier  medical 
schools. 

The  school  had  its  beginning  in  Willoughby 
Medical  College,  founded  on  March  3,  1834,  at 
Willoughby,  Ohio,  and  later  moved  to  Columbus 
where  it  continued  under  that  name  until  1848 
when  it  became  Starling  Medical  College.  In  1892, 
Starling  Medical  College  absorbed  the  Columbus 
Medical  College  which  had  been  founded  in  1875. 
In  1907  Starling  Medical  College  merged  with 
Ohio  Medical  University,  which  had  been  founded 
in  1892,  to  form  Starling-Ohio  Medical  College. 
The  college  was  operated  under  that  name  until 
1914  when  the  College  of  Medicine,  Ohio  State 
University,  was  founded.  At  that  time  all  the 
property  of  Starling-Ohio  Medical  College  was 
turned  over  to  the  state  for  the  new  medical  col- 
lege at  Ohio  State  University  and  the  staff  of  the 
Starling-Ohio  School  was  absorbed  by  the  new 
state  medical  college. 


Court  Decision  on  Injunction  Against 
Illegal  Practice 

Widespread  interest  has  been  aroused  over  the 
outcome  of  litigation  in  Huntington,  West  Vri- 
ginia  prosecuted  by  several  members  of  the  medi- 
cal profession  of  that  city  against  an  unlicensed 
limited  practitioner. 

After  criminal  prosecution  for  practicing  medi- 
cine without  a license  had  resulted  in  the  acquittal 
of  the  practitioner,  Dr.  R.  M.  Sloan  and  several  of 
his  colleagues  petitioned  in  the  county  circuit 
court  for  an  injunction  to  prevent  the  defending 
practitioner  from  continuing  his  illegal  activities. 
The  circuit  court  sustained  a demurrer  of  the  de- 
fendant practitioner  but  on  its  own  motion  certi- 
fied its  decision  to  the  Supreme  Court  of  Appeals 
of  the  state  for  review. 


November,  1933 


State  News 


727 


The  Supreme  Court  overruled  the  demurrer, 
thus  reversing  the  circuit  court,  and  enjoined  the 
unlicensed  practitioner  from  engaging  in  the 
practice  of  medicine  and  surgery  in  West 
Virginia. 

Aside  from  being  a unique  way  of  protecting 
the  public  against  the  activities  of  unqualified 
and  incompetent  practitioners,  the  West  Virginia 
case  is  significant  in  that  it  has  blazed  the  way 
for  militant  action  in  cases  where  courts  have 
failed  in  their  duty  to  convict  illegal  practitioners 
of  criminal  charges. 

Pertinent  comment  on  the  case  was  made  re- 
cently by  Dr.  William  C.  Woodward,  director  of 
the  Bureau  of  Legal  Medicine  and  Legislation  of 
the  American  Medical  Association,  as  follows: 

“Summing  up  the  effects  of  the  decision  of  the 
Supreme  Court  of  Appeals  of  West  Virginia  in 
this  case,  it  may  be  said  that  in  that  state  a li- 
censed physician  is  definitely  entitled  to  protec- 
tion against  competition  by  persons  engaged  un- 
lawfully in  the  practice  of  medicine.  To  afford 
such  protection,  a court  of  equity  may  issue  an  in- 
junction restraining  a competing  unlicensed  prac- 
titioner from  practicing.  The  facts  that  the  un- 
licensed practitioner  has  been  tried  on  a criminal 
charge  and  acquitted  and  that  he  is  liable  to  other 
criminal  prosecutions  if  he  continues  to  practice 
do  not  prevent  a court  of  equity  from  issuing  such 
injunction.  The  court  may  set  by  virtue  of  its 
inherent  authority  as  a court  of  equity,  and  in  the 
absence  of  express  statutory  authority.” 

As  Dr.  Woodward  points  out,  this  decision  is 
binding  only  in  West  Virginia  but  it  is  of  some 
persuasive  influence  in  courts  elsewhere. 

“If  physicians  can  establish  their  rights  to  in- 
junctions as  defensive  weapons  to  protect  them- 
selves against  unfair  and  illegal  competition,  they 
will  no  longer  be  helpless  against  the  possible 
sloth,  lack  of  interest,  political  manipulations  and 
venality  of  officers  and  agents  charged  with  the 
enforcement  of  the  medical  practice  acts,”  he 
declared. 

Emphasizing  the  value  of  injunctions  in  such 
cases,  Dr.  Woodward  said: 

“In  favor  of  the  use  of  injunctions  of  the  medi- 
cal profession  and  of  the  public  against  the  activi- 
ties of  unauthorized  practitioners  of  medicine,  it 
may  be  pointed  out  that  prevention  is  the  only 
safeguard  against  the  damage  that  such  practi- 
tioners may  do,  and  prevention  is  afforded  by  in- 
junctions only.  Fines  and  imprisonment  for 
offenses  committed  long  ago  do  not  afford  relief 
from  injuries  from  past  misconduct  nor  protect 
against  the  consequences  of  offenses  to  be  com- 
mitted in  the  future.” 

Those  of  the  profession  who  become  disgusted 
occasionally  over  the  failure  of  law  enforcement 
officers  to  do  their  duty  and  discouraged  over  the 
seeming  increase  in  the  number  of  quacks,  cultists 
and  racketeers,  may  take  courage  from  the  suc- 
cess of  the  West  Virginia  attack  on  the  problem. 


PUBUCHEAmi  NOTES 


At  the  recent  annual  meeting  of  the  Amer- 
ican Public  Health  Association  at  Indianapolis, 
two  Ohio  cities  were  honored  when  announcement 
was  made  of  awards  in  the  annual  health  con- 
servation contest  sponsoi’ed  by  the  U.  S.  Chamber 
of  Commerce  and  the  American  Public  Health 
Association.  Cincinnati  won  first  honors  for  hav- 
ing made  the  best  showing  in  improvement  of 
public  health  among  cities  of  population  between 

250.000  and  500,000.  Toledo  was  one  of  five 
cities  to  win  honorable  mention  in  the  same 
group.  Detroit  took  first  place  in  cities  of  over 

500.000  population ; Syracuse,  N.  Y.  and  New 
Haven,  Conn.,  tied  for  first  in  cities  between 

100.000  and  250,000.  The  group  of  cities  with  a 
population  between  50,000  and  100,000  was 
headed  by  East  Orange,  N.  J.;  the  20,000  to 

50.000  group  by  Brookline,  Mass.,  and  the  group 
of  cities  of  less  than  20,000  population  by  Lodi, 
California.  About  300  cities  took  part  in  the  con- 
test. 

— Dr.  M.  C.  Hanson,  health  commissioner  of 
Mansfield  and  Richland  County,  has  gone  to  New 
Haven,  Conn.,  where  he  will  take  a year’s  post- 
graduate course  in  public  health  at  Yale  Uni- 
versity on  a scholarship  awarded  by  the  Rocke- 
feller Foundation.  Dr.  John  H.  Hayes,  formerly 
connected  with  the  State  Department  of  Health, 
has  been  appointed  acting  health  commissioner  to 
serve  until  Dr.  Hanson’s  return. 

— Dr.  F.  S.  Wright  has  been  reappointed  a 
member  of  the  board  of  health  of  Martins  Ferry 
for  a five-year  term. 


— The  Bureau  of  Occupational  Diseases,  succes- 
sor in  the  State  Department  of  Health  to  the 
former  Division  of  Industrial  Hygiene,  reports 
that  in  1932,  1169  reports  of  occupational  dis- 
eases were  passed  upon,  of  which  1069  were  com- 
pensable, 90  were  non-compensable  and  10  were 
acute  mishaps  to  be  classified  as  accidents.  The 
aggregate  figure  compares  with  gross  totals  of 
1189  in  1928,  1412  in  1929,  1334  in  1930  and 
1309  in  1931.  Non-compensable  diseases  for  the 
respective  years  were  48,  68,  59  and  77,  acute 
mishaps  not  computed. 

There  are  22  diseases  in  Ohio’s  compensable 
list,  a copy  of  which  may  be  obtained  by  any 
one  interested  on  request  to  the  Bureau.  Ex- 
perience shows  that  dermatitis  accounts  for  more 
than  70  per  cent  of  the  total  cases. 


Governor  White  has  appointed  as  members  of 
the  Ohio  Commission  for  the  Blind,  Dr.  A.  D. 
Frost,  Columbus,  who  will  serve  until  1935,  and 
Dr.  R.  C.  Wise,  Mansfield,  who  will  serve  until 
1936. 


I 


iVEWS  NOTESs^OHIO 


Columbus — Dr.  0.  H.  Sellenings  has  retired 
after  28  years  of  active  practice  in  Columbus. 

Stonecreek — Dr.  0.  C.  Crawford  has  opened 
offices  here.  Until  recently  he  was  for  many 
years  on  the  medical  staff  of  the  Baltimore  and 
Ohio  Railroad. 

Columbus — Dr.  and  Mrs.  John  Edwin  Brown 
have  returned  from  Boston  where  they  visited 
their  son,  Dr.  John  Edwin  Brown,  Jr.,  resident 
physician  at  the  Boston  Children’s  Hospital.  Dr. 
Brown  attended  the  annual  meeting  of  the  Amer- 
ican Academy  of  Ophthalmology  of  which  he  is 
a past  president. 

Cincinnati — A plea  for  physicians  to  be  alert 
and  to  hold  firm  to  their  stand  against  the  so- 
cialization of  medicine  was  made  by  Dr.  Ralph 
G.  Carothers,  president  of  the  Association  of  Sur- 
geons of  the  Pennsylvania  Railroad  in  an  address 
before  the  recent  annual  convention  of  the  oi'gani- 
zation  here. 

Findlay — Dr.  R.  S.  Rilling,  who  recently  com- 
pleted a year’s  work  in  surgery  at  Lakeside  Hos- 
pital, Cleveland,  has  opened  offices  here. 

Richwood — Offices  have  been  opened  here  by 
Dr.  J.  M.  Gettrost,  formerly  of  Columbus. 

Cleveland — Announcement  has  been  made  of 
the  marriage  of  Miss  Mary  Schaefer,  a student 
at  the  St.  John’s  Hospital  School  of  Nursing,  and 
Dr.  N.  S.  Greene,  a member  of  the  staff  at  the 
Warrensville  Tuberculosis  Sanatarium. 

Middletown — Dr.  R.  A.  Hill  and  Dr.  E.  T. 
Storer  have  returned  from  Chicago  where  they 
took  post-graduate  work  at  the  Cook  County 
Hospital. 

Painesville — Dr.  John  D.  Marsh,  first  lieuten- 
ant in  the  medical  reserve  corps,  has  been  as- 
signed to  six  months’  service  at  the  Conservation 
Camp  at  Camp  Knox,  Ky. 

Columbus — Dr.  F.  W.  Harrah  addressed  the 
North  Carolina  Urological  Society  at  Raleigh, 
N.  C.,  on  October  9,  on  “Primary  Carcinoma  of 
the  Ureter — Illustrated  Report  of  Two  Cases”. 

Springfield — Dr.  G.  C.  Ullery  has  returned 
from  a hunting  trip  through  Alaska. 

Marion — The  importance  of  periodic  health  ex- 
aminations was  discussed  by  Dr.  John  A.  Dodd  in 
an  address  before  the  Marion  Rotary  Club. 

Mt.  Vernon — Dr.  Harry  Butler,  formerly  con- 
nected with  the  faculty,  University  of  Cincin- 
nati, College  of  Medicine,  has  moved  here  and 
opened  offices  for  general  practice. 


Alliance — Offices  have  been  opened  here  by  Dr. 
J.  R.  Caldwell,  formerly  of  Follansbee,  West 
Virginia. 

Zanesville — Dr.  W.  L.  Cruise  has  been  ap- 
pointed chief  surgeon  of  the  Zanesville  district 
of  the  New  York  Central  Railroad,  succeeding 
the  late  Dr.  C.  U.  Hanna. 

Wellston — Dr.  M.  D Smith,  formerly  of  Co- 
lumbus, has  opened  offices  here. 

Wilmington — Dr.  W.  L.  Regan  has  resumed 
active  practice  here  after  serving  on  the  medical 
corps  of  a Conservation  Camp  in  California. 

Lima — The  Fifth  Annual  Series  of  Post- 
Graduate  Lectures,  sponsored  by  the  Academy  of 
Medicine  of  Lima  and  Allen  County  was  given 
recently  by  Dr.  Lewellys  F.  Barker,  professor  of 
medicine,  Johns  Hopkins  University. 

Leesburg — Dr.  M.  A.  Roth,  until  recently  a 
member  of  the  medical  staff  at  the  Dayton  State 
Hospital,  has  opened  offices  for  general  prac- 
tice here. 

Kenton — Offices  have  been  opened  here  by  Dr. 
Robert  I.  McPhail,  formerly  of  Leetonia. 

Alliance - — A discussion  of  surgical  treatment 
of  tuberculosis  was  given  by  Dr.  B.  C.  Barnard 
at  a recent  meeting  of  the  local  Kiwanis  Club. 

Zanesville — Dr.  R.  B.  Bainter,  who  recently  re- 
turned from  a trip  abroad,  addressed  the  local 
Kiwanis  Club  relative  to  conditions  there,  es- 
pecially in  Russia. 

Toledo — Dr.  J.  M.  McWilliam  has  returned 
from  Boston  Lying-In  Hospital  where  he  took 
post-graduate  work. 

Millersburg — Dr.  L.  E.  Anderson,  former  Mt. 
Hope  physician,  has  moved  to  Greenville  where 
he  has  opened  offices  for  general  practice. 

Ottawa — The  local  Kiwanis  Club  was  addressed 
recently  by  Dr.  F.  G.  Maurer,  Lima,  and  C.  L. 
Recker,  Ottawa  attorney. 

Bainbridge — Dr.  Theodore  Cutright,  who  re- 
cently completed  his  internship  at  University 
Hospital,  Columbus,  has  located  here. 

Barberton — Offices  for  general  practice  have 
been  opened  here  by  Dr.  Frank  M.  Warner,  who 
recently  completed  his  internship  at  Akron 
Peoples’  Hospital  and  post-graduate  work 

abroad. 

New  Bremen — Announcement  has  been  made  of 
the  marriage  of  Miss  Helen  Vornholt,  New 


November,  1933 


State  News 


729 


Why  some  builders  always 

SUCCEED 

while  others  always  fail 


Not  because  they  are  more  experienced — not  because  they 
are  more  brilliant — not  because  they  get  the  easy  jobs — 
not  because  they  are  more  influential — not  because  cir- 
cumstances favor  them  ...  No,  but  because  they  in- 
variably insist  on  definite  and  complete  specifications  to 
guide  them  in  every  detail  of  construction  and  installa- 
tion. The  public  expects  the  same  definite  and  complete 
prescription  from  physicians.  When  the  indications  call 
for  Wagner’s  Vichy,  leave  no  doubt  in  your  patient’s 
mind,  write  “Wagner’s  Vichy.”  The  specified  prescrip- 
tion in  acidosis  conditions  for  three  generations. 


WAGNER 

MEDICINAL  LABORATORIES 


The  W.  T.  Wagner’s  Sons  Co. 

In  Cincinnati  since  1868 


WAGNER? 

VICHY 

(artificial) 

for  alkalization 


* 


% 

WACKY 

(ARTIFICIAL) 

© 

WCNTiriCAur  PREPARED  FROM  OlSTIUtD  «"»  J 
ARO  PURC  CHEMICALS 

SrW.T.WAGNER'S  SONS  CO 

CINCINNATI,  OHIO  I 

{ l mi 

730 


The  Ohio  State  Medical  Journal 


November,  1933 


Bremen,  and  Dr.  Roger  Tecklinburg,  at  present 
an  intern  at  Lima  Memorial  Hospital. 

Cincinnati — Dr.  Joseph  L.  DeCourcy  has  re- 
turned from  a European  trip.  While  in  Switzer- 
land Dr.  DeCourcy  addressed  the  International 
Association  for  the  Study  of  Goiter  in  session  at 
Berne. 

Youngstown — Dr.  H.  E.  Blott  recently  cele- 
brated the  45th  anniversary  of  his  entrance  into 
active  practice. 

Bamesville — The  local  Rotary  Club  was  ad- 
di'essed  recently  by  Dr.  R.  H.  Wilson,  Martins 
Ferry,  on  his  recent  trip  through  Russia. 

Toledo — Dr.  P.  Bruce  Brockway  has  been 
elected  international  director  and  director  of  the 
executive  committee  of  the  Knights  of  the  Round 
Table. 


Xenia — The  members  of  the  institutional  staff 
of  the  Ohio  Soldiers’  and  Sailors’  Orphans’  Home 
gave  a welfare  party  recently  for  Dr.  and  Mrs. 
A.  C.  Messenger.  Dr.  Messenger  resigned  as 
medical  director  of  the  home  recently  after  many 
years  of  service  as  a member  of  the  medical  staff 
and  five  years  as  its  chief.  He  has  been  suc- 
ceeded by  Dr.  Thomas  F.  Humphrey,  until  re- 
cently connected  with  the  Department  of  Pedi- 
atrics, University  of  Cincinnati,  College  of 
Medicine. 

Troy — Dr.  Kenneth  F.  Lowry,  formerly  of 
Brooklyn,  N.  Y.,  has  located  here  and  has  be- 
come an  associate  of  Dr.  Warren  B.  Coleman. 

Mechanicsburg — Dr.  John  Hathaway,  formerly 
an  interne  at  Grant  Hospital,  Columbus,  has 
opened  offices  here. 


Columbus — Dr.  Sterling  B.  Taylor,  chief  sur- 
geon for  the  New  York  Central  Railroad,  has  been 
elected  president  of  the  American  Association  of 
Railway  Surgeons. 

London — Offices  have  been  opened  here  by  Dr. 
William  M.  McShane,  formerly  of  Cincinnati. 

Circleville — An  interesting  talk  on  medical  and 
health  subjects  was  made  recently  before  the  local 
Rotary  Club  by  Dr.  W.  P.  Smith,  Columbus. 

Xenia — An  accident  prevention  campaign  is 
being  waged  in  Xenia  by  cooperating  agencies, 
led  by  the  Greene  County  Medical  Society  work- 
ing through  a committee  composed  of  Dr.  Paul 
D.  Espey,  Dr.  R.  R.  McClellan  and  Dr.  Marshall 
Best. 

Attica — Dr.  Avery  D.  Powell,  formerly  of  North 
Baltimore,  has  located  here  and  will  engage  in 
general  practice. 

Cleveland — Word  has  been  received  here  of  the 
election  of  Dr.  Victor  F.  Woldman,  Cleveland,  as 
secretary  of  the  American  Medical  Association  of 
Vienna. 

Columbus — Dr.  Claude  S.  Perry  has  been  com- 
missioned as  captain  in  the  Medical  Reserve  Corps 
and  assigned  to  the  39th  Surgical  Hospital  Corps. 

Middleport — Dr.  C.  A.  Poindexter  is  conva- 
lescing from  serious  injuries  received  in  an  auto- 
mobile accident. 

Wooster — Dr.  J.  J.  Kinney  presented  an  inter- 
esting address  on  medical  and  health  subjects  at 
a recent  meeting  of  the  Wooster  Kiwanis  Club. 

Dayton — Dr.  Vernon  L.  Hart,  for  the  past  year 
connected  with  the  Dayton  Clinic,  has  left  for 
Minneapolis  where  he  will  join  the  teaching  staff 
of  the  University  of  Minnesota,  College  of 
Medicine. 

Lisbon — Dr.  J.  N.  Calhoun  was  the  honored 
guest  at  a surprise  party  at  his  home  in  com- 
memoration of  his  birthday.  He  has  been  in 
active  practice  here  since  1885. 


HOSPITAL  NOTES 


— Dr.  E.  R.  Brush  has  been  elected  chief  of  the 
staff  at  Bethesda  Hospital,  Zanesville,  succeeding 
the  late  Dr.  C.  U.  Hanna.  Other  officers  of  the 
staff  are:  Vice  president,  Dr.  G.  B.  Trout,  and 
secretary,  Dr.  L.  E.  Grimes. 

— Women’s  and  Children’s  Hospital,  Toledo,  re- 
cently celebrated  its  50th  anniversary  with  a 
dinner  at  which  Dr.  T.  Wingate  Todd,  Cleveland, 
was  the  principal  speaker.  The  celebration  also 
marked  the  25th  anniversary  of  Dr.  Walter  W. 
Brand  as  chief  of  staff  of  the  institution. 

— The  newly  completed  tuberculosis  sanatorium 
of  Cleveland  City  Hospital  was  christened  the 
John  H.  Lowman  Memorial  Pavilion  at  recent 
dedicatory  ceremonies  as  a tribute  to  Dr.  John  H. 
Lowman,  founder  of  the  Anti-Tuberculosis  League 
of  Cleveland  and  an  international  pioneer  in 
tuberculosis  work. 

— The  Hale  Hospital,  Wilmington,  was  be- 
queathed a trust  fund  of  $2,000  under  the  terms 
of  the  will  of  the  late  Mrs.  Dora  F.  West. 

— Under  the  terms  of  the  will  of  the  late  Eliza- 
beth F.  Schmidt,  Columbus,  Mt.  Carmel  Hospital 
was  bequeathed  $4,000 ; Children’s  Hospital, 
$1,000  and  the  Franklin  County  Tuberculosis  Hos- 
pital, $1,000. 

— Five  new  internes  have  begun  service  at  St. 
Mary  Hospital,  Cincinnati.  They  are:  F.  C. 

Haberman,  J.  H.  Jansen,  Jr.,  F.  P.  Swing,  K.  T. 
Johnston  and  A.  J.  Huesman.  Those  completing 
internships  will  practice  as  follows:  Glenn  S. 

Lampkin,  at  Winchester;  James  G.  Inman,  at 
Manchester;  Louis  N.  Podesta  and  William  Mc- 
Shane, at  Cincinnati,  and  Marshall  Dunham, 
Oshkosh,  Wisconsin. 

— Mansfield  General  Hospital  will  receive  $10,- 


November,  1933 


State  News 


731 


Edward  Reinert 

Ph.G.,  M.D. 

247  East  State  Street  Columbus,  Ohio 

Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 

FRANK  GALLEN,  M.D.,  LEE  A.  HAYS,  M.D., 

Dermatology  Roentgenology 

Tel.  Main  1537  University  5842 


W.  H.  MILLER,  M.  D. 

328  East  State  St.  Columbus,  Ohio 

Office  Telephone,  MAin  3743  Residence,  EVergreen  5644 

Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

Prompt  and  Full  Report 


732 


The  Ohio  State  Medical  Journal 


November,  1933 


THE  MERCER  SANITARIUM  - MERCER,  PENNA. 

For  Nervous  and  Mild  Mental  Disorders.  Located  at  Mercer,  Pa.,  30  miles  from  Youngs- 
town. Farm  of  75  acres  with  registered  tuberculin-tested  herd.  Re-educational  measures 
emphasized,  especially  arts  and  crafts  and  outdoor  pursuits.  Modern  laboratory  facilities. 
Address 

W.  W.  Richardson,  M.D.,  Medical  Director 

(Formerly  Chief  Physician,  State  Hospital  for  Insane,  Norristown,  Pa.) 


000  under  the  terms  of  the  will  of  the  late  Charles 
A.  Ritter. 

— The  following  resident  physician  and  interns 
have  been  appointed  at  several  Toledo  hospitals: 
St.  Vincents,  Patrick  McCarthy,  Toledo,  and  T.  J. 
Reichenbach,  Sandusky,  resident  physicians; 
Mercy  Hospital,  Thomas  A.  Owens,  University  of 
Michigan,  resident  physician,  and  A.  Wooster, 
University  of  Michigan,  and  I.  P.  Campbell,  Uni- 
versity of  Toronto,  internes;  Flower  Hospital,  C. 
R.  Markwood,  resident  physician;  Women’s  and 
Children’s  Hospital,  Umbert  Melaragno  and 
Donald  Shaffer,  resident  physicians.  East  Side 
Hospital,  A.  W.  Hemphill,  resident  physician. 

— Twelve  physicians  have  been  appointed  in- 
ternes at  Akron  City  Hospital  as  follows:  J.  H. 

Bond,  Arthur  Dobkin,  Ralph  E.  Wetzel,  Marshall 
Werner,  Theodore  Krutky,  Harry  S.  Berlesky, 
Wayne  W.  Houser,  Merle  J.  Brown,  Luvern  C. 
Garling,  Stanley  C.  Stroff,  Edwin  R.  Watson, 
Mack  E.  Moore  and  Lyman  H.  Heine. 

—The  following  resident  physicians  and  in- 
ternes have  been  appointed  at  People’s  Hospital, 
Akron:  J.  S.  Newton,  chief  resident;  E.  Green- 
ston  and  R.  L.  Findley,  assistant  residents;  S.  H. 
Mirmelstein  and  George  Glowacki,  interns. 

— Dr.  A.  S.  Robinson  has  been  elected  chief  of 
staff  of  Akron  City  Hospital,  succeeding  Dr.  H. 
B.  Conn.  Dr.  Robinson  has  appointed  the  follow- 
ing committees:  Executive,  Dr.  Robinson,  chair- 
man, Dr.  E.  A.  Freeman,  Dr.  L.  R.  C.  Eberhard 
and  Dr.  D.  B.  Lowe;  program,  Dr.  J.  G.  Lemmon, 
Dr.  C.  C.  Pinkerton,  and  Dr.  Roy  Barnwell;  in- 
terne teaching,  Dr.  E.  L.  Saylor. 

— Six  new  internes  have  been  appointed  as  fol- 
lows at  the  Springfield  City  Hospital:  Wilbur  D. 
Dice,  David  M.  Earl,  Ford  E.  Eddy,  Thomas  S. 
Gerspacher,  Donald  F.  Kyle,  and  Rudolph  A. 
Styblo. 

— New  intex'nes  appointed  at  St.  Thomas  Hos- 
pital, Akron,  are  Max  Cluff,  N.  Tsaloff  and  Louis 
Adelman. 

— The  following  advisory  board  has  been  se- 
lected in  organization  of  the  staff  at  Good  Samar- 
itan Hospital,  Dayton:  Dr.  B.  W.  Beatty,  chair- 
man, Drs.  R.  C.  Austin,  Sterling  Ashmun,  B.  W. 
Beatty,  C.  A.  Coleman,  H.  D.  Cassell,  Daman  A. 
Crist,  F.  J.  Driscoll,  J.  D.  Fouts,  C.  P.  Grover, 
J.  K.  Hoerner,  M.  R.  Haley,  N.  C.  Hochwalt, 
H.  H.  Hatcher,  J.  A.  Judy,  A.  F.  Kuhl,  E.  J. 
Price,  F.  C.  Payne,  M.  D.  Prugh,  C.  H.  Tate  and 
Clifford  R.  Weis. 


— Dr.  Jacob  A.  Stout  has  been  elected  chief  of 
staff  at  St.  Anthony’s  Hospital,  Columbus.  Dr. 
Huston  Fulton  was  elected  secretary-treasurer. 

— The  board  of  county  commissioners  of  Guern- 
sey County  has  made  application  for  Federal 
funds  to  be  used  in  the  erection  of  a county  hos- 
pital. 

- — Internes  recently  appointed  at  Miami  Valley 
Hospital,  Dayton,  are:  Frank  W.  Prather,  Rus- 

sell E.  Huber,  Burtos  G.  Must,  William  L.  Wead, 
George  W.  Slagle,  Charles  Mumma,  Paul  Lenhart, 


Medical  Exams,  Dec.  6-7-8 

At  a regular  meeting  of  the  State  Medical 
Board  in  Columbus,  October  3,  the  dates  for  the 
mid-winter  examinations  given  by  the  board  were 
set  as  December  6,  7,  and  8. 

Miss  Ruth  Clotz,  superintendent  of  the  Nurse 
Training  School,  Grant  Hospital,  was  appointed 
by  the  board  as  a member  of  the  Nurse  Examin- 
ing Committee,  succeeding  Miss  Caroline  McKee, 
resigned. 

Following  hearings,  the  board  revoked  the  cer- 
tificate of  P.  W.  Welsh,  Cleveland,  hydro-thera- 
pist, for  illegal  practice  of  medicine;  revoked  the 
certificate  of  Leon  J.  Delson,  Cincinnati,  chiropo- 
dist, for  grossly  improper  and  dishonest  conduct 
and  for  violations  of  the  rules  and  regulations  of 
the  board,  and  suspended  the  certificate  of  Dr. 
Johanna  A.  C.  Roth,  Columbus,  recently  convicted 
for  violation  of  the  Federal  narcotic  law. 


Cincinnati — Charles  F.  Williams  has  con- 
tributed a fund  of  $1,500  to  the  College  of  Medi- 
cine, University  of  Cincinnati,  for  a fellowship 
in  cancer  research. 


CLASSIFIED  ADVERTISEMENTS 

Rates  for  advertisements  under  this  heading  are  50  cents 
per  line,  payable  in  advance.  Minimum  charge  of  $1.00 
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publication. 


Assistance  to  Medical  Writers — Abstracts,  Translations, 
Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  Place,  Chicago, 
Illinois. 


For  Sale,  cheap — Established  practice,  Northwestern  Ohio ; 
agricultural  region.  Leaving  because  of  other  interest. 
Money  from  the  start.  M.W.L.,  care  Ohio  State  Medical 
Journal . 

For  Sale  or  Rent — Office  of  Dr.  W.  D.  Moccabee,  deceased. 
Equipment  includes  instruments,  library,  electrical  equip- 
ment, and  a goodly  supply  of  drugs.  Office  is  centrally  lo- 
cated in  the  business  district  of  Cardington,  Ohio.  Call  or 
write  Mrs.  Martha  Moccabee,  Cardington,  Ohio. 


December,  1933 


Advertisements 


737 


THE  SAWYER  SANATORIUM 


WHITE  OAKS  FARM,  MARION,  OHIO 


Treats  Nervous 
and  Mental 
Diseases 

• 

Home  atmosphere  combines 
with  modern  hospital  facilities 
at  the  Sawyer  Sanatorium. 

We  wish  you  all  a Merry  Christ- 
mas and  a prosperous,  happy 
1934. 

SAWYER  SANATORIUM 

WHITE  OAKS  FARM  MARION,  O. 


The  Ohio  State  Medical  Association 


Ohio  State  Medical  Journal 

Entered  as  second  class  matter  July  5,  1905,  at  the 
Postoffice  at  Columbus,  Ohio,  under  act  of  Con- 
gress of  March  3,  1879 : Acceptance  for  mailing 
at  special  rate  of  postage  provided  for  in  Section 
1103,  Act  of  Oct.  3,  1917.  Authorized  July  10,  1918. 

Published  monthly  by 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 
131  East  State  Street,  Columbus,  Ohio 
Telephone:  ADams  7045 


This  journal  is  published  for  and  by  the  members 
of  the  Ohio  State  Medical  Association.  The  Publica- 
tion Committee  does  not  assume  responsibility  for 
opinions  expressed  by  individual  essayists.  It  en- 
deavors to  maintain  a high  standard  of  advertising. 
Its  advertising  policy  is  governed  by  the  rules  of  the 
Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 


Subscription  $3.00  per  year ; single  copies  30  cents. 
Issued  under  the  direction  of  the  Publication 
Committee. 


PUBLICATION  COMMITTEE 

Andrews  Rogers,  M.D.,  Chairman  (1934) Columbus 

A.  B.  Denison,  M\D.  (1936) — — . — _ — _ — . — Cleveland 
Gilbert  Mieklethwaite,  M.D.  (1936) Portsmouth 

EXECUTIVE  STAFF 

Don  K.  Martin Editor-Manager 

Alice  B.  Haney Advertising  Manager  g 


Officers  1933-1934 


PRESIDENT 

C.  L.  Cummer,  M.D Cleveland 


PRESIDENT-ELECT 
John  A.  Caldwell,  M.D. 

TREASURER 
James  A.  Beer,  M.D.  _ 

Columbus 

EXECUTIVE  SECRETARY 
Don  K.  Martin  .. Columbus 


ASS’T  EXECUTIVE  SECRETARY 
Charles  S.  Nelson Columbus 


State  Council 

First 

District 

Park 

G.  Smith,  M.D 

Cincinnati 

Second 

District 

E. 

M. 

Huston,  M.D. 



Dayton 

Third 

District 

O. 

P. 

Klotz,  M.D _ 

Fourth 

District 

B. 

J. 

Hein,  M.D. 

Fifth  : 

District 

H. 

V. 

Paryzek,  M.D.  

Sixth 

District 

H. 

s. 

Davidson,  M.D.  

Seventh 

District 

E. 

B. 

Shanley,  M.D. 

— New 

Philadelphia 

Eighth 

District 

E. 

R. 

Brush,  M.D 



Zanesville 

Ninth 

District 

I. 

P. 

Seiler,  M.D ... 

Piketon 

Tenth  District 

S.  J.  Goodman,  M.D Columbus 

Ex-Officio,  The  Ex-President 
H.  M.  Platter,  M.D Columbus 


738 


The  Ohio  State  Medical  Journal 


December,  1933 


OFFICERS  OF  DISTRICT  AND  COUNTY  SOCIETIES 

Secretary 


Societies  President 

First  District 

Adams Samuel  Clark,  Cherry  Fork- 

Brown. 


.0.  T.  Sproull,  West  Union 3d  Wednesday  in  April,  June,  Aug., 

Oct. 

E.  B.  Hannah,  Georgetown Geo.  P.  Tyler,  Jr..  Ripley 4th  Wednesday  in  Feb.,  May  and 

Nov. 

Butler H.  O.  Lund,  Middletown.. Walter  Roehll,  Middletown 2d  Wednesday,  monthly. 

Clermont J.  K.  Ashburn,  Batavia Allan  B.  Rapp,  Owensville 3d  Wednesday,  monthly. 

Clinton  F.  A.  Peele,  Wilmington  . Wm.  L.  Regan,  Wilmington 1st  Tuesday,  monthly. 

Fayette S.  E.  Boggs,  Washington  C.  H J.  F.  Wilson,  Washington  C.H 1st  Thursday,  monthly. 

Hamilton Samuel  Iglauer,  Cincinnati JH.  F.  Downing,  Cincinnati Monday  evening  of  each  week. 

Highland C.  C.  Cropper,  Lynchburg W.  B.  Roads,  Hillsboro 1st  Wednesday,  monthly. 

Warren J.  E.  Witham,  Waynesville James  Arnold,  Lebanon 1st  Tues.  Apr.,  May,  June, 

Sept.,  Oct.,  and  Nov. 

Second  District Cyril  Hussey,  Sidney H.  R.  Huston,  Dayton 

Champaign N.  M.  Rhodes,  Urbana _L.  A.  Woodburn,  Urbana 2d  Thursday,  monthly. 

Clark C.  W.  Evans,  Springfield Roger  Marquart,  Springfield 2d  and  4th  Wednesday  noon. 

Darke W.  T.  Fitzgerald,  Greenville .W.  D.  Bishop,  Greenville 2nd  Friday,  monthly. 

Greene L.  L.  Taylor,  Yellow  Springs JH.  C.  Schick,  Xenia 1st  Thursday,  monthly. 

Miami _F.  D.  Kiser,  Tippecanoe  City G.  A.  Woodhouse,  Pleasant  Hill 1st  Friday,  monthly,  except  July 

and  August. 

Montgomery C.  D.  Smith,  Dayton  ... JMiss  M.  E.  Jeffrey,  Dayton 1st  and  3d  Friday  each  month. 

Preble C.  M.  Treffinger,  Eaton C.  J.  Brian,  Eaton 

Shelby R.  E.  Paul,  Botkins A.  B.  Lippert,  Sidney 


3d  Thursday,  monthly. 

1st  Friday,  monthly. 


Third  District C.  E.  Hufford,  Toledo J.  H.  Marshall,  Findlay 

Allen  Burt  Hibbard,  Lima L.  C.  Thomas,  Lima 3d  Tuesday,  monthly. 

Auglaize E.  F.  Heffner,  Wapakoneta C.  C.  Berlin,  Wapakoneta 2nd  Thursday,  bi-monthly. 

Hancock A.  E.  King,  Mt.  Cory — H.  O.  Crosby,  Findlay 1st  Thursday,  monthly. 

Hardin F.  M.  Elliott,  Ada JW.  N.  Mundy,  Forest 17th  of  each  month. 

Logan O.  C.  Amstutz,  Bellefontaine W.  H.  Carey,  Bellefontaine 1st  Friday,  monthly. 

Marion E.  L.  Brady,  Marion J.  W.  Jolley,  Marion 1st  Tuesday,  monthly. 

Mercer M.  B.  Fishbaugh,  Celina F.  E.  Ayers,  Celina 2d  Thursday,  monthly. 

Seneca Paul  Leahy,  Tiffin R.  E.  Hershberger,  Tiffin 3rd  Thursday,  monthly. 

Van  Wert A.  T.  Rank,  Van  Wert R.  H.  Good,  Van  Wert 1st  Tuesday,  monthly. 

Wyandot B.  A.  Moloney,  Upper  Sandusky W.  L.  Naus,  Upper  Sandusky 1st  Thursday,  monthly. 


Fourth  District (With  Third  District  in  Northwestern  Ohio  District) 

Defiance __S.  E.  DeMuth,  Hicksville J).  J.  Slosser,  Defiance 3d  Thursday,  monthly,  except 

July,  August,  December. 

Fulton P.  S.  Bishop,  Delta Geo.  McGuffin,  Pettisville 2nd  Thursday,  monthly. 

Henry T.  P.  Delventhal,  Napoleon F.  M.  Harrison,  Napoleon 1st  Wednesday,  monthly. 

Lucas — L.  R.  Effler,  Toledo A.  P.  Hancuff,  Toledo Friday,  each  week. 

Ottawa..... R.  A.  Willett,  Elmore Cyrus  R.  Wood,  Port  Clinton 2d  Thursday,  monthly. 

Paulding C.  E.  Houston,  Paulding Gaile  L.  Doster,  Paulding 3d  Wednesday,  monthly. 

Putnam E.  Blackburn,  Kalida _W.  B.  Light,  Ottawa 1 1st  Tuesday,  monthly. 

Sandusky D.  W.  Philo,  Fremont J.  C.  Boyce,  Fremont Last  Thursday,  monthly. 

Williams ...B.  C.  Bly,  Bryan JH.  R.  Mayberry,  Bryan 3d  Thursday,  monthly. 

Wood F.  L.  Sterling,  Bowling  Green R.  N.  Whitehead,  Bowling  Green 3d  Thursday,  monthly. 


Fifth  District JH.  V.  Paryzek,  Councilor 

Ashtabula J.  F.  Docherty,  Conneaut 

Cuyahoga H.  V.  Paryzek,  Cleveland 

Erie J.  C.  Kramer,  Sandusky 

Geauga H.  E.  Shafer,  Middlefield 

Huron W.  W.  Lawrence,  Norwalk 

Lake G.  O.  Hedlund,  Painesville 

Lorain Herman  Campbell,  Elyria 

Medina Harry  Streett,  Litchfield 

Trumbull: E.  P.  Adams,  Warren 


—  Chrm.  Com.  on  Arrangements .Cleveland. 

—A.  M.  Mills,  Ashtabula 2nd  Tuesday,  monthly. 

—  Clarence  H.  Heyman,  Cleveland 3d  Fri.  Feb.,  March,  May,  Sept., 

Nov.,  Dec. 

— G.  A.  Stimson,  Sandusky Last  Wednesday,  monthly,  except 

July,  Aug.,  Sept. 

—  Isa  Teed-Cramton,  Burton Last  Wednesday,  Apr.  to  Oct. 

Geo.  F.  Linn,  Norwalk  ... .3d  Tuesday,  February,  May, 

August,  Nov. 

JB.  T.  Church,  Painesville 4th  Tuesday,  monthly. 

W.  E.  Hart,  Elyria 2d  Tuesday,  monthly. 

J.  K.  Durling,  Wadsworth 1st  Thursday,  monthly. 

Jt.  H.  McCaughtry,  Warren 3d  Thursday,  monthly,  except 

June,  July,  August. 


December,  1933 


The  Ohio  State  Medical  Journal 


739 


Societies  President 


Secretary 


Sixth  District _A.  E.  Brant,  Youngstown J.  H.  Seiler,  Akron 2d  Wed.,  Jan.,  April  and  Oct. 

Ashland H.  M.  Gunn,  Ashland Paul  E.  Kellogg,  Ashland .2nd  Friday,  Sept,  to  May. 

Holmes Clyde  Bahler,  Walnut  Creek C.  T.  Bahler,  Walnut  Creek 1st  Tuesday,  quarterly,  Jan.,  April, 

July,  October. 

Mahoning J.  P.  Harvey,  Youngstown W.  M.  Skipp,  Youngstown 3d  Tuesday,  monthly. 

Portage S.  U.  Sivon,  Ravenna E.  J.  Widdecombe,  Kent 1st  Thursday,  monthly. 

Richland C.  H.  Bell,  Mansfield  ._ Mabel  Emery,  Mansfield Last  Thursday,  monthly. 

Stark H.  Welland,  Canton F.  S.  VanDyke,  Canton 2d  Tuesday,  monthly. 

Summit J.  H.  Selby,  Akron A.  S.  McCormick,  Akron 1st  Tuesday,  monthly. 

Wayne W.  A.  Morton,  Wooster R.  C.  Paul,  Wooster 2d  Tuesday,  monthly. 


Seventh  District.™ 


Belmont G.  L.  Ramsey,  Powhatan  Point C.  W.  Kirkland,  Bellaire -1st  Thurs.,  monthly,  4 p.  m., 

except  July  and  August. 

Carroll (With  Stark  Co.  Society) 

Columbiana J.  W.  Robinson,  Lisbon John  Fraser,  East  Liverpool .2d  Tuesday,  monthly. 

Coshocton Floyd  Craig,  Coshocton J.  D.  Lower,  Coshocton . East  Thursday,  monthly. 

Harrison A.  C.  Grove,  Jewett W.  C.  Wallace,  Hopedale 3d  Wednesday,  monthly. 

Jefferson S.  A.  Harris,  Steubenville John  Y.  Bevan,  Steubenville East  Thursday,  monthly. 

Monroe G.  W.  Steward,  Woodsfield A.  R.  Burkhart,  Woodsfield 2d  Wednesday,  monthly. 

Tuscarawas F.  B.  Larimore,  New  Phila G.  L.  Sackett,  New  Phila 2d  Thursday,  monthly. 


Eighth  District 


Athens C.  E.  Welch,  Nelsonville.™ T.  A.  Copeland,  Athens 1st  Monday,  monthly. 

Fairfield JE.  B.  Roller,  Lithopolis __.C.  W.  Brown,  Lancaster 2d  Tuesday,  monthly. 

Guernsey C.  C.  Headley,  Cambridge JE.  F.  Hunter,  Cambridge 1st  and  3rd  Thursday  each  month. 

Licking Geo.  W.  Sapp,  Newark G.  A.  Gressle,  Newark Last  Friday,  monthly. 

Morgan D.  G.  Ralston,  McConnelsville C.  E.  Northrup,  McConnelsville 3d  Wednesday,  monthly. 

Muskingum C.  M.  Rambo,  Zanesville Beatrice  T.  Hagen,  Zanesville 1st  Wednesday,  monthly. 

Noble 

Perry James  Miller,  Corning E.  J.  Crosbie,  New  Lexington 3d  Monday,  monthly. 

Washington W.  W.  Sauer,  Marietta G.  M.  James,  Marietta 2d  Wednesday,  monthly. 


Ninth  District 

Gallia O.  A.  Vornholt,  Gallipolis -Milo  Wilson,  Gallipolis 

Hocking H.  M.  Boocks,  Logan M.  H.  Cherrington,  Logan..... 

Jackson J.  S.  Hunter,  Jackson J.  J.  McClung,  Jackson 

Lawrence Cosper  Burton,  Ironton Anne  D.  Marting,  Ironton 

Meigs C.  A.  Poindexter,  Middleport H.  M.  Crumley,  Pomeroy 

Pike E.  E.  Wills,  Waver ly _R.  T.  Leever,  Waverly 

Scioto T.  G.  McCormick,  Portsmouth Wm.  E.  Scaggs,  Portsmouth  .. 

Vinton 0.  S.  Cox,  McArthur _H.  S.  James,  McArthur 


1st  Wed.,  Feb.,  May,  Sept,  and  Dec. 

Quarterly. 

2nd  Tuesday,  monthly. 

1st  Thursday,  monthly. 

3d  Thursday,  bi-monthly. 

1st  Monday,  monthly. 

2d  Monday,  monthly. 

3d  Wednesday,  monthly. 


Tenth  District 


Crawford E.  C.  Brandt,  Crestline R.  L.  Solt,  Bucyrus 1st  Monday,  monthly. 

Delaware Geo.  D.  Lowry,  Delaware J.  G.  Parker,  Delaware 1st  Tuesday,  monthly. 

Franklin Jonathan  Forman,  Columbus George  J.  Heer,  Columbus Every  Monday,  8:30  p.  m. 

Knox S.  O.  Gantt,  Centerburg JR.  L.  Eastman,  Mt.  Vernon Last  Thursday,  monthly. 

Madison R.  S.  Postle,  London G.  C.  Scheetz,  West  Jefferson 4th  Wednesday,  monthly. 

Morrow F.  M.  Hartsook,  Cardington T.  Caris,  Mt.  Gilead 1st  Wednesday,  monthly. 

Pickaway C.  G.  Stewart,  Circleville C.  C.  Beale,  Circleville 1st  Friday,  monthly. 

Ross Glen  Nisley,  Chillicothe W.  C.  Breth,  Chillicothe 1st  Thursday,  monthly. 

Union E.  J.  Marsh,  Broadway..™. Angus  Maclvor,  Marysville 2d  Tuesday,  monthly. 


740 


Advertisements 


December,  1933 


A MODERN  ETHICAL  HOSPITAL  AT  LOUISVILLE 

Rates:  $25.00  Per  Week  and  up 

ALCOHOLIC  TREATMENT  destroys  the  craving  for  alrohol.  restores  the  appetite  and  sleep,  and  rebuilds 
the  patient’s  physical  and  nervous  state.  Whiskey  withdrawn  gradually.  No  limit  on  the  amount  neces- 
sary to  prevent  or  relieve  delirium. 

NERVOUS  patients  are  accepted  by  us  for  observation  and  diagnosis  as  well  as  treatment. 

DRUG  TREATMENT  is  one  of  GRADUAL  RE- 
DUCTION. It  relieves  the  constipation,  re- 
stores the  appetite  and  sleep.  Withdrawal  pains 
absent.  No  Hyoscine  or  Rapid  Withdrawal 
methods  used  unless  the  patient  desires  same. 

MENTAL  PATIENTS  have  every  comfort  of  their  home. 

FEMALE  PATIENTS : Nervous  separated  from  mild  men- 
tal. Female  attendants  only ; absolute  privacy ; com- 
fortable. well-appointed  ladies’  lounge. 

923  Cherokee  Road  Phone  East  1488) 

THE  STOKES  SANATORIUM' 

Louisville,  Ky. 

29  Years  Treating  Nervous  Patients.  Acres  of  well-kept  grounds  and  trees. 


Windsor^  Hospital 

The  Windsor  Hospital  and  Sanitarium  is 
completely  equipped  with  all  the  best  appa- 
ratus for  giving  Hydrotherapy,  Occupa- 
tional Therapy,  and  other  treatments  for 
all  types  of  Nervous  disorders,  acute  and 
chronic. 

John  H.  Nichols,  M.D. 

Medical  Director 

Phone  Chagrin  Falls  360 
CHAGRIN  FALLS,  OHIO 

ESTABLISHED  35  YEARS 


THE  OXFORD  RETREAT 

Oxford,  Ohio 

Incorporated  1882  New  Buildings  1926 

. . for  . „ . 

Nervous  and  Mild  Mental  Cases 

R.  HARVEY  COOK,  Physician-in-Chief 


FIRE  PROOF  — COMPLETELY  EQUIPPED  — WRITE  FOR  DESCRIPTIVE  CIRCULAR 


AN  approved  and  fully  equipped  Sanitarium 
for  convalescence,  diagnosis,  physical 
therapy,  and  medical  attention  under  recog- 
nized physicians. 

Created  like  a country  estate,  28  miles  south 
of  Pittsburgh.  No  mental  or  drug  cases. 
Admission  by  letter  from  physician  is  desired. 
Reports  will  be  made  to  him  on  request. 
Specially  interested  in  diabetes,  arthritis,  neu- 
ritis, anemias,  cardiovascular  diseases,  gen- 
eral orthopedic  conditions.  Isolation  for  nerv- 
ous cases.  Physical  therapy  in  all  phases. 
Address  professional  mail  to  G.  H.  McKinstry, 
M.D.,  Box  483  i;  Hillsview  Farms,  Washing- 
ton, Pa.  Phone:  Washington  2650. 


PUBH©  H®  ABTM  - SOCIAL  WBILFAR 
MEDHGAIL  ECONOMICS 
"&md  ©E.CAN1EAT10N  PROBLI 

1, Vith  Editorial  Comment  by  D KM.  ^===S:5^>( 


Never  has  the  need  for  coordination  and  co- 
operation, harmony  and  unity,  and  effective  ac- 
tivity in  the  ranks  of  the  medical  profession  been 

more  acute  than  now. 

The  past  year  has 
witnessed  the  birth  of 
new  and  increasingly 
complex  social  and 
economic  problems 
vitally  affecting  scientific  medicine,  medical  prac- 
tice and  the  independence  of  the  individual  phy- 
sician. Additional  and  perhaps  more  complicated 
questions  of  equal  or  greater  importance  will  de- 
velop during  the  ensuing  12  months. 

To  meet  future  challenges  and  solve  satisfae- 


At  present  some  physicians  in  the  state  who 
have  previously  been  members  of  medical  organi- 
zation have  allowed  their  membership  to  lapse. 
In  some  counties  there  are  physicians  who  un- 
doubtedly are  eligible  to  membership  in  medical 
organization  but  who,  for  reasons  of  their  own, 
have  failed  to  affiliate  with  their  county  medical 
society. 

Aside  from  the  factor  of  self  preservation,  there 
are  numerous  reasons  why  every  worthy  and 
eligible  physician  should  maintain  membership  in 
medical  organization.  Briefly  some  of  these  are: 

It  is  an  assurance  of  the  physician’s  standing 
in  his  community,  before  the  public,  the  law  and 
the  profession. 


“SUBSCRIPTIONS  EXPIRE” 

Also  Membership  Dues 

The  envelope  containing  this  issue  of  your  Journal  bears  the  admonition 
“Annual  Subscriptions  Expire  With  This  Issue”. 

Postal  regulations  permit  the  subscription  announcement  to  be  carried  on 
the  Journal  envelope,  but  do  not  permit  reference  to  “annual  dues” ; hence  the 
wording  as  it  appears. 

However,  as  you  know,  subscription  to  The  Journal  is  included  in  your 
annual  dues  to  the  Ohio  State  Medical  Association  which  are  payable  in  ad- 
vance. 

Dues  for  the  calendar  year  1934  should  be  paid  now  to  the  secretary- 
treasurer  of  your  County  Medical  Society  in  order  that  the  proportion  of  annual 
State  Association  dues  may  be  transmitted  by  him  before  January  1 to  the 
State  Headquarters  office. 

Annual  dues  in  the  State  Association  for  1934  paid  and  transmitted  before 
the  first  of  the  year,  mean  continuous  good  standing  in  medical  organization; 
continuous  receipt  of  The  Journal ; and  material  assistance  to  your  local  and 
state  officers  and  committees. 


torily  new  questions  of  direct  concern  to  every 
physician,  medical  organization  must  function 
systematically  and  effectively.  It  has  done  so  in 
the  past.  No  sales  talk  is  necessary  to  empha- 
size the  importance  and  usefulness  of  medical  or- 
ganization from  the  standpoint  of  the  public  and 
the  medical  profession.  Its  record  speaks  for 
itself. 

However,  to  carry  on  and  strengthen  its  forces 
to  meet  increasing  problems,  medical  organization 
must  have  the  enthusiastic  and  undivided  interest 
and  active  support  of  every  eligible  physician  in 
Ohio. 


It  helps  to  maintain  organization  machinery  for 
the  service  of  all  members. 

It  makes  possible  the  publication  of  the  Ohio 
State  Medical  Journal,  a consecutive  record  of 
scientific,  economic,  social,  legal  and  legislative 
developments  and  events  of  direct  interest  to 
every  practitioner. 

It  provides  the  means  for  contact  with  state 
and  federal  departments  and  for  impressing  upon 
the  executive,  administrative  and  legislative 
branches  of  the  government  the  concerted  medical 
viewpoint. 

It  provides  the  means  for  cooperation  with 
other  state-wide  and  national  groups  and  organi- 
zations interested  in  common  problems  of  public 
health  and  professional  practice. 

It  affords  protection  against  unwarranted  mal- 


753 


754 


The  Ohio  State  Medical  Journal 


December,  1933 


practice  suits  and  the  maintenance  of  a service 
which  makes  unpopular  various  attempts  to 
swindle  physicians. 

It  makes  possible  the  maintenance  of  State  As- 
sociation bureaus,  departmental  and  committee 
activities  for  the  benefit  of  the  entire  membership. 

It  provides  a unanimity  of  effort  in  medical  and 
health  questions  and  a united  force  to  combat 
those  endeavoring-  to  undermine  the  profession 
and  establish  unsound  and  dangerous  medical  and 
health  programs. 

In  short,  every  physician  needs  the  benefits 
which  medical  organization  has  to  offer  as  interest 
on  his  membership  investment,  and  medical  or- 
ganization, to  maintain  adequate  machinery  and 
be  of  the  greatest  service  to  its  members,  needs 
the  active  support  of  all  physicians  who  can 
qualify  for  membership. 

Every  physician  will  be  doing  himself  and  the 
medical  profession  as  a whole  a good  turn  by 
transmitting  at  once  his  1934  dues  to  the  secre- 
tary-treasurer of  his  county  medical  society  so 
that  the  proportion  of  annual  State  Association 
dues  may  be  transmitted  to  the  State  Headquar- 
ters Office  before  January  1. 

If  possible,  dues  in  advance  for  all  members 
for  1934  in  the  State  Association  should  be  cer- 
tified to  the  headquarters  office  of  the  State  Asso- 
ciation within  the  next  two  weeks  or  by  December 
15,  in  order  that  such  members  may  be  certified 
to  the  American  Medical  Association,  which,  for 
the  first  time  since  1931,  has  in  the  course  of 
preparation  a new  edition  of  the  American  Medi- 
cal Directory. 

It  is  particularly  important  that  all  eligible 
physicians  be  included  in  that  directory  as  mem- 
bers of  medical  organization.  This  directory  is 
used  officially  not  only  by  the  medical  profession, 
but  by  insurance  companies,  railroad  companies, 
industries,  public  officials  and  others,  as  to 
identification,  affiliation  and  standing  of  physi- 
cians. 

$ 


Public  Health 


Some  of  the  new  trends  in  public  health  admin- 
istration were  paid  particular  attention  at  the 
recent  annual  conference  of  Ohio  health  commis- 
sioners in  Columbus, 
indicating  O h i o’s 
public  health  set-up 
is  progressing  with 
the  times  and  func- 
tioning effectively  de- 
spite curtailed  finances  and  man-power. 

A considerable  portion  of  the  program  was  de- 
voted to  discussions  of  certain  phases  of  pre- 
ventive medicine  which  deal  with  the  health  and 
medical  problems  of  the  individual.  Comprehen- 
sive study  was  devoted  to  methods  and  develop- 
ments in  strictly  community  health  matters  but 
more  than  usual  interest  was  manifested  in  those 
aspects  of  preventive  medicine  which  have  here- 
tofore been  handled  as  only  incidental  to  the 


regular  routine  functions  of  the  average  health 
department. 

Special  emphasis  was  placed  on  community 
projects  and  programs  designed  to  meet  the  health 
problems  of  children  of  pre-school  and  school  ages. 
The  importance  of  immunization  and  vaccination 
from  the  standpoint  of  the  individual  child  as  well 
as  the  community  as  a whole  was  stressed.  The 
benefits  of  proper  food  and  diet,  periodic  physical 
examinations,  prompt  medical  attention  for  the 
correction  of  physical  defects  in  small  children, 
prenatal  and  postnatal  care  of  mothers,  etc.,  were 
summarized  by  various  speakers. 

The  interest  manifested  by  the  health  officials 
of  the  state  in  some  of  the  newer  phases  of  pre- 
ventive medicine  and  their  decision  to  give  these 
new  activities  greater  emphasis  in  the  future 
should  be  of  particular  interest  to  the  medical 
profession  of  the  state  since  physicians  in  private 
practice  will  be  expected  to  play  a major  role  in 
these  projects. 

The  part  which  physicians  in  private  practice 
should  take  in  such  undertakings  is  obvious.  As 
brought  out  at  the  Columbus  conference,  health 
officials  should  not  and  cannot  provide  the  pro- 
fessional services  which  are  an  indispensable  part 
of  personal  preventive  medicine.  The  educational 
and  promotional  features  of  community  programs 
for  early  immunization,  periodic  physical  exami- 
nations, correction  of  defects  in  children,  pre- 
natal and  postnatal  care,  etc.,  can  and  should  be 
handled  by  local  health  departments.  The  func- 
tion of  providing  professional  services  is  that  of 
the  practicing  medical  profession. 

It  is  evident,  judging  from  the  conference  dis- 
cussions that  the  health  officials  of  Ohio  are  re- 
lying on  the  active  cooperation  and  assistance  of 
physicians  in  private  practice  in  their  efforts  to 
provide  a more  thorough  and  more  inclusive  com- 
munity health  service  for  their  respective  com- 
munities. By  working  with  and  assisting  their  local 
health  officers,  physicians  can  render  a public 
service  of  great  benefit  and  at  the  same  time  en- 
large the  scope  of  their  individual  practices. 

It  has  been  predicted  frequently  in  recent  years 
that  the  physician  of  the  future  must  devote 
greater  attention  to  the  preventive  aspects  of 
medical  practice  or  suffer  serious  curtailment  cf 
his  practice.  If  the  health  officers  of  the  state  are 
willing  to  assume  the  task  of  educating  the  public 
to  make  the  family  physician  an  adviser  in  pre- 
ventive as  well  as  curative  medicine,  they  cer- 
tainly are  entitled  to  all  the  active  cooperation 
which  the  medical  profession  is  able  to  give  them. 
As  a matter  of  fact,  the  physician  in  his  daily  con- 
tacts and  calls  can  with  propriety  do  much  to 
stimulate  interest  in  the  advantages  which  await 
those  who  avail  themselves  of  the  preventive 
measures  that  are  a part  of  the  services  offered 
by  present-day  medicine. 

It  should  be  encouraging  to  the  medical  pro- 
fession of  Ohio  to  know  that  there  is  no  dis- 


December,  1933 


Editorial 


755 


position  on  the  part  of  official  health  administra- 
tion in  Ohio  generally  to  infringe  upon  the  rights 
and  privileges  of  the  physician  in  private  prac- 
tice. It  may  be  assumed  from  the  attitude  taken 
by  those  attending  the  recent  commissioners’  con- 
ference that  active  cooperation  between  the  medi- 
cal profession  and  the  health  officers  of  the  state 
is  one  of  the  primary  aims  of  those  responsible  for 
safeguarding  the  health  of  Ohio’s  population. 
For  this,  and  other  obvious  reasons,  it  is  ex- 
tremely important  that  physicians  as  individuals 
and  as  members  of  medical  organization  assist 
their  local  health  departments  in  every  way  pos- 
sible and  take  advantage  of  opportunities  offered 
to  become  a cog  in  machinery  set  up  to  benefit  the 
public  and  to  broaden  the  scope  of  private  prac- 
tice. Public  health  administration  in  Ohio  is  at 
present  on  firm  ground  because  an  unusual  degree 
of  cooperation  between  medical  organization  and 
the  health  officials  of  the  state  has  been  estab- 
lished. It  will  remain  so  as  long  as  this  attitude 
continues. 

^ 4|J  yi 


During  the  next  few  months,  most  of  the  county 
medical  societies  of  the  state  will  hold  their  an- 
nual elections  of  officers,  delegates  to  the  annual 
meeting  of  the  State  Associa- 
tion, and,  in  some  instances, 
chairmen  of  important  local 
committees. 

The  importance  of  selecting 
interested  and  active  members 
for  all  official  positions  in  the  society  cannot  be 
over-emphasized,  especially  at  this  time  when  the 
full  strength  of  medical  organization  must  be 
maintained  in  order  that  critical  problems  affect- 
ing the  medical  profession  may  be  met  with  cour- 
age and  conviction. 


Elections 


A medical  society  without  strong,  active  and 
judicious  leadership  is  like  a rudderless  ship.  It 
may  float  along  but  it  may  not  travel  in  the  right 
direction  and  the  chances  are  it  will  not  show 
much  of  a record  of  accomplishments  when  an  in- 
ventory is  taken. 


Such  will  not  be  the  case  of  the  society  which 
exercises  judgment  in  the  selection  of  its  officers 
and  in  the  choice  of  its  committee  chairmen  and 
committee  personnel. 


The  same  discriminating  judgment  should  be 
shown  by  each  society  in  picking  its  delegates  and 
alternates  to  the  annual  meeting  of  the  State 
Association.  Members  who  are  interested  in  or- 
ganization activities  and  will,  if  necessary,  make 
sacrifices  to  attend  the  State  Association  meeting 
should  be  selected.  Each  component  county  society 
should  be  fully  represented  in  the  House  of  Dele- 
gates of  the  State  Association  as  it  has  a right  to 
be  under  the  democratic  foim  of  medical  organi- 
zation. The  roll  calls  of  past  state  meetings  show 
a rather  poor  attendance  record  by  the  delegates 


from  some  county  societies.  In  some  cases,  the 
societies  are  pax’tly  to  blame  because  of  indiffer- 
ence on  their  part  in  the  selection  of  their  official 
delegates. 

Election  of  officers  is  and  should  be  regarded  as 
a serious  obligation  by  the  membership  of  every 
county  society.  It  is  something  more  than  the 
passing  around  of  honors  or  the  work  which  ac- 
companies such  honors.  No  county  society  can 
expect  to  function  properly  unless  it  makes  full 
use  of  the  leadership  which  exists  within  its 
ranks. 


Additional  evidence  as  to  how  important  and 
necessary  it  is  for  every  physician  to  be  cautious 
and  well-informed  regarding  financial  and  legal 
matters  incidental  to  his  pro- 
Insmrance  fessional  practice  is  found  in 
the  record  of  a recent  msur- 
Cf>V©rag©  ance  case  decided  in  the  Fed- 
eral Courts  against  the  physi- 
cian involved. 

The  case  arose  over  an  effort  on  the  part  of 
the  physician,  who  specialized  in  surgery,  to  col- 
lect from  an  insurance  company  following  an 
illness  which  resulted  in  paralysis  agitans.  The 
suit  set  up  the  claim  that  the  surgeon  had  sus- 
tained a complete  and  permanent  loss  of  use  of 
his  right  hand  and  arm ; that  he  had  been  insured 
as  an  operating  surgeon;  that  for  all  practical 
purposes  his  arm  and  hand  were  completely  and 
permanently  lost  to  him  in  pursuing  the  occupa- 
tion for  which  he  was  insured,  and,  therefore, 
that  he  was  entitled  to  75  per  cent  of  the  capital 
amount  of  the  policy  under  a special  “dismember- 
ment or  complete  and  permanent  loss  clause”  of 
the  policy. 

The  insurance  company  contended  before  the 
trial  court  which  directed  a verdict  in  favor  of  the 
company  that  the  physician  had  resumed  a portion 
of  his  practice;  that  he  maintained  an  office  and 
was  consulted  by  patients  for  diagnosis;  that  he 
could  use  a stethoscope,  write  prescriptions,  and 
perform  other  functions  that  are  a part  of  medi- 
cal practice. 

The  case  was  appealed  and  the  U.  S.  Appellate 
Court  in  determining  the  appeal  against  the 
physician  ruled  that  the  record  showed  that  the 
plaintiff’s  arm  and  hand  were  of  sufficient  actual 
practical  use  to  him  in  his  occupation  as  to  pre- 
vent the  company  from  being  liable.  The  verdict 
also  pointed  out  that  he  had  been  insured  as  a 
physician  and  surgeon  and  that  the  fact  that  95 
per  cent  of  his  work  had  been  surgery  was  not 
made  part  of  the  insurance  contract  or  brought 
to  the  attention  of  the  company  when  the  policy 
was  issued. 

“There  is  no  doubt”,  the  Appellate  Court  said, 
“that  appellant  has  sustained  a very  great  and 
serious  loss  in  the  use  of  his  right  arm  and  hand 


756 


The  Ohio  State  Medical  Journal 


December,  1933 


and  it  is  permanent.  He  has  been  deprived  of 
that  use  which  no  doubt  was  dearer  to  him  than 
any  other  part  of  his  work,  but  that  fact  itself  is 
not  determinative  of  his  right  to  recover  in  this 
action.  This  is  not  a suit  for  damages,  but  it  is 
one  to  enforce  a contract  right,  and  we  cannot 
enlarge  upon  the  terms  of  the  contract.” 

Here  is  the  case  of  a physician  who  believed 
himself  protected  against  the  very  contingency 
which  happened,  yet  because  of  the  terms  of  the 
contract  in  his  policy,  he  was  unable  to  collect. 

Before  any  insurance  policy  is  taken  out  it  is 
highly  important  that  the  physician  read  the 
policy  carefully  so-  that  he  may  be  correctly  in- 
formed as  to  exactly  what  is  covered  by  the 
policy  and  obtain  dependable  legal  advice  if  he  is 
uncertain  as  to  the  terms  of  the  policy  and  itc- 
coverage. 

The  old  but  still  timely  motto  of  “investigate 
before  investing”  should  be  followed  by  every 
physician  in  all  his  financial  and  business  deal- 
ings. 


Physicians  are  learning,  especially  in  these 
times  of  slow  collections,  that  it  pays  to  be  busi- 
ness-like in  their  dealings  with  their  patients. 

Many  physicians  have 
made  a practice  of  mak- 
ing verbal  or  written 
agreements  for  install- 
ment payments  with  pa- 
tients unable  to  pay  their 
bills  in  full.  In  most  instances,  patients  have 
been  eager  and  willing  to  make  such  an  arrange- 
ment and  the  plan  has  worked  successfully  both 
from  the  standpoint  of  the  patient  and  that  of 
the  physician. 

Some  physicians  have  learned  from  experience 
that  it  pays  to  keep  themselves  well  informed  on 
legal  questions  pertaining  to  the  collection  of  de- 
linquent accounts. 

For  example,  there  have  been  a number  of  re- 
cent cases  where  physicians  have  lost  amounts 
due  them  from  the  estates  of  deceased  patients 
or  have  been  compelled  to  wait  an  unnecessarily 
long  time  for  their  money  simply  because  they 
have  been  dilatory  in  filing  their  claims  against 
the  estates. 

The  present  Probate  Code  of  Ohio  provides 
that  “creditors  shall  present  their  claims,  whether 
due  or  not  due,  to  the  executor  or  administrator 
within  four  months  after  the  date  of  his  appoint- 
ment”. Claims  presented  after  four  months  shall 
not  prevail  against  bona  fide  purchasers  or 
against  executors  or  administrators,  or  the  sur- 
viving spouse,  or  bona  fide  distributees. 

The  physician  in  these  days  can  not  afford  to 
be  slip-shod  in  his  business  affairs.  Those  who 
are,  either  lose  the  confidence  of  their  clientele  or 
lose  their  legitimate  profits,  or  both. 


Not  long  ago,  Owen  D.  Young,  rated  as  one  of 
the  best  brains  in  the  nation,  addressed  a group 
of  students  at  Radcliffe  College  relative  to  some 
of  the  vital  political  and 
economic  questions  which  are 
puzzling  old  and  young,  rich 
and  poor,  laborer  and  em- 
ployer. 

“There  has  been  a great  cry  for  economic 
planning”,  Mr.  Young  declared.  “I  often  wonder 
whether  the  people  who  call  for  it  really  mean 
what  they  say.  Are  they  willing  to  surrender 
their  individual  freedom  to  the  extent  necessary 
to  cooperate  in  a plan?  It  is  fruitless  to  demand 
unified  action  by  a large  number  of  industrial 
units  and  by  the  individuals  connected  with  them 
and  expect  to  retain  for  each  unit  and  each  in- 
dividual the  same  freedom  and  the  same  kind  of 
initiative  which  existed  before  the  plan  was 
made.  Too  many  people  seem  to  think  that  we 
can  have  a comprehensive  plan  without  paying 
anything  for  it.  They  are  all  for  the  advantage 
of  the  plan,  but  they  resist  the  price. 

“Beware  of  being  misled  by  temporary  catch- 
words. Their  purpose  is  only  to  excite  emotional 
commendation  or  praise.  They  are  chiefly  refuges 
from  thought.  Industrial  planning  is  not  so  sim- 
ple as  the  term  would  indicate.  Rugged  individ- 
ualism is  not  so  bad,  however  much  we  jeer  the 
phrase  today.  Communism  is  not  to  be  substituted 
for  capitalism  merely  because  the  one  is  alleged 
to  be  new  and  the  other  old. 

“The  machine  has  its  problems  and  its  poetry 
just  as  the  sweating  backs  of  workers  had.  As  I 
have  said  before,  the  new  era  of  the  1920’s  was 
not  all  bad,  and  the  new  deal  of  the  1930’s  will  not 
be  all  good.  It  will  be  for  you  to  select  free  from 
prejudice  and  with  a sensitive  conscience  those 
things  which  are  best  in  both.” 

Mr.  Young’s  views  on  the  complicated  prob- 
lems confronting  mankind  are  refreshing.  They 
indicate  that  those  who  look  before  they  leap  are 
not  going  to  be  misled  by  sugar-coated  phrases 
and  high-sounding  theories. 

Although  he,  of  course,  made  no  direct  reference 
to  the  knotty  problems  confronting  the  medical 
professon,  Mr.  Young’s  sound  advice  may  well  be 
heeded  by  those  members  of  the  profession  who 
feel  the  urge  to  junk  the  present  program  of 
medical  practice  and  launch  into  new  ventures  and 
initiate  new  systems,  untried  and  of  doubtful 
merit.  As  has  been  pointed  out  substitution  of 
questionable  programs  for  ones  which  have  proved 
the  test  of  time  is  not  so  simple  as  some  would 
have  us  believe.  True,  some  changes  are  neces- 
sary and  should  be  made.  But,  as  the  best  minds 
in  the  profession  have  emphasized  time  and  again, 
all  of  the  old — most  of  it  in  fact — is  not  bad  and 
should  not  be  thrown  overboard  simply  because 
the  spirit  of  the  times  has  created  the  urge  for 
extensive  change  and  experimentation. 


Economic 

Planning 


C.  W.  Wyckoff,  M.D.,  Cleveland,  Ohio 


IN  my  presentation  of  this  subject,  I have  not 
attempted  to  introduce  any  new  or  astound- 
ing facts. 

I feel  quite  sure  that  in  what  I have  to  say, 
the  nose,  ear  and  throat  surgeons  who  have  had 
twenty  years  or  more  of  experience  will  also  con- 
cur. It  is  the  test  of  time  which  really  proves  the 
worth  of  any  accepted  treatment  and  confines  it 
to  the  cases  which  will  actually  be  benefited  by  it. 

There  is  not  one  of  the  special  branches  of 
medicine  or  surgery  with  which  the  pediatrician 
comes  in  more  frequent  contact  than  that  of  nose, 
ear  and  throat.  Pie  is  the  first  man  on  the  job 
usually,  and  it  is  up  to  him  to  decide  whether  ton- 
sils and  adenoids  should  come  out,  whether  a simis 
condition  is  to  be  treated  surgically,  whether  an 
ear  drum  paracentesis  should  be  performed  or 
whether  a mastoid  operation  is  indicated,  and  it  is 
to  be  desired  than  an  opinion  beneficial  to  the  little 
patient  will  be  rendered  and  that  it  will  be 
dictated  by  sane  experience  and  an  honest  con- 
science. May  I venture  to  further  state  that  this 
also  applies  to  our  colleagues  as  well,  and  also  to 
school  physicians  or  physicians  in  well  children’s 
institutions  who  are  too  prone  to  recommend  ton- 
sil enucleation  because  of  the  appearance  of  the 
tonsils,  very  little  effort  being  made  to  learn  their 
history.  My  advice  to  them  is  that  it  is  not  what 
a tonsil  looks  like,  it  is  what  harm  it  is  doing  and 
how  it  may  influence  the  general  health  of  the 
child  at  present  and  in  later  years. 

When  a young  physician  starts  to  practice 
medicine,  he  is  of  the  opinion  that  the  tonsils  and 
adenoids  if  at  all  troublesome  in  any  case,  should 
be  immediately  removed.  Thus  does  he  advise  in. 
his  first  years  of  practice.  Then  slowly  he  is  per- 
mitted in  the  course  of  years  to  re-examine  some 
of  these  throats  in  cases  he  had  strongly  urged 
removal  of  the  offending  tissue,  because  of  a very 
outstanding  physical  difficulty.  The  advice  was 
not  followed  for  some  reason  or  other  and  the 
physical  difficulty  corrected  itself.  He  is  sur- 
prised to  find  the  tonsils  in  very  good  condition, 
or  on  the  other  hand  the  throat  may  have  been 
well  operated  upon  and  the  condition  for  which 
the  operation  was  performed  is  unchanged.  In 
addition,  other  complications  have  ensued  which 
seem  to  be  the  direct  result  of  removing  the  ton- 
sils. Hence  does  he  slowly,  painfully  but  surely 
leam  in  nature’s  post-graduate  medical  course 
that  he  is  dealing  with  a very  inconstant  problem 
in  the  way  of  the  human  body  and  that  if  he  will 
be  patient,  nature  though  slow  and  subtle  can 
usually  be  relied  upon  for  help. 

Read  before  the  First  General  Session,  Ohio  State  Medical 
Association  at  the  87th  Annual  Meeting,  Akron,  September 
7 and  8,  1933. 


May  I be  pardoned  for  refreshing  your  mem- 
ories as  to  the  function,  anatomy  and  physiology 
of  the  tonsil.  Placed  as  it  is  on  either  side  of  the 
upper  end  of  the  respii’atory  passage  where  it 
comes  in  constant  contact  with  the  inspired  air, 
food  and  infection  coming  through  the  mouth; 
considering  also  its  gross  and  minute  structure, 
one  should  concede  that  it  must  have  a definite 
function.  The  complete  physiological  function  of 
this  gland  is  of  course  not  understood,  but  the 
laryngologists  agree,  I believe,  that  the  tonsils  act 
as  a barrier  against  bronchial  and  pulmonary  in- 
fection. Soon  after  birth  it  is  not  uncommon  to 
find  a hypertrophy  of  these  glands  to  such  a de- 
gree that  they  interfere  with  respiration.  Natural- 
ly such  tonsils  are  not  pathologic  even  if  they 
contain  pathogenic  organisms.  The  hypertrophy 
is  a natural  growth  of  glandular  tissues  which 
have  a greater  part  to  play  than  was  originally 
intended  by  nature. 

Realizing  that  the  tonsil  structurally  is  a lymph 
gland,  it  is  not  unreasonable  to  believe  that  it  per- 
forms the  same  function.  During  early  life  we 
find  a much  higher  per  cent  of  lymphocytes  re- 
latively than  in  older  children  and  adults.  This  is 
undoubtedly  partly  due  to  the  metabolism  of  fats 
and  carbohydrates.  If  there  are  excesses  or  de- 
ficiencies in  these  elements  or  in  the  vitamins 
necessary  for  a normal  metabolism  or  a calcium 
deficiency,  we  may  have  a tremendous  lymphocyte 
increase  also  a marked  increase  in  all  the  lym- 
phoid tissues  in  the  body  and  especially  the  tonsils 
and  adenoids.  This  occurs  in  the  so-called  exu- 
dative infant  and  child  and  also  in  the  overfed, 
underfed  and  improperly  fed  child. 

Hence  it  is  very  advisable  in  the  cases  of  en- 
larged tonsils  and  adenoids  in  our  little  patients 
not  to  be  too  hasty  in  our  advice  for  operation 
but  first  to  consider  well  the  state  of  the  child’s 
nutrition  and  whether  it  is  properly  fed. 

Experience  teaches  one  to  leave  them  alone, 
unless  it  is  very  evident  that  such  pathological 
destruction  has  occurred  so  as  to  destroy  all  the 
remaining  normal  functioning  tissue.  It  is  not 
always  easy  to  form  an  opinion;  one  must  con- 
sider numerous  factors — the  amount  of  respira- 
tory obstruction,  difficulty  in  swallowing  solid 
food,  frequent  gagging  and  vomiting  when  there 
is  no  digestive  disturbance  apparent,  the  occur- 
rence of  repeated  inflammatory  conditions  of  the 
throat,  the  acuteness  of  the  inflammatory  con- 
dition of  the  cervical  glands;  also  the  general 
condition  of  the  child.  If  he  is  in  poor  state  of 
nutrition,  anemic,  manifests  a tendency  to  re- 
peated systemic  infections,  it  certainly  indicates 
that  a diseased  tonsil  is  responsible. 

For  a physician  to  draw  definite  conclusions 


757 


758 


The  Ohio  State  Medical  Journal 


December,  1933 


from  his  experience  even  after  years  in  private 
practice  is  quite  wrong,  as  a few  outstanding 
results  of  operated  or  unoperated  cases  are  bound 
to  bias  his  opinion.  Hence  it  is  rather  helpful  in 
forming  an  opinion  to  read  up  the  frequent  and 
various  tonsil  and  adenoid  studies.  There  is  no 
doubt  that  by  far  too  many  tonsil  operations  have 
been  performed  and  will  continue  to  be  for  several 
years.  It  is  at  present  deemed  so  necessary  that 
as  a prophylactic  urge  for  children  it  ranks  sec- 
ond only  to  such  really  necessary  prophylactic 
measures  as  the  giving  of  toxin  antitoxin  and 
smallpox  vaccination. 

There  is  one  tonsil  study  which  I shall  refer 
to,  because  it  has  been  made  with  very  careful  at- 
tention to  details,  that  is  Kaiser’s  report  in  1930 
of  a study  of  2200  tonsillectomitized  children  with 
an  equal  number  of  controls  three  and  ten  years 
after  operation.  After  carefully  considering  all 
of  his  data  one  can  make  the  general  deduction 
that  it  is  at  once  apparent  that  tonsillectomy  does 
not  remove  from  children  many  or  in  fact  any  of 
the  usual  disease  hazards  of  childhood.  All  of  the 
complaints  and  infections  incident  to  school  life 
are  occurring  in  children  who  have  been  operated 
upon  as  well  as  in  those  who  have  not.  From  this, 
as  well  as  in  those  from  other  control  studies  it 
is.  evident  that  one  must  abandon  the  hope  that 
removal  of  tonsils  and  adenoids  will  radically 
change  a child  and  confer  the  type  of  protection 
so  much  desired  for  it. 

The  hazards  of  a tonsil  operation  are  death 
from  the  anesthesia,  a distressing  if  not  a dis- 
astrous hemorrhage,  the  aspiration  of  a loose 
tooth,  pneumonia,  or  an  accompanying  throat  in- 
fection with  severe  cervical  adenitis  or  otitis 
media  purulenta  or  mastoiditis  necessitating  an- 
other operation  and  so  on.  These  I claim  are 
quite  enough  to  make  one  cautious  in  urging  or 
even  advising  an  operation  reputed  to  the  layman 
to  be  so  simple  and  harmless. 

Let  us  consider  briefly  the  generally  accepted 
indications,  from  a pediatric  standpoint,  in  the 
order  of  their  importance,  for  removal  of  tonsils 
and  adenoids. 

( 1 ) Mouth  Breathing : — This  induces  nasal  diffi- 
culty, increases  chances  for  infection,  throws  the 
jaws  out  so  a mal  occlusion  of  teeth  result,  but 
first  be  certain  that  a deviated  nasal  septum  or 
underdeveloped  nasal  passages  or  a high  vaulted 
bony  palate  is  not  the  cause. 

(2)  Frequent  attacks  of  sore  throat  and  ton- 
sillitis. 

(3)  The  presence  of  positive  or  suspected  evi- 
dence of  the  rheumatic  syndrome  manifestations 
as  rheumatism,  chorea  and  heart  disease.  These 
are  very  definite  indications  in  view  of  the  les- 
sened incidence  of  heart  disease  in  operated  cases. 

(4)  Persistent  marked  enlargement  of  cervical 
lymph  glands  when  no  other  cause  is  found  as 
leukemia  or  Hodgkin’s  disease. 

(5)  Chronic  and  recurrent  discharging  ears. 

(6)  Recurrent  and  chronic  cases  of  pyelitis  or 
pyelonephritis  often  have  as  the  exciting  cause 
pathogenic  micro-organisms  of  the  tonsil,  the  re- 


moval of  which,  brings  about  a marked  improve- 
ment or  even  permanent  cure. 

(7)  Periodic  vomiting  attacks  will  often  ceaSe 
after  tonsillectomy. 

(8)  Chronic  albuminuria  may  have  its  source 
from  a silent  tonsil  infection  or  from  frequent 
attacks  of  acute  tonsillitis.  It  is  estimated  that 
in  75  per  cent  of  cases  of  acute  tonsillitis,  some 
degree  of  nephritis  results.  This  of  course  usually 
clears  itself  but  it  may  leave  an  albuminuria. 

(9)  Malnutrition  is  also  supposed  to  be  an  in- 
dication when  other  causes  have  been  eliminated 
but  in  my  experience  it  has  been  a most  rare  in- 
dication. 

(10)  Unexplained  fever  in  absence  of  other  in- 
dications for  it.  Of  course  an  obscure  or  hidden 
tonsil  infection  might  be  the  cause,  but  this  rea- 
son seems  to  me  too  much  of  a subterfuge  for  the 
advising  physician. 

(11)  For  the  prevention  of  respiratory  infec- 
tions, such  as  laryngitis,  bronchitis  and  pneu- 
monia and  persistent  hard  winter  coughs.  But 
this  indication  should  not  even  be  considered,  as 
these  ailments  are  not  only  unimproved,  but  may 
be  actually  made  worse. 

(12)  The  prevention  or  diminution  in  severity 
of  diphtheria  and  scarlet  fever.  We  do  know  of 
course  that  the  sequellae  in  these  cases  are  much 
less  severe  if  the  tonsils  and  adenoids  are  out. 
But  this  by  itself  is  scarcely  a justifiable  indica- 
tion. 

(13)  Frequent  head  colds  are  also  used  as  a 
very  frequent  indication  but  it  certainly  should 
not  be  for  both  tonsil  and  adenoids,  as  only  the 
latter  would  have  any  influence  on  the  head  colds 
and  if  tonsils  are  also  removed  it  destroys  a 
source  for  slow  immunization  of  the  body  and  this 
obligation  is  taken  up  by  the  accessory  sinuses  or 
the  pharyngeal  solitary  lymph  follicles. 

Adenoids  of  course  are  simply  an  overgrowth 
of  normal  glandular  structure  in  the  nasopharynx. 
Just  how  they  spring  from  the  vault  of  the  naso- 
pharynx we  do  not  know,  but  apparently  a large 
amount  of  glandular  tissue  exists  in  this  region, 
placed  there  by  nature  to  further  prevent  in- 
fection. Their  rapid  enlargement,  however,  may 
become  a detriment  to  the  child.  As  a rule  the 
adenoids  are  not  of  large  size  until  the  end  of 
the  first  year,  but  frequently  infants  are  born 
with  them  or  a cold  infection  developing  in  the 
first  week  or  two  of  the  infant’s  life  will  cause 
them  to  enlarge  immediately.  These  may  subside 
by  the  end  of  the  first  six  or  eight  months  if  the 
child  is  fortunate  enough  to  escape  frequent  colds. 

Subjecting  such  infants  to  too  cold  a sleeping 
room  or  exposure  outdoors  in  the  winter  months 
greatly  aggravates  this  condition.  Hence,  a mother 
should  be  properly  cautioned.  Also  too  frequent 
use  of  oil  nose  drops  very  definitely  aggravates 
the  growth  of  adenoids.  It  is  a very  rare  infant 
under  the  age  of  one  year  who  must  have  its 
adenoids  removed,  and  when  such  is  the  case  they 
are  very  apt  to  recur. 

As  to  the  best  age  for  the  operation,  I think 
that  three  years  and  after  is  better  in  every  way, 
but  if  it  is  fairly  safe  for  the  child  to  wait,  five 
or  six  years  of  age  is  best.  At  this  time  better  co- 
operation is  secured  from  the  child  as  regards 


December,  1933 


Throat  and  Ear  Problems — Wyckoff 


759 


anesthesia  and  also  in  the  after  care.  The  season 
of  year  does  not  matter  a great  deal,  except  that 
in  the  winter  months  post-operative  head  cold 
infection  must  be  guarded  against  and  the  patient 
not  be  allowed  to  go  out  of  doors  for  two  or  three 
weeks  after  the  operation. 

I am  convinced  that  post-operative  complica- 
tions as  cervical  adenitis,  abscessed  ears  and  mas- 
toditis  and  pneumonia  can  be  greatly  diminished 
if  every  child  is  kept  off  his  feet  for  one  week  fol- 
lowing the  operation.  Invariably  the  man  operat- 
ing gives  instruction  to  allow  the  child  to  remain 
in  bed  for  a day  or  two  and  after  a week  or  ten 
days  to  bring  him  to  the  office  for  inspection  for- 
getting about  the  physical  and  nervous  strain  on 
the  child  and  the  exposure  to  the  weather  if  it  is 
at  all  inclement. 

EAR  PROBLEMS 

It  is  during  childhood  that  by  far  the  most 
precarious  time  exists  for  the  ear.  This  is  the 
period  when  infections  of  the  middle  ear  are  most 
often  encountered,  due  principally  to  complica- 
tions from  the  acute  infectious  diseases.  It  is 
during  this  period  that  most  of  the  cases  of  de- 
struction take  place  in  the  internal  ear,  which 
leads  to  deaf  mutism. 

Because  of  this  fact  it  is  most  important  that 
the  physician  has  a good  working  knowledge  of 
the  anatomy,  function  and  diseases  of  the  middle 
ear  and  also  of  the  labyrinth,  and  it  behooves  him 
to  refresh  his  knowledge  occasionally  of  these 
parts,  for  greater  benefit  to  his  patients  and  a 
personal  satisfaction  of  thoroughness. 

In  regard  to  the  pathological  difficulties  of  the 
ear,  the  classification  is  the  same  as  in  adult  life. 
The  matter  of  prime  importance  is  for  the  phy- 
sician and  especially  the  pediatrician  to  be  a 
sufficiently  well  trained  otologist  to  recognize 
these  ailments  and  pi'omptly  invite  the  aid  of  a 
real  otologist  if  the  treatment  is  not  succeeding. 

In  the  external  ear,  we  see  frequently  in  the 
very  young  infant  a simple  purulent  inflammation 
of  the  canal,  due  probably  to  birth  secretions,  bath 
water  or  regurgitated  milk.  This  condition  clears 
promptly  and  apparently  without  harm  to  the  ear. 
Next  is  furunulosis  of  the  canal,  which  is  faiidy 
common  in  infants,  easily  recognized  and  not  diffi- 
cult to  treat.  Another  troublesome  condition  of 
the  external  canal  is  eczema,  but  this  too  responds 
moderately  well  to  the  usual  salves  employed  for 
eczema,  and  dietary  supervision.  A fourth  diffi- 
culty is  that  of  a foreign  body  in  the  external 
meatus  in  the  way  of  fabric  or  insects  or  solid 
matter. 

It  is  important  for  the  physician  to  bear  in  the 
mind  that  the  harmful  results  of  such  a condition 
come  with  very  few  exceptions  from  the  efforts 
directed  towards  their  removal.  An  undisturbed 
foreign  body  lodges  usually  in  the  outer  mem- 
branous part.  Very  often  the  parent  has  pushed 
it  in  farther  by  his  efforts,  and  then  the  physician 
with  an  improper  instrument,  clumsily  used  in  a 


struggling  child  may  succeed  in  pushing  the  body 
into  the  osseous  portion  of  the  canal.  Hence  if 
there  is  any  doubt  in  his  mind  as  to  his  ability  to 
extract  the  body,  he  should  certainly  let  the  oto- 
logist take  the  responsibility. 

Next  let  us  consider  a few  of  the  most  fre- 
quently seen  middle  ear  difficulties.  The  first  is 
acute  tubal  catarrhal  inflammation,  a condition 
fairly  frequently  observed  but  probably  not  too 
often  recognized  by  the  physician.  It  is  a simple 
inflammation  of  the  mucosa  of  the  Eustachian 
tube,  and  may  or  may  not,  give  rise  to  aural 
symptoms,  according  to  the  partial  or  complete 
closure  of  the  lumen  of  the  canal.  The  predis- 
posing factors  are  anything  interfering  with  nor- 
mal nasal  respiration,  especially  post-nasal  ade- 
noids or  high  placed  or  much  enlarged  tonsils. 
The  exciting  factor  of  course  is  the  common  head 
cold.  When  the  tube  is  partly  occluded,  the  air 
supply  to  tympanum  naturally  is  diminished,  with 
more  or  less  negative  air  pressure  in  ear  cavity. 
This  results  of  course  in  retraction  of  the  drum 
or  simply  a dull  lusterless  membrane,  so  that  with 
either  of  these  signs  present  one  may  feel  positive 
of  the  tubal  congestion  and  of  the  presence  of 
adenoids. 

This  is  a most  frequent  cause  of  earache  in 
children,  the  drum  not  showing  any  redness. 
Hypersensitiveness  just  back  of  the  ramus  of  tho 
lower  jaw,  below  the  ear  lobe  is  also  sign  of 
tubal  congestion. 

Tubal  congestion  and  increased  lymphoid  tissue 
in  the  naso-pharynx  are  only  two  of  the  numerous 
predisposing  factors  in  the  etiology  of  acute 
otitis.  Other  causes  are  the  depressed  constitu- 
tional states  resulting  from  simple  malnutrition, 
or  marasmus  or  digestive  disturbances  as  summer 
diarrhea,  et  cetera.  Among  the  acute  exciting 
causes  are: 

(1)  Headcolds — this  being  by  far  the  most 
common  cause. 

(2)  The  acute  exanthemata.  Scarlet  fever  and 
measles  being  much  more  frequently  accompanied 
by  acute  tympanic  disease  than  diphtheria,  and 
the  cases  progressing  to  acute  suppurative  mas- 
toiditis are  much  more  frequent  in  these  dis- 
eases. About  75  per  cent  of  the  cases  of  deafness 
resulting  in  later  years  developed  their  suppurat- 
ing ears  from  the  contagious  diseases.  Epidemic 
influenza  is  also  a cause  of  a very  severe  type. 

(3)  Nasal  irrigation,  snuffing  up  solutions 
through  the  nostrils  and  the  continuous  and  gen- 
erous use  of  nose  drops  are  also  ready  causes. 

(4)  Traumatic  injuries  due  to  falls  or  forcible 
blows  on  the  ear  are  rare  factors. 

As  to  the  acute  suppurative  type  of  middle  ear 
inflammation,  the  symptoms  are  quite  different 
than  the  ordinary  textbook  would  have  us  be- 
lieve and  in  this  way  they  aive  misleading  to  the 
general  practitioner.  In  the  first  place  they  are 
most  often  vague  or  absent,  quite  unlike  the  case 
of  the  adult. 

When  acute  purulent  otitis  media  occurs  as  a 
complication  of  one  of  the  infectious  diseases,  the 


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The  Ohio  State  Medical  Journal 


December,  1933 


symptoms  are  more  or  less  masked  by  those  of  the 
primary  illness.  In  pneumonia  it  occurs  frequently 
four  to  seven  days  after  the  onset;  in  acute 
bronchitis,  after  the  disease  has  subsided;  in  tbe 
acute  intestinal  disturbances  ten  to  fourteen  days 
after  onset.  When  it  is  primary  it  may  also  be 
more  or  less  masked. 

From  the  vague  symptomatology  and  the  very 
definite  physical  signs  of  acute  otitis  it  makes  it 
absolutely  imperative  for  the  physician  to  make 
daily  routine  ear  examinations  in  all  cases  of 
sick  or  ailing  children  which  is  not  as  easy  as  it 
might  be,  considering  a nervous,  wriggling  child 
with  small  or  tortuous  ear  canals  filled  with  soft 
wax  and  fine  cilia. 

Treatment  of  acute  otitis  media  purulenta  is 
essentially  the  same  in  children  as  adults.  Early 
and  free  paracentesis  of  the  drum,  better  a few 
unnecessarily  incised  drum  membranes  than  one 
allowed  to  go  too  long.  However,  in  my  ex- 
perience, if  a mastoiditis  is  going  to  occur,  it 
seems  to  occur  whether  or  not  the  drum  is  in- 
cised early  or  if  it  ruptures  spontaneously.  I 
consider  it  quite  in  the  field  of  the  pediatrician  to 
perform  his  own  paracentesis.  It  is  of  course  most 
important  that  he  knows  what  he  is  about  or 
irreparable  damage  may  result  to  the  ossicles  by 
an  incision  carried  up  too  high  or  the  bony  wall 
of  the  tympanic  vault  struck  by  too  bold  a plunge 
of  the  knife.  I believe,  too,  that  during  his  first 
few  years  in  practice  the  pediatrist  incises  many 
drums  which  later,  he  will  let  go  for  twenty -four 
hours  or  more,  using  palliative  treatment  and 
with  marked  success.  As  to  the  efficacy  of  use  of 
a 5 per  cent  phenol  in  glycerine  for  relieving  pain, 
I need  say  nothing  except  that  along  with  a pre- 
scription for  nose  drops  it  is  the  most  frequently 
used  remedy  in  pediatrics.  But  ear  drops  should 
only  be  used  for  a day  or  two  and  only  frequent 
enough  to  keep  the  patient  comfortable.  If  used 
for  long  it  not  only  stuffs  up  the  external  canal 
with  a flaky  white  exudate  but  seems  to  soften  the 
lining  of  the  canal  and  it  may  also  retard  the  re- 
covery of  an  inflamed  drum  membrane. 

As  to  the  proper  duration  of  the  discharge  from 
a suppurating  ear  and  its  later  effect  upon  the 
hearing  there  is  considerable  argument. 

In  the  absence  of  fever  or  pain  and  if  a child 
plays  and  is  doing  well  in  general,  I can  see  no 
harm  if  the  ear  does  discharge  for  six  weeks,  un- 
less the  pus  becomes  fetid  in  the  least  degree.  I 
have  seen  many  of  these  children  years  after  their 
trouble  and  their  hearing  seems  normal.  But  if  the 
temperature  drops  to  normal  and  later  returns — 
or  if  it  persists  from  the  onset  whether  the  child 
is  comfortable  or  not,  and  if  this  situation  has 
obtained  for  three  weeks,  the  physician  should  re- 
quest consultation  with  the  otologist  for  there  is 
undoubtedly  a surgical  mastoid.  We  are  certainly 
grateful  to  the  otologists  for  teaching  us  that  a 
mastoiditis  does  not  have  to  progress  to  the  classi- 
cal protruding  ear  lobe  stage  in  order  to  decide 


the  necessity  for  opening.  However,  there  are 
some  ear  surgeons  a trifle  over-progressive,  who 
would  go  into  the  mastoid  at  the  end  of  two  weeks 
or  ten  days  or  on  a recent  case  of  mine  in  one 
week. 

In  closing  I might  state  a few  general  points 
about  acute  mastoiditis  in  infants  and  young  chil- 
dren. The  mastoid  process  does  not  exist  as  such 
in  the  early  months  of  life,  about  one  cell  only  is 
present  toward  the  end  of  the  first  year,  but  the 
child  is  never  too  young  for  mastoiditis.  Even  in 
the  early  months  acute  middle  ear  inflammation 
may  give  rise  to  necrosis  of  the  outer  antrum  wall 
and  result  in  a subperiosteal  abscess. 

Notwithstanding  that,  knowing  that  such  mor- 
tally serious  complications  may  occur,  let  us 
physicians  be  ever  watchful  and  thoughtful,  not 
too  conservative,  nor  yet  too  radical.  Let  us  con- 
sult with  the  otologist  while  there  is  still  time  for 
debate. 

It  has  been  my  purpose  in  these  crudely  as- 
sembled remarks  to  simply  emphasize  that  more 
sincere  attention  be  paid  to  this  very  troublesome 
part  of  the  child’s  anatomy.  I know  that  only  too 
often  in  our  hurried  daily  routine  we  fail  to  con- 
sider thoroughly  our  problem  in  hand  and  espe- 
cially as  to  the  result  for  the  permanent  welfare 
of  the  patient  in  advising  for  or  against  a tonsil 
or  adenoid  operation  or  sinus  or  ear  treatment. 

10515  Carnegie  Avenue. 

yi  yi  4|i 

Announcement  has  been  made  that  the  Amer- 
ican Association  for  the  Study  of  Goiter  for  the 
fifth  time  will  offer  a $300  first  prize  and  two 
honorable  mention  awards  for  the  best  essays, 
based  upon  original  research  work  on  any  phase 
of  goiter,  presented  at  the  next  annual  meeting 
of  the  association,  to  be  held  in  Cleveland,  June 
7,  8 and  9,  1934.  Competing  manuscripts  must  be 
written  in  English  and  submitted  to  the  corre- 
sponding secretary,  Dr.  John  J.  R.  Yung,  670 
Cherry  Street,  Terre  Haute,  Indiana,  by  April  1, 
1934.  The  prizes  are  offered  to  stimulate  research 
in  goiter;  especially  in  regard  to  the  basic  cause 
of  goiter.  The  first  prize  for  1933  was  awarded 
to  Anne  B.  Heyman,  M.S.,  University  of  Michi- 
gan, for  her  essay  on  “The  Bacteriology  of  Goiter 
and  the  Production  of  Thyroid  Hyperplasia  in 
Rabbits  on  a Special  Diet”. 


Announcement  has  been  made  by  Dr.  J.  H. 
Seiler,  Akron,  secretary  of  the  Union  Medical 
Association,  comprising  the  county  medical  so- 
cieties of  the  Sixth  District  of  the  Ohio  State 
Medical  Association,  that  the  annual  meeting  of 
the  Sixth  District  organization  will  be  held  on 
Wednesday,  January  10,  1934,  at  the  Massillon 
State  Hospital.  The  program  for  the  meeting  is 
now  being  arranged  and  will  be  announced  in  the 
near  future. 


Spinal  Cord  Changes  In  Pernicious  Anemia 

Charles  E.  Kiely,  M.D.,  Cincinnati,  Ohio 


THE  clinical  diagnosis  of  pernicious  anemia 
is  often  first  suspected  from  the  neurologi- 
cal symptoms. 

According  to  Woltman1  the  disease  is  accom- 
panied by  neurological  symptoms  in  from  50  to  80 
per  cent  of  cases,  30  per  cent  being  neuritis  and 
the  remaining  50  per  cent  serious  cord  lesions.  In- 
terest in  the  latter  arises  from  the  great  regu- 
larity with  which  two  bilateral  systems,  judging 
at  least  clinically,  are  almost  exclusively  involved. 
Predominantly  the  posterior  tracts  of  a Goll  and 
Burdach  with  the  crossed  pyramidal  tracts  in  the 
lateral  column  undergo  a progressive  degenera- 
tion, and,  leaving  aside  objections  to  be  raised 
later,  the  clinical  symptoms  correspond  well 
enough  to  such  lesions.  From  the  columns  of 
Goll  and  Burdach  we  expect  such  ataxia  as  is 
seen  in  tabes;  from  the  crossed  pyramidal  tracts 
the  spasticity  that  occurs  in  a much  rarer  dis- 
ease, lateral  sclerosis. 

Clinically,  in  pernicious  anemia  we  see  a 
neurological  syndrome  which  combines  the  two 
and  we  teach  our  students  to  search  further  for 
pernicious  anemia  when  they  encounter  a spastic 
ataxia.  It  is  generally  admitted  that  in  one  case 
the  ataxic  symptoms  may  mask  their  spastic  op- 
ponents or  vice  versa,  and  Oppenheim*  says  that 
post-mortems  explain  the  predominance  by  de- 
generation in  the  posterior  columns  outrunning 
that  of  the  anterior  or  in  reversal  of  that  order. 
Thus  is  summed  up  the  bare  bones  of  our  knowl- 
edge of  the  neurological  lesions  of  pernicious 
anemia  and  from  this  point  on  we  may  justly  pro- 
ceed to  study  exceptions  to  the  clinical  picture, 
relation  of  pathology  to  symptomatology,  and 
theorize  about  etiology. 

Clinically,  the  disease  not  infrequently  begins 
as  far  as  the  patient  has  knowledge  with  pares- 
thesias in  fingers  or  toes.  This  fits  well  with 
Woltman’s  findings  of  30  per  cent  showing  neu- 
ritis, but  not  infrequently  the  first  symptom  is 
clumsiness  in  the  finer  movements  of  the  fingers, 
buttoning,  sewing,  piano  playing,  or  perhaps  less 
frequently  staggering  due  to  axtaxia  in  the  legs 
or  stiffness  from  spasticity.  It  is  of  great  clinical 
importance  that  these  subjective  symptoms  con- 
firmed by  objective  findings  such  as  finger-nose, 
heel-knee  ataxia,  exaggerated  tendon  reflexes  and 
Babinski  sign  or  some  of  its  modifications  precede 
by  long  perioods  the  characteristic  microscopic 
blood  changes.  On  more  than  one  occasion  in 
our  service  in  the  Cincinnati  General  Hospital  we 
have  predicted  from  cord  symptoms  the  onset  of 
pernicious  anemia  at  a time  the  blood  picture  was 

Read  before  the  Section  on  Nervous  and  Mental  Diseases, 
Ohio  State  Medical  Association,  at  the  87th  Annual  Meeting, 
Akron,  September  7-8,  1933. 


utterly  normal.  The  admission  must  be  made  that 
this  preceded  the  days  when  the  crucial  import- 
ance of  achlorhydria  was  known.  No  doubt  a 
gastric  analysis  would  have  made  the  prediction 
much  less  of  a prophecy. 

The  literature  shows  some  cases  where  a limita- 
tion of  the  disease  process  to  a restricted  level 
of  the  cord  has  produced  a picture  close  to  myeli- 
tis, but  these  are  rare.  Girdling  sensations  are 
not  uncommon,  but  are  not  accompanied  by  such 
severe  pains  as  accompany  tabes.  Argyll-Robert- 
son  pupil  has  been  reported,  though  very  rarely, 
and  justifies  the  postulation  of  coincident  cerebro- 
spinal syphilis  and  pernicious  anemia.  Neither 
disease  guarantees  freedom  from  the  other.  Un- 
scrambling such  combinations  need  not  keep  the 
clinician  awake  at  night. 

When  pernicious  anemia  is  first  diagnosed  by 
the  neurologist,  he  usually  encounters  a patient 
whose  history  is  of  tingling  in  the  fingers,  or  toes 
followed  by  ataxia  as  shown  objectively  in  clum- 
siness of  the  fingers  or  ataxic  gait,  and  the  blood 
picture  frank  or  suspicious  of  pernicious  anemia 
is  present  with  rare  exceptions.  Lately,  loss  of 
vibration  sense  in  the  bones  has  been  given  great 
diagnostic  importance.  Loss  of  such  sensation  in 
the  sacrum  has  been  said  to  have  great  weight, 
but  it  is  present  in  tabes,  and  I believe  as  a result 
of  75  examinations  with  a tuning  fork  of  stan- 
dardized vibration  that  the  importance  of  sacral 
vibratory  loss  is  over-rated.  I have  seen  an  iso- 
lated loss  of  vibratory  sense  there  in  three  cases 
of  unquestionable  neurosis  and  one  of  feeble- 
mindedness. Pernicious  anemia  patients  quite 
regularly  show  loss  of  vibration  sense  in  the 
sacrum  and  lower  bones,  but  there  is  nothing 
pathognomonic  in  the  formula.  Position  sense  of 
the  fingers  and  toes  is  usually  impaired,  the  ten- 
don jerks  are  exaggerated,  and  Babinski’s  or 
other  signs  present. 

I have  twice  seen  pernicious  anemia  develop 
in  patients  diagnosed  as  neurotic.  The  one  had 
a history  of  violent  temper  and  financial  extra- 
vagance that  brought  a complacent  husband 
almost  to  ruin.  She  fell  into  the  hands  of  Minot, 
who  found  achlorhydria  in  her  and  a son.  In 
spite  of  the  skepticism  of  myself  and  two  inteim- 
ists,  she  ultimately  ran  the  typical  course  and 
died.  The  second,  a woman  of  life-long  hypo- 
chondriacal complaining,  unexpectedly  had  her 
legs  give  way  on  an  unfinished  road-bed  of  broken 
rock.  In  view  of  the  previous  history,  her  sube- 
quent  complaints  were  ascribed  to  a traumatic 
neurosis.  Quite  suddenly  she  developed  the  clin- 
ical picture  of  pernicious  anemia  and  subsequently 
died. 

Considering  the  enormous  number  of  whining, 


761 


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The  Ohio  State  Medical  Journal 


December,  1933 


extravagant,  and  bad  tempered  women  one  en- 
counters clinically,  I can  only  conclude  that  the 
pernicious  anemia  was  a coincidence  in  both  cases 
and  no  neurotic  symptoms  attachable  to  perni- 
cious anemia  can  be  postulated.  Also  there  is 
no  psychosis  pathognomonic  of  the  disease.  David- 
son and  Gulland3  report  two  patients  in  each  of 
whom  exacei'bation  of  pernicious  anemia  was  pre- 
ceded by  psychotic  episodes.  From  the  literature 
they  conclude  that  no  characteristic  psychosis 
accompanies  pernicious  anemia. 

Pathological  examination  of  nerve  tissue  from 
cases  of  pernicious  anemia  roughly  coincide  with 
the  clinical  symptoms  but  gives  rise  to  several 
clinical-pathological  contradictions.  Largely,  we 
find  degeneration  of  the  columns  of  Goll  and 
Burdach  and  the  pyramidal  tracts,  but  some  ano- 
malies appear.  One  must  trace  a degenerated 
tract  to  its  cells  of  origin  to  find  the  most  likely 
source  of  the  trouble.  For  the  pyramidal  tracts 
these  would  be  the  Betz  cells  in  the  cortex  and 
cytological  examination  shows  them  to  our  great 
satisfaction  in  a state  of  degeneration.  Likewise 
the  cells  of  Clarke’s  column  in  the  spinal  cord 
are  atrophic  and  the  cerebellar  tracts  to  which 
they  give  rise  sclerotic  so  that  ataxia  is  well  ex- 
plained. On  the  other  hand,  the  columns  of  Goll 
and  Burdach  are  quite  regularly  involved 
(Adami4,  CollieF)  but  there  is  not,  as  in  tabes, 
any  lesion  of  the  sensory  radicles  as  they  enter 
the  cord  in  spite  of  similar  radicular  pains  and 
constricting  paresthesias,  and  further  the  cells 
in  the  sensory  ganglia  giving  rise  to  the  tracts 
in  question  are  unaffected.  Correlation  of  symp- 
tomatology and  pathology  in  pernicious  anemia  is 
in  much  the  same  boat  as  in  disseminated 
sclerosis.  In  that  disease,  pathology  is  found  with- 
out symptomatology  and  vice  versa:  Spasticity 

without  lesion  of  the  pyramidal  tracts,  lesions  of 
the  pyramidal  tracts  without  history  of  spastic- 
ity ante-mortem.  The  only  definite  correlation 
found  is  disseminated  lesions  with  disseminated 
symptomatology.  One  can  say  of  pernicious 
anemia  that  spastic  ataxia  is  usually  present 
ante-mortem  and  degeneration  of  the  posterior 
and  lateral  columns  post-mortem. 

Some  further  pathological  observations  need  to 
be  added.  Myelin  degeneration  precedes  axonal. 
The  degeneration  begins  in  the  center  of  the 
affected  tracts  and  spreads  outwardly.  The  pro- 
cess begins  in  the  dorsal  portion  and  spreads  up 
and  down,  sometimes  as  far  as  the  internal  cap- 
sule. The  cord  is  edematous,  not  shrunken. 
Davidson  and  Gulland3  regard  the  tract  degenera- 
tion as  primary  and  atrophy  of  Betz  and  Clarke’s 
column  cells  as  secondax-y.  Karsner8  reports  slight 
atrophy  in  the  fronto-parietal  lobe.  Davidson7 
saw  no  difference  in  treated  and  untreated  except 
slight  glial  response. 

Speculation  on  the  relation  of  the  anemia  to  the 
cord  change  raises  some  interesting  points.  The 
first  is  whether  the  anemia  is  their  direct  cause. 


In  favor  of  this  opinion  is  the  occurrence  of  the 
combined  systemic  cord  syndrome  in  the  anemia 
of  other  diseases.  Profound  secondary  anemias 
sometimes  cause  it.  I have  seen  one  case  with 
gastric  and  one  with  uterine  cancer  and  the 
literatui'e  contains  many  such  instances.  More 
defensible  is  the  supposition  that  toxins  of  the 
malignant  growth  cause  both  anemia  and  cord 
changes  for  experimental  anemia  fails  to  px-oduce 
ixx  axxinxals  the  expected  cord  changes.  Hemolytic 
toxins,  B.  Welchii,  phenylhydrazine  and  hemolytic 
sex-a  have  failed  to  affect  the  cord.  Another  fact 
against  this  theory  is  the  failure  of  cox-d  changes 
to  remit  with  the  blood  pictui’e  in  pex-nicious 
anemia.  Just  before  the  day  of  liver  thei’apy  the 
Cincinnati  General  Hospital  was  equipped  with  a 
depax-tixxent  of  heliotherapy  for  tx-eatment  of 
tuberculosis  axxd  many  cases  of  pex-nicious  anemia 
wex-e  also  subjected  to  months  of  light  exposux-e. 
Lasting  remissions  of  the  blood  picture  wex-e  px-o- 
duced  without  affecting  the  cord  symptoms  except 
in  one  case8.  The  dux-ation  of  the  anemia  must 
be  considex-ed  in  evaluation  of  this  ax-gument.  The 
blood  system  is  capable  of  extended  x-egeneratioxx, 
the  nex-vous  system  of  very  little  and  stands  con- 
tinued injux-y  vex-y  badly.  Possibly  earlier  ti’eat- 
ment  of  the  anemia  would  have  saved  the  cord 
before  irreparable  damage  was  done,  but  no  such 
eori-elation  appears  in  the  sex-ies  treated  by  helio- 
therapy. 

Against  anemia  being  the  direct  cause  of  cord 
changes  is  also  their  frequent  appeax-ance  before 
the  anemia  and  the  occux-x-ence  of  the  combined 
systemic  syndi’ome  in  cases  not  showing  anemia 
of  any  kind.  Such  instances  no  doubt  are  rare, 
but  unknown  causes  produce  the  syndrome  and 
Oppenheim  reports  one  case  in  pax-esis  and  quotes 
Zahn’s  cases  of  familial  combined  systemic 
sclerosis. 

The  postulate  that  a common  factor  causes  the 
blood,  cord,  and  gastric  changes  can  be  best 
defended.  Gulland  presumes  that  some  patients 
have  a susceptible  nervous  system  which  shows 
changes  before  the  toxin  or  the  deficiency  has  done 
enough  liver  damage  to  evoke  the  megaloblastic 
response  of  bone  marrow.  This  hex-editary  pre- 
disposition seems  less  of  a deus  ex  machina  when 
we  remember  that  a gastric  px-ediposition  is  well 
substantiated.  Blood  relatives  of  the  patients  have 
again  and  again  shown  achlorhydria.  This  also 
explains  the  failux-e  of  cord  symptoms  to  remit 
with  the  blood,  for  one  can  postulate  that  the  pres- 
sui-e  of  the  toxin  is  enough  x-elieved  to  make  the 
megaloblastic  response  unnecessary,  but  not 
enough  to  spax-e  the  nervous  tissues.  This  also 
explains  cases  of  combined  systemic  sclex-osis 
without  anemia  at  any  stage.  The  condition  never 
becomes  sex-ious  enough  to  affect  anything  but  the 
susceptible  nex-vous  system. 

Gulland  feels  that  the  postponement  of  death 
from  anemia  by  liver  therapy  has  already  demon- 
strated the  susceptibility  of  the  nex-vous  system 


December,  1933 


Spinal  Cord  Changes — Kiely 


763 


and  that  we  will  see  a higher  proportion  of  cord 
involvement  than  before. 

With  the  advent  of  something  deserving  the 
name  of  a cure  for  pernicious  anemia,  the  neuro- 
logist would  be  inclined  to  predict  that  remission 
of  the  cord  symptoms  would  depend  on  the  length 
of  their  existence  before  the  initiation  of  therapy, 
but  reports  of  the  efficacy  of  liver  in  giving  such 
relief  are  contradictory. 

Minot,  Murphy,  and  Cornell  saw  little  result, 
but  Ungley  and  Suzmann9  report  eight  cases  back 
at  work  of  thirty  who  entered  hospital,  bed- 
ridden. Starr10  reports  eight  cases  without  any 
improvement  in  cord  symptoms.  Richardson11  saw 
four  cases  of  moderate  and  eight  of  complete 
clinical  improvement  out  of  fourteen  showing 
ataxia.  In  his  whole  series,  sixty-seven  cases,  he 
has  never  seen  ataxia  develop  in  the  face  of  treat- 
ment. (Length  of  observation,  six  to  twenty- 
four  months  and  up.)  Krause12  reports  all  of  four 
cases  progressing  to  paralysis  in  spite  of  im- 
proved blood  picture.  Curschman13  reports  two 
with  the  same  result. 

Ungley  and  Suzmann14  present  a later  report. 
Of  thirty  cases  treated  with  liver,  seventeen  have 
improved,  eight  are  stationary  or  worse,  and  five 
died;  of  thirty-one  in  whom  liver  was  not  used, 
none  improved,  three  were  stationary  or  worse, 
and  twenty-eight  died.  They  have  not  analyzed 
for  correlation  between  duration  before  treatment 
and  therapeutic  result,  but  conclude  that  insuffi- 
cient liver  administration  is  demonstrable  in  the 
unimproved  cases.  That  delay  in  commencing 
liver  therapy  permits  irreversible  changes  to  es- 
tablish in  the  spinal  cord  seems  a defenseless 
postulate  in  the  face  of  the  frequency  with  which 
combined  systemic  sclerosis  has  actually  begun 
and  progressed  after  the  initiation  of  liver 
therapy  in  adequate  amounts.  Ungley  and  Suz- 
mann think  that  the  amount  of  liver  necessary  to 
bring  the  blood  picture  to  normal  is  not  enough 
to  spare  the  nervous  system  which  would  require 
the  continuance  of  full  doses  of  liver  after  im- 
provement in  the  blood  picture. 

My  own  experience  with  eight  cases  is  as  fol- 
lows: 

Case  1. — A female  (Mrs.  S,),  of  fifty,  suffered 
from  gastric  upsets  for  twenty  years  and  in 
March,  1930,  began  to  notice  disturbance  of  gait. 
She  was  treated  for  change  of  life  for  six  months, 
and  when  brought  to  the  office  was  too  ataxic  to 
walk  unaided.  The  clinical  picture  was  typical 
in  every  way.  She  had  two  months,  bed  rest  with 
ventriculin  and  dilute  hydrochloric  acid.  The  blood 
and  nei*vous  systems  improved  pari  passu  and 
since  February,  1931,  she  has  been  coming  to  the 
office  in  a street  car,  unaided.  At  the  present 
time,  (August,  1933),  a slightly  broad-based  gait 
is  the  only  remnant  of  her  ataxia. 

Case  2. — Lily  S.,  aged  forty  years,  had  suffered 
from  “acid  mouth”  and  raw  tongue  for  more  years 
than  she  can  estimate.  On  January  19,  1929,  fol- 
lowing extraction  of  some  teeth,  she  suffered  from 
what  was  probably  an  hysterical  interlude  rather 


than  truly  organic  nervous  symptoms,  for  she  had 
a feeling  of  great  weight  placed  upon  her  and 
terrible  mental  agony  and  thought  her  bones  were 
splintered  and  coming  through  her  flesh.  There 
were  also  episodes  of  tightness  in  the  throat  and 
with  difficult  breathing  (globus  hystericus  or 
laryngeal  crisis).  She  was  not  up  and  around 
until  May  of  that  year  and  then  noticed  difficulty 
in  walking.  It  was  two  years  later  that  I first 
saw  her;  the  ataxia  was  extreme.  She  walked 
with  the  aid  of  the  furniture  and  came  downstairs 
backwards,  holding  to  the  railing.  Blood  and 
spinal  fluid  were  negative  for  lues  and  the  clinical 
and  laboratory  examinations  typical  for  perni- 
cious anemia.  With  ventriculin  the  blood  picture 
has  come  to  normal  and  the  ataxia  is  so  improved 
as  to  permit  walking  unaided. 

Case  3. — Mrs.  L.  B.  S.  This  is  perhaps  the 
most  interesting  case.  In  1918,  the  patient  had 
a so-called  “break-down”  and  could  not  walk. 
When  seen  in  1924,  she  presented  the  typical  pic- 
ture of  combined  systemic  sclerosis  with  perni- 
cious anemia.  For  four  years  her  cord  symptoms 
aggravated  very  slowly  and  the  blood  count  got 
below  four  million  only  once.  In  1928,  she  began 
to  eat  raw  liver  and  had  a lasting  remission  of 
her  neurological  symptoms  that  leaves  her  with 
only  a slight  ataxia.  Since  the  introduction  of 
liver  extracts  a small  dose  maintains  her. 

Case  4. — Mrs.  B.,  64.  In  September,  1928,  she 
first  experienced  weakness  in  the  knees  and  when 
I saw  her  six  months  later  she  had  enough  ataxia 
to  need  a cane.  Tendon  jerks  were  bilaterally 
exaggerated,  there  was  bilateral  Babinski  and  loss 
of  position  sense  in  the  toes.  RBC  was  3,000,000; 
Hm  70  per  cent.  Smears  showed  1 per  cent  myelo- 
cytes, aniscoytosis,  poikyloctytosis,  and  slight 
polychromasia.  Gastric  analysis  showed  no  free 
HC1.  RBC,  April,  1929,  was  2,384,000;  in  June 
4,736,000;  in  October  3,200,000.  In  spite  of  the 
poor  blood  showing  her  ataxia  disappeared.  I saw 
her  again  in  September,  1931,  walking  without 
the  slightest  difficulty,  but  have  no  blood  count 
for  that  year.  In  August,  1933,  she  shows  only 
a slightly  broad-based  gait  and  loss  of  position 
sense  in  the  first  and  fifth  toes  on  the  left.  RBC 

5.056.000,  Hm  77  per  cent.  She  takes  two  or  three 
vials  of  liver  extract  daily. 

Case  5. — Mrs.  E.,  age  57.  In  1929  she  consul- 
ted Drs.  Hoppe  and  McIntyre,  who  diagnosed  her 
trouble  as  pernicious  anemia  and  put  her  on  liver 
therapy.  She  improved  and  quit  taking  liver.  I 
saw  her  in  October,  1932,  completely  unable  to 
walk  because  of  ataxia.  Liver  therapy  was  re- 
sumed. She  was  under  my  care  until  December, 

1932.  While  in  these  two  months  her  blood  count 
rose  from  2,920,000  to  5,000,000  her  locomotion 
scarcely  improved  at  all.  When  last  traced  in 
August,  1933,  she  was  still  largely  incapacitated 
by  ataxia. 

Case  6.- — Mrs.  M.  J.,  age  54,  was  first  seen 
March  3,  1933.  Tingling  had  begun  in  her  fin- 
gers about  one  year  before.  Varius  procedures 
including  the  inevitable  extraction  of  teeth  were 
employed.  No  blood  count  was  done.  Her  legs 
became  ataxic  and  when  first  seen  she  had  the 
typical  pallor  and  a degree  of  ataxia  requiring 
support  under  both  shoulders.  The  diagnosis  was 
obvious  at  a glance.  The  first  red  count  was 

2.430.000.  She  has  had  treatment  with  ventricu- 
lin and  later  with  liver  extract.  As  of  August, 

1933,  her  blood  count  is  hovering  around  4,500,000 
and  she  can  now  walk  without  assistance,  though 
still  quite  ataxic. 


764 


The  Ohio  State  Medical  Journal 


December,  1933 


Case  7.- — -Mrs.  R.,  age  63,  consulted  Dr.  Hugh 
Fee  of  South  Lebanon  in  September,  1931,  for  a 
cold.  He  suspected  anemia  and  a blood  count 
showed  only  2,000,000  RBC.  Her  blood  count 
reached  4,500,000  by  November  of  that  year.  On 
her  removal  to  Cincinnati  she  came  under  my  care 
in  March,  1932.  The  neurological  symptoms  are 
entirely  subjective — tingling  and  drawing  sensa- 
tions in  the  fingers  and  some  clumsiness  in  finer 
movements.  Vibratory  sense  in  this  case  is  quite 
normal.  On  moderate  dosage  of  liver  she  main- 
tains her  blood  count  and  works  hard  at  home, 
even  doing  the  family  washing.  She  retains, 
however,  a definite  anemic  tinge  of  the  skin. 

Case  8. — Mrs.  G.,  69,  consulted  me  on  January 
23,  1933,  because  of  mental  depression  with  sui- 
cidal ideation,  which  began  in  December,  1929, 
three  months  after  her  husband’s  death.  Her  his- 
tory presented  nothing  to  suggest  anemia  except 
the  single  complaint  of  tingling  in  the  fingers,  but 
examination  showed  some  loss  of  position  sense  in 
the  toes  with  entire  loss  of  vibratory  sense  at  the 
right  anterior  superior  spine  and  the  sacrum,  the 
tibia  and  both  malleoli.  RBC  was  2,970,000,  Hm 
50  per  cent.  Liver  therapy  was  instituted  and  on 
the  very  next  count  about  two  weeks  later 
was  5,790,000;  Hm.  82  per  cent.  She  has 
maintained  a normal  count  since  and  vibratory 
sense  has  improved  in  the  affected  places  but  her 
depression  seems  entirely  unimproved.  It  is  of 
particular  interest  that  this  woman  was  a patient 
of  Dr.  Sawyer’s  for  four  months  in  1931  because 
of  her  depression  and  at  that  time  showed  a nor- 
mal red  count  on  two  occasions. 

CONCLUSION 

The  following  conclusions  seem  justified:  The 

cord  symptoms  are  the  result  of  a directly  acting 


toxin  or  deficiency  rather  than  the  anemia.  Ad- 
mitting exceptions,  the  Betz  cells  and  their  axones 
in  the  pyramidal  tracts,  the  cells  of  Clarke’s  col- 
umn and  their  axones  in  the  cerebellar  tracts,  and 
the  columns  of  Goll  and  Burdach  (without  in- 
volvement of  their  cells  of  origin  in  the  dorsal 
nuclei)  are  habitually  degenerated.  The  selec- 
tivity for  these  systems  remains  unexplained. 
Treatment  with  liver  extract  frequently  relieves 
these  symptoms,  but  often  does  not.  That  a dose 
sufficient  to  relieve  the  megaloblastic  response  can 
be  too  little  for  the  cord  symptoms,  is  a valuable 
postulate. 

Pearl. Market  Bank  Bldg. 


BIBLIOGRAPHY 

1.  Woltman,  J.  H. : Am.  Jour.  Med.  Sc.,  157:400,  1919. 

2.  Oppenheim,  H. : Text  Book  of  Neurology.  Foulis, 
Edinburgh  and  London,  1911. 

Anemia.  Mosby,  St.  Louis,  1930. 

3.  Davidson,  L.  S.  P.,  and  Gulland,  C.  L. : Pernicious 

Anemia.  Mosby,  St.  Louis,  1930. 

4.  Adami,  J.  G.,  and  Nichols,  A.  G. : Principles  of 

Pathology.  Lea  and  Febiger,  Philadelphia  and  New  York, 
1911. 

5.  Collier : Pierce’s  Text  Book  of  the  Practice  of  Medi- 
cine. Oxford  Med.  Science,  1930. 

6.  Karsner,  H.  T. : Human  Pathology.  J.  B.  Lippin- 

cott,  Phila.  and  London,  1926. 

7.  Davidson,  S.  : Edinburgh  Med.  Jour.,  35:322,  June, 

1928.  Davison,  C. : Jour,  of  the  Pro.  Soc.  for  Exp.  Biol, 

and  Med.,  28:6,  March,  1931. 

8.  Heuer,  G.,  and  Schwartz,  P.  : Med.  Bull.  Univ.  of 

Cincinnati,  5:1:32. 

9.  Ungley,  C.  C.,  and  Suzman,  M.  M. : New  Castle  Med. 

Jour.,  9:67,  1929. 

10.  Starr,  P.  : Jour.  A.  M.  A.,  96:15,  April  11,  1931. 

11.  Richardson,  W. : New  England  Med.  Jour.,  200:540, 
March  14,  1929. 

12.  Krause,  F. : Klin.  Wochensch.,  8 :2177,  Nov.  19,  1929. 

13.  Curehman,  H. : Med.  Klin.,  25:1767,  Nov.  15,  1929. 

14.  Ungley,  C.  C.,  and  Suzman,  M.  M. : Brain,  52:271, 

1929. 


Samuel  S.  Quittner,  M.D.,  and  Rudolph  S.  Reich,  M.D.,  Cleveland,  Ohio 


IT  IS  a trite  saying  that  no  specialist  is  worthy 
of  the  name  unless  he  considers  his  specialty 
from  the  viewpoint  of  the  body  as  a whole. 
With  this  end  in  view  we  are  asking  you  as  otolo- 
gists to  become  orthopedic  minded  for  the  time 
being. 

Bone  and  joint  complications  of  mastoiditis  are 
common  enough  to  warrant  more  than  a passing 
thought.  That  there  is  a proper  method  of  recog- 
nizing and  treating  them  to  the  end  that  the  pa- 
tient may  have  the  best  end  result  is  acknowl- 
edged. It  is  our  purpose  to  review  our  experience 
on  this  phase  of  the  subject  and  emphasize  cer- 
tain points. 

All  of  us  in  our  otological  experiences  recall  the 
characteristic  complications  of  sinus  thrombosis, 
or  to  be  more  exact  the  phlebitis  of  the  lateral 
sinus.  Here  joints  primarily — synovial  cavities 
such  as  the  pleura — seem  to  be  the  essential  selec- 
tive joints.  It  is  especially  the  larger  joints — 

Read  before  the  Eye,  Ear,  Nose  and  Throat  Section,  Ohio 
State  Medical  Association,  at  the  87th  Annual  Meeting, 
Akron,  September  718,  1933. 


hip,  elbow,  knee — that  seem  to  have  this  selective 
affinity.  There  is  no  need  to  mention  the  septic 
picture  of  sinus  thrombosis,  chill  (evanescent  or 
great)  typical  septic  fever,  the  temperature  rang- 
ing from  103  to  104.  But  in  its  course  there  may 
or  may  not  be  a particularly  severe  chill  (followed 
by  a sudden  extremely  high  temperature  from  105 
to  106  F.  At  once  we  are  on  our  guard  for  this  is 
the  usual  picture  preceding  the  joint  complication. 
True  it  may  be  the  pleura  or  a perinephritic  ab- 
scess but  most  often  we  can  expect  a joint  or  bone 
involvement.  Such  may  be  the  course  in  a typical 
sinus  thrombosis. 

One  of  us— (Quittner) — wishes  to  bring  for 
your  consideration  a type  of  mastoiditis  that  very 
frequently  produces  the  bone  and  joint  complica- 
tions in  which  there  is  no  demonstrable  sinus 
thrombosis.  He  believes  he  can  identify  it  from 
his  experiences.  It  certainly  is  not  generally  rec- 
ognized or  described;  and  the  only  reference  that 
can  be  found  is  a monograph  by  Korner  written 
in  1902. 

Let  us  take  for  example  a case  of  mastoiditis — 


December,  1933 


Mastoiditis — Quittner  & Reich 


765 


acute  or  an  acute  exacerbation  of  a chronic.  We 
have  decided  to  explore  the  mastoid,  and  we  come 
upon  much  bleeding'  bone.  There  is  no  tendency 
to  a coalescent  type  of  abscess  cavity  or  cavities, 
nothing'  but  continuous  hard  or  semi-soft  bleeding 
bone.  This  does  not  apply  to  an  operation  of  a 
first  week  mastoid  where  it  is  conceivable  that  this 
is  too  early  to  expect  true  necrosis  to  take  place, 
although  even  these  can  be  the  type  referred  to, 
but  one  in  which  judgment  has  been  used  and  is 
now  in  the  second  or  third  week  and  one  feels  an 
operation  is  needed — imperative  or  otherwise. 

It  is  this  type  of  mastoid  we  have  come  to  fear 
the  most.  There  is  no  tendency  to  pus  formation. 
It  is  in  this  type  that  one  often  sees  the  plate  of 
the  lateral  sinus  hard  but  bleeding.  There  is  a 
lull  in  symptoms  following  the  operation,  and  all 
seems  well.  Seven  to  ten  days  later  a dramatic 
rise  of  temperature  follows  and  you  are  greeted 
with  a sinus  thrombosis.  Inspect  your  field  and 
you  are  surprised  with  a complete  melting  away 
of  the  previous  hard  sinus  plate  and  you  feel  the 
soft  sinus  with  your  probe  or  already  enter  a 
necrotic  sinus. 

Such  is  the  mastoid  referred  to,  but  it  may 
never  be  a sinus  thrombosis  and  yet  have  all  the 
typical  symptoms  of  such  a lesion.  In  its  very 
nature  it  justifies  the  diagnosis — osteophlebitis. 
The  small  bone  vessels  become  thrombosed — throw 
out  their  septic  material  into  the  circulation — or 
advance  by  consecutive  thrombosis  (as  Eagleton 
would  have  it)  and  become  the  meningitis  with- 
out ocular  evidence  of  contiguous  necrosis. 

Experience  has  shown  it  may  pursue  a typical 
blood  current  picture  and  is  difficult  to  differen- 
tiate from  sinus  thrombosis.  Its  complications 
are  usually  the  joints  which  may  be  the  larger 
ones  but  do  often  involve  the  smaller  ones  such  as 
phalangeal  or  clavicular  or  even  muscular  ab- 
scesses in  contra-distinction  to  sinus  thrombosis 
which  favors  the  larger  joints.  We  know  of  no 
case  involving  the  pleura.  So  far  there  has  been 
no  positive  blood  culture  which,  of  course,  one 
should  expect  in  sinus  thrombosis.  Further  chill 
(or  chilly  feelings)  and  rigor  may  be  present  but 
certainly  not  to  the  extent  of  sinus  thrombosis 
are  a minimum  consideration.  It  may  not 
give  a septic  picture  per  se  but  there  may  be 
within  twelve  to  twenty-four  hours  after  the 
mastoidectomy,  a sudden  high  sharp  rise  of  tem- 
perature with  chill  or  no  chill  and  the  next  day  a 
periostitis  of  a long  bone  or  a joint  shows  involve- 
ment. Or  even  before  an  operation  there  may  be 
a swollen  tender  joint  and  by  exenteration  of  the 
mastoid  see  a toxic  joint  rapidly  subside. 

It  is  well  to  remember  this  typical  picture  of 
osteophlebitis  and  its  possibilities  for  in  it  enters 
consequential  matters  of  diagnosis  and  treatment. 

We  have  never  seen  a death  in  this  type  of 
case  where  the  course  favors  localization  in  joints 
or  bones.  The  course  may  be  stormy  and  involved 
but  these  very  localizations  seem  to  bring  some- 


thing out  in  the  body  that  overcomes  the  infec- 
tion and  one  can  predict  recovery.  On  the  con- 
trary a septic  course  with  no  localization  though 
it  may  get  well — as  we  recall  one  case  of  ex- 
tremely high  recessional  type  of  temperature  of 
one  weeks’  duration — usually  portends  a serious 
finality. 

Korner  specifically  states  there  is  a definite  en- 
tity called  osteophlebitis.  His  description  is  much 
like  the  composite  picture  just  presented.  He  fur- 
ther states  that  it  occurs  mostly  in  the  young  and 
young  adults. 

You  may  well  ask  how  can  you  prove  it  was 
not  sinus  thrombosis,  knowing  that  cases  have 
been  demonstrated  at  autopsy  having  had  sinus 
thrombosis  and  have  gotten  well  without  opera- 
tive interference. 

Take  for  example  a case  pursuing  a moderate 
temperature  two  weeks  complaining  only  of  severe 
pain  in  the  mastoid  area.  Operation  is  decided, 
and  within  twenty-four  hours  after  the  operation 
the  temperature  has  a sharp  rise  to  105°  plus 
and  within  another  twenty-four  hours  a large 
joint  shows  involvement.  The  case  then  pursues 
a typical  septic  course  for  five  to  six  weeks.  One 
other  joint  is  involved  and  then  a gradual  reces- 
sion of  all  symptoms  to  complete  recovery.  At 
no  time  was  the  sinus  sought  for  or  jugular  vein 
tied  off.  We  think  you  will  agree  this  was  not  a 
sinus  thrombosis. 

With  some  variations  we  could  mention  two 
other  cases  of  a like  nature.  Time  will  not  per- 
mit a presentation  of  the  other  typical  variations 
mentioned,  for,  while  the  cause  and  prognosis  are 
of  great  importance  the  treatment  and  considera- 
tion of  the  bone  or  joint  complication  is  of  equal 
importance. 

We  conceive  that  the  case  being  originally  oto- 
logical — the  complication  is  usually  handled  by  the 
orthopedic  surgeon  but  the  guidance  is  certainly 
always  otological.  Often  the  question  will  arise — - 
can  a joint  involvement  give  the  high  septic  pic- 
ture that  the  thrombosis  or  osteophlebitis  gives. 
Our  answer  is  yes — and  it  enters  largely  in  dif- 
ferential diagnosis. 

Again  the  primary  joint  may  be  the  focus  for 
dissemination  to  other  joints  or  one  may  feel  the 
mastoid  is  the  focus  for  the  joint  involvement. 
Occasionally  in  the  milder  cases  only  toxic  arth- 
ritis is  encountered  which  may  be  multiple.  We 
can  recall  one  case  in  which  a young  child  in  the 
course  of  an  acute  otitis  with  practically  no  mas- 
toid symptoms  disclosed  a swollen  tender  knee 
joint  and  was  relieved  within  forty-eight  hours 
by  mastoidectomy. 

However’,  the  type  mostly  to  be  recognized  is 
the  true  septic  type  of  bone  or  joint.  The  signs 
and  symptoms  of  acute  osteomyelitis  are  so  well 
known  and  easily  recognized  that  it  need  not  be 
elaborated  here.  On  the  other  hand,  the  septic 
joint  is  much  more  important  to  recognize  from 
the  standpoint  of  progress  of  disease  and  end  re- 


766 


The  Ohio  State  Medical  Journal 


December,  1933 


suit  that  we  cannot  over-emphasize  this  phase  of 
the  subject. 

With  a sudden  rise  of  temperature  the  patient 
becomes  more  irritable  and  there  is  complaint  of 
pain  in  the  affected  joint,  especially  on  the  slight- 
est motion.  If  this  joint  is  superficial  (as  the 
knee)  there  is  an  early  and  persistent  effusion, 
local  heat  and  complete  limitation  of  motion  due 
to  muscle  spasm.  Any  attempt  at  passive  motion 
is  met  by  complete  resistance.  In  the  ankle, 
elbow,  wrist  and  phalangeal  joints  effusion  may 
also  be  elicited  but  in  the  deeper  hip  and  shoulder 
joints  (where  no  effusion  is  determined)  the  diag- 
nosis of  septic  joint  is  much  more  difficult.  It  is 
our  opinion  that  if  the  temperature  pain  and 
muscle  spasm  persist  at  least  forty-eight  hours 
these  joints  should  be  classified  as  septic. 

There  is  another  form  of  septic  arthritis  in 
which  other  joints  are  involved  but  as  toxic  joints  * 
only.  This  is  the  type  most  easily  overlooked  be- 
cause of  the  multiplicity  of  joints  involved.  A 
careful  histoi’y  will  reveal  that  the  process  was 
initiated  with  one  joint  and  after  a few  days  the 
other  joints  became  involved.  If  the  case  remains 
untreated  and  the  process  subsides  the  toxic 
joints  improve  but  the  original  focus  still  per- 
sists (probably  at  that  stage)  as  a subacute  septic 
joint  with  destruction  and  ankylosis.  In  these 
cases  it  is  necessary  to  obtain  a careful  history 
and  a thorough  differentiation  made  between  sep- 
tic and  toxic  joints. 

As  for  the  role  of  the  X-ray  in  these  conditions 
(as  has  been  reported  many  times  by  writers  on 
this  subject)  this  process  should  be  recognized 
early  before  there  is  any  frank  bone  destruction. 
In  other  words,  when  the  X-ray  demonstrates  a 
change  (and  this  usually  requires  five  to  seven 
days)  surgical  intervention  has  been  delayed  too 
long.  The  X-ray  might  be  used  occasionally  to 
show  some  atrophy  or  widening  of  the  joint  space 
to  indicate  effusion.  It  is  well  to  determine  this 
by  comparing  X'-ray  of  healthy  opposite  joint. 

As  for  the  bacteriology — in  our  experience  the 
organism  encountered  in  the  joint  is  always  the 
same  as  the  one  in  the  original  focus — the  mas- 
toid. Streptococcus  hemolyticus  being  by  far  the 
predominant  one,  occasionally  staphylococcus 
aureus — more  rarely  staphylococcus  albus. 

TREATMENT 

When  the  diagnosis  of  septic  joint  has  been 
made  surgical  intervention  should  be  immediately 
resorted  to.  One  of  us  (Reich)  has  described  the 
technique  in  a previous  paper.  The  sooner  the 
drainage  the  better  the  prognosis  but,  of  course, 
modified  by  the  invading  organism.  Obviously 
the  earlier  one  evacuates  the  better  the  chance  of 
restoration  of  joint  function. 

Occasionally  the  question  arises  when  to  open 
a joint  which  may  be  toxic.  It  is  our  policy  not 
to  wait  more  than  forty-eight  hours  if  there  is  no 
tendency  toward  improvement.  Our  experience 


has  been  that  we  have  never  had  damage  result 
from  aspirating  a possible  toxic  effusion  but  a 
great  deal  of  harm  ensues  by  leaving  a septic 
joint  believed  to  be  toxic. 

We  believe  in  conservative  treatment.  That  is 
aspiration  and  lavage,  repeated  every  three  to 
four  days  if  necessary,  depending  on  recurrence 
of  effusion,  temperature,  symptoms,  etc.  Radical 
exposure  is  unnecessary  and  favors  destruction 
and  adhesions.  For  the  osteomyelitis  of  the  long 
bones  we  believe  in  early  incision  to  or  through 
the  pei’iosteum.  We  do  not  wait  for  frank  pus. 
There  is  no  harm  in  making  this  simple  incision 
plus  drainage  and  very  often  are  favored  with  an 
immediate  drop  of  high  temperature  and  sub- 
sidence of  the  process.  Certainly  it  often  averts 
sequestration. 

SUMMARY 

Lateral  sinus  thrombosis  gives  frequent  joint 
complications  but  these  are  mostly  t'he  larger 
ones. 

The  osteophlebitis  type  of  acute  mastoiditis  ap- 
pears to  have  a predilection  for  not  only  joint 
complications  but  also  for  the  long  bones.  While 
the  larger  joints  are  involved,  it  also  favors  the 
small  joint. 

The  complications  manifest  themselves  by  a 
sudden  high  rise  of  temperature  (continuing  as  a 
septic  type)  with  complaint  of  localized  pain  in 
the  affected  bone  or  joints. 

Early  recognition  and  early  surgical  interven- 
tion in  the  affected  bone  or  joint  is  necessary  for 
the  best  prognosis  with  elimination  of  the  mas- 
toiditis as  the  primary  source  of  symptoms. 

10515  Carnegie  Ave, 

$ ^ 

New  Ohio  Physicians 

The  following  have  been  licensed  through  reci- 
procity by  the  State  Medical  Board  to  practice 
medicine  and  surgery  in  Ohio:  John  B.  Beeson, 
Wooster,  Rush  Medical  College;  George  T.  Bly- 
denburgh,  Delaware,  Cornell  University;  John 
Edwin  Brown,  Jr.,  Columbus,  Harvard  Medical 
School;  Charles  E.  Dillard,  Dayton,  Meharry 
Medical  College;  James  R.  Dowling,  Massillon, 
Queen’s  University;  Leonard  H.  B.  Foote,  Akron, 
Howard  University;  Albert  G.  Hartenstein, 
Stockport,  University  of  MJarylancL;  Burr  M- 
Hathaway,  Akron,  University  of  Micthigan; 
Bernhard  Newburger,  Cincinnati,  Johns  Hopkins 
University;  George  T.  O’Byrne,  Lima,  University 
of  Colorado;  Charles  J.  Reichenbach,  Toledo, 
University  of  Michigan;  Leon  Devale  Robinson, 
Jr.,  Guysville,  University  of  Arkansas;  Russell 
W.  Rummell,  Youngstown,  Jefferson  Medical  Col- 
lege; James  Kelley  Smith,  Cincinnati,  Howard 
University;  Martin  M.  Weinbaum,  Cleveland, 
Washington  University;  Charles  S.  Hough. 
Xenia,  Maharry  Medical  College. 


S.  R.  Salzman,  M.D.,  Toledo,  Ohio 


SINCE  1917  a vast  literature  on  encephalitis 
has  appeared.  A great  many  types  and  va- 
rieties have  been  described,  and  many  classi- 
fications have  been  advanced,  based  chiefly  upon 
the  disease  which  preceded  it.  Distinction  is  also 
made,  depending  on  involvement  of  pyramidal  or 
extrapyramidal  areas  of  the  brain. 

The  clinical  picture  varies  somewhat,  depending 
upon  which  portions  of  the  brain  receive  the 
greatest  amount  of  injury.  All  types  of  encepha- 
litis, however,  have  many  features  in  common. 

An  interesting  and  probably  a very  important 
feature  of  all  the  various  types  reported  is  the 
failure  to  reveal  or  isolate  the  virus  responsible. 
It  does  not  seem  reasonable  that  several  dozen  dif- 
ferent viruses  could  be  responsible  for  the  many 
types  and  varieties  of  this  disease  which  have 
been  reported. 

It  is  just  possible  that  an  understanding  of  the 
factors  responsible  for  one  type  of  encephalitis 
may  lead  to  a clearer  conception  of  all  types;  and 
with  this  in  mind  the  writer  has  summarized 
some  of  his  experiences  with  one  type  which 
seems  so  far  to  have  been  entirely  overlooked  in 
medical  literature. 

Since  1922  the  writer  has  been  aware  of  the 
fact  that  cases  of  chronic  encephalitis  in  associa- 
tion wth  infection  of  the  gallbladder  are  not  un- 
common. In  spite  of  the  fact  that  a total  of  four- 
teen proved  cases  were  reported  (Nos.  1,  2,  and  3) 
this  clinical  syndrome  does  not  seem  to  have  re- 
ceived any  recognition  in  medical  literature. 

This  is  not  difficult  to  understand.  The  experi- 
ences of  the  writer  point  to  the  fact  that  many 
medical  men  fail  to  recognize  encephalitis  except 
when  it  occurs  in  epidemic  form.  Undoubtedly, 
this  is  due  to  faulty  teaching,  and  to  the  use  of 
the  term  “epidemic”  in  connection  with  encepha- 
litis. When  it  is  recognized,  it  is  looked  upon  as  a 
primary  infectious  disease,  due  to  some  virus  in 
the  cerebro-spinal  axis,  and  no  attempt  made  to 
look  elsewhere  for  a primary  focus.  Should  the 
clinician  recognize  a biliary  tract  infection  in  a 
patient  with  encephalitis,  he  assumes  that  no  con- 
nection exists  between  the  two  conditions. 

Because  the  earlier  cases  seen  occurred  during 
the  years  when  the  first  epidemic  of  lethargic  en- 
cephalitis was  prevalent  in  the  United  States,  it 
was  assumed  that  those  cases  in  which  the  associa- 
tion of  gallbladder  infection  and  encephalitis  was 
noted  belonged  to  the  so-called  epidemic  type.  Ex- 
cept for  one  case,  in  November,  1928,  during  a 
severe  epidemic  of  influenza  and  immediately  fol- 

Read  before  the  Medical  Section,  Ohio  State  Medical  As- 
sociation, at  the  87th  Annual  Meeting:,  Akron,  September  7 
and  8,  1933. 


lowing  a severe  attack  of  influenza  (3),  no  fur- 
ther opportunity  presented  itself  to  study  this 
phase  of  the  subject.  For  the  present,  at  least, 
this  fact  cannot  be  satisfactorily  proved. 

Whatever  the  final  verdict  may  be  regarding 
this  point,  the  fact  remains  that  we  have,  at  least 
in  the  neighborhood  of  Toledo,  a form  of  chronic 
encephalitis  in  various  degrees  of  severity,  clinic- 
ally resembling  lethargic  encephalitis.  These 
cases  are  associated  with  and  due  to  infections  in 
the  gallbladder  and  biliary  tract,  and  are  promptly 
relieved  and  clinically  cured  by  measures  directed 
towards  the  cure  of  the  bile  tract  infection. 

The  clinical  picture  in  individual  cases  may  be 
vague,  nevertheless  the  complete  syndrome  is 
quite  clear.  The  onset  is  usually  very  gradual 
and  so  insidious  that  the  patient  is  unable  to  give 
a definite  date  for  the  beginning  of  the  illness. 

The  earliest  symptoms  are  exhaustion,  easy  fa- 
tigue and  drowsiness.  Myotonia  is  very  common 
and  in  two  cases  was  the  most  serious  complaint. 
Gradually  memory  disturbances  become  evident, 
forgetfulness,  inability  to  concentrate,  difficulty 
in  expressing  ideas,  and  hesitance  and  groping  for 
words.  In  the  most  severe  cases  the  patient  may 
lose  the  trend  of  thought  and  forget  what  he  was 
talking  about,  or  will  frequently  repeat  himself. 
Crossness  and  irritability  are  noted  by  the  family 
and  friends.  Muscular  incoordination  is  quite 
common  and  clumsiness  is  manifested  by  dropping 
of  objects.  A coarse  tremor  is  quite  frequent  and 
staggering  is  almost  a universal  symptom.  Only 
in  one  case  was  there  a tendency  to  fall  or  lurch 
to  one  side  while  walking. 

Drowsiness  during  the  day  and  insomnia  at 
night  is  perhaps  the  most  consistent  symptom  in 
this  condition.  The  insomnia  is,  of  course,  only 
an  early  symptom  and  may  later  be  followed  by  a 
tendency  to  sleep  all  the  time.  Mild  depression  or 
delirium  and  irrational  states  were  present  in 
eight  cases. 

Muscular  soreness  and  shooting  pains  of  the 
radicular  type  occur,  but  not  as  commonly  as  in 
the  acute  types  of  encephalitis.  Pain,  soreness 
and  subjective  stiffness  of  the  neck  occur.  Eye 
symptoms  are  commonly  limited  to  transitory 
diplopia  and  blui-ring  of  vision;  distortion  of  ob- 
jects and  disturbance  in  color  sense  are  less  com- 
mon symptoms. 

The  objective  findings  resemble  those  found  in 
the  epidemic  forms  of  encephalitis.  Masked  facies 
is  present.  Eye  symptoms  are  nearly  always 
noted  but  are  transitory  in  character;  ptosis, 
nystagmus  and  blurring  of  the  disc  are  common, 
and  weakness  of  the  abducens  nerve  is  often  noted. 
Some  degree  of  neck  rigidity  is  universally  pres- 


767 


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The  Ohio  State  Medical  Journal 


December,  1933 


ent.  Cogwheel  rigidity  is  noted  in  the  more 
severe  types,  and  Hoffman’s  sign  is  quite  com- 
mon. The  abdominal  reflexes  are  often  absent  or 
cannot  be  elicited  in  one  or  more  quadrants. 
Babinski’s  sign  is  usually  obtained  but  may  vary 
from  day  to  day  or  appear  on  alternate  sides  at 
different  times.  Lasque’s  sign  has  not  been  noted. 

Despite  the  apparent  myotonia,  deep  muscle  re- 
flexes are  usually  somewhat  exaggerated  and 
have  never  been  decreased.  Glossopharyngeal 
paralysis  has  been  noted  only  once,  but  slight 
difficulty  in  swallowing  is  somewhat  more  common. 

Spinal  fluid  changes  are  increased  pressure  and 
cell  counts.  The  count  ranged  from  11  to  78  in 
this  series.  Increase  of  globulin  and  total  pro- 
tein and  a luetic  type  of  gold  curve  was  present 
in  every  case  tested ; xanthromia  and  frank 
hemorrhage  was  not  noted  in  any  case. 

A few  of  the  typical  cases  seen  since  the  last 
report  in  1929  will  be  summarized. 

Case  1.  Mrs.  S.  H.,  St.  Vincent’s  Hospital  No. 
7921.  Female,  housewife,  age  60. 

History:  Patient  was  a diabetic  under  treat- 

ment since  1923;  required  22  units  of  insulin 
daily.  For  many  years  had  a procidentia  sup- 
ported by  a pessary.  Was  seen  September,  1927, 
because  of  profuse  bleeding  from  an  ulcerated 
cervix.  Vaginal  hysterectomy  was  done  Septem- 
ber 11,  1927. 

Pathological  report  showed  ulceration  and  ero- 
sion, infected  endometrium,  but  no  malignancy. 

Convalescence  seemed  quite  normal  until  Sep- 
tember 25  when  patient  complained  of  pain  in  the 
abdomen  and  desire  to  urinate  frequently,  drowsi- 
ness and  dimness  of  vision. 

Examination:  Patient  is  drowsy;  bilateral 

ptosis  present;  seems  to  fatigue  easily  while  an- 
swering questions  and  drops  off  to  sleep.  Ba- 
binski  present  on  right  side,  neck  slightly  rigid. 

Sugar  began  to  appear  in  the  urine  despite  de- 
crease in  food  intake  and  increase  in  insulin  dos- 
age to  30  units  daily.  Acetone  appeared  and 
gradually  increased  in  quantity.  Ptosis  increased, 
drowsiness  marked,  speech  defect  became  notice- 
able and  aphasia  developed.  Swallowing  became 
progressively  more  difficult  until  patient  was  un- 
able to  take  even  liquid  nourishment  and  was  sus- 
tained by  glucose  and  saline  solutions  under  the 
skin  and  in  the  vein.  Neck  became  very  rigid,  ab- 
dominal reflexes  were  absent,  and  bilateral  Ba- 
binski  present.  Cog-wheel  rigidity  of  arms 
was  noted.  The  fundus  was  negative.  Upper 
right  rectus  rigidity  and  tenderness  were  elicited 
even  when  she  was  in  a stupor. 

Laboratory  data:  Blood  sugar,  after  hysterec- 
tomy, varied  from  0.087  to  0.132  mgs.  percent. 
Sept.  21,  four  days  after  symptoms  of  encepha- 
litis appeared,  blood  sugar  was  170  mgs.  per  100 
cc.  and  finally  rose  to  267  mgs.  on  October  12. 

White  count:  12,600  on  Sept.  25;  11,900  on 
Sept.  27. 

Blood  chemistry,  October  3:  NPN  46  mgs.; 

urea,  23  mgs.;  creatinine,  1.6  mgs. 

Spinal  fluid:  Sept.  28,  Cell  count  3;  Globulin,  a 

trace;  Gold  curve,  Oct.  3,  Cell  count 

13;  Globulin,  one  plus;  Gold  curve,  

Oct.  9,  Cell  count  18;  Globulin,  one  plus;  Gold 
curve  0012233210. 

The  diagnosis  of  active  cholecystitis  with  a sec- 
ondary encephalitis  was  made  and  operation  ad- 


vised. Dr.  L.  A.  Levison  saw  the  case,  and  con- 
curred in  the  diagnosis.  A consultant  from  out 
of  the  state  was  called  and  diagnosed  cerebral  vas- 
cular disease  and  gave  a bad  prognosis.  Opera- 
tion was  delayed  a few  days,  but  consent  was 
finally  obtained.  Under  local  anesthesia  a simple 
cholecystostomy  was  done.  A very  large,  thick 
walled  gallbladder,  containing  inspissated  bile  was 
found.  Drainage  was  instituted.  Culture  from 
scrapings  of  the  gallbladder  wall  showed  a pure 
culture  of  staphylococcus. 

Convalescence  was  stormy  for  one  week  because 
of  a cardiac  problem  which  developed  after  opera- 
tion. At  the  end  of  one  week  the  patient  was 
much  improved,  she  took  nourishment,  was  able  to 
speak  clearly.  Some  confusion  was  present  for 
another  week,  after  which  convalescence  was 
rapid. 

The  diabetes  gave  no  further  trouble,  and  on 
December  1 she  left  the  hospital  on  a diet  of  pro- 
tein 52,  fat  120,  carbohydrates  65,  and  taking  only 
ten  units  of  insulin  once  daily. 

For  nearly  three  and  one-half  years  she  was 
well,  enjoying  a life  of  full  activity.  She  then  de- 
veloped a carcinoma  of  the  stomach  from  which 
she  recently  died. 

Case  2.  Mrs.  A.  B.,  age  69,  widow. 

Has  been  under  care  since  September,  1925. 
She  measures  5 ft.  2 in.  and  weighs  190  pounds. 
Blood  pressure  was  240/120.  Heart  considerably 
enlarged  and  E.  K.  G.  showed  right  bundle  branch 
block.  She  responded  only  indifferently  to  dietetic 
directions  but  did  reduce  her  weight  to  168  pounds 
and  following  the  weight  reduction  her  blood  pres- 
sure ranged  between  165  and  212  systolic  and  96 
and  120  diastolic. 

I was  called  to  see  her  at  Marion,  Indiana, 
March  10,  1931.  History  obtained  was  as  fol- 
lows : 

For  three  months  she  had  been  weak,  tired,  and 
drowsy.  For  days  at  a time  she  had  been  irra- 
tional and  was  with  difficulty  kept  in  bed.  She 
would  insist  on  getting  up  to  keep  an  imaginary 
appointment  at  my  office.  She  did  not  recognize 
her  family.  She  had  involuntaries  of  both  blad- 
der and  bowels.  Blood  pressure  ranged  between 
180  and  220  systolic.  Blood  chemistry  was  within 
normal  limits,  and  urine  showed  only  a trace  of 
albumin. 

Examination:  The  patient  did  not  recognize 

me.  She  was  muttering  constantly  and  was  in  a 
state  of  agitation  and  was  held  by  restraint 
sheets.  Neck  was  moderately  rigid,  facies  mask- 
like. Lungs  were  clear  and  heart  showed  no 
changes  other  than  those  previously  noted. 
There  was  no  cyanosis  or  dyspnoea.  Tongue  dry 
and  coated.  Liver  was  palpable  three  finger- 
breadths  below  the  costal  border  and  seemed 
quite  tender;  and  I thought  I could  feel  a dis- 
tended gallbladder.  Pelvis  negative.  No  edema 
present. 

Reflexes:  Abdominal  could  not  be  obtained; 

cog-wheel  rigidity  of  both  arms;  Babinski  on 
both  sides. 

Fundus  showed  moderate  sclerosis  and  tortu- 
osity of  vessels,  but  no  hemorrhages,  slight  blur- 
ring of  both  discs. 

Blood:  Red  cells,  4,600,000;  white  cells,  11,200. 

Urine:  Albumin  1 plus;  no  sugar;  indican  1 

plus;  urobilinogen  positive  in  1-50  dilution. 

Blood  pressure  215/105. 

Spinal  fluid  seemed  under  increased  pressure; 
cell  count  22;  globulin  increased. 

The  differential  diagnosis  between  uremia, 


December,  1933 


Chronic  Encephalitis — Salzman 


769 


cerebral  arteriosclerosis  and  cholecystitis  with 
chronic  encephalitis  need  not  be  gone  into  here. 
The  final  diagnosis  arrived  at  was  cholecystitis, 
with  cholelithiasis  and  chronic  encephalitis. 

A large  gallbladder,  containing  six  stones,  was 
found  at  operation.  Gallbladder  drainage  was 
instituted.  At  the  end  of  one  week  the  patient 
was  rational,  eating  well,  and  co-operative.  She 
left  the  hospital  at  the  end  of  three  weeks,  fully 
recovered. 

Now,  after  more  than  two  and  a half  years, 
and  at  the  age  of  seventy-two,  this  patient  is  as 
well  as  her  hypertension  and  cardiac  condition 
will  permit. 

Case  S.  Mrs.  M.  A.  S.,  age  67.  Housewife. 
St.  Vincent’s  Hospital  No.  5694.  Seen  July  28, 
1932. 

History:  For  several  weeks  she  had  been 

getting  progressively  weaker;  complained  of  pain 
under  right  costal  border  going  to  right  shoulder ; 
for  past  week  vision  had  been  blurred  and  ob- 
jects appeared  green,  black,  or  yellow.  Memory 
poor,  and  had  difficulty  in  expressing  her 
thoughts,  chiefly  due  to  inability  to  find  the  right 
word.  When  left  alone,  promptly  fell  asleep, 
but  was  easily  roused. 

Examination:  Masklike  facies  noted;  pupils 

react  sluggishly  to  light  and  accommodation. 
Teeth  all  out.  Throat  negative.  Neck  slightly 
rigid.  Lungs  and  breast  negative.  Heart  not 
enlarged;  tones  clear;  systolic  murmur  at  apex; 
no  widening  at  base  of  heart.  Blood  pressure 
148/84.  Vessels  moderately  sclerosed.  Abdomen: 
Liver  palpable  two  fingerbreadths  below  costal 
border;  tenderness  present.  Spleen  not  palpable; 
kidney  in  normal  position.  Pelvis  normal. 

Reflexes:  Neck  rigid;  abdominal  reflexes  ab- 
sent; Babinski  pi’esent  on  right  side.  Knee  jerks 
normal  or  slightly  diminished.  Fundus  showed 
slight  blurring  of  discs  and  moderate  tortuosity 
of  vessels. 

Temperature  ranged  between  99  and  100.4;  had 
one  chill.  Pulse  varied  from  64  to  84,  respiration 
from  18  to  26. 

Laboratory  data:  Stools  negative  for  occult 

blood.  Urine,  specific  gravity  1010  to  1020;  trace 
of  albumin  and  occasional  hyaline  cast.  Red 
blood  cells,  3,830,000;  white  cells,  11,850;  hemo- 
globin 85%.  Wassermann  and  Kahn  tests,  on 
blood,  negative. 

Spinal  puncture:  Cell  count  54  cells  per  cc.; 
total  protein  71  mgs.;  gold  curve  0001223210. 

Graham-Cole  cholecystogram  showed  a large 
gallbladder,  with  delayed  emptying  time ; no 
stones. 

Diagnosis:  Chronic  cholecystitis  with  chronic 

encephalitis.  Operation  disclosed  a large,  dis- 
tended, tense  gallbladder.  Enlarged  glands  were 
present  along  the  cystic  duct.  Section  was  re- 
moved for  study,  and  drainage  instituted. 

Pathological  report:  Gallbladder  shows  con- 

siderable congestion  of  vessels,  minute  hemor- 
rhagic areas  present;  crypts  infected  and  sur- 
face epithelium  denuded  and  considerable  fibrosis 
present,  indicating  chronic  infection.  Diagnosis: 
Chronic  active  cholecystitis.  Culture  from  gall- 
bladder and  bile  were  reported  negative. 

This  patient  was  a very  excellent  example  of 
the  association  between  the  character  of  the  bile 
obtained  from  the  drainage  tube  and  the  clin- 
ical condition  of  the  patient,  a phase  which  will 
be  taken  up  later.  Except  for  these  variations, 
this  patient  made  an  excellent  recovery  and  left 


the  hospital  in  three  weeks.  She  has  remained 
completely  well. 

Case  4-  Mi's.  H.  P.,  housewife,  46  years  old. 

History:  Has  had  pain  in  epigastrium  and  be- 

tween shoulder  blades  for  several  months.  Be- 
fore this,  for  years  she  had  qualitative  indigestion. 
Recently  she  has  become  very  nervous,  irritable, 
and  while  she  is  drowsy  during  the  day,  insomnia 
is  present  at  night.  Her  sleep  is  fitful  and  dis- 
turbed by  vivid  and  unpleasant  dreams.  Diplopia 
and  disturbances  in  vision  noted;  particularly,  she 
states  that  at  various  times  objects  seem  colored. 
She  is  forgetful  and  finds  it  difficult  to  talk  co- 
herently, forgetting  what  she  started  to  say,  and 
frequently  repeats  sentences.  At  times,  uncon- 
trollable twitching  and  jerking  of  arms  and  legs 
are  present  and  are  noted  by  the  family  when  she 
sleeps.  Has  lost  25  pounds  in  weight.  Strength 
loss  considerable.  Walking  is  difficult,  she  stag- 
gers frequently. 

Examination:  Neck  moderately  rigid.  Pupils 

are  equal  and  react  to  light  and  in  accommoda- 
tion; nystagmus  present,  direction  not  noted. 
Ptosis  of  both  eyelids  is  present.  Teeth  show 
some  pyorrhea.  Thyroid  gland  slightly  enlarged. 
Lungs  negative.  Heart  enlarged,  apex  beat  10 
cms.  to  the  left  of  mid-sternal  line;  impulses 
forceful,  tones  at  apex  clear  and  of  good  quality. 
Soft  systolic  murmur  present  along  left  border  of 
sternum  and  heard  at  apex,  not  transmitted  to 
left.  Width  at  base  not  increased.  A2  accentu- 
ated; no  murmur.  Blood  pressure  180/96.  Blood 
vessels  moderately  thickened.  Abdomen:  Liver 

just  palpable;  tenderness  under  right  costal  bor- 
der quite  marked  and  upper  right  rectus  rigidity 
is  definite.  Balance  of  abdomen  is  negative.  Pel- 
vis: Small  fibroid  of  uterus  present.  Extremities 
normal.  No  tremor  is  present;  Lehey  sign  nega- 
tive. Skin  is  harsh  and  dry. 

Reflexes : Abdominal  not  obtainable.  Knee 

jerks  diminished;  no  pathological  reflexes  present. 

Laboratory  data:  Red  blood  cells  4,170,000; 

white  blood  cells  8200;  hemoglobin  75  per  cent. 
Differential  count:  Polys  64  per  cent;  lymphs 

33  per  cent;  many  transitionals. 

Sedimentation  rate:  20  per  cent  in  30  minutes; 
36  per  cent  in  60  minutes. 

Blood  chemistry:  NPN  35.2  mgs.  per  hundred 
cc.;  creatinine  1.6  mgs.;  sugar  102  per  cent. 
Blood  Wassermann  is  negative. 

Spinal  fluid:  Cell  count,  15;  total  protein  60 
mgs.,  sugar  40  mgs.  per  100  cc.  Gold  curve 
0112233210.  Wassermann  negative. 

Metabolism  60  per  cent.  This  high  metabolic 
reading  was  disregarded  as  patient  had  been  told 
that  she  had  a goiter  and  was  extremely  nervous 
and  fearful;  and  when  taken  in  connection  with 
her  slow  pulse,  which  ranged  between  66  and  84 
during  ten  days  observation  at  the  hosiptal,  her 
dry  skin,  lethargy  and  drowsiness,  a toxic  goiter 
could  easily  be  ruled  out. 

.Y-ray  study:  Gastro-intestinal  tract  reported 

negative.  Cholecystogram  showed  a normal  gall- 
bladder. 

Diagnosis:  Hypertension,  cardiac  hypertrophy, 
moderate  arterio-sclerosis,  colloid  goiter,  chronic 
cholecystitis  with  chronic  encephalitis. 

Despite  the  negative  cholecystogram,  the  gall- 
bladder was  considered  to  be  actively  infected; 
and  as  the  patient  did  not  respond  to  conservative 
measures  and  had  been  ill  a long  time,  operation 
was  done  November  9,  1931. 


770 


The  Ohio  State  Medical  Journal 


December,  1933 


Surgeon’s  notes:  Gallbladder  large  and  tense; 
could  not  be  emptied  by  pressure.  Many  glands 
along  the  ducts.  Gallbladder  was  removed. 

Pathologist’s  report:  Gallbladder  wall  edemat- 
ous; mucosa  highly  congested.  Microscopically, 
the  wall  of  gallbladder  shows  active  edema  and 
scattered  areas  of  inflammatory  cell  infiltration 
are  noted.  Crypts  contain  a muco-cellular  exudate. 
The  folds  are  denuded  of  epithelium.  Pathologic 
diagnosis:  Chronic  active  cholecystitis. 

Patient  made  an  uninterrupted  recovery,  and 
while  still  complaining  of  fullness  in  the  neck 
(due,  probably,  to  fear  of  goiter)  she  is  well. 

Case  5.  Sister  C.  Nun,  Tiffin,  Ohio.  35  years 
old.  Seen  Sept.  13,  1932. 

History:  Distress  in  epigastrium  three  to  four 

hours  after  meals,  relieved  by  food.  She  noted 
tarry  stools  during  May  and  June.  Constipation 
present.  Lost  ten  to  twelve  pounds  in  weight.  No 
vomiting,  but  much  nausea.  Very  nervous  and 
irritable.  Easily  fatigued.  Had  nervous  break- 
down five  years  before,  with  similar  group  of 
symptoms.  No  other  illness  in  past. 

The  diagnosis  of  duodenal  ulcer  was  not  veri- 
field  by  the  Z-ray  and  the  gallbladder  was  re- 
ported as  normal.  Nevertheless,  she  was  put  upon 
an  ulcer  regimen  with  apparent  relief  of  abdomi- 
nal symptoms. 

On  October  18  she  wrote  stating  that  she  was 
not  well,  but  that  her  symptoms  had  changed. 

Present  complaint:  Feels  depressed,  tired  and 
weak;  has  pain  in  right  shoulder  and  back,  pain 
being  worse  when  in  bed.  Has  noted,  too,  tremb- 
ling of  arms  and  legs,  bloating  after  meals,  but 
no  epigastric  pain,  and  a disagreeable  taste  in 
the  mouth.  Insomnia  and  restless  sleep,  and 
awakens  with  a start  from  sound  sleep. 

She  was  entered  at  St.  Vincent’s  Hospital  for 
study,  Hospital  No.  70242. 

Examination  at  this  time  revealed  the  follow- 
ing additional  signs:  Moderate  rigidity  of  neck; 
diplopia,  no  other  eye  phenomena;  Hoffman’s 
sign  constant  on  right  side,  absent  on  left;  Babin- 
ski  constant  on  left  side;  abdominal  reflexes 
present  first  two  days  of  hospital  stay,  then  dis- 
appeared. 

Laboratory  data:  Urine  1020;  negative  for 

albumin,  sugar;  urobilinogen  1 plus  at  1-30  dilu- 
tion. Blood:  Red  cells,  3,870,000;  Hb.  75  per 

cent;  white  cells,  10,800.  Differential  count: 
Neutrophiles  72  per  cent,  (non-filament  forms 
20  per  cent)  ; lymphocytes  25  per  cent;  eosino- 
philes  1 per  cent;  fragile  cells  2 per  cent. 

Z-ray  recheck  of  gallbladder,  Nov.  7:  Gall- 

bladder again  reported  negative. 

Spinal  punctui-e:  Pressure  80  mm.  Cell  count 
8 ; total  protein  50  mgs.  Gold  cuxwe  showed  change 
only  in  4th  and  5th  tubes. 

Lai’ge  quantities  of  pi’oteose  isolated  from  the 
ui’ine  in  this  patient,  (vide  infra) . 

Metabolism  plus  11  per  cent. 

The  diagnosis  of  chronic  cholecystitis  with 
early  encephalitis  was  made  on  clinical  findings 
and  the  spinal  fluid. 

Operation  was  done  and  a very  thickwalled 
gallbladder,  adherent  to  the  duodenum  was  found 
and  removed. 

Pathological  x-epoi't:  Gallbladder  shows  some 

edema;  walls  thickened;  mucosa  granular.  Mi- 
croscopically the  wall  shows  distended  and  con- 
gested blood  vessels,  considerable  edema,  infected 


crypts.  Folds  of  mucosa  flattened;  epithelium  par- 
tially denuded.  Diagnosis,  chronic  active  chole- 
systitis. 

Convalescence  uneventful.  This  patient  felt  un- 
usually well  by  the  third  day  and  volunteei’ed  the 
information  that  she  now  realized  that  her  mem- 
ory had  been  vei-y  poor  for  some  weeks,  and  that 
a queer  sensation  at  the  back  of  the  head  was 
gone. 

This  patient  was  unusual  in  that  she  had  local 
abdominal  symptoms  and  discomfort.  The  ma- 
jority of  the  cases  of  encephalitis  I have  seen  do 
not  have  sufficient  discomfort  in  the  abdomen  to 
call  the  physician’s  attention  to  this  part  of  the 
body. 

There  ai-e  ceiffain  facts  in  connection  with  the 
x'ecovei'y  of  these  cases  worthy  of  note. 

It  was  noted  in  all  cases  of  encephalitis  in 
which  cholecystostomy  was  done,  that  the  clinical 
improvement  of  the  patient  could  be  predicted  by 
inspection  of  the  di’ainage  bottle.  In  all  cases  only 
slight  improvement  in  the  mental  pictui'e  and  in 
the  disappeai’ance  of  abnormal  reflexes  was  noted 
while  the  bile  drainage  was  dai’k  blown  or  black. 
Very  decided  improvement  was  noted  immediately 
after  the  color  of  the  bile  became  light  yellow  or 
golden  brown.  Usually  this  occurred  by  the  third 
day. 

Occasionally,  as  in  Case  3,  after  the  bile  be- 
came light  in  color  and  the  patient  appeared 
clear  mentally  and  seemed  much  improved,  the 
bile  suddenly  became  again  vei'y  dark.  Co-inci- 
dental with  this  inci’ease  in  the  density  of  the 
bile,  the  patient  became  befogged  mentally,  talked 
irrationally,  and  would  not  l’espond  to  questions 
nor  pay  any  attention  to  her  sux-roundings.  The 
following  day  the  bile  was  again  clear  and  light 
color,  and  the  patient  much  better.  She  remai’ked 
to  me,  “I  was  ‘goofy’  yesterday”.  This  association 
between  the  character  of  the  bile  and  the  mental 
state  of  the  patient  is  so  cleai’-cut  that  even  the 
internes  on  the  service  have  learned  to  use  it  as 
a guide  in  pi’edicting  the  impi’ovement  in  the 
clinical  picture  of  the  case. 

Case  5 called  attention  to  what  has  been  men- 
tioned in  an  eaxdier  publication.  No  history  could 
be  obtained  fi’om  this  patient  of  any  unusual 
sensory  distui’bance  or  mental  let-down.  However, 
on  the  third  day  following  opei’ation  she  re- 
marked,  “A  peculiar,  numb  feeling  I had  at  the 
back  of  my  head  for  months,  is  gone.  Also,  I 
realize  my  memory  has  been  poor  for  a long  time. 
My  head  seems  to  feel  clear  for  the  first  time  in 
months.” 

It  is  not  at  all  uncommon  for  these  patients  to 
be  so  below  par  mentally  that  they  cannot  give  a 
clear  history  until  after  the  opei’ation  is  done  and 
they  ai’e  on  the  l’oad  to  recovery. 

Except  for  a veiy  few  cases,  whei'e  the  illness 
was  of  unusual  severity  (cases  1 and  2)  and  gen- 
ei’al  debility  was  quite  max-ked,  all  these  patients 
wei-e  able  to  leave  the  hospital  at  the  end  of  two 
weeks,  completely  l’ecovei'ed. 

When  we  appi’eciate  that  most  of  these  patients 


December,  1933 


Chronic  Encephalitis — Salzman 


771 


had  been  ill  for  weeks  and  usually  for  many 
months,  we  cannot  help  but  feel  that  there  is  a 
direct  association  between  the  encephalitis  and  the 
infection  which  was  present  in  the  biliary  tract  in 
these  cases. 

This  rapid  and  complete  recovery  naturally 
brings  up  the  question  of  the  nature  of  this  type 
of  encephalitis. 

The  three  possible  causes  are: 

First:  Bacterial: 

The  objections  to  this  explanation  were  fully 
gone  into  in  my  previous  publications  and  the 
limited  time  prevents  their  repetition  here.  Since 
the  oi’iginal  publication  has  appeared  so  many 
types  and  varieties  of  encephalitis  have  been  re- 
ported that  several  dozen  viruses  must  be  pre- 
supposed in  order  to  explain  the  great  number  of 
encephalitides  reported. 

Second : Toxic : 

A neurotoxin  as  the  cause  of  this  type  of  en- 
cephalitis must  be  considered.  Vincent5  has  re- 
ported the  isolation  of  an  exotoxin  from  the  colon 
bacillus.  None  of  our  cases  showed  colon  bacillus 
in  the  culture,  and  B.  coli  is  a very  rare  organism 
in  gallbladder  infections. 

Third,  Allergic: 

In  an  earlier  paper  the  possible  allergic  nature 
of  the  syndrome  under  consideration  was  men- 
tioned and  an  attempt  was  made  to  verify  this 
theory  by  isolating  secondary  proteoses  from  the 


urine'1  and  making  intracutaneous  tests  in  five 
dilutions.  This  was  done  on  patient  No.  5.  She 
reacted  to  three  dilutions,  1:100,  1-1000,  and 

1-10,000,  with  well  marked  wheals,  pseudopods, 
areolae  and  edema  developing  within  a few  min- 
utes at  each  site.  Similar  tests  on  twelve  con- 
trols were  negative. 

A more  detailed  report  of  this  phase  of  the 
subject  is  given  in  another  paper.7 


SUMMARY 

(1) .  There  is  a form  of  chronic  encephalitis  in 
association  with  infection  in  the  gallbladder. 

(2) .  The  encephalitis  is  promptly  cured  by  re- 
lieving the  biliary  tract  infection. 

(3) .  Five  cases  are  reported  in  detail. 

(4) .  Some  proof  of  the  allergic  nature  of  this 
type  of  encephalitis  is  presented. 

1708  Jefferson  Avenue. 


BIBLIOGRAPHY 

1.  Salzman,  S.  R. — Relation  of  Gallbladder  Infection  to 
Encephalitis.  Medical  Journal  and  Record.  July  2,  1924. 

2.  Is  Encephalitis  an  Infectious,  Epidemic  Disease? 
Archives  of  Neurology  and  Psychiatry.  Nov.,  1925.  Vol.  14, 
P.  230. 

3.  A Further  Experience  in  the  Etiology  and  .Treatment 
of  Encephalitis.  Annals  of  Medicine:  Vol.  2,  No.  10,  P.  1076. 
April,  1929. 

4.  McIntyre,  H.  D.  Ohio  State  Medical  Jr.,  Vol.  29, 
No.  4,  1933.  P.  239. 

5.  Vincent,  H.  American  Journal  of  Med.  Science,  Vol. 
183,  March,  1932.  P.  301. 

6.  Oriel,  G.  H.,  Barber,  H.  W.  The  Lancet,  1930.  No. 
2,  P.  231. 

7.  Annals  of  Medicine — To  be  published. 


Lead  Poisoning  Followed  by  Diffuse  Vascular  Disease 

Zolton  T.  Wirtschafter,  M.D.,  Cleveland,  Ohio 


THE  existence  of  a relationship  between  lead 
poisoning  and  hypertension,  together  with 
the  coincidence  of  renal  disease,  has  for  a 
long  time  been  a much  debated  queston.  Both 
clinically  and  experimentally,  conflicting  results 
have  been  obtained. 

Dominguez1,  after  administering  lead  to  rabbits, 
concluded  from  the  pathological  examination  of 
the  circulatory  system  and  kidneys,  and  from  ob- 
servations on  blood  pressure  by  the  van  Leersum 
method,  that  acute  lead  poisoning  is  not  accom- 
panied by  a rise  in  blood  pressure  in  rabbits.  He 
found  but  one  animal,  in  which  the  calcification  of 
the  small  vessels  of  the  kidney  and  the  glomerular 
destruction  were  pronounced,  that  developed  a 
pathologically  high  blood  pressure.  His  results 
agreed  with  the  idea  of  an  intimate  relationship 
between  the  vascular  apparatus  of  the  kidney  and 
high  blood  pressure.  According  to  Petroff",  how- 
ever, both  acute  and  chronic  plumbism  produce  a 
persistent  hypertension  in  the  rabbit  and  in  the 
dog.  Beckman'1  was  also  able  to  produce  hyper- 

Read  before  the  Section  on  Public  Health  and  Preventive 
Medicine,  Ohio  State  Medical  Association,  at  the  87th 
Annual  Meeting,  Akron,  September  7 and  8,  1933. 


tension  in  rabbits  by  acute  lead  intoxication.  The 
mechanism  of  the  acute  hypertension  has  been  at- 
tributed to  a vasoconstriction  produced  by  the 
direct  action  of  lead  on  the  vascular  musculature. 
This  has  been  demonstrated  by  Tscherkess1  on 
isolated  organs  of  rabbits,  by  perfusion  with  lead 
acetate  and  nitrate  in  concentrations  of  from 
1:1000  to  1:10,000,000.  Vasoconstriction  occurred 
even  after  the  ganglia  had  been  excluded  by 
nicotine,  and  the  sympathetic  nerve  endings  with 
apocodeine,  indicating  that  the  action  of  the  lead 
was  directly  on  the  vascular  musculature.  Elsch- 
nig5  observed  constriction  of  the  retinal  arteries 
in  a painter  suffering  from  acute  lead  poisoning. 

Chronic  lead  intoxication  has  been  demonstrated 
clinically  to  be  associated  with  arterial  hyper- 
tension. Thus,  Allbutt  and  Gibson6,  Harris7,  Hay- 
hurst8,  and  Feil  and  Balsac9  have  found  hyper- 
tension to  be  present,  as  a rule,  in  workers  exposed 
to  lead  over  long  periods  of  time.  Mayers10,  in  a 
survey  of  lead  workers  in  New  York,  concluded 
that  (a)  “it  does  seem  as  though  there  may  pos- 
sibly be  some  relationship  between  the  action  of 
the  lead  on  the  neurovascular  system  and  the 
hyptertension  which  is  found  among  these  lead 


772 


The  Ohio  State  Medical  Journal 


December,  1933 


workers,  (b)  the  incidence  of  arteriosclerosis  is 
relatively  high  among  all  workers  of  the  social 
and  economic  classes  from  which  lead  workers  are 
recruited,  and  (c)  the  part  which  prolonged  ex- 
posure to  lead  plays  in  the  production  of  this 
arteriosclerosis  is  questionable”. 

CASE  REPORT 

In  the  case  which  is  to  be  presented  at  this  time, 
the  diagnosis  of  lead  poisoning  was  beyond  ques- 
tion. The  patient  was  closely  observed  for  four 
years  after  the  inception  of  the  condition  until 
death  occurred.  This  man,  a painter,  presented 
himself  at  Cleveland  City  Hospital  in  1926  suffer- 
ing  from  an  acute  attack  of  lead  poisoning.  At 
this  time  he  was  42  years  of  age  and  had  been 
working  continuously  with  lead  for  the  past  25 
years. 

He  was  admitted  to  the  Hospital  with  the  com- 
plaint of  weakness  and  paralysis  of  both  wrists 
of  seven  days’  duration.  His  past  history  and 
family  history  were  essentially  negative.  Sig- 
nificant physical  findings  were  as  follows — Severe 
dental  caries  and  pyorrhea  alveolaris  were  pres- 
ent. A blue  margin  was  present  at  the  bases  of 
the  lower  front  teeth.  The  apex  beat  was  in  the 
fifth  interspace  in  the  nipple  line.  Blood  pressure 
was  140/80  mm.  of  Hg.  The  radial  arteries  were 
not  sclerotic.  There  was  a complete  paralysis  of 
the  radial  innervation  of  the  left  forearm  and 
hand  and  of  the  flexors  and  extensors  of  the 
right  forearm.  The  intensity  of  the  grip  of  the 
hands  was  markedly  diminished.  Urine  was  nor- 
mal except  for  an  occasional  hyaline  cast.  There 
was  a marked  secondary  anemia  as  evidenced  by 
an  erythrocyte  count  of  3,112,000  and  hemoglobin 
of  80  per  cent.  There  was  a moderate  degree  of 
anisocytosis,  poikilocytosis,  and  basophilic  stip- 
pling. The  leukocyte  count  was  9,6000.  The  Was- 
serman  reaction  was  negative.  The  patient  was 
placed  on  calcium  therapy  and  was  discharged 
from  the  hospital  showing  no  marked  signs  of  im- 
provement. 

During  the  four-year  interval  between  the  acute 
attack  and  the  onset  of  the  final  illness,  his  ac- 
tivity was  limited,  the  patient  working  only  six 
months  during  this  time.  The  patient’s  final  ill- 
ness had  its  onset  four  months  before  death  occur- 
red. At  that  time  he  had  an  occipital  headache 
for  one  day  which  was  followed  the  next  day  by 
nausea  and  vomiting.  He  also  complained  of 
nervousness  and  occasional  mental  confusion. 

Significant  physical  findings  at  this  time  were 
as  follows — Fundic  examination  showed  some 
blurring  of  the  disc  margin.  The  retinal  arteries 
were  not  tortuous,  but  they  were  reduced  in  size 
with  some  nicking  of  the  veins.  Although  the 
teeth  were  very  carious  and  there  was  marked  re- 
cession of  the  gums,  there  was  no  evidence  of  a 
lead  line.  The  left  border  of  cardiac  dullness  was 
9.5  cm.  from  the  mid-sternal  line.  Blood  pressure 
varied  from  190/110  to  210/125  mm.  Amyl 
nitrite  administration  failed  to  lower  the  blood 
pressure.  The  grasp  of  both  hands  was  below 
normal,  especially  on  the  right.  Renal  function 
tests  showed  marked  insufficiency.  Thus,  the 
phenolsulphonphthalein  excretion  was  only  25  per 
cent  in  two  hours.  Mosenthal  test  showed  an  al- 
most complete  fixation  of  specific  gravity,  with 
the  night  volume  being  60  per  cent  of  the  day 
volume.  The  Volhard-Fahr  concentration  test 
showed  an  inability  to  concentrate  beyond  1.016. 
Blood  chemistry  examinations  showed  a moderate 
degree  of  nitrogen  retention.  Thus,  the  urea 
nitrogen  averaged  about  28.6  (3  determinations) 


while  the  creatinine  was  3.2  mg.  per  100  cc.  There 
was  a severe  secondary  anemia.  Differential 
smear  was  entirely  normal,  showing  no  stippling, 
anisocytosis  or  poikilocytosis.  Urinalysis  showed 
a clear  acid  urine  containing  occasional  fine  gran- 
ular casts  and  a large  amount  of  albumin  on  sev- 
eral occasions.  The  condition  of  the  patient  im- 
proved slightly  and  he  was  discharged  10  days 
after  admission. 

LABORATORY  DATA 
Amyl  Nitrite  Administration 


Minutes 

Blood  Pressure 

0 

210/120 

2% 

260/130 

4 

245/125 

5 

220/120 

Mosenthal  Test: 

ts 

V 

c 

e 

e 

O 

e 

o 

« 

c 

u 

S 

*« 

4> 

3 

u 

d 

Sediment 

Qi 

03 

> 

« 

O, 

03 

10:00  A.M. 

260  cc. 

Acid 

1.011 

1 plus  Occasional  fine 

small  granular 

12  :00  N. 

140 

Acid 

1.010 

1 plus  cast 

2:00  P.M. 

90 

Acid 

1.009 

1 plus 

4 :00  P.M. 

195 

Acid 

1.008 

1 plus 

6 :00  P.M. 

205 

Acid 

1.010 

Trace 

8:00  P.M. 

190 

Acid 

1.007 

Trace 

8:00  A.M. 

640 

Acid 

1.011 

2 plus  Occasional  fine 

— 

granular  cast 

1710  cc. 

Volhard-Fahr  Concentration  Test: 


Specimen 

Volume 

Specific  Gravity 

11  A.M. 

171  cc. 

1.011 

2 P.M. 

200 

1.015 

5 P.M. 

140 

1.016 

8 P.M. 

126 

1.015 

8 A.M. 

460 

1.016 

1097  cc. 


Blood  Chemistry  Analyses: 


Date 

11-11-30 

11-13-30 

11-20-30 

Urea  Nitrogen 

31.9 

27.3 

26.7 

Creatinine 

3.3 

3.1 

3.2 

Sugar 

C02  Content 

85.0 

59.5 

Urea  Clearance 

(cc.  per  Min.) 

18.3 

14.0 

pH 

7.33 

Plasma  NaCl 

611.0 

Calcium 

9.3 

Blood  Counts: 

Erythi’ocytes  2,830,000 

Leucocytes  5,750 

Hemoglobin  55% 

Six  weeks  after  being  discharged  from  the  hos- 
pital, the  patient  was  readmitted  in  a comatose 
condition,  showing  a typical  left  hemiplegia. 
During  his  stay  in  the  hospital  his  blood  pressure 
varied  from  195/110  to  244.140  (on  admission). 
Urinalysis  revealed  large  amounts  of  albumin. 
Nitrogen  retention  was  much  more  severe  than  on 
his  previous  admission.  A working  diagnosis  of 
diffuse  vascular  disease  with  hypertension, _ to- 
gether with  cerebral  hemorrhage  into  the  right 
cortex,  was  made  on  admission.  Thirteen  days 
after  admission,  the  patient  expired.  (1-29-31). 


December,  1933 


Lead  Poisoning- 


-WlRTSCHAFTER 


773 


LABORATORY  DATA 


Blood  Chemistry  Analyses: 


Date 

1-16-31 

1-17-31 

1-21-31 

Urea  Nitrogen 

46.1 

40.2 

72.8 

Creatinine 

5.0 

5.2 

4.9 

C02  Content 

47.3 

51.7 

pH 

7.46 

7.45 

Urea  Clearance 

9.3 

10.3 

Blood  Counts: 

Erythrocytes  3,700,000 

Leucocytes  11,000 

Hemoglobin  60  % 

POST-MORTEM  EXAMINATION* * 

Post-mortem  examination  revealed  the  following 
facts  of  interest — -“The  heart  weighs  500  grams. 
The  left  ventricle  is  increased  in  size.  On  the  sur- 
face there  are  several  small  areas  of  fibrosis. 
The  pericardium  and  the  rest  of  the  epicardium 
is  smooth  and  glistening.  The  valvular  apparatus 
is  intact.  The  myocardium  is  thickened.  The 
coronaries  are  patent.  The  aorta  shows  areas  of 
atherosclerosis  and  some  calcification,  chiefly  in 
the  arch  and  the  abdominal  portion.  The  kidneys 
are  markedly  reduced  in  size,  normal  in  shape. 
They  weigh  together  178  grams.  The  capsules 
strip  with  considerable  resistance,  tearing  some 
of  the  kidney  substance. 

The  stripped  surfaces  are  greyish-red,  granular. 
There  are  a few  small,  depressed  stellate  areas, 
and  yellow  circumscribed  areas  about  3 mm.  in 
diameter.  Cut  surfaces  are  yellowish-red.  The 
cortices  are  markedly  reduced  in  thickness,  being 
only  1 or  2 mm.  thick  in  places.  The  peripelvic 
fat  is  very  much  increased  in  amount.  The  pelves 
and  ureters  are  normal”.  Gross  examination  of 
the  calvarium  and  contents  was  as  follows:  “The 
calvarium  is  normal.  The  dura  is  very  adherent 
to  the  inner  surface  of  the  skull.  The  dural 
sinuses  are  normal.  The  surface  of  the  brain  is 
quite  dry  and  the  brain  tissue  is  firmer  than  nor- 
mal. The  right  lateral  ventricle  contains  a small 
amount  of  clear  fluid.  The  left  lateral  ventricle 
contains  a small  amount  of  blood-stained  fluid. 
The  floor  of  the  left  lateral  ventricle  bulges  into 
the  lumen.  The  left  temporal  lobe  feels  soft  and 
fluctuant,  especially  at  the  pole.  Frontal  sections 
of  the  fixed  brain  show  an  extensive  hemorrhage 
of  the  right  internal  capsule  with  considerable 
destruction  of  the  brain  substance  and  hemor- 
rhage into  the  ventricle.  The  left  lateral  ventricle 
is  distended  and  contains  a small  amount  of 
blood.”  Microscopic  examination  revealed  moder- 
ate sclerosis  of  medium-sized  arteries  of  the 
heart. 

In  the  lungs  there  was  moderate  sclerosis  of 
large  vessels.  In  the  spleen  there  was  severe  scle- 
rosis of  both  small  and  large  vessels,  being  most 
severe  in  the  arterioles.  An  occasional  arteriole 
in  the  adrenals  was  sclerotic.  The  kidneys  showed 
the  following  microscopic  picture:  “There  is 

considerable  destruction  of  the  architecture.  There 
is  severe  sclerosis  of  large  and  small  vessels  with- 
out necrosis.  Inter-tubular  fibrosis  is  present  both 
in  the  cortex  and  medulla.  Some  of  the  glomerular 
capsules  show  thickening  with  partial  and  total 
hyalinization  of  many  of  the  tufts.  Around  the 
lai-ge  vessels  there  is  a moderate  round  cell  infil- 
tration. The  straight  tubules  contain  hyaline 
casts.  There  is  a patchy  congestion.  A few  of 
the  straight  tubules  show  calcification.” 


* Autopsy  performed  by  R.  Dominguez,  M\D.,  St.  Luke’s 
Hospital,  Cleveland,  Ohio. 

* Through  the  kindness  of  Dr.  J.  R.  Monihan  of  Cleve- 
land, I was  given  the  opportunity  to  observe  this  case  and 
use  the  records. 


Arterioles  in  the  liver  and  pancreas  also 
showed  severe  sclerosis  with  hyalinization  of  many 
of  the  arterioles  in  the  pancreas.  Thus,  the 
pathological  diagnoses  which  are  of  significance 
in  the  present  discussion  were:  (a)  Cerebral  hem- 
orrhage in  the  right  internal  capsule  with  rupture 
into  the  right  lateral  ventricle,  (b)  Internal  hy- 
drocephalus involving  the  left  lateral  ventricle, 
(c)  Arterial  and  arteriolarsclerosis  of  the  spleen, 
pancreas,  liver  and  adrenals,  (d)  Arteriolar 
nephrosclerosis,  (e)  Cardiac  hypertrophy,  (f)  Ar- 
teriosclerosis of  the  heart,  slight. 

It  is  significant,  in  view  of  later  findings,  that 
at  the  time  of  the  first  hospitalization  there  was 
no  hypertension  present  (140/80)  ; nor  was  there 
any  evidence  of  cardiac  enlargement  or  peripheral 
arteriosclerosis  of  greater  degree  than  one  would 
expect  in  any  man  42  years  of  age.  Furthermore, 
there  were  no  signs  of  renal  insufficiency  or  dam- 
age, other  than  an  occasional  hyaline  cast  which 
may  occur  in  any  acute  metallic  intoxication. 
After  the  acute  attack,  even  these  casts  disap- 
peared. The  radial  palsy  did  not  completely  dis- 
appear after  the  acute  intoxication  quieted  down. 
He  was  unable  to  work  because  of  moderate  weak- 
ness of  the  wrists. 

On  his  second  hospital  admission,  four  years 
after  the  acute  attack,  the  patient,  at  the  age  of 
46  years,  presented  the  clinical  picture  of  a man 
20-30  years  his  senior,  as  far  as  his  cardio-vascu- 
lar  and  renal  condition  was  concerned.  There 
can  be  very  little  question  that  his  hypertension 
was  not  of  the  essential  or  neurovascular  type, 
but  was  associated  with  diffuse  vascular  disease. 
This  is  supported  by  the  findings,  in  that,  (a) 
There  was  marked  sclerosis  of  the  radial  ar- 
teries, (b)  The  fundi  showed  evidence  of  ar- 
teriolar sclerosis,  (c)  There  was  evidence  of 
marked  renal  insufficiency  without  a history  of 
acute  nephritis,  (d)  Administration  of  amyl  ni- 
trite did  not  lower  the  blood  pressure  as  it  does 
in  the  so-called  neurovascular,  or  essential,  hyper- 
tension, and  (e)  There  was  an  history  of  long- 
continued  exposure  to  lead.  This  conception  of 
this  case  was  further  corroborated  by  the  pa- 
tient’s death  following  a typical  cerebral  accident 
and  by  the  autopsy  findings  which  as  given  above 
were  typical  of  diffuse  arterial  and  arteriolar 
sclerosis,  with  arteriolar  nephrosclerosis. 

I observed  another  case*  not  unlike  the  above. 
This  man,  age  63,  had  been  an  inspector  of  lead 
storage-battery  elements  for  a perod  of  twelve 
years.  The  exposure  to  lead  was  chiefly  through 
the  air,  rather  than  by  means  of  the  hands.  One 
year  before  death,  the  patient  complained  of  con- 
stipation, colic,  weakness  of  extremities,  malaise, 
metallic  taste  in  his  mouth,  and  loss  of  weight  of 
two  years’  duration.  He  became  impotent  soon 
after  exposure  to  lead  began,  twelve  years  pre- 
viously. Although  the  urine  at  the  first  visit 
showed  no  albumin,  glucose,  casts  or  red  blood 
cells,  a few  months  later  there  was  a moderate 
amount  of  albumin  present,  etc.  Blood  pressure 
was  265/160  mm.  Wasserman  was  negative.  There 
was  present  a marked  secondary  anemia  with 
anisocytosis  and  poikilocytosis  but  no  basophilic 


774 


The  Ohio  State  Medical  Journal 


December,  1933 


stippling.  Fundi  showed  typical  vascular  sclero- 
sis. The  patient  died  of  cardiac  failure. 

The  autopsy*  revealed  the  following  conditions 
which  are  of  significance  in  the  present  discus- 
sion, namely,  (a)  Generalized  arteriosclerosis, 
very  severe;  most  severe  in  aorta  and  cerebral, 
coronary  and  renal  arteries,  (b)  Coronary  sclero- 
sis, severe,  involving  both  vessels  with  thrombosis 
of  the  ramus  descendens  anterior  of  the  left  coro- 
nary artery,  (c)  Hypertrophy  and  dilatation  of  the 
entire  heart,  (d)  Myocardial  fibrosis,  and  (e) 
Nephrosclerosis,  arterial  and  arteriolar.  Chemi- 
cal examination  revealed  an  abnormal  deposit  of 
lead  in  the  bones  and  soft  tissues.  Among  the 
bone  specimens  the  largest  percentage  of  lead  was 
found  in  the  lower  part  of  the  femur  (0.28  per- 
cent) , and  the  next  greatest  percentage  in  the 
head  of  the  tibia  (0.15  per  cent).  Among  the  soft 
tissues  the  greatest  percentage  was  found  in  the 
kidney,  being  greater  than  that  in  the  lower  part 
of  the  femur  (0.33  per  cent).  The  liver  contained 
the  next  greatest  percentage  (0.14  per  cent).  Un- 
doubtedly the  organs  in  this  case  contained  much 
larger  amounts  of  lead  at  the  time  exposure  to 
lead  ceased  three  years  before  death  occurred.  The 
amount  of  lead  found  in  the  bones  in  this  case  was 
much  greater  than  in  cases  where  there  has  been 
no  known  exposure  to  lead.  Thus,  Minot  and  Aub11 
found  no  lead  in  the  bones  of  19  out  of  26  cases  in 
which  there  had  been  no  history  of  recent  indus- 
trial lead  exposure  or  history  of  plumbism.  Four 
of  the  remaining  seven  cases  in  which  lead  was 
found  had  a definite  history  of  lead  exposure  at 
some  time  during  their  lives.  In  the  remaining 
three  cases  it  is  likely  that  there  had  been  lead  ex- 
posure at  some  time  during  life  which  had  been 
overlooked.  One  must  not  ignore  the  important 
role  which  lead  undoubtedly  played  in  the  patho- 
genesis of  the  unusually  severe  generalized  ar- 
terial and  arteriolar  sclerosis  which  these  cases 
exhibited. 

Chemical  examination  of  bones  and  soft  tissues 
for  lead:** 


c 

^ £ 
be. 5 

'5  8 

£ ft 


ft 

ui 

■o  5 
*£  g 

bD 

Ss 

g . 

< g 

"O  • 

S g £?*> 

< o bn 

> fcfi 

b£ 

tJ  br.'V  e 

Head  of  tibia 

. 180 

30 

0.29 

0.15 

Shaft  of  tibia 

- 95 

49.5 

0.00 

0.00 

Lower  part  of  tibia ... 

. 90 

26.5 

0.09 

0.10 

Lower  part  of  femur*- 

120 

41 

0.34 

0.28 

Upper  part  of  radius 

and  ulna 

- 85 

24 

0.03 

0.04 

Lower  part  of 

humerus  

. 80 

30 

0.00 

0.00 

Ribs  

_ 25 

2.1 

0.00 

0.00 

Wet  Weight 

Soft  Tissues  Of  Specimen 


Kidney  

9 

0.03 

0.33 

Liver  

110 

0.15 

0.14 

Brain 

130 

0.10 

0.08 

Stomach  

62 

0.03 

0.05 

Spleen  . 

34 

0.00 

0.00 

Ruhl12  reports  a 

case  quite  similar  to 

the  two 

mentioned  above. 

His  patient 

was  a 51- 

-year-old 

* Autopsy  performed  by  Dr.  H.  Goldblatt,  Associate  Di- 
rector, Institute  of  Pathology,  Western  Reserve  University, 
Cleveland,  Ohio. 

**  Chemical  Analysis  performed  by  R.  F.  Hanzal,  Wes- 
tern Reserve  University. 


man  who  had  been  exposed  to  lead  paints  for  37 
years.  For  two  and  one-half  years  before  his 
hospital  admission,  this  man  had  had  typical  epi- 
leptiform attacks  at  varying  intervals,  together 
with  severe  headache,  loss  of  memory,  depression 
and  increasing  bodily  weakness  in  the  intervals. 
As  in  the  present  instance,  the  chief  physical  find- 
ing was  a “definite  but  fluctuating  hypertension 
with  cardiac  hypertrophy  and  beginning  renal  in- 
sufficiency”. Ruhl’s  patient  died  of  a typical 
cerebral  accident.  Just  before  death,  the  blood 
pressure  had  been  215/155  mm.  Autopsy  findings 
in  this  case  revealed  “the  typical  picture  of  the 
hypertensive  sclerosis  of  the  arterial  system;  hy- 
pertrophy especially  marked  in  the  left  ventricle, 
and  the  aorta  showed  a comparatively  slight  gen- 
eralized atherosclerosis.  There  were  also  red 
granular  kidneys”.  Microscopically,  the  kidneys 
showed  severe  arterial  and  arteriolar  sclerosis 
with  hyalinization  of  many  of  the  glomerular 
tufts.  Grossly,  the  brain  showed  a large  fresh 
apoplectic  hemorrhage  in  the  right  front  brain 
stem  with  encroachment  onto  the  internal  capsule. 
There  were  multiple  areas  of  softening  of  the 
brain  tissue.  The  macroscopically  visible  arteries 
showed  patches  of  atherosclerosis.  Ruhl  demon- 
strated microscopically  the  extensive  arteriolar 
sclerosis  and  also  the  rupture  of  these  vessels  in 
the  region  of  the  multiple  punctuate  hemorrhages 
and  areas  of  softening  throughout  the  brain.  He 
attributes  the  epileptiform  attacks  which  this  man 
had  to  these  multiple  areas  of  softening  which  in 
many  places  showed  organization  and  fibrosis. 

Pathologically,  one  cannot  dogmatically  state 
that  the  diffuse  vascular  sclerosis  in  any  individ- 
ual case  is  due  to  chronic  lead  intoxication  since 
the  picture  one  sees  at  autopsy  is  not  unlike  that 
in  the  usual  sclerosis  associated  with  senility.  As 
stated  previously,  arteriolar  sclerosis  together 
with  hypertension  due  to  lead  has  been  produced 
experimentally  by  Petroff  and  others.  Of  special 
significance,  however,  in  this  case,  is  the  history 
of  long-continued  exposure  to  lead,  together  with 
the  relatively  young  age  of  the  patient  as  com- 
pared to  the  vascular  picture  which  is  exhibited. 
This  case,  in  conclusion,  supports  the  conception 
that  long-continued  exposure  to  lead  may  lead  to 
severe  and  persistent  hypertension  which  is  asso- 
ciated with  marked  arterial  sclerosis  and  with, 
what  is  of  more  significance,  arteriolar  sclerosis 
especially  marked  in  the  kidney. 

414  Smythe  Bldg. 

BIBLIOGRAPHY 

1.  Dominguez,  Archives  of  Pathology,  1928,  5,  577. 

2.  Petroff,  Abstracted  in  Ber.  u.d.  ges.  Physiol,  i.  exper. 
Pharmakol.,  1930,  56,  394. 

3.  Beckman,  Deutsch.  Arch.  F.  klin.  Med.,  1925,  149,  177. 

4.  Tscherkess,  Arch.  f.  exp.  Path.  u.  Pharm.,  1925,  108, 
220. 

5.  Elschnig,  Wien.  med.  Wchnsch.,  1898,  48,  1305. 

6.  Allbutt  and  Gibson  ; quoted  by  Fishberg,  Hyperten- 
sion and  Nephritis,  1931,  494,  Lea  and  Febiger,  Philadelphia. 

7.  Harris,  Arch.  Int.  Med.|,  1918,  22,  129. 

8.  Hayhurst,  Am.  Journ.  Med.  Sciences,  1914,  147,  788. 

9.  Feil  and  Balsac,  Paris  Med.,  1923,  47,  466. 

10.  Mayers,  Journ.  Ind.  Hygiene,  1927,  9,  239. 

11.  Minot  and  Aub,  Journ.  Ind.  Hygiene,  1924,  6,  125. 

12.  Ruhl,  Med.  Klin.,  Berlin,  1929,  25,  187. 


The  President’s  P&ge 


A Personal  Communication  to  the  Membership  from 

C.  L.  Cummer,  M.D.,  President,  Cleveland,  Ohio 


Never  before  in  the  history  of  our  country  have  there  been  so  many  radical  changes 
in  social  theory  and  governmental  policy  as  in  recent  times.  Many  have  come  rapidly 
and  unexpectedly,  often  without  warning;  others  have  been  slower  changes  or  de- 
velopments by  evolution  of  established  methods  of  meeting  social  difficulties.  One 
example  of  the  latter  is  the  gradual  development  of  a well-defined  “doles”  system. 
The  action  of  the  voters  of  Ohio  in  the  November  election  in  adopting  by  an  over- 
whelming majority  the  old-age  pension  proposal  gives  definite  indication  of  the  public 
thought  and  shows  what  would  have  been  considered  impossible  a few  short  years  ago — 
public  support  of  “socialization”. 

In  normal  times,  especially  when  business  was  prosperous  and  sources  of  public 
revenue  abundant,  the  burden  upon  the  government  in  caring  for  public  wards  and  the 
relatively  small  number  of  indigents  was  easily  borne.  With  staggering  unemployment 
during  these  days  of  economic  upheaval,  the  load  upon  society  in  caring  for  the  needs 
of  those  who  are  unemployed,  together  with  the  relative  decrease  of  the  normal  sources 
of  revenue  for  these  purposes,  has  made  necessary  prompt  and  often  times  radical 
measures  to  meet  the  situation. 

It  is  obvious  and  undeniable  that  citizens  in  distress  through  no  fault  of  their  own 
should  and  must  be  furnished  with  necessities — food,  clothing  and  shelter,  and  medical 
service.  True  to  its  ideals,  the  medical  profession  has  been  rendering  without  re- 
muneration an  increasing  amount  of  service  to  the  needy,  while  suffering  with  a drastic 
decrease  in  income  from  those  patients  able  to  pay  anything. 

In  most  communities  inadequate  provision  has  been  made  for  the  medical  care  of 
the  needy  sick,  even  when  local  funds  were  available  for  such  purpose.  Many  public 
officials  with  the  strabismus  often  characteristic  of  the  politician  have  felt  that  the 
medical  profession  must  continue  to  render  medical  care  whether  or  not  physicians  had 
sufficient  income  to  maintain  themselves  and  their  practice.  In  many  official  quarters  it 
has  been  taken  for  granted  that  the  physician  should  make  this  contribution  to  charity 
regardless  of  the  cost  to  him,  while  the  right  of  other  purveyors  of  necessities  to,  at 
least,  the  cost  of  their  services  or  commodities  has  been  recognized. 

Recently,  with  the  extension  of  the  federal  government’s  plan  for  “relief”,  arrange- 
ment was  made  whereby  some  federal  funds  became  available  for  medical  care.  The 
State  Relief  Commission  adopted  a plan  and  program  of  medical  fees  available  to  those 
physicians  who  were  willing  to  accept  its  terms  and  register  with  the  local  officials. 
The  social  implication  in  the  inauguration  of  such  a plan  is  all  too  apparent.  The 
example  set  and  accepted  by  society  is  an  obvious  trend  toward  further  socialization  of 
medicine.  On  the  other  hand,  we  grant  that  the  needy  sick  must  be  given  medical  care. 

As  a part  of  the  present  social  unrest,  physicians  as  well  as  other  citizens  are  in 
a state  of  mind  characterized  by  uncertainty  and  in  some  instances  by  extreme  dis- 
couragement, Some  members  have  shown  a disposition  to  criticize  med’cal  organization 
for  forces  and  tendencies  over  which  the  medical  profession,  especially  in  these  times  of 
radical  change,  has  had  too  little  influence.  It  must  be  recognized  that  some  system 
must  and  will  develop  from  the  present  chaos.  Medical  service  is  fundamental  and  if 
the  medical  profession  is  to  preserve  for  itself  its  identity,  integrity  and  professional 
status,  it  must  be  united.  Medical  orga/nization  must  represent  the  greatest  possible 
number  of  eligible  physicians.  We  know  not  what  problems  of  a governmental  and 
social  nature  may  develop  in  addition  to  the  serious  ones  now  confronting  us ; whatever 
they  may  be,  they  can  be  met  with  the  greatest  degree  of  safety  and  security  to  us 
only  if  the  profession  is  in  position  to  speak  and  act  as  a unit  rather  than  as  a group 
of  separate  individuals  about  to  be  “regimented”  into  a system  of  medical  service 
inimical  to  medical  science  and  hostile  to  the  best  interests  of  society. 

The  officers,  Council  and  committees  of  the  State  Medical  Association  not  only 
invite  but  urge  the  membership  to  submit  its  problems,  recommendations  and  construc- 
tive criticism.  Each  member’s  security  and  benefits  through  medical  organization  will 
be  increased  just  that  much  by  his  own  efforts  in  enlisting  in  medical  organization  every 
eligible  physician. 

The  dues  for  membership  in  medical  organization  at  this  time  constitute  the  most 
important  and  relatively  most  valuable  expenditure  that  can  be  made  by  you  who  must 
rely  on  medical  practice  as  your  life  work  and  for  your  livelihood. 


775 


Preliminary  Plans  for  1934  Annual  Meeting;  Committee 
Appointments^  Problems  of  Medical  Care;  Hospital 
Group  Payment  Plans;  and  Numerous  Other  Vital 
Questions  Considered  by  Council 


MINUTES 

The  Council  of  the  Ohio  State  Medical  Associa- 
tion met  in  the  headquarters  office,  Columbus,  at 
1:00  P.  M.  on  Sunday,  October  29,  1933. 

Officers,  Councilors  and  committee  chairmen 
present  were:  President,  Dr.  Cummer;  Ex-Presi- 
dent, Dr.  Platter;  Treasurer,  Dr.  Beer;  Coun- 
cilors, Drs.  Smith,  Huston,  Klotz,  Hein,  Paryzek, 
Davidson,  Shanley,  Brush,  Seiler  and  Goodman; 
Dr.  Stone,  chairman,  and  Dr.  Upham,  member  of 
the  Policy  Committee;  Dr.  Bowman,  chairman  of 
the  Medical  Economics  Committee;  Dr.  Southard, 
State  Director  of  Health,  and  Executive  Secretary 
Martin. 

The  minutes  of  the  Council  meeting’s  held  dur- 
ing the  recent  annual  meeting  of  the  Association 
in  Akron,  September  6,  7 and  8,  1933  (pages  647 
to  650,  inclusive,  of  the  October  1933  issue  of  The 
Journal),  were  read,  and  on  motion  by  Dr. 
Brush,  seconded  by  Dr.  Huston  and  carried,  were 
approved. 

ANNUAL  MEETING  QUESTIONS 

For  the  guidance  of  the  Program  Committee 
and  the  Committee  on  Arrangements  for  future 
meetings,  Councilors  submitted  comments  and 
impressions  on  the  recent  annual  meeting  in 
Akron.  A number  of  Councilors  expressed  the 
opinion  that  the  program  and  other  functions 
during  the  meeting  were  too  rushed  and  crowded 
when  only  two  days  are  devoted  to  the  annual 
meeting,  and  recommended  that  three  days  be 
given  to  future  meetings.  The  general  consensus 
of  opinion  was  that  the  Akron  meeting  was  a 
genuine  success,  and  the  Council  expressed  official 
approval  and  commendation  to  the  Program 
Committee  and  to  the  local  committees  of  the  Sum- 
mit County  Medical  Society  for  attention  to  all  de- 
tails adding  to  the  success  of  the  meeting. 

There  was  submitted  for  the  consideration  and 
information  of  the  Council  a financial  statement 
on  the  recent  annual  meeting,  showing  that  with 
bills  received  and  paid  to  date  there  was  a balance 
of  approximately  $480.00  to  the  credit  of  the  State 
Association  on  income  from  exhibit  space  over 
expenditures. 

Time  and  Place  for  1934  Annual  Meeting 

In  compliance  with  requests  made  to  the  Coun- 
cilors in  advance,  they  submitted  for  considera- 
tion comments  from  members  in  their  respective 
districts  relative  to  the  time  and  place  for  the 
1934  annual  meeting,  the  House  of  Delegates 
having  authorized  the  Council  to  make  decision  on 


this  matter.  Various  Councilors  discussed  the 
advantages  or  disadvantages  between  combining 
the  1934  annual  meeting  with  the  annual  meet- 
ing of  the  American  Medical  Association  in  Cleve- 
land scheduled  for  June  11  to  15,  1934,  with  the 
idea  of  abandoning  the  scientific  program  for  the 
State  Association  and  confining  the  sessions  of 
the  State  Association  at  that  time  to  the  House 
of  Delegates  and  other  organization  business,  or 
a complete  annual  meeting  of  the  State  Associa- 
tion at  another  time  and  place. 

Each  of  the  following  motions  were  discussed 
in  detail: 

On  motion  by  Dr.  Goodman,  seconded  by  Dr. 
Klotz  and  earned,  the  Council  decided  that  the 
1934  annual  meeting  of  the  State  Association 
would  be  held  in  Columbus. 

On  motion  by  Dr.  Platter,  seconded  by  Dr. 
Paryzek  and  carried,  the  Council  decided  that  the 
1934  annual  meeting  should  be  held  in  the  Fall. 

On  motion  by  Dr.  Paryzek,  seconded  by  Dr. 
Hein  and  earned,  the  exact  dates  for  the  1934 
annual  meeting  were  left  to  the  determination  of 
a committee  consisting  of  the  President,  the 
Chairman  of  the  Council  Program  Committee,  and 
the  Chairman  of  the  Council  Committee  on  Ar- 
rangements. 

PROBLEMS  OF  MEDICAL  CARE  TO  THE  NEEDY 
UNEMPLOYED 

Attention  was  called  to  the  communication 
under  date  of  October  17,  1933,  addressed  to  the 
presidents  and  secretaries  of  component  county 
medical  societies  and  academies  of  medicine,  ac- 
companied by  an  advance  proof  of  an  article  and 
an  analysis  of  the  situation  and  problems  of 
medical  care  of  the  indigents  and  needy  sick,  pub- 
lished on  pages  710  to  713,  inclusive,  of  the  No- 
vember, 1933,  issue  of  The  Journal  just  off  the 
press. 

Special  reference  was  made  to  preceding 
articles  in  the  October,  1933,  Journal,  pages  683 
to  665;  September,  1933,  Journal,  page  563; 
August,  1933,  Journal,  pages  516  to  518;  April, 
1933,  Journal,  pages  257  to  258;  March,  1932, 
Journal,  pages  203  to  207 ; September  23,  1933 
issue  of  the  Journal  A.  M.  A.,  pages  1026  and 
1027. 

Attention  was  called  to  the  recent  appointment 
and  organization  of  a Medical  Advisory  Commit- 
tee to  the  State  Relief  Commission,  consisting  of 
the  presidents  of  the  Ohio  State  Medical  Associa- 
tion, the  Ohio  State  Dental  Society,  the  Ohio 


776 


December,  1933 


State  News 


777 


State  Nurses’  Association  and  the  Ohio  State 
Pharmaceutical  Association,  in  addition  to  the 
Chairman,  Dr.  H.  G.  Southard,  State  Director  of 
Health. 

On  motion  by  Dr.  Paryzek,  seconded  by  Dr. 
Goodman  and  carried,  the  Council  granted  its  ap- 
proval that  Dr.  Cummer,  the  President,  serve  on 
such  committee  at  the  request  of  the  State  Relief 
Commission. 

Comments,'  queries,  criticisms  and  information 
on  problems  of  administration  in  connection  with 
medical  care  of  the  needy,  were  summarized  by 
Dr.  Stone,  chairman  of  the  Policy  Committee,  in- 
cluding communications  from  the  following 
counties:  Belmont,  Butler,  Columbiana,  Guernsey, 
Hancock,  Hardin,  Harrison,  Licking,  Lucas,  Ma- 
honing, Meigs,  Miami,  Montgomery,  Richland, 
Ross,  Summit  and  Trumbull. 

Members  of  Council  submitted  information  on 
developments  in  their  respective  districts  together 
with  analyses  of  action  taken  or  contemplated  by 
the  component  societies  within  their  respective 
districts. 

Official  Statement  and  Policy  on  Medical  Care 
to  the  Needy 

Dr.  Stone,  chairman  of  the  Policy  Committee, 
reported  on  a meeting  of  the  committee  held  on 
the  morning  of  this  day,  and  which  meeting  fol- 
lowed preliminary  conferences  on  problems  of 
medical  relief. 

Dr.  Stone  submitted  for  official  consideration  of 
the  Council  a detailed  report  containing  specific 
recommendations  to  the  State  Relief  Commission, 
including  recommendations  that  the  temporary 
proposed  plan  and  fee  schedule  announced  by  the 
State  Relief  Commission  be  abandoned;  that  fed- 
eral-state funds  available  for  medical  care  to  the 
needy  should  be  apportioned  to  each  community 
entitled  to  such  care  on  the  basis  of  the  needy 
population,  and  that,  based  on  definite  local  situa- 
tions peculiar  to  each  community,  local  plans  and 
temporary  fee  schedules*  should  be  worked  out  on 
the  basis  of  agreements  between  the  county  medi- 
cal society  and  the  local  relief  officials. 

The  official  statement  which  Dr.  Stone  sub- 
mitted in  writing  was  unanimously  adopted  upon 
motion  by  Dr.  Platter,  seconded  by  Dr.  Klotz  and 
carried.  This  report  and  formal  statement  ap- 
pears on  pages  780  to  783  of  this  issue  of  The 
Journal  and  is  incorporated,  through  this  ref- 
erence, as  a part  of  these  minutes. 

HOSPITAL  GROUP  INSURANCE  PAYMENT  PLANS 

Dr.  Stone,  chairman  of  the  Policy  Committee, 
analyzed  in  detail  the  developments  in  various 
sections  of  the  country  on  group  hospital  payment 
plans  for  hospital  service.  He  analyzed  for  the 
Council  the  legal,  economic  and  professional 
phases  of  this  question  and  called  special  attention 
to  the  detailed  article  on  this  subject  published  on 
pages  714  to  717,  inclusive,  of  the  November,  1933, 
issue  of  the  Ohio  State  Medical  Journal. 


On  behalf  of  the  Policy  Committee,  Dr.  Stone 
submitted  for  the  consideration  of  the  Council  the 
following  official  statement  and  resolutions: 

Report  and  Resolutions 

The  Council  believes  that  the  Ohio  State  Medi- 
cal Association  should  interest  itself  in  all  pro- 
posals affecting  the  care  of  the  sick.  In  consider- 
ing any  hospital  group  payment  plan  for  hospital 
service,  it  feels  that  such  plan  will  be  contrary  to 
public  interest  unless  there  is  evidence  that  pro- 
vision is  made  for  the  following: 

1.  Determination  of  rate  upon  basis  of  accurate 
actuarial  figures. 

2.  Establishment  of  adequate  reserves. 

3.  Sufficient  spread  of  the  field  so  that  disaster 
to  any  one  group  will  not  destroy  the  reserves  of 
the  insurer. 

4.  Selling  of  insurance  only  when  adapted  to 
the  individuals  it  aims  to  serve. 

5.  Definite  provision  that  medical  service  will 
not  be  included  at  outset  or  at  any  future  time. 

In  general  this  Council  views  any  projects  for 
hospital  insurance  with  skepticism. 

a.  It  doubts  whether  accurate  actuarial  inform- 
ation is  available. 

b.  It  doubts  whether  hospitals  are  able  to  estab- 
lish adequate  reserves  in  advance  because  of  the 
financial  difficulties  under  which  most  hospitals 
are  known  to  be  operating  at  present. 

c.  It  feels  that  the  selling  of  such  insurance 
will  become  a promotion  matter. 

d.  No  assurance  has  been  given  that  complete 
medical  service  will  not  be  included  at  some  future 
date ; and  further,  the  proposed  inclusion  of 
laboratory,  roentgenological,  resident  and/or  in- 
terne service  is  in  itself  furnishing  medical  ser- 
vice. 

e.  The  alignment  of  insured  groups  to  a certain 
hospital  or  group  of  hospitals  is  destructive  of  the 
traditional  relationship  of  physician-patient. 

f.  The  inevitable  public  advertisement  of  hos- 
pital insurance  is  certain  to  serve  directly  or  in- 
directly as  an  advertisement  of  the  members  of 
the  visiting  and  associated  staffs,  and  would  be  a 
discrimination  against  many  physicians  not  affili- 
ated with  the  insuring  hospitals. 

Therefore,  the  Council  recommends  that  any 
component  society  of  the  Ohio  State  Medical  Asso- 
ciation refuse  sanction  to  any  hospital  insurance 
project  until  complete  study  has  been  made  by 
the  county  medical  society,  and  until  all  pertinent 
data  have  been  submitted  to,  and  acted  upon,  by 
the  Council  of  the  Ohio  State  Medical  Association. 

On  motion  by  Dr.  Huston,  seconded  by  Dr. 
Brush  and  carried,  the  Council,  after  further  dis- 
cussion, unanimously  adopted  the  foregoing  re- 
port as  an  official  expression  of  policy. 

Attention  was  also  called  to  the  article  on  new 
state  statutes  and  regulations  providing  reim- 
bursement to  some  hospitals  for  services  to  in- 
digents injured  in  automobile  accidents,  page  722 
of  the  November,  1933,  issue  of  The  Journal. 

At  this  point  Dr.  Goodman,  Secretary  of  Coun- 
cil, was  called  away  from  the  meeting  and  Presi- 
dent Cummer  designated  Dr.  Brush  as  Secretary 
Pro-Tern. 

WORKMEN’S  COMPENSATION  PROBLEMS 

In  the  absence  of  Dr.  Bigelow,  chairman  of  the 
special  committee  of  the  State  Medical  Associa- 
tion which  has  held  a series  of  conferences  with  a 


778 


The  Ohio  State  Medical  Journal 


December,  1933 


similar  special  committee  of  the  Ohio  Hospital 
Association  relative  to  annual  hospital  contracts 
with  the  State  Industrial  Commission  in  work- 
men’s compensation  cases  and  especially  pertain- 
ing to  X-ray  service.  Dr.  Paryzek,  a member  of 
the  committee,  submitted  a report.  He  reviewed 
correspondence  following  the  last  Council  meeting 
in  connection  with  the  joint  report  of  the  two 
committees  to  the  Medical  Department  of  the  In- 
dustrial Commission.  He  reviewed  correspondence 
between  Dr.  Dorr,  Chief  Medical  Examiner  of  the 
Commission,  Dr.  Bigelow  and  Dr.  Harmon,  chair- 
man of  the  Hospital  Association’s  committee. 

Special  attention  was  called  to  the  official  com- 
munication sent  to  the  Industrial  Commission 
from  the  committees  of  the  Ohio  Hospital  Associa- 
tion and  the  Ohio  State  Medical  Association 
(published  as  a part  of  the  minutes  of  the  last 
Council  meeting  on  page  647  of  the  October,  1933, 
issue  of  the  Ohio  State  Medical  Journal). 

In  view  of  misunderstandings  still  existing  on 
this  question.  Dr.  Paryzek  recommended  approval 
of  the  suggestion  made  by  Dr.  Harmon  that  he 
and  Dr.  Bigelow  hold  a conference  in  the  near 
future  with  Dr.  Dorr  for  the  purpose  of  explain- 
ing that  in  hospital  cases  (in-patients)  where  the 
hospital  maintains  an  X-ray  department  the 
technical  X-ray  service  cost  be  covered  in  the  per 
diem  contract  rate  between  the  hospital  and  the 
Commission,  and  that  payment  for  professional 
interpretative  service  rendered  by  physicians 
should  be  made  directly  to  such  physicians  by  the 
Industrial  Commission  in  accord  with  a fee 
schedule  modified  to  meet  these  conditions,  it 
being  explained  that  these  recommendations  are 
not  intended  to  change  the  present  X-ray  fee 
schedule  where  roentgenologists  or  other  physi- 
cians maintain  and  operate  their  own  equipment 
as  well  as  render  interpretative  and  diagnostic 
service  in  workmen’s  compensation  cases. 

On  motion  by  Dr.  Huston,  seconded  by  Dr. 
Davidson  and  carried,  the  recommendation  sub- 
mitted by  Dr.  Paryzek  was  approved  by  the  Coun- 
cil. 

Members  of  Council  discussed  at  some  length 
other  problems  in  connection  with  workmen’s  com- 
pensation, especially  the  continued  delays  in  the 
payment  of  medical  fees.  A discussion  was  held 
on  administrative  procedure  and  recommendations 
for  improvement  as  contained  in  a report  of  the 
Special  Workmen’s  Compensation  Committee  of 
the  Ohio  State  Medical  Association  (pages  377  to 
380,  inclusive,  of  the  June,  1933,  issue  of  The 
Journal),  as  well  as  to  the  articles  on  workmen’s 
compensation  in  the  July  and  September,  1933, 
issues  of  The  Journal. 

Information  was  submitted  on  procedure  by 
other  interested  groups,  including  the  Ohio  Manu- 
facturers’ Association,  on  questions  of  workmen’s 
compensation  administration.  The  financial  status 
of  the  workmen’s  compensation  fund  was  also 
discussed  as  well  as  the  proposed  policy  of  the 


Industrial  Commission  to  prosecute  flagrant  vio- 
lations of  the  Workmen’s  Compansation  Law  and 
its  regulations. 

On  motion  by  Dr.  Paryzek,  seconded  by  Dr. 
Hein  and  carried,  the  President  was  authorized 
and  requested  to  appoint  a special  committee  of 
three  to  confer  with  officials  of  the  Industrial 
Commission  in  an  effort  to  secure  more  prompt 
handling  of  cases  and  more  prompt  payment  of 
medical  fees. 

Pursuant  to  that  action,  President  Cummer  ap- 
pointed the  following  committee: 

B.  J.  Hein,  Chairman;  J.  Craig  Bowman,  L.  L. 
Bigelow. 

PROFESSIONAL  QUESTIONS 
A communication  under  date  of  September  13, 
1933,  from  Dr.  J.  B.  H.  Waring,  Wilmington, 
Ohio,  was  submitted  for  the  consideration  of  the 
Council. 

The  President  reviewed  prior  correspondence 
and  called  attention  to  previous  action  of  the 
Council  at  its  meeting  on  December  11,  1932,  in 
regard  to  an  appeal  by  Dr.  Waring  from  action  of 
the  Clinton  County  Medical  Society  (Council 
minutes,  page  45,  January,  1933,  issue  of  The 
Journal,  and  minutes  of  the  Council  meeting  of 
March  5,  1933,  page  249,  April  1933,  issue  of 
The  Journal ). 

The  Council  reaffirmed  its  action  as  shown  in 
those  minutes,  and  announced  that  any  attempt 
by  Dr.  Waring  for  reinstatement  in  medical  or- 
ganization must  be  taken,  in  the  first  instance, 
locally  through  the  Clinton  County  Medical  So- 
ciety. 

APPOINTMENT  OF  COMMITTEES 
Dr.  Cummer,  the  President,  announced  the  ap- 
pointment of  the  following  committees  (in  ad- 
dition to  the  standing  committees  already  ap- 
pointed and  confirmed  by  the  House  of  Delegates 
at  the  recent  annual  meeting),  subject  to  Council 
approval : 

Council  Committee  on  Auditing  and 
Appropriations 

B.  J.  Hein,  Chairman,  Toledo;  H.  V.  Paryzek, 
Cleveland;  S.  J.  Goodman,  Columbus. 

Council  Committee  on  Program 
H.  V.  Paryzek,  Chairman,  Cleveland;  John  A. 
Caldwell,  Cincinnati;  H.  M.  Platter,  Columbus. 

Council  Committee  on  Arrangements 
S.  J.  Goodman,  Chairman,  Columbus;  E.  R. 
Brush,  Zanesville;  E.  M.  Huston,  Dayton. 

On  separate  motions  duly  seconded  and  carried, 
the  Council  confirmed  the  appointments  of  each 
of  the  foregoing  constitutional  committees. 

Other  Committee  Appointments 
The  President  recommended  that  the  Council 
create  a special  Judicial  Committee  for  the  pur- 
pose of  study  and  recommendation  to  the  Council 
on  questions  which  arise  pertaining  to  ethics,  pro- 
fessional relations,  constitutional  provisions,  and 


December,  1933 


State  News 


779 


similar  matters.  On  motion  by  Dr.  Klotz,  seconded 
by  Dr.  Beer  and  carried,  the  Council  authorized 
the  creation  and  appointment  by  the  President  of 
such  committee. 

Judicial  Committee 

President  Cummer  announced  the  personnel  of 
the  Judicial  Committee  as  follows: 

H.  M.  Platter,  Chairman,  Columbus;  John  A. 
Caldwell,  Cincinnati ; I.  P.  Seiler,  Piketon. 

Special  Committee  on  Military  and  Veterans’ 
Affairs 

Upon  authorization  by  the  Council  through 
motion  duly  seconded  and  carried,  the  continuance 
of  a Special  Committee  on  Military  and  Veterans’ 
Affairs  was  authorized  and  the  President  re- 
quested to  make  such  appointments,  pursuant  to 
which  authorization  President  Cummer  an- 
nounced the  personnel  of  such  committee  as  fol- 
lows: 

Louis  Feid,  Chairman,  Cincinnati;  John  A. 
Sipher,  Norwalk;  A.  J.  McCracken,  Belief ontaine. 

Committee  on  Preventive  Medicine  and  Periodic 
Health  Examinations 

The  President  submitted  for  the  consideration 
of  Council,  action  by  the  Section  on  Obstetrics 
and  Pediatrics  at  the  last  annual  meeting,  recom- 
mending the  creation  of  a committee  on  maternal 
hygiene.  The  Council  discussed  previous  requests 
for  similar  special  committees  and  called  atten- 
tion to  the  established  policy  against  the  creation 
of  numerous  special  committees  and  the  inclusion 
of  educational  and  preventive  medicine  functions 
under  the  broad  scope  of  the  Committee  on  Pre- 
ventive Medicine  and  Periodic  Health  Examina- 
tions. 

Dr.  Cummer  also  submitted  for  the  considera- 
tion of  the  Council  a request  for  the  appoint- 
ment of  a pediatrician  on  the  Committee  on  Pre- 
ventive Medicine  and  Periodic  Health  Examina- 
tions. 

After  detailed  consideration,  upon  motion  sec- 
onded and  carried,  the  Council  authorized  the 
President  to  add  to  the  Special  Committee  on  Pre- 
ventive Medicine  and  Periodic  Health  Examina- 
tions a representative  obstetrician  and  a repre- 
sentative pediatrician. 

Pursuant  to  that  action,  the  President  an- 
nounced the  appointment  of  such  Committee  on 
Preventive  Medicine  and  Periodic  Health  Exami- 
nation as  follows: 

V.  C.  Rowland,  Chairman,  Cleveland ; C.  W. 
Burhans,  Cleveland;  Jonathan  Forman,  Colum- 
bus; Beatrice  T.  Hagen,  Zanesville;  R.  R.  Hender- 
shott,  Tiffin;  A.  J.  Skeel,  Cleveland;  C.  I.  Stephen, 
Ansonia. 

MISCELLANEOUS 

Dr.  Cummer  reported  briefly  on  the  recent  An- 
nual Conference  of  Medical  Editors  and  Secre- 
taries held  under  the  auspices  of  the  American 


Medical  Association  in  Chicago,  September  22  and 
23.  He  called  attention  to  the  fact  that  Dr. 
Upham,  chairman  of  the  Board  of  Trustees  of 
the  A.  M.  A.,  had  presided  and  called  the  meeting 
to  order;  that  Dr.  Tuckerman,  chairman  of  the 
Medical  Defense  Committee  of  the  State  Asso- 
ciation, had  presented  a comprehensive  discussion 
on  problems  of  malpractice.  Dr.  Cummer  called 
special  attention  to  a number  of  other  papers  on 
the  program,  including  plans  for  interesting 
scientific  exhibits  at  annual  meetings  of  state 
associations. 

A brief  discussion  was  held  on  the  program  and 
other  details  of  the  recent  meeting  of  the  Inter- 
national Postgraduate  Medical  Association  in 
Cleveland. 

Dr.  Paryzek  submitted  a brief  verbal  report  on 
medical  and  social-welfare  phases  of  the  recent 
Ohio  Welfare  Conference  in  Cleveland  held 
October  3 to  6. 

Dr.  Southard  reported  on  the  high  points  of  the 
recent  Annual  Conference  of  Ohio  Health  Com- 
missioners held  in  Columbus  October  19  and  20. 

A report  was  submitted  on  progress . and  de- 
velopments since  the  last  Council  meeting  on  com- 
plaints against  solicitation  of  patients  in  work- 
men’s compensation  cases,  as  well  as  advertise- 
ments by  certain  physicians. 

Attention  was  called  to  provisions  of  the  Na- 
tional Recovery  Administration  pertaining  to 
physicians,  previously  analyzed  in  The  Journal. 

Questions  were  raised  and  comments  made  on 
issues  of  general  and  special  interest,  including 
pending  constitutional  amendments  before  the 
voters  at  the  coming  election  Tuesday,  November 
7,  including  old-age  pension,  county  home  rule 
government  proposal,  proposal  for  10-mill  tax- 
ation limitation  on  real  estate,  and  pending 
amendments  of  the  federal  and  state  constitutions 
for  prohibition  repeal. 

Membership  Data 

Figures  submitted  showed  5,074  members  in  the 
State  Association  to  date  for  1933,  compared  with 
5,309  on  the  same  date  last  year  and  with  the 
total  for  1932  of  5,352. 

Emphasis  was  placed  by  the  President  on  the 
necessity  of  special  activity  by  the  Councilors  in 
contact  with  societies  in  their  respective  districts 
for  the  payment  promptly  in  advance  of  1934 
membership  dues.  In  this  connection  attention 
was  also  called  to  the  first  editorial  on  this  sub- 
ject in  the  current  November  issue  of  The  Jour- 
nal. 

Further  business  being  called  for  and  none 
being  presented,  the  Council  adjourned  to  meet  at 
the  call  of  the  President. 

Signed:  S.  J.  Goodman,  M.D., 

Secretary  of  Council. 

E.  R.  Brush,  M.D., 
Secretary  Pro-Tem. 


Council  of  State  Medical  Association  Requests  Changes 
in  Administrative  Procedure  for  Medical  Care 
of  the  Needy  Unemployed 


Anticipating-  that  definite  changes  and  correc- 
tions in  the  tentative-  temporary  plan  for  ad- 
ministration of  federal-state  funds  for  medical 
care  of  the  needy  sick  would  be  found  advisable 
following  the  preliminary  plan  and  state-wide  fee 
schedule  announced  by  the  State  Relief  Com- 
mission on  September  20,  the  Council  of  the  Ohio 
State  Medical  Association  assembled,  through  the 
headquarters  office  and  otherwise,  information 
and  sentiment  among  the  membership  of  the  State 
Association  from  all  sections  of  Ohio;  and  at  its 
meeting  on  October  29,  the  Council  made  definite 
recommendations  to  the  State  Relief  Commission 
for  abandonment  of  the  state-wide  fee  schedule 
plan. 

The  Council  further  recommended  that  the 
available  federal-state  funds  be  apportioned  to 
local  communities  as  nearly  as  possible  on  the 
basis  of  the  needy  population  or  in  proportion  to 
the  share  of  such  funds  to  which  such  communi- 
ties are  entitled  and  which  would  be  necessary  to 
supplement  local  funds  as  part  of  the  “relief” 
program  to  the  needy  sick. 

Fearful  that  a detrimental  precedent  would  be 
set  were  the  medical  profession,  through  organiza- 
tion, officially  to  acquiesce  in  the  present  tem- 
porary plan  or  any  of  its  outstanding  features, 
the  Council  felt  that  on  account  of  the  wide 
variation  of  problems  in  local  communities  that 
adjustments  and  modifications  must  necessarily 
be  made  locally. 

Responsive  to  the  sentiment  expressed  by  a 
number  of  the  component  county  medical  societies 
and  academies  of  medicine  that  any  state-wide 
governmental  fee  schedule  would  have  a tendency 
to  establish  in  the  minds  of  the  people  a false  and 
inferior  value  on  medical  service,  the  Council  in- 
corporated in  official  resolutions  and  a formal 
statement  to  the  State  Relief  Commission  alter- 
nate procedure  to  meet  the  temporary  situation. 

commission’s  problems  expressed 

It  is,  of  course,  recognized  that  the  State  Relief 
Commission  has  very  definite  and  serious  prob- 
lems confronting  it,  that  the  amount  of  federal 
funds  available  for  medical  care  to  the  needy  un- 
employed is  inadequate,  but  the  Commission  felt 
that  the  plan  and  fee  schedule  announced  late  in 
September  (carried  in  the  October  issue  of  The 
Journal  and  further  analyzed  with  developments 
in  the  November  Journal)  was  the  most  practical 
method  which  could  be  considered  by  the  Commis- 
sion, at  least  at  this  time. 

While  at  the  time  this  article  went  to  press  the 


State  Relief  Commission  had  not  taken  official 
action  on  the  recommendations  submitted  by  the 
Council  of  the  Ohio  State  Medical  Association, 
officials  and  members  of  the  Relief  Commission 
had  expressed  themselves  as  opposed  or  at  least 
reluctant,  especially  at  this  time,  to  modify  its 
tentative  program. 

Members  of  the  Relief  Commission  have  ex- 
pressed themselves  as  believing  that  in  spite  of 
no  official  acceptance  by  medical  organization  of 
the  plan  and  fee  schedule,  there  were  enough  phy- 
sicians in  each  community  who  were  willing  to 
conform  to  the  plan  as  already  announced  in 
Ohio  to  care  for  the  needy  sick  in  each  community, 
and  that  if  sufficient  physicians  do  not  register 
with  the  local  relief  officials  as  participants  in 
the  plan,  the  other  alternative  may  be  for  the 
State  Relief  Commission  to  hire  physicians  on 
salary  contracts  to  handle  the  needy  sick  in  each 
community. 

DIFFERENT  INTERPRETATIONS 

It  has  been  pointed  out  to  officials  of  the  Relief 
Commission  that  there  is  apparent  conflict  be- 
tween the  state  regulations,  which  do  not  provide 
that  the  fee  schedule  announced  can  be  augmented 
by  local  funds,  and  Regulations  7 governing  fed- 
ei-al  funds,  which  provide  that  the  schedule  “shall 
not  preclude  the  payment  of  additional  amounts 
from  local  funds”.  In  spite  of  this  apparent  dif- 
ference in  interpretation,  the  Relief  Commission 
is  convinced  that  under  the  general  terms  of  fed- 
eral regulations  governing  federal  funds  for 
“relief”  administered  directly  under  the  State 
Relief  Commission  in  Ohio,  the  Commission  in  this 
state  has  authority  to  adopt  whatever  regulations 
it  considers  necessary  to  care  for  the  needy  sick. 

A number  of  county  medical  societies  and 
academies  of  medicine  have  gone  on  record  official- 
ly as  unwilling  to  accept  the  plan  and  fee  schedule 
of  the  State  Relief  Commission. 

The  medical  profession,  of  course,  realizes  that 
medical  care  must  and  will  be  given  to  the  in- 
digent and  needy.  The  profession  for  several 
years  has  been  bearing  a disproportionately 
heavy  load  in  caring  for  the  needy  sick,  and  in 
most  instances  without  any  remuneration.  The 
sentiment  as  expressed  by  some  of  the  county 
medical  societies  seems  to  be  that  the  fundamental 
principles  and  humanitarian  spirit  of  the  pro- 
fession must  prevail  in  its  consideration  of  this 
question,  that  on  account  of  the  economic,  social 
and  governmental  implications  and  possible  end- 
results  from  a standardized  system  of  fees  and 
practice,  medical  organization  cannot  approve 


780 


December,  1933 


State  News 


781 


such  a system;  but  that  those  members  of  the 
profession  who  can  afford  to  do  so  will  continue 
to  care  for  their  needy  clientele  during  this 
emergency  without  remuneration,  that  those  mem- 
bers of  the  profession  who  as  individuals  wish  to 
do  so  may,  without  professional  disapproval, 
register  and  care  for  the  needy  sick  under  plans 
locally  devised  by  local  relief  officials  or  under 
general  provisions  of  the  State  Relief  Commission. 

CONTRACT  PLAN  ANALYZED 

The  sentiment  of  the  medical  profession  as 
gauged  by  the  Council  seems  to  be  that  while  the 
tentative  system  for  administering  federal  relief 
for  medical  service  in  Ohio  at  the  present  time 
contained  objectionable  features,  this  or  any  other 
plan  which  attempts  to  preserve  the  family- 
physician  relationship  as  well  as  the  free  choice 
by  the  individuals  of  their  medical  attendants  is 
preferable  to  a contract  system  whereby  physi- 
cians are  employed  on  salary  by  governmental 
units  to  care  for  the  needy.  In  most  instances 
where  the  latter  system  has  been  inaugurated,  the 
result  actually  is  that  such  contract  physicians 
care  for  only  a relatively  small  proportion  of  the 
needy  sick  and  that  the  majority  of  the  physicians 
continue  to  care  for  most  such  cases  without 
remuneration. 

While  it  is  still  felt  that  adjustments  and 
modifications  must  be  made  from  time  to  time  in 
the  administration  of  “relief”  to  meet  new  prob- 
lems and  exigencies,  the  Federal  Relief  Adminis- 
tration at  the  time  this  was  written  had  not 
definitely  clarified  some  of  the  questions  which 
have  developed. 

As  the  “major”  objective  in  the  federal  relief 
program  at  this  time,  all  the  facilities  and  per- 
sonnel of  the  Ohio  Relief  Commission  have  re- 
cently been  concentrated  on  getting  under  way 
the  public  works  relief  program,  estimated  to  put 
30,000  unemployed  to  work  immediately  on  var- 
ious types  of  public  construction.  It  was  esti- 
mated that  perhaps  as  much  as  $8,000,000  a month 
in  federal  funds  might  be  available  in  Ohio  for 
this  purpose,  at  least  for  a period  of  several 
months.  This  would,  of  course,  augment  the  bond 
issue  revenue  enacted  by  some  of  the  cities  and 
political  subdivisions  for  the  extension  of  public 
work  programs,  the  idea  being  to  return  as  many 
as  possible  unemployed  to  gainful  occupation, 
thus  transferring  them  from  the  classification  of 
“unemployed  relief”  to  the  classification  of  “work 
relief”. 

THE  OFFICIAL  STATEMENT  AND  RESOLUTIONS  BY 
THE  COUNCIL 

The  following  statement  and  resolutions  in- 
corporate the  official  action  of  the  Council  of  the 
Ohio  State  Medical  Association  at  its  meeting  on 
October  29.  This  official  statement  was  trans- 
mitted on  the  following  day  to  the  State  Relief 
Commission  as  well  as  to  the  secretaries  of  the 


component  county  medical  societies  and  academies 
of  medicine. 

The  Resolutions 

Intimately  identified  and  genuinely  concerned 
as  the  medical  profession  is  with  all  problems  of 
public  and  individual  health,  social  welfare, 
economic  distress,  unemployment,  possible  under- 
nourishment and  other  factors  inimical  to  physical 
well-being,  human  safety  and  comfort,  the  Ohio 
State  Medical  Association,  representing  the  great 
majority  of  ethical  and  legally  qualified  physicians 
in  Ohio,  desires  to  cooperate  with  all  official  and 
voluntary  agencies  similarly  concerned  with  these 
problems. 

As  an  altruistic  profession,  physicians,  in  in- 
numerable cases,  have  continued  to  care  for  the 
indigent  sick  and  semi-indigent  sick  for  so  long 
that  the  matter  has  become  a tradition.  With  the 
unusual  situation  at  the  present  time  a consider- 
able portion  of  the  public  has  come  to  look  to  the 
medical  profession  for  this  sort  of  service  without 
any  remuneration,  in  spite  of  the  fact  that  the 
medical  profession  as  a group  requires  economic 
support  in  relative  proportion  to  other  groups. 

The  situation  is  a public  responsibility  and 
should  be  remedied.  On  the  other  hand,  physi- 
cians, in  many  instances,  have  not  been  receiving 
sufficient  income  from  their  total  practice  to  make 
it  possible  for  them  to  continue  to  carry  .the  extra 
burden  of  the  needy  sick  who  are  unable  to  pay. 

As  announced  in  Rules  and  Regulations  No.  7 
issued  by  the  Federal  Emergency  Relief  Commis- 
sion “the  policy  adopted  shall  be  to  augment  and 
render  more  adequate  facilities  already  existing 
in  the  community  for  the  provision  of  medical  care 
by  the  medical,  nursing  and  dental  professions  to 
indigent  persons”,  and  that  “all  fees  shall  be 
established  on  the  basis  of  an  appreciable  re- 
duction from  the  prevailing  minimum  charges  for 
similar  services  in  the  state  and  local  com- 
munities, with  due  recognition  of  the  certainty, 
simplicity  and  promptness  of  payment”. 

We  are  further  in  agreement  with  the  policy  as 
announced  by  the  federal  government  and  ap- 
proved by  the  State  Relief  Commission  “to  recog- 
nize within  legal  and  economic  limitations  the 
traditional  family  and  family-physician  relation- 
ship in  the  authorization  of  medical  care  for  in- 
digent persons”,  and  with  the  further  principle  of 
endeavoring  to  preserve,  as  far  as  possible,  the 
“free  choice”  by  individuals  in  the  selection  of 
physicians. 

Since  the  issuance  by  the  State  Relief  Com- 
mission of  Ohio  of  its  Supplement  No.  1 to  Fed- 
eral Rules  and  Regulations  No.  7,  under  date  of 
September  20,  1933,  establishing  a temporary 
plan  for  emergency  medical  care  to  the  needy  un- 
employed, numerous  problems  have  arisen.  It  was, 
of  course,  recognized  that  the  amount  of  federal- 
state  funds  available  for  distribution  by  the  State 
Relief  Commission  to  local  communities,  was 
limited,  and  that  these  funds  would  be  inadequate 
to  provide  necessary  medical  care.  We  appreciate 
the  cooperative  spirit  of  the  State  Relief  Com- 
mission and  the  State  Director  of  Health  in  wish- 
ing to  make  available  as  promptly  as  possible 
those  funds  that  could  be  distributed  for  this 
purpose  in  Ohio. 

We  find,  however,  that  in  some  communities 
there  has  been  a tendency  to  utilize  the  inadequate 
fee  schedule  proposed  by  the  State  Relief  Com- 
mission as  a “pattern”  or  gauge  for  general  medi- 
cal services  in  spite  of  the  fact  that  the  State 
Relief  Commission  has  specifically  stated  that 


782 


The  Ohio  State  Medical  Journal 


December,  1933 


“these  fees  are  not  intended  to  establish  such  low 
rates  in  ordinary  practice”. 

It  is  estimated  in  many  communities  that  the 
“overhead  expense”  to  physicians  in  rendering- 
service  to  patients  is  at  least  50  per  cent  of  the 
ordinary  fees  collected.  As  the  suggested  fee 
schedule  proposed  by  the  State  Relief  Commission 
is  in  many  instances  less  than  one-half  or  even 
one-third  of  the  ordinary  fees,  physicians  are  con- 
fronted with  the  problem  of  continuing  to  render 
medical  care  to  the  needy  at  a definite  financial 
loss. 

It  is  our  opinion  that  on  account  of  the  widely 
varying  local  problems  and  conditions  peculiar  to 
each  community,  it  is  impractical  and  not  feasible 
to  apply  a standard  fee  schedule  for  the  entire 
state,  which,  if  attempted,  will  lead  to  misunder- 
standings and  difficulties.  It  is  our  desire  to  aid 
in  meeting  the  present  medical  emergency  relief 
x’equirements,  and  for  this  reason  we  feel  that 
certain  adjustments  and  modifications  are  neces- 
sary. 

It  is  our  recommendation,  therefore, 

1.  That  the  temporary  plan  and  fee  schedule 
proposed  by  the  State  Relief  Commission  in  its 
announcement  of  September  20,  1933  to  local  re- 
lief officials  be  abandoned,  and  that  in  each  com- 
munity which  is  receiving  or  is  entitled  to  receive 
federal  funds  for  “relief”,  the  State  Relief  Com- 
mission apportion  on  the  basis  of  the  needy  popu- 
lation the  proportionate  share  of  such  funds  to 
which  such  communities  are  entitled,  without  a 
definite  stipulation  as  to  the  amount  of  the  fees 
for  each  case  seiwed,  but  with  the  definite  under- 
standing that  the  general  regulations  and  limita- 
tions under  which  such  funds  are  distributed  be 
adhered  to  strictly; 

2.  That  the  relief  officials  in  each  community, 
after  official  local  conferences  and  agreements 
with  representatives  of  the  county  medical  so- 
cieties, establish  fee  schedules  applying  in  such 
communities  for  services  to  the  indigent  and  the 
needy  unemployed  at  approximately  two-thirds  of 
the  customary  fees,  with  due  consideration  for 
customary  fees  in  each  community,  with  proper 
differentiation  between  fees  for  house  calls  and 
office  service,  and  with  proportionate  differentia- 
tion between  day  and  night  services,  mileage,  dis- 
tance and  difficulty  in  reaching  patients. 

3.  That  the  proportion  of  the  federal-state 
funds  available  be  supplemented  by  local  funds  on 
which  to  base  such  local  agreement  of  fees  in 
accordance  with  the  provision  in  Federal  Regula- 
tions 7 to  the  effect  that  “this  schedule  (fee 
schedule)  shall  only  apply  where  the  expenditure 
of  federal  relief  funds  is  involved  and  shall  not 
preclude  the  payment  of  additional  amounts  from 
local  funds”; 

4.  That  in  cases  of  injuries  or  disabilities  not 
contemplated  under  ordinary  house  or  office  calls, 
the  schedule  of  fees  under  the  Workmen’s  Com- 
pensation Law  with  the  present  20  per  cent  dis- 
count be  the  prevailing  fees  for  such  services  to 
the  needy; 

5.  That  in  those  communities  where  federal- 
state  funds  are  not  available  the  principles  set 
forth  in  this  statement  shall  be  adopted  through 
conferences  between  representatives  of  the  county 
medical  societies  and  public  officials,  particularly 
those  principles  pertaining  to  the  preservation  of 
the  family  and  family-physician  relationship  and 
the  “free  choice”  by  the  patient  of  his  medical 
attendant ; 

6.  That  in  view  of  the  fact  that  the  “relief” 
program  is  emergency  and  temporary , the  medical 
profession  in  each  community,  through  its  official 
county  society  or  academy  of  medicine  have 


equal  authority  with  the  public  officials  or  local 
relief  commissions  to  determine  when  such  emerg- 
ency and  temporary  plan  shall  end,  at  least  in  so 
far  as  medical  service  is  concerned; 

7.  That  it  be  clearly  understood  that  any  fee 
schedule  adopted,  approved  or  in  effect  locally 
shall  apply  only  for  medical  services  to  the  in- 
digents or  needy  unemployed  and  during  the  term 
of  the  present  emergency. 

It  is  agreed  by  the  Council  of  the  Ohio  State 
Medical  Association  that  this  statement  and  re- 
port be  transmitted  promptly  to  the  State  Relief 
Commission  for  its  information,  and  to  the  secre- 
taries of  the  county  medical  societies  and  acade- 
mies of  medicine  for  their  information,  guidance 
and  comments. 

In  view  of  the  fact  that  at  the  present  time  42 
counties  or  parts  of  counties  in  Ohio  are  eligible 
to  federal-state  funds  for  “relief”,  many  ques- 
tions have  arisen  as  to  the  system  in  the  other 
communities.  The  counties  or  parts  of  counties 
in  Ohio  which  up  to  this  time  have  qualified 
through  assumption  of  local  obligations  and  relief 
expenditures  to  receive  federal-state  funds  to  sup- 
plement their  “relief”  programs,  are:  Adams, 

Allen,  Ashtabula,  Athens,  Belmont,  Butler,  Car- 
roll,  Clark  (Springfield  and  Springfield  Town- 
ship), Columbiana,  Crawford  (Bucyrus),  Cuya- 
hoga, Defiance  (Defiance),  Erie  (Sandusky), 
Franklin,  Guernsey,  Hamilton,  Hocking,  Jackson, 
Jefferson,  Lawrence,  Licking,  Logan,  Lorain, 
Lucas,  Mahoning,  Marion,  Meigs,  Miami  (Troy 
and  Piqua),  Montgomery,  Muskingum,  Perry, 
Portage,  Ross,  Sandusky  (Fremont),  Scioto, 
Seneca  (Fostoria),  Shelby  (Sidney),  Stark,  Sum- 
mit, Trumbull,  Tuscarawas  (New  Philadelphia, 
Uhrichsville  and  Dover),  and  Vinton. 

LEGAL  RESPONSIBILITY  FOR  MEDICAL  RELIEF 

Under  state  laws  each  local  political  subdivision 
is  responsible  for  the  care  of  its  indigent  citizens, 
including  medical  service  even  in  normal  times. 

The  primary  plan  of  the  Federal  Relief  Ad- 
ministration is  to  apportion  to  any  state  entitled 
to  receive  federal  money  approximately  $1.00  for 
each  $3.00  expended  by  the  state  and  its  political 
subdivisions  out  of  public  monies  from  all  sources 
for  relief  purposes  during  the  preceding  quarters 
of  the  year. 

Broad  discretionary  powers  are  vested  in  the 
Federal  Relief  Administration  as  well  as  in  the 
State  Relief  Commission,  which  may  set  up  var- 
ious types  of  relief  administration  in  the  counties. 

Under  federal  and  state  regulations  local  relief 
agencies  are  expected  to  pay  the  first  share  of  the 
cost  of  unemployment  relief  in  their  own  com- 
munities, and  the  State  Relief  Commission  may 
exact  certain  obligations  from  the  counties  before 
making  federal  funds  available  for  local  use.  In 
order  to  control  expenditures  and  administration, 
all  expenditures  for  relief,  under  a legally  con- 
stituted local  relief  administration,  must  be  cen- 
tered in  such  relief  director  or  relief  commission. 

As  pointed  out  in  previous  issues  of  the  Ohio 
State  Medical  Journal,  particularly  the  article  in 
the  April,  1933,  issue,  pages  257  and  258,  there 


December,  1933 


State  News 


783 


are  a number  of  sources  by  which  local  com- 
munities may  raise  funds  for  relief,  including  that 
part  of  the  general  revenue  fund  of  the  political 
subdivisions  (including  townships)  set  aside  for 
poor  relief  work;  as  well  as  by  the  issuance  of 
special  poor  relief  bonds,  county  proportion  of 
excise  taxes  on  public  utilities,  and  diversion  of 
gasoline  tax. 

HOW  FEDERAL-STATE  FUNDS  ARE  USED 
The  usual  procedure  in  the  counties  is  not  to 
re-allocate  federal-state  funds  to  the  township 
but  to  supplement,  under  centralized  control,  local 
funds  with  federal-state  funds  to  the  extent  the 
emergency  requires. 

According  to  the  set-up  the  township  trustees 
and  the  municipal  officials  continue  to  function  as 
the  fiscal  agents  of  those  political  subdivisions  in 
as  far  as  making  local  funds  available  is  con- 
cerned, but  when  such  local  funds  are  supple- 
mented under  federal-state  regulations  by  federal 
funds,  the  relief  administration  has  final  super- 
vision. 

The  custom  of  some  townships  in  failing  to 
appropriate  money  for  poor  relief,  including 
medical  care,  is  too  general.  Some  local  public 
officials  have  frankly  taken  advantage  of  the 
medical  profession  by  assuming  that  medical  care 
will  be  rendered  by  physicians  whether  or  not  any 
remuneration  is  provided. 

As  to  the  procedure  in  getting  on  the  “relief 
rolls”,  applicants  for  relief  must  apply  to  the  local 
relief  officials,  and  if  they  have  not  been  receiving 
general  “relief”,  such  as  food  and  clothing,  but 
if  the  need  arises  for  medical  care  and  they  are 
not  able  to  pay  for  it,  they  are  entitled  to  such 
medical  care  relief  upon  proper  authorization. 

STATE  STATUTES  AND  REGULATIONS 
As  pointed  out  and  cited  in  the  article  on  prob- 
lems of  medical  care  to  the  needy  published  in  the 
November  issue  of  The  Journal,  state  statutes  and 
regulations  for  local  medical  care,  when  not  in- 
volved with  federal  funds  administered  through 
the  State  Relief  Commission,  were  set  forth  in  de- 
tail in  the  March,  1932,  issue  of  The  Journal, 
pages  203  to  207. 

A part  of  the  Ohio  statutes  (Section  3480  of 
the  General  Code  of  Ohio)  reads  as  follows: 
“Relief,  how  obtained;  notice  to  trustees  or 
officers. — When  a person  in  a township  or  muni- 
cipal corporation  requires  public  relief,  or  the 
services  of  a physician  or  surgeon,  complaint 
thereof  shall  be  forthwith  made  by  a person  hav- 
ing knowledge  of  the  fact  to  the  township  trustees, 
or  proper  municipal  officer.  If  medical  services 
are  required,  and  no  physician  or  surgeon  is 
regularly  employed  by  contract  to  furnish  medical 
attendance  to  such  poor,  the  physician  called  or 
attending  shall  immediately  notify  such  trustees 
or  officers,  in  writing,  that  he  is  attending  such 
person,  and  thereupon  the  township  or  municipal 
corporation  shall  be  liable  for  relief  and  services 
thereafter  rendered  such  person,  in  such  amount 
as  such  trustees  or  proper  officers  determine  to  be 
just  and  reasonable.  If  such  notice  be  not  given 


within  three  days  after  such  relief  is  afforded  or 
services  begin,  the  township  or  municipal  cor- 
poration shall  be  liable  only  for  relief  or  services 
rendered  after  notice  has  been  given.  Such  trus- 
tees or  officer,  at  any  time  may  order  the  discon- 
tinuance of  such  services,  and  shall  not  be  liable 
for  services  or  relief  thereafter  rendered.” 


New  Books  Received 

Frontiers  of  Medicine,  by  Morris  Fishbein, 
M.D.,  editor  of  The  Journal  of  the  American 
Medical  Association.  One  of  a series  of  volumes 
by  well-known  scholars  presenting  the  essential 
features  of  those  fundamental  sciences  which  are 
the  foundation  stones  of  modern  industry.  This 
brief  acocunt  of  medical  progress  begins  with  a 
description  of  the  period  previous  to  Hippocrates 
and  takes  the  reader  through  eight  additional 
epochs  to  the  present  time.  The  Williams  & Wil- 
kins Company,  Baltimore,  publishers;  price  $1.00. 

Medical  Relations  Under  Workmen’s  Compensa- 
tion, a report  prepared  by  the  Bureau  of  Medical 
Economics,  American  Medical  Association,  trac- 
ing the  evolution  of  compensation  systems,  dis- 
cussing some  of  the  problems  involved  in  ad- 
ministering them,  and  appraising  the  present 
position  of  such  systems.  American  Medical  As- 
sociation, 535  North  Dearborn  Street,  Chicago, 
publisher;  price  75  cents. 

The  History  and  Epidemiology  of  Syphilis,  by 
William  Allen  Pusey,  M.D.,  professor  of  dermat- 
ology emeritus,  University  of  Illinois  and  former 
president  of  the  American  Dermatological  Asso- 
ciation; Charles  C.  Thomas,  220  East  Monroe 
Street,  Springfield,  Illinois,  publisher;  price,  $2.00. 

Hospital  Medical  Statistics,  by  Caroline  R. 
Martin,  M.D.,  director,  Central  Medical  Statistical 
Bureau,  New  York  Department  of  Hospitals;  a 
brief  description  of  the  system  used  by  the  de- 
partment with  which  she  is  connected  in  obtaining 
hospital  medical  statistics  and  how  they  should  be 
applied  for  administrative  purposes  and  in  the 
cure  and  prevention  of  disease;  J.  B.  Lippincott 
Company,  Philadelphia,  publishers;  price,  $1.00 
per  copy. 

The  Joy  of  Living,  an  autobiography  in  two 
volumes  by  Franklin  H.  Martin,  M.D.,  written  in 
narrative  form,  Volume  1 covers  the  life  of  the 
author  from  childhood  until  the  period  of  the 
World  War.  Volume  2 is  an  account  of  the  activi- 
ties of  the  Advisory  Commission  of  the  Council 
of  National  Defense  of  which  Dr.  Martin  was  a 
member  and  recites  intimate  events  in  connection 
with  the  great  personalities  that  participated  in 
and  directed  the  World  War.  Forewords  have 
been  contributed  by  some  of  Dr.  Martin’s  associ- 
ates, including  Newton  D.  Baker,  Daniel  Willard, 
Dr.  William  J.  Mayo  and  Dr.  George  W.  Crile; 
Doubleday,  Doran  & Company,  Garden  City,  New 
York,  publishers;  price,  $7.00  for  the  two 
volumes. 


•gram 


Annual  Health  Commissioners''  Conference 


Fourteenth  Annual  Conference  of  Ohio  Health 
Commissioners  with  the  State  Department  of 
Health,  held  October  19  and  20  at  the  Deshler- 
Wallick  Hotel,  Columbus,  was  one  of  the  best- 
attended  and  beneficial  gatherings  of  official  pub- 
lic health  workers  held  in  Ohio. 

Approximately  300  health  commissioners,  pub- 
lic health  nurses  and  other  official  health  workers 
atended  the  two  days  meeting.  Numerous  ad- 
ministrative and  economic  problems  relating  to1 
public  health  were  discussed  and  instructive 
papers  dealing  with  some  of  the  newer  methods 
for  the  prevention  and  control  of  disease  were 
presented. 

The  conference  was  opened  by  the  annual  ad- 
dress of  the  state  director  of  health,  Dr.  H.  G. 
Southard,  followed  by  an  address  by  Dr.  L.  L. 
Bigelow,  Columbus,  a past  president  of  the  Ohio 
State  Medical  Association,  on  “Medical  Mile- 
stones”. Both  addresses  dealt  with  medicine’s  con- 
tribution to  civilization  and  stressed  the  im- 
portance of  the  role  which  the  physician  and  his 
aides  have  played  in  the  economic  and  social  prog- 
ress of  mankind. 

Dr.  Southard  and  Dr.  Bigelow  paid  tribute  to 
the  late  Dr.  Charles  0.  Probst,  for  many  years  a 
leader  in  official  public  health  work  in  Ohio,  citing 
him  as  a good  example  of  the  kind  of  men  who, 
in  official  and  unofficial  capacities,  have  made 
lasting  and  beneficial  contributions  to  the  progress 
of  civilization. 

What  Medicine  Has  Accomplished  in  Ohio  in 
Past  100  Years  Reviewed  by  Dr.  Southard 

Various  contributions  which  medicine  has  made 
throughout  the  centuries  were  reviewed  by  Dr. 
Southard  in  his  remarks  on  “The  Economic  Status 
of  Public  Health  Administration”.  Of  particular 
interest  was  his  discussion  of  what  scientific  and 
preventive  medicine  have  accomplished  in  Ohio 
during  the  past  100  years. 

“At  the  age  of  twenty-seven — one  hundred 
years  ago,”  Dr.  Southard  said,  “Ohio  had  a popu- 
lation of  937,903  living  in  numerous  backwoods 
settlements  or  in  isolated  little  individual  clear- 
ings. * * * The  savage  red  man  had  long  ceased 
to  be  a menace,  and  dangerous  wild  animals,  the 
wolf,  the  bear  and  the  catamount  were  rapidly 
dwindling  in  numbers,  but  there  was  one  foe  by 
far  more  deadly  than  all  these  had  ever  been  that 
still  continued  to  annually  reap  an  appalling  har- 
vest of  death.  This  was  disease.  Cholera  and 
virulent  smallpox  periodically  swept  the  state; 
malaria  and  typhoid  fever  devastated  whole  set- 
tlements; milk  sickness,  mysterious,  deadly, 
slaughtered  entire  families;  diphtheria,  diarrhea 
and  enteritis,  and  other  ailments  of  early  child- 


hood killed  almost  one-fourth  of  all  babies  before 
their  first  year  had  passed.  The  newborn  babe 
had  a life  expectancy  of  about  25  years. 

“Should  one  of  our  citizens  of  one  hundred 
years  ago  return,  he  would  be  told  that  cholera 
had  been  unknown  in  Ohio  for  many  years;  that 
cases  of  maleria  are  so  infrequent  that  many  of 
our  physicians  have  never  seen  one;  that  typhoid 
fever  and  diphtheria  are  now  preventable  and 
that  when  cases  occur  they  are  due  to  careless- 
ness, negligence  or  ignorance;  that  few  deaths 
occur  from  smallpox  (we  would  be  ashamed  to 
mention  the  number  of  cases  each  year)  ; that 
only  five  per  cent  of  the  babies  born  in  our  day 
fail  to  reach  one  year  of  age,  and  that  the  new- 
born babe  now  has  a life  expectancy  of  58  years. 

“We  could  tell  him  of  many  complete  recoveries 
from  tuberculosis;  we  could  tell  him  how  public 
health  is  protected  by  supervision  of  water  and 
milk  supplies;  how  the  traveling  public  may  be 
assured  of  health  protection  in  inspected  tourist 
camps  and  of  safe  drinking  water  where  signs  of 
the  Ohio  Department  of  Health  appear;  of  the 
constant  guardianship  of  both  city  and  rural  com- 
munities by  local  health  departments;  of  the  in- 
vestigation and  checking  of  local  outbreaks  of 
communicable  disease;  of  the  inspection  of  school 
children  that  epidemics  may  not  occur,  and  of  the 
examination  of  younger  children  that  defects  may 
be  corrected  by  physicians  or  dentists  before  the 
child  enters  school.  We  could  tell  of  great  re- 
duction of  maternity  death  rates  since  his  day, 
due  to  prenatal  and  postnatal  care,  and  we  would 
tell  of  the  instruction  of  children  in  the  care  of 
the  body,  that  they  may  reach  manhood  and 
womanhood  physically  fit.” 

Statistics  were  presented  by  Dr.  Southard  to 
show  the  great  saving  in  life  which  has  been  re- 
corded in  Ohio  since  1920  when  the  present 
Hughes-Griswold  health  code  became  effective. 
He  pointed  out  that  while  the  population  of  Ohio 
has  increased  more  than  1,000,000,  or  17.8  per 
cent,  during  the  past  13  years,  there  were  only 
3.4  per  cent  more  deaths  in  1932  than  in  1920. 
Dr.  Southard  said  that  in  1920  every  128th  mother 
died  in  childbirth;  in  1932  every  188th  mother 
died  from  this  cause.  In  1920,  he  said,  every  12th 
child  born  died  before  its  first  birthday;  in  1932 
this  figure  had  been  reduced  to  every  17th  child. 
He  cited  the  decrease  in  the  death  rates  of  some 
of  the  more  common  diseases  since  1920  when 
every  12th  death  in  Ohio  was  due  to  tuberculosis 
and  in  1933  when  every  21st  death  was  due  to  this 
cause.  The  death  rate  among  children  between 
the  ages  of  five  and  19  years  has  been  reduced 
from  42  per  cent  to  27  per  cent,  he  said,  and  the 
death  rates  for  the  following  diseases  have  de- 


784 


December,  1933 


State  News 


785 


creased  as  indicated:  Typhoid  fever,  66  per  cent; 
scarlet  fever,  40  per  cent;  diphtheria,  65  per  cent; 
measles,  76  per  cent  and  whooping  cough,  58  per 
cent.  Additional  fifigures  were  presented  by  Dr. 
Southard  to  show  the  importance  and  value  cf 
efficient  public  health  administration  both  from 
an  economic  and  humanitarian  standpoint. 

In  conclusion,  Dr.  Southard  attributed  the  great 
saving  in  human  lives  and  suffering  which  has 
been  made  in  Ohio  to  the  progress  of  medical 
science,  the  effective  and  faithful  work  of  the 
medical  profession,  and  the  efficient  official  public 
health  program  which  has  been  established  in 
Ohio  through  cooperation  of  the  medical  profes- 
sion and  official  public  health  departments.  He 
urged  the  health  workers  of  Ohio  to  continue  with 
the  splendid  work  they  have  been  doing  and  sug- 
gested that  they  solicit  the  aid  of  the  worthy 
citizens  of  their  respective  communities  in  their 
endeavors  so  that  public  sentiment  might  be 
sufficiently  aroused  to  insure  adequate  financial 
support  now  and  in  the  future  for  carrying  on  a 
work  which  he  said  could  be  measured  in  dividends 
of  millions  of  dollars  and  which  has  contributed 
more  to  human  happiness  than  any  other  one 
thing  in  all  history. 

Medicine’s  Contributions  to  Civilization 
Summarized  in  Colorful  Way  by  Dr.  Bigelow 

In  a scholarly,  instructive  and  entertaining 
paper,  Dr.  Bigelow  reviewed  some  of  the  high- 
spots  of  medical  history,  pointing  out  how  medi- 
cine had  been  an  important  factor  in  the  progress 
of  mankind  and  why  its  contributions  have  been 
more  fundamental  and  vital  than  all  other  inven- 
tions and  discoveries  which  have  contributed  to 
the  comforts  and  conveniences  of  modern  life. 

In  his  comments  regarding  the  lives  and  work 
of  some  of  the  heroes  of  medicine,  Dr.  Bigelow  re- 
vealed in  a colorful  maner  the  wide  scope  of 
medicine  and  pointed  out  the  debts  modern  medi- 
cine and  society  at  large  owe  to  the  thought  and 
activity  of  the  men  of  the  past  who  have  con- 
tributed the  knowledge  which  is  the  basis  for 
modem  methods  used  in  the  prevention  and  cure 
of  disease. 

Dr.  Bigelow  painted  a graphic  picture  of  the 
superstitution  and  ignorance  that  had  to  be  over- 
come, the  intolerance  and  fanaticism  that  stood 
in  the  way,  and  the  persecution  and  even  death 
that  were  often  the  lot  of  the  pioneering  spirits 
whose  discoveries  and  teachings  are  the  milestones 
marking  the  progress  of  medicine.  In  reviewing 
briefly  the  contributions  of  some  of  the  better 
known  figures  in  medical  history,  Dr.  Bigelow 
assembled  the  fundamental  facts  and  theories 
which  form  the  background  of  modem  medicine 
and  which  have  had  a special  influence  on  medical 
advancement,  concluding  with  the  opinion  that  the 
real  appeal  of  medicine  as  a profession  lies  in 
“the  rich  heritage  of  the  past  with  its  prophecy 
of  greater  things  to  come  and  the  responsibility 


and  privilege  of  playing  a part,  however  humble 
the  part  may  be”. 

Developments  in  Communicable  Disease 
Field  Discussed  by  Several  Speakers 

The  second  session  of  the  conference,  presided 
over  by  Dr.  J.  I.  Nisbet,  health  commissioner  of 
Preble  County,  was  for  the  most  part  devoted  to 
discussions  of  new  developments  in  the  preven- 
tion  and  treatment  of  communicable  diseases. 

Dr.  William  B.  Wherry,  head  of  the  Department 
of  Bacteriology  and  Hygiene,  College  of  Medicine, 
University  of  Cincinnati,  discussed  the  subject, 
“Recent  Developments  in  the  Treatment  and 
Immunization  of  Communicable  Diseases”. 

Dr.  Wherry  based  his  remarks  largely  on  ex- 
perimental work  which  has  been  and  is  at  present 
being  carried  on  by  his  department  in  developing 
immunizing  antigens  and  serums  for  the  control 
and  treatment  of  diseases  and  conditions  which 
have  heretofore  not  been  managed  by  the  use  of 
serums  to  any  extensive  degree.  Of  particular 
interest  was  his  review  of  experimental  work  with 
serums  in  the  diagnosis  and  treatment  of  tul- 
aremia, undulant  fever  and  gonori’hea.  Much  of 
this  wox'k,  Dx\  Wherry  pointed  out,  is  still  in  the 
experimental  stage  but  the  results  to  date  ax-e 
hopeful,  and  he  expi’essed  confidence  that  in  the 
not  distant  future  the  field  of  conditions  which 
can  be  managed  by  serums  would  be  considerably 
enlarged. 

“Progress  in  Diphthex-ia  Immunization”  was  the 
subject  of  a talk  by  Dr.  M.  V.  Veldee,  a member  of 
the  staff  of  the  United  States  Public  Health  Sex’- 
vice.  Dr.  Veldee  reviewed  the  experimental  work 
which  led  to  the  perfecting  of  toxoid  and  de- 
scribed in  detail  why  it  is  superior  to  toxin  anti- 
toxin. Being  a more  stable  compound  it  is  not 
greatly  affected  by  temperature  changes,  he 
pointed  out,  and  it  produces  gx-eater  immunity 
with  a fewer  number  of  injections  than  toxin 
antitoxin.  Dr.  Veldee  also  described  the  newest 
one-dose  toxoid  which  contains  potassium  alum, 
producing  better  immunization  and  minimizing  re- 
action following  injection.  A lax-ge  part  of  his 
discussion  dealt  with  the  scientific  steps  which 
have  been  taken  in  impx’oving  immunization 
methods  and  with  statistics  gathered  in  vax'ious 
communities  showing  in  a comparative  way  the 
degree  of  effectiveness  of  the  vax’ious  methods. 

Emphasis  Placed  on  Ways  to  Protect  the 
Health  of  Pre-School  and  School  Child 

Formal  as  well  as  informal  discussions  of 
health  problems  involving  the  pi’e-school  and 
school  child  were  given  a prominent  place  on  the 
program. 

At  the  annual  luncheon  for  public  health 
nux’ses,  Dr.  J.  Dean  Boylan,  health  commissioner 
of  Xlnion  County,  addressed  a large  gathex’ing  of 
nurses  and  health  commissioners  on  “Study  of  the 
Nutrition  of  the  School  Child”. 

Dr.  Boylan,  basing  his  obsexwations  on  special 


786 


The  Ohio  State  Medical  Journal 


December,  1933 


work  being  done  by  his  department,  declared  that  have  not  lost  sight  of  the  individual  pupil  and 


the  present  financial  distress  is  producing  a 
serious  health  pi'oblem  especially  among  children 
who  are  beginning  to  show  the  effects  of  meager 
and  badly  balanced  diets. 

Dr.  Boylan  described  in  detail  the  program  he 
had  instituted  in  his  county  in  an  effort  to  meet 
the  threats  arising  from  undernourishment  of 
children.  His  program,  he  revealed,  calls  for  the 
recording  of  the  weight  of  each  school  child  each 
month  and  a tabulation  of  weight  totals  of  each 
grade  in  each  school.  The  result  has  been  the 
stimulation  of  rivalry  between  grades  and  schools 
and  the  development  of  local  interest  in  all  health 
measures  helpful  in  maintaining  or  improving 
weight  records.  School  officials,  teachers  and 
parents  have  taken  an  interest  in  the  work,  he 
pointed  out,  resulting  in  provision  for  extra  food 
where  necessary  and  use  of  better  diets  in  the 
homes.  By  keeping  nutrition  and  weights  on  a 
contest  basis,  Dr.  Boylan  pointed  out,  it  has  been 
possible  to  minimize  nutrition  problems. 

Statistics  gathered  in  connection  with  these 
school  weight  contests  show,  Dr.  Boylan  said,  that 
in  general,  conditions  were  worst  among  first 
grade  children,  moderately  bad  in  the  next  five 
grades,  least  serious  in  the  seventh  grade,  and 
alarming  in  character  in  the  eighth  grade,  in- 
dicating that  depression  diets  were  highly  un- 
satisfactory for  very  small  children  but  grad- 
ually met  the  needs  of  children  as  they  advanced 
to  puberty  when  their  inadequacy  to  meet  the 
demands  for  rapid  growth  become  apparent. 

Dr.  Boylan  emphasized  the  fact  that  food  is  not 
the  only  factor  affecting  nutrition  but  pointed  out 
that  substantial  gains  in  weight  depend  to  some 
extent  on  ability  to  assimilate  the  food  and  on 
environmental  factors.  He  said  that  investigations 
made  by  his  department  have  shown  that  weight 
losses  have  been  recorded  or  proper  weight  levels 
not  attained  in  schools  where  there  was  not  ade- 
quate supervision  during  the  lunch  hour;  where 
heating  and  ventilation  were  bad;  where  the 
school  room  morale  was  bad;  where  children  are 
overtaxed  during  examinations  or  by  rehearsals 
for  entertainments. 

“We  have  reached  the  obvious  conclusion,”  Dr. 
Boylan  said,  “that  nutrition  is  affected  by  three 
great  factors,  viz.,  the  health  of  the  children,  the 
adequacy  of  the  food  supply,  and  the  environment. 
By  analyzing  the  situation  for  each  grade  and 
each  child  we  determine  the  choice  of  remedies  to 
be  applied.  * * * Our  investigations  seem  to 
establish  the  opinion  that  excessive  emphasis  has 
been  placed  upon  physical  abnormalities  and  that 
equally  or  more  important  but  less  evident  fac- 
tors in  under-nourishment  are  often  neglected. 
When  I advocate  more  attention  to  group  studies 
it  should  be  understood  that  I am  not  advocating 
abandonment  of  interest  in  individuals  and  their 
defects,  but  these  problems  must  not  be  given 
preference  when  a general  danger  exists.  We 


even  in  schools  with  high  average  gains  we  en- 
deavor to  leam  if  each  child  is  making  satisfac- 
tory progress.  Where  the  answer  is  in  the  nega- 
tive we  start  a routine  of  study,  including  a com- 
parison of  actual  weight  with  average  weight 
tables,  and  investigation  to  determine  if  remedial 
defects  are  present,  but  we  do  not  permit  our- 
selves to  forget  that  we  are  public  health  workers 
and  that  problems  of  general  importance  to  the 
public  must  be  given  priority  in  consideration.” 

Warning  his  fellow  health  workers  that  the  en- 
suing months  will  be  difficult  ones  for  relief  and 
health  workers,  Dr.  Boylan  said: 

“In  a crisis  of  this  sort  weight  variations  of 
children  will  provide  a ready  and  fairly  reliable 
index  of  the  public  health.  We  should  consider  it 
our  first  duty  to  get  an  adequate  comprehension 
of  the  public  health  phases  of  the  current  situa- 
tion. Some  of  us  may  have  to  relax  our  own 
efforts  at  relief  so  that  we  may  guide  the  groups 
needed  to  provide  adequate  service.  We  should  be 
satisfied  with  an  opportunity  to  perform  one  job 
well.” 

An  interesting  and  general  discussion  of  the 
problems  of  child  health  was  presented  by  Dr. 
J.  H.  Hayes,  health  commissioner  of  Mansfield 
and  Richland  County,  in  a paper  on  “Protection 
of  Our  Children”. 

Dr.  Hayes  declared  that  protection  of  the  health 
of  the  child  should  begin  even  before  its  birth 
through  prenatal  care  of  the  mother.  The  health 
commissioner  and  public  health  nurse,  he  said, 
should  play  a leading  role  in  this  work  through 
education  of  the  public  as  to  the  value  of  pre- 
natal care.  He  also  emphasized  the  value  of  post- 
natal care  for  the  mother  and  child  and  education 
of  the  public  along  these  lines. 

Other  steps,  Dr.  Hayes  said,  are  protection  of 
the  food,  water  and  milk  supplies  of  the  child; 
the  control  and  prevention  of  contagious  diseases 
in  both  the  preschool  and  school  child;  periodic 
health  examinations  and  routine  school  examina- 
tions, etc. 

Dr.  Hayes  urged  complete  cooperation  between 
health  departments  and  the  medical  profession  in 
every  community  in  physical  examination  and 
immunization  programs,  stressing  the  importance 
of  reaching  children  even  before  they  enter  school 
so  that  physical  defects  may  be  corrected  and  the 
child  protected  against  contagious  diseases.  He 
advocated  immunization  by  the  attending  physi- 
cian soon  after  the  birth  of  a child  and  expressed 
the  hope  that  more  physicians  would  take  an 
active  interest  in  this  phase  of  medicine. 

Administrative  and  Legal  Questions  Are 
Considered;  Attorney  General  Is  Speaker 

One  session  of  the  conference,  at  which  Dr.  E, 
R.  Brush,  health  commissioner  of  Zanesville,  pre- 
sided, was  devoted  to  discussions  of  administrative 
and  legal  questions. 

One  of  the  guest  speakers  was  the  Hon.  John 


December,  1933 


State  News 


787 


W.  Brisker,  attorney  general  of  Ohio.  Mr.  Bricker 
emphasized  the  importance  of  the  role  in  govern- 
ment played  by  official  public  health  departments 
and  pointed  out  that  it  was  regrettable  that  pub- 
lic health  administration  had  failed  to  receive  the 
moral  and  financial  support  which  it  deserves. 
Mr.  Bricker  deplored  lack  of  local  intei*est  in 
public  health  administration  in  many  communities 
and  pointed  out  the  evils  and  fallacies  of  over- 
centralization of  all  branches  of  government,  in- 
cluding public  health  administration.  He  de- 
clared that  eveiy  community  could  and  should 
maintain  an  efficient  local  public  health  depart- 
ment and  should  not  expect  the  State  or  Federal 
governments  to  carry  on  activities  which  can  be 
done  in  a more  effective  manner  under  local  con- 
trol and  through  local  initiative.  Mr.  Bricker  as- 
sailed interference  with  local  governmental  ac- 
tivities by  outsiders,  pointing  out  that  the  basic 
set-up  for  public  health  administration  in  Ohio 
provides  for  an  ideal  system  of  local  responsibility 
and  initiative  with  a minimum  of  supervision  and 
control  by  the  state.  He  expressed  the  belief  that 
public  health  administration  in  Ohio  is  one  branch 
of  government  which  is  open  to  little,  if  any, 
criticism  of  over-expansion  and  extravagance. 
Mr.  Bricker  urged  his  listeners  to  continue  with 
the  splendid  work  most  of  them  have  been  doing 
in  their  local  districts  and  predicted  that  public 
support  would  be  forthcoming  in  the  near  future 
to  reward  them  for  the  meritorious  function  they 
are  performing. 

“Modern  State  Health  Regulations”  was  the 
subject  of  a talk  by  Dr.  Edward  S.  Godfrey,  di- 
rector of  local  health  administration,  New  York 
State  Department  of  Health.  Dr.  Godfrey  ex- 
plained in  detail  many  of  the  provisions  of  the 
New  York  State  health  code,  comparing  and  con- 
trasting them  with  similar  provisions  of  the  Ohio 
Health  Code.  He  reviewed  the  work  of  a com- 
mission appointed  several  years  ago  by  the  then 
Governor  Roosevelt  to  recodify  the  New  York 
health  laws  and  cited  the  reasons  given  by  the 
commission  for  amending  certain  provisions  of  the 
old  code. 

Charles  G.  McBride,  secretary  of  the  Ohio  Milk 
Marketing  Commission,  addressed  the  conference 
on  “Public  Health  Aspects  and  Interpretation  of 
the  New  State  Milk  Control  Law.”  After  a re- 
sume of  the  provisions  of  the  law  which  was  en- 
acted at  the  last  regular  session  of  the  Ohio  Gen- 
eral Assembly,  Mr.  McBride  complimented  the 
health  commissioners  of  Ohio  on  their  interest  in 
this  phase  of  public  health  work  and  expressed 
appreciation  to  those  who  have  assisted  the  Com- 
mission in  administering  the  new  law  and  provid- 
ing it  with  factual  data,  statistics,  etc.  He  pledged 
the  cooperation  of  the  Commission  with  the  var- 
ious local  health  departments  and  the  State  De- 
partment of  Health  and  asked  their  support  and 
cooperation  in  enforcing  and  administering  the 
milk  control  act. 


In  the  absence  of  Dr.  H.  J.  Powell,  health  com- 
missioner of  Bowling  Green  and  Wood  County, 
who  was  convalescing  from  injuries  received  in  an 
automobile  accident,  a paper  prepared  by  him  on 
the  subject,  “Where  Are  We  in  Public  Health  and 
Where  Are  We  Going?”  was  read  by  Professor  J. 
W.  Carmichael  of  Bowling  Green  State  College. 
Dr.  Powell’s  observations  on  the  subject  were  that 
the  new  aim  of  public  health  administration 
should  be  for  more  extensive  attention  to  the 
health  and  welfare  of  the  individual  and  less  em- 
phasis on  sanitation  and  statistical  work.  He  con- 
tended that  the  ultimate  aim  of  public  health 
work  should  be  to  know  the  individual  and  to 
teach  him  to  live  and  get  along  in  his  environ- 
ment. Dr.  Powell  predicted  that  personal  pre- 
ventive medicine  will  become  of  increasing  im- 
portance in  ensuing  years  and  that  cooperative 
programs  to  provide  this  type  of  service  to  the 
public  sponsored  by  the  medical  profession  and 
public  health  departments  would  result  in  great 
benefit  to  society  at  large. 

William  R.  Foss,  representative  from  Mercer 
County  to  the  90th  General  Assembly,  who  was 
scheduled  to  address  the  conference  on  “What  Is 
Wrong  With  Our  Present  Health  Laws?”  was 
unable  to  be  present. 

Governor  George  White,  who  had  been  sched- 
uled to  open  the  conference,  but  who  was  unable 
to  do  so  because  of  pressing  official  business,  paid 
the  conference  a visit  at  the  final  session  and  in  a 
brief  talk  expressed  appreciation  for  the  untiring 
and  faithful  work  of  local  and  state  public  health 
workers  and  pledged  his  continued  support  to 
public  health  administration  in  Ohio. 

Engineering  Projects,  New  Legislation  and 
Miscellaneous  Subjects  Presented 

Additional  subjects  discussed  at  the  conference 
were : 

“New  Legislation”,  by  James  E.  Bauman,  as- 
sistant director  of  health,  who  summarized  and 
interpreted  some  of  the  measures  enacted  by  the 
90th  General  Assembly  which  had  a bearing  on 
public  health  administration;  “Records  and 
Bookkeeping”,  by  Dr.  M.  C.  Hanson,  former 
health  commissioner  of  Mansfield,  Miss  Martha 
McFarland,  clerk  of  the  Mansfield  Board  of 
Health,  Dr.  James  F.  Wilson,  health  commissioner 
of  Washington  C.  H.  and  Fayette  County,  and 
Dr.  R.  H.  Markwith,  health  commissioner  of  Sum- 
mit County;  “Rural  Health  Project  in  Hocking 
County”,  by  Dr.  W.  B.  Lacock,  health  commis- 
sioner of  Logan  and  Hocking  County,  and  “Re- 
sume of  the  Engineering  Problems  Under  the 
NR  A”,  by  F.  H.  Waring,  chief  engineer,  State 
Department  of  Health.  Mr.  Waring’s  review  of 
the  public  health  phases  of  Ohio’s  public  works 
program  showed  that  up  to  October  1,6  applica- 
tions for  193  sanitary  improvement  projects  from 
96  municipalities  and  three  counties  had  been 
filed  with  the  Public  Woi'ks  Administration, 


788 


The  Ohio  State  Medical  Journal 


December,  1933 


estimated  to  cost  $44,132,033  and  that  applications 
for  79  projects  from  46  municipalities  and  three 
counties  were  in  the  course  of  preparation, 
estimated  to  cost  $15,860,361. 

* * * 

Following  is  a list  of  those  who  registered  at 
the  Conference,  exclusive  of  employes  of  the 
various  bureaus  and  divisions  of  the  State  De- 
partment of  Health: 

Health  Commissioners — Dr.  S.  J.  Ellison,  Adams  County  ; 
Dr.  J.  J.  Sutter,  Allen  County ; Dr.  G.  B.  Fuller,  Ashland 
County ; Dr.  W.  S.  Weiss,  Ashtabula  County ; Dr.  J.  M. 
Higgins,  Athens  County ; Dr.  Roy  C.  Hunter,  Auglaize 
County;  Dr.  F.  R.  Dew,  Belmont  County;  Dr.  J.  G.  Ander- 
son, Brown  County ; Dr.  C.  J.  Baldridge,  Butler  County ; 
Dr.  Glenn  C.  Dowell,  Carroll  County ; Dr.  R.  R.  Richison, 
Clark  County ; Dr.  C.  R.  Colburn,  Clermont  County ; Dr.  W. 

K.  Ruble,  Clinton  County ; Dr.  Seward  Harris,  Columbiana 
County ; Dr.  D.  M.  Criswell,  Coshocton  County ; Dr.  G.  T. 
Wasson,  Crawford  County;  Dr.  Robert  Lockhart,  Cuyahoga 
County ; Dr.  W.  D.  Bishop,  Darke  County ; Dr.  B.  B.  Barber, 
Delaware  County ; 

Dr.  F.  M.  Houghtaling,  Erie  County ; Dr.  W.  R.  Coleman, 
Fairfield  County;  Dr.  James  F.  Wilson,  Fayette  County;  Dr. 
H.  L.  Mitchell,  Franklin  County  ; Dr.  C.  F.  Hartman,  Fulton 
County ; Dr.  F.  W.  Shane,  Gallia  County  ; Dr.  Walter  Corey, 
Geauga  County ; Dr.  W.  C.  Marshall,  Greene  County  ; Dr.  D. 

L.  Cowden,  Guernsey  County  ; Dr.  E.  H.  Schoenling,  Hamil- 
ton County ; Dr.  S.  F.  Whisler,  Hancock  County ; Dr.  J.  H. 
Holcomb,  Hardin  County  ; Dr.  J.  M.  Scott,  Harrison  County  ; 
Dr.  J.  R.  Bolles,  Henry  County;  Dr.  John  L.  Walker,  High- 
land County  ; 

Dr.  W.  B.  Lacock,  Hocking  County ; Dr.  J.  C.  Elder, 
Holmes  County ; Dr.  B.  C.  Pilkey,  Huron  County  ; Dr.  Brinton 
J.  Allison,  Jackson  County;  Dr.  J.  P.  Young,  Jefferson 
County;  Dr.  C.  B.  Elliott,  Lake  County;  Dr.  F.  R.  Stewart, 
Lawrence  County ; Dr.  Edward  M.  Cass,  Licking  County ; 
Dr.  Lee  Traul,  Logan  County ; Dr.  H.  R.  O’Brien,  Lorain 
County  ; Dr.  F.  F.  DeVore,  Lucas  County ; Dr.  Robert  Trim- 
ble, Madison  County ; Dr.  G.  Y.  Davis,  Mahoning  County ; 
Dr.  N.  Sifritt,  Marion  County ; Dr.  W.  T.  Mahoney,  Medina 
County ; Dr.  W.  S.  Ellis,  Meigs  County ; Dr.  F.  E.  Ayers, 
Mercer  County ; 

Dr.  E.  R.  Hiatt,  Miami  County ; Dr.  H.  H.  Pansing, 
Montgomery  County;  Dr.  James  B.  Naylor,  Morgan  County; 
Dr.  R.  L.  Pierce,  Morow  County ; Dr.  Beatrice  T.  Hagen, 
Muskingum  County ; Dr.  G.  M.  Mason,  Noble  County ; Dr. 
C.  B.  Finefrock,  Ottawa  County;  Dr.  F.  J.  Crosbie,  Perry 
County ; Dr.  C.  C.  Beale,  Pickaway  County ; Dr.  R.  T.  Leever, 
Pike  County;  Dr.  R.  D.  Worden,  Portage.  County;  Dr.  J.  I. 
Nisbet,  Preble  County ; Dr.  L.  M.  Piatt,  Putnam  County ; Dr. 
J.  H.  Hayes,  Richland  County;  Dr.  R.  E.  Bower,  Ross 
County ; Dr.  F.  M.  Teeple,  Sandusky  County ; Dr.  G.  W. 
Fishbaugh,  Scioto  County  ; Dr.  J.  J.  Heaton,  Seneca  County ; 
Dr.  A.  B.  Lippert,  Shelby  County ; Dr.  O.  C.  Ricksecker, 
Stark  County ; Dr.  R.  H.  Markwith,  Summit  County ; Dr.  J. 
Blickensderfer,  Tuscarawas  County;  Dr.  J.  D.  Boylan,  Union 
County;  Dr.  Charles  Keyser,  Van  Wert  County;  Dr.  Edward 
Blair,  Warren  County ; Dr.  Alfred  G.  Sturgiss,  Washington 
County:  Dr.  W.  G.  Rhoten,  Wayne  County;  Dr.  W.  A. 
Held,  Williams  County;  Dr.  L.  W.  Naus,  Wyandot  County; 

Dr.  M.  D.  Ailes,  Akron  ; Dr.  Floyd  Stamp,  Alliance ; Dr. 
C.  B.  Meuser,  Ashland  ; Dr.  H.  A.  Finefrock,  Barberton  ; Dr. 
W.  J.  Shepard,  Bellaire ; Dr.  W.  G.  Carlisle,  Bucyrus ; Dr. 
Clyde  L.  Vorhies,  Cambridge ; Dr.  F.  M.  Sayre,  Canton ; A. 
J.  Lyle,  Circleville  ; Dr.  Harold  J.  Knapp,  Cleveland  ; Dr.  N. 
C.  Dysart,  Columbus  ; Dr.  O.  O.  Blakeslee,  Conneaut ; Dr.  A. 
O.  Peters,  Dayton;  Dr.  G.  O.  Higley,  Delaware;  Dr.  C.  F. 
Savage,  Delphos ; J.  D.  Craig,  Dover ; Dr.  G.  W.  Stober, 
East  Cleveland  ; Dr.  Ed  Miskall,  East  Liverpool ; Arthur  S. 
Johnston,  East  Palestine;  Dr.  George  F.  French,  Elyria; 
Martha  Laffey,  R.N.,  Findlay;  L.  W.  Gibson,  Fostoria ; Dr. 
E.  L.  Vermilya,  Fremont ; Dr.  J.  G.  Mannhardt,  Galion ; 
Martha  Dingoss,  R.N.,  Kenton ; Dr.  Wallace  J.  Benner, 
Lakewood ; Dr.  J.  B.  Poling,  Lima ; Dr.  T.  J.  Mohr,  Lock- 
land  ; Dr.  Valloyd  Adair,  Lorain  ; Dr.  J.  B.  McClure,  Mari- 
etta ; Dr.  Kenneth  D.  Smith,  Marion  ; John  Donovan,  Martins 
Ferry ; Dr.  G.  D.  Lummis,  Middletown ; A.  M.  Reese,  Mingo 
Junction;  Dr.  Julius  Shamansky,  Mt.  Vernon;  Dr.  Gubert 
Hyde,  Nelsonville ; Dr.  W.  H.  Knauss,  Newark ; Dr.  C.  L. 
Bell,  Norwalk ; Dr.  L.  O.  Saur,  Norwood ; Dr.  H.  W. 
Lautenschlager,  Oakwood ; Mrs.  Clara  C.  Wildor,  R.N., 
Painesville  ; 

L.  G.  Whitney,  Piqua ; Dr.  O.  D.  Tatje,  Portsmouth;  Dr. 
George  C.  Bishop,  St.  Bernard,  Dr.  C.  P.  McKee,  St.  Marys  ; 
Dr..  R.  T.  Holzbach,  Salem ; Dr.  Paul  M.  Spurney,  Shaker 
Heights;  J F.  Sonnanstine,  Shelby;  Dr.  O.  M.  Craven, 
Springfield;  Julius  A.  Pizzoferrato,  Steubenville;  Dr.  J.  A. 
Gosling,  Tiffin;  Dr.  W.  S.  Holley,  Toledo:  Dr.  H.  D.  Mc- 
Culloch, Toronto;  Dr.  C.  A.  Morgan,  Van  Wert;  Dr.  Alfred 
W.  Voit,  Wapakoneta ; Dr.  M.  T.  Knappenberger,  Warren ; 
Carl  S.  Davis,  Wellston  ; Dr.  J.  S.  McCulloch,  Wellsville; 
Dr.  A.  D.  DeHaven,  Xenia ; Dr.  Coyt  H.  Beight,  Youngstown, 
and  Dr.  E.  R.  Brush,  Zanesville. 

Public  Health  Nurses  and  Guests — Margaret  McWethy, 
Wooster;  Bertha  Clemmer,  Orrville ; Gladys  R.  Hughes, 
Wheelersburg ; Lucy  E.  Lynn,  Portsmouth ; Mrs.  Georgia 


Sikes,  Portsmouth ; Goldia  Young,  Portsmouth ; Lenore 
Wheaton,  Dover;  Margaret  G.  Jones,  Gallipolis ; Luetta 
Speice,  Cambridge;  Elizabeth  Weigand,  Sidney;  Viola  Dorner, 
Sidney ; Dessie  Piper,  St.  Clairsville ; Mrs.  Mary  Connolly 
Bullis,  Van  Wert;  Marcile  Spayd,  Van  Wert;  Miriam  Wolf, 
Mansfield ; Rhea  Hartzler,  Bellefontaine ; Nadean  G.  Face, 
Zanesville ; Betty  Moore,  Zanesville ; Helen  Ranly,  Miamis- 
burg ; Oma  Cartwright,  Miamisburg ; Rhea  Denton,  Lancas- 
ter; Mrs.  T.  Wardell,  Mt.  Vernon;  Ila  Ward,  Mt.  Vernon; 
Alice  Beckman,  Batavia  ; Agnes  B.  Smith,  Greenfield  ; Martha 
Reiter,  Napoleon ; Lelia  Abele,  Zanesville ; Mary  Murphy, 
Cambridge;  Bertha  E.  Shields,  Newark;  Jennie  Ruth,  Jack- 
son  ; Ella  F.  Bazler,  Newark ; Ethel  M.  Snyder,  Columbus , 

Mary  L.  Sears,  Columbus ; Ruth  Guthrie,  Ashland ; Edna 

M.  Travis,  Marion  ; Alma  G.  Denney,  Marion ; Dolores  Mc- 
Manos,  Marion  ; Essie  Bliss,  New  Lexington  ; Betty  M.  Cog- 
gins, Ironton ; Charity  M.  Sherod,  Oberlin  ; Mable  E.  Wade, 
Oberlin  ; Martha  Dingess,  Kenton ; Charlotte  Smith,  Steu- 
benville ; Nettie  L.  Kross,  Toledo ; Ruth  Ford,  Toledo ; 
Matilda  Murbach,  Toledo  ; Ruth  Schindler,  New  Philadelphia  ; 
K.  C.  Gibbons,  Waynesville;  R.  Philbrook,  Columbus;  F. 
Samson,  Columbus  ; Mabel  Allyn,  Middletown  ; Margaret  Mc- 
Kenna Jones,  Columbus  ; 

Myrhl  Albright,  Columbus  ; Ruth  Rieber,  Columbus  ; Mary 
W.  Christy,  Dayton  ; Grace  E.  Brady,  Dayton  ; Fannie  Howe, 
Lancaster;  Ethel  Ochsner,  Wapakoneta;  Charlotte  Phelps, 
Circleville;  Gertrude  Winesburg,  Piqua;  Violet  Henwood, 
Shelby ; Pauline  Baker,  London  ; Helen  G.  Hart,  Cincinnati ; 
Martha  Miller,  Cincinnati ; Mrs.  Emma  R.  Davis,  Paines- 
ville ; Helen  Hayden,  Mansfield  ; Lucy  Craft,  Caldwell ; Alice 
Whittier,  Delaware ; Helen  Haughton,  Columbus ; Romaine 
Blackmore,  Columbus ; Edith  Sharritt,  Columbus ; 

G.  P.  Herman,  Fremont;  D.  R.  Mellon,  Youngstown;  Mrs. 
B.  R.  Duckworth.  Greenfield ; Mrs.  R.  T.  Holzbach,  Salem ; 
Harold  Boecher,  Chillicothe  ; E.  R.  Miller,  Chillicothe;  Dr.  L. 
H.  Ludwig,  St.  Clairsville ; L.  H.  Allwardt,  Chillicothe ; Mary 
Stevenson,  Newark  ; Mrs.  Norma  Seibert,  Columbus  ; Mrs.  J. 
B.  Poling,  Lima;  Grace  E.  Corlett,  Painesville;  Viola  Baird, 
Zanesville ; Betty  Power,  Zanesville  ; Mrs.  M.  D.  Ailes,  Akron  ; 
Dr.  R.  B.  Tate,  Akron  ; Flora  B.  Howe,  Lancaster ; Florence 
Dunton,  Circleville ; Edna  G.  Shepard,  Bellaire ; _ Florence 
Spaulding,  Steubenville ; Mrs.  Christine  Nussersmith,  Steu- 
benville ; Marian  Neal,  Newark,  Martha  McFarland,  Mans- 
field. 


About  25  physicians  attended  the  annual  meet- 
ing of  the  Ohio  Association  of  State  Hospital 
Physicians  at  Massillon  recently.  Among  those 
who  took  part  in  the  program  were:  Dr.  L.  L. 
Poage,  Dayton;  Dr.  Arthur  G.  Hyde,  Massillon; 
Dr.  L.  Gilbert  Little,  Cleveland;  Dr.  B.  A.  Wil- 
liams, Cincinnati;  Dr  J.  F.  Bateman,  Cincinnati; 
Dr.  M.  N.  Fowler,  Athens;  Dr.  J.  0.  Newton, 
Cleveland;  Dr.  J.  R.  Rohrbaugh,  Cleveland;  Dr. 
H.  H.  Fockler,  Columbus;  Dr.  N.  W.  Kaiser,  To- 
ledo; Dr.  Nicholas  Michael,  Columbus;  Dr.  Be- 
atrice Postle,  Columbus;  Dr.  A.  A.  Petty,  Day- 
ton;  Dr.  H.  M.  Turk,  Lima,  and  Dr.  Arthur  T. 
Hopwood,  Orient. 


Between  30  and  40  members  of  the  Eclat  Club, 
consisting  of  physicians  who  served  with  the 
American  Expeditionary  Forces  in  France,  at- 
tended the  14th  annual  gathering  of  the  club  in 
Youngstown,  as  guests  of  Dr.  James  A.  Sher- 
bondy.  Prominent  physicians  and  surgeons  from 
all  parts  of  the  country  attended  the  gathering. 
The  scientific  program  and  clinics  were  presented 
by  five  Youngstown  physicians,  Drs.  Armin  El- 
saesser,  Ralph  R.  Morrall,  William  H.  Bunn,  John 
R.  Lewis  and  E'dward  C.  Goldcamp. 


Eleventh  Post  Graduate  Course  held  by  the 
Academy  of  Medicine  of  Toledo  and  Lucas  County 
was  held  November  22-24  with  Allan  Winter 
Rowe,  Ph.D.,  Boston,  as  the  lecturer.  The  lec- 
ture dealt  with  “Certain  Aspects  of  Endocrine 
Disorders”. 


News  Neng|s  From 

County  Societies  Academies 


First  District 

ACADEMY  OF  MEDICINE 
OF  CINCINNATI 

(Harold  F.  Downing,  M.D.,  Secretary) 

November  6 — General  session.  Program:  “Con- 
trol of  the  Circulation  in  the  Small  Vessels”,  Dr. 
Carl  J.  Wiggers,  professor  of  physiology,  West- 
ern Reserve  University,  School  of  Medicine; 
“Clinical  Aspects  of  Peripheral  Vascular  Diseases 
Due  to  Changes  in  the  Blood  Vessels”,  Dr.  Roy 
W.  Scott,  professor  of  clinical  medicine,  Western 
Reserve  University,  School  of  Medicine;  “Diag- 
nosis and  Management  of  Peripheral  Vascular 
Disease”,  Dr.  Geza  de  Takats,  assistant  profes- 
sor of  Surgery,  Northwestern  University,  School 
of  Medicine;  discussion  by  Dr.  Walter  M.  Simp- 
son, Dayton. 

November  13 — General  session.  Program: 
“Prolapse  of  the  Kidney”,  with  motion  pictures, 
Dr.  Parke  G.  Smith;  discussion  by  Dr.  W.  Orville 
Ramey;  “Cancer  of  the  Breast”,  Dr.  Otto  J. 
Siebert;  discussion  by  Dr.  Charles  Goosmann. 

November  20 — General  session.  Program:  “The 
Para-Thyroid  Gland”,  Dr.  Plinn  Morris,  Detroit. 

November  27 — General  Session.  Program: 
“Present  Status  of  Therapy  in  Pneumonia”,  Dr. 
J.  L.  Tuechter;  “Bronchial  Lavage”,  Dr.  Howard 
L.  Stitt;  discussion  by  Dr.  C.  E.  Wooding  and 
Dr.  Eslie  Asbury. 

Adams  County  Medical  Society  met  in  regular 
session  October  25  at  Manchester  with  23  mem- 
bers and  guests  present.  The  program  was  pre- 
sented by  Dr.  S.  L.  Meltser,  Portsmouth;  Dr.  J. 
G.  Inman,  Manchester,  and  Dr.  M.  L.  Purdin, 
West  Union.  Dr.  Meltser  presented  a paper  on 
“X-Ray  Interpretations”.  The  subject,  “Tuber- 
culosis in  Children”,  was  discussed  by  Dr.  Inman, 
and  Dr.  Purdin  spoke  on  “Public  Relations”. 
Following  the  program,  a business  meeting  was 
held.  Dr.  Samuel  Clark,  Cherry  Fork,  was  elected 
president  for  the  ensuing  year,  and  Dr.  M.  L. 
Purdin,  vice-president.  Other  officers  were  re- 
elected.— News  Clipping. 

Butler  County  Medical  Society  met  in  Middle- 
town  on  October  27.  After  a paper  on  “Otitis 
Media  in  Children”  had  been  read  by  Dr.  E.  M. 
Morris,  Middletown,  John  F.  Neilan,  Butler 
County  relief  director,  discussed  the  state  and 
federal  rules  and  regulations  pertaining  to  med- 
ical relief  for  indigents,  following  which  there 
was  a round-table  discussion. — News  Clipping. 

Clermont  County  Medical  Society  held  a din- 
ner meeting  November  15  at  Owensville.  Dr. 
Parke  G.  Smith,  Cincinnati,  new  councilor  of  the 


First  District,  was  present  and  spoke  on  eco- 
nomics and  organization  matters.  Dr.  Reed  Shank 
presented  a paper  on  “Appendicitis  in  Children”, 
and  Dr.  John  Skavlem  spoke  on  “Chronic  Lung- 
Suppuration”. — Bulletin. 

Warren  County  Medical  Society  held  a business 
and  social  meeting  November  7 at  Harmon  Hall, 
Lebanon.  Dr.  Parke  G.  Smith,  Cincinnati,  now 
councilor  of  the  First  District,  was  a guest  of  the 
society  and  spoke  briefly  on  organization  and 
economic  questions  of  interest  to  the  membership. 
— News  Clipping. 

Second  District 

Clark  County  Medical  Society  held  a scientific 
and  business  meeting  October  25  at  the  Spring- 
field  City  Hospital.  Dr.  H.  A.  McKnight  ad- 
dressed the  society  on  “Information  on  .the  Pan- 
creas”. Dr.  D.  W.  Hogue  presented  a report  of 
the  1933  annual  meeting  of  the  State  Association 
at  Akron.  During  the  business  session,  the  presi- 
dent was  authorized  to  appoint  a committee  on 
medical  economics. — News  Clipping. 

Darke  County  Medical  Society  met  October  27 
at  the  Service  Restaurant,  Greenville.  The  guest 
speakers  were  Dr.  Charles  McGavran  and  Dr.  J. 
H.  Warren,  both  of  Columbus,  who  discussed  the 
subject,  “Chemical  Manifestations  and  Radio- 
graphic  Evidence  of  Disease  Affecting  the  Eso- 
phagus and  Stomach”. — News  Clipping. 

Greene  County  Medical  Society  met  in  regular 
session  November  2 at  Xenia.  Dr.  C.  E.  Wooding, 
Cincinnati,  addressed  the  society  on  “The 
Etiology,  Diagnosis  and  Treatment  of  Non-Tuber- 
cular  Bronchial  Suppurations”.  Dr.  H.  L.  Stitt, 
Cincinnati,  demonstrated  the  technique  of 
bronchial  lavage  in  the  treatment  of  chest  lesions. 
Both  discussions  were  illustrated  with  X-ray 
plates  and  motion  pictures. — H.  C.  Schick,  M.D., 
secretary. 

Miami  County  Medical  Society  held  a dinner 
meeting  November  3 at  the  Piqua  Memorial  Hos- 
pital. The  principal  speaker  was  Dr.  Berton  M. 
Hogle,  Troy,  who  presented  a paper  on  “Anes- 
thesia”. The  subject  was  discussed  by  Dr.  Rus- 
sell Gardner,  Troy,  and  Drs.  W.  T.  Wilkins  and 
W.  W.  Weis,  both  of  Piqua.  At  the  business  ses- 
sion, resolutions  of  sympathy  relative  to  the 
death  of  Dr.  S.  N.  Bausman,  Pleasant  Hill,  were 
adopted. — Bulletin. 

Montgomery  County  Medical  Society  in  regular- 
session  November  3 was  entertained  with  a sym- 
posium on  “Deep  X-Ray  Therapy”,  by  Dr.  H.  W. 
Burnett,  Dr.  Henry  Snow,  Jr.,  and  Dr.  R.  J. 


789 


790 


The  Ohio  State  Medical  Journal 


December,  1933 


Price.  Dr.  T.  C.  Sheridan  discussed  the  sub- 
ject “A'-ray  in  Skin  Diseases”,  and  Dr.  H.  H. 
Wagner  spoke  on  “Radiation  in  Gynecology”. 

On  November  17  the  society  was  entertained 
at  a dinner  meeting  by  the  Miami  Valley  Hos- 
pital. At  that  meeting  Dr.  Julien  E.  Benjamin, 
Cincinnati,  addressed  the  society  on  “Certain 
Present-Day  Aspects  of  Cardio-Vascular  Disease 
from  the  Public  Health  Point  of  View”. — Bulletin. 

Third  District 

Allen  County — The  Academy  of  Medicine  of 
Lima  and  Allen  County  was  addressed  on  Octo- 
ber 17  by  Dr.  William  H.  Gordon,  Detroit.  Dr. 
Gordon  discussed  “The  Heart,  Coronary  and 
Thyroid”. — News  Clipping. 

Hardin  County  Medical  Society  met  October 
26  in  Kenton,  with  members  of  the  District 
Nurses’  Association  as  guests.  The  principal 
speakers  were  Dr.  Carl  W.  Sawyer,  Marion,  who 
discussed  “The  Psychoses”,  and  Mrs.  Elizabeth 
P.  August,  secretary  of  the  Ohio  State  Nurses’ 
Association,  who  spoke  on  “Team  Work  in  Med- 
ical and  Nursing  Care”. — News  Clipping. 

Logan  County  Medical  Society  elected  officers 
for  the  ensuing  year  at  its  regular  meeting  Nov- 
ember 3 at  the  Hotel  Ingalls,  Bellefontaine.  Those 
elected  were:  President,  Dr.  John  L.  Maurer, 
West  Liberty;  vice-president,  Dr.  C.  K.  Startz- 
man,  Bellefontaine;  secretary-treasurer,  Dr.  R. 
A.  Firmin,  Zanesfield;  legislative  committeeman, 
Dr.  J.  P.  Harbert,  Bellefontaine;  delegate,  Dr. 
Startzman;  alternate,  Dr.  F.  R.  Makemson,  Belle- 
fontaine. After  the  business  session,  the  society 
was  addressed  by  C.  A.  Inskeep,  county  relief 
director,  regarding  the  new  state  and  federal 
regulations  on  medical  poor  relief. 

After  its  October  meeting  on  October  6,  the 
society  visited  the  Bellefontaine  Armory  where 
it  witnessed  demonstrations  by  the  Bellefontaine 
company  of  the  112  Medical  Regiment,  Ohio 
National  Guard,  commanded  by  Dr.  Hobart  L. 
Mikesell. — News  Clipping. 

Marion  County — The  Academy  of  Medicine  of 
Marion  held  three  meetings  during  November. 
At  a special  meeting  on  November  2,  the  Academy 
discussed  the  question  of  medical  relief  to  the 
poor  and  made  plans  for  presentation  of  a pro- 
gram to  County  Relief  Director  John  A.  Abel. 
On  Tuesday,  November  7,  the  Academy  held  its 
regular  monthly  meeting,  a large  part  of  the 
time  being  devoted  to  a discussion  of  organizing 
the  staff  at  Marion  City  Hospital.  On  Novem- 
ber 14,  the  Academy  held  a joint  dinner  meeting 
with  the  Marion  County  Bar  Association  at  the 
Harding  Hotel.  The  guest  speaker  was  Dr.  H. 
M.  Platter,  Columbus,  past  president  of  the  Ohio 
State  Medical  Association,  who  spoke  on  the  sub- 
ject “Medico-Legal  Relationships”. — News  Clip- 
ping. 

Van  Wert  County  Medical  met  in  regular  ses- 
sion November  7 at  the  Van  Wert  County  Hos- 


pital. The  guest  speaker  was  Dr.  Geo.  T.  O’Byrne, 
Lima,  who  read  a paper  on  “The  Feeding  of  Pre- 
mature Infants,  With  Special  Reference  to  the 
Use  of  Copper  and  Iron”.  The  data  was  based 
on  18  months’  observation  at  Cook  County  Hos- 
pital, Chicago.  At  the  business  session,  Dr.  A. 
T.  Rank  was  re-elected  president  and  Dr.  R.  H. 
Good  was  re-elected  secretary-treasurer,  for  the 
ensuing  year.  Dr.  Laurence  Irvin,  Ohio  City,  was 
elected  vice  president. — News  Clipping. 

Fourth  District 

ACADEMY  OF  MEDICINE  OF  TOLEDO  AND 
LUCAS  COUNTY 

(A.  P.  Hancuff,  M.D.,  Secretary) 

November  3 — General  Meeting.  Program: 
“Urinary  Tract  Infections — A Consideration  of 
Factors  Influencing  Structural  Pathology”,  Dr. 
R.  E.  Cumming,  Detroit;  “Serial  Roentgen-Ray 
Studies  in  Urinary  Tract  Infections”,  Dr.  H.  A. 
Jarre,  Detroit. 

November  10 — Annual  joint  meeting  of  the 
Academy  and  the  Toledo  Dental  Society.  Pro- 
gram: “Cleft  Palate  and  Harelip”,  Chalmers  J. 
Lyons,  D.D.S.,  Ann  Arbor,  Michigan;  “Oral  Con- 
ditions of  Interest  to  Both  Professions”,  J.  W. 
Kemper,  D.D.S.,  Ann  Arbor,  Michigan. 

November  17  — Medical  Section.  Program: 
“A  Differential  Study  of  the  Various  Types  of 
Colitis”,  Dr.  J.  A.  Bargen,  Rochester,  Minn. 

November  2b — Surgical  Section.  Program: 
“The  Association  of  Endocrine  Disorders  with 
Problems  of  Behavior  and  Personality”,  Allan 
W.  Rowe,  Ph.D.,  Boston. 

Putnam  County  Medical  Society  in  session 
October  10  at  Pandora  was  addressed  by  Dr.  P.  I. 
Tussing,  Lima,  on  “Heart  Disease”.  A chicken 
dinner  was  served  preceding  the  meeting. — News 
Clipping. 

Sandusky  County  Medical  Society  discussed  the 
question  of  medical  service  for  the  indigent  at  its 
meeting  at  Fremont  on  October  26.  County  Com- 
missioner Albert  Binsack  addressed  the  meeting 
on  this  question  after  which  there  was  a round- 
table discussion  and  a committee  composed  of 
Drs.  D.  W.  Philo,  J.  C.  Boyce  and  J.  L.  Curtin 
was  named  to  confer  with  county  relief  officials 
on  a program  relative  to  the  pay  of  physicians 
for  services  to  the  poor. — News  Clipping. 

Fifth  District 

CLEVELAND  ACADEMY  OF  MEDICINE 

(C.  H.  Heyman,  M,D.,  Secretary) 

November  3 — Clinical  and  Pathological  Sec- 
tion. Program:  “A  Case  of  Streptococcus  Sep- 
ticemia with  Recovery”,  Dr.  Edward  R.  Rinaldi; 
“A  Case  of  Unusual  Oesophageal  Obstruction”, 
Dr.  E.  P.  McNamee;  discussion  by  Dr.  F.  W. 
Dixon;  “Lumbar  Ganglionectomy  for  Organic 
Vascular  Occlusion  with  Arterial  Spasm”,  Dr.  J. 
N.  Wychgel;  “A  Case  of  Influenzal  Meningitis 


December,  1933 


State  News 


791 


Treated  by  Spinal  Drainage”,  Dr.  Raymond  J. 
Stasney;  “Presentation  of  a Case  of  Anemia”, 
Dr.  H.  V.  Paryzek;  “Inflammatory  Carcinoma  of 
the  Breast”,  Dr.  E.  A.  Mastics;  discussion  by  Dr. 
L.  A.  Pomeroy;  “Two  Cases  of  Adherent  Peri- 
cardium”, Dr.  Richard  Dexter. 

November  10 — Experimental  Medicine  Section. 
Program:  “Prevention  of  Precipitation  in  Fon- 
tana Stain  Preparations”,  Dr.  B.  S.  Kline;  “A 
Method  for  the  Study  of  Patency  of  the  Foramen 
Ovale”,  Dr.  P.  Gross  and  Dr.  M.  Goodman;  “The 
Restoration  of  Antigenicity  to  a Possible  Haptene 
Fraction  of  Diphtheria  Toxin”,  E.  E.  Ecker, 
Ph.  D.;  “Experimental  Pulmonary  Embolism  and 
Cardiac  Hypertrophy  in  Dogs”,  Dr.  Howard  T. 
Karsner  and  Dr.  M.  A.  Simon;  “A  Study  of  the 
Pathogenesis  of  Arteriolar  Sclerosis”,  Dr.  A.  R. 
Moritz  and  Ruth  Oldt,  B.S.;  “Renal  Denervation 
— Observations  on  Blood  Pressure  and  Renal 
Function  in  a Patient  with  Hypertension”,  Dr.  R. 
Domingues,  Dr.  C.  H.  Lenhart,  Dr.  C.  T.  Way, 
and  E.  Pomeroy,  Ph.D. 

November  15— Industrial  Medicine  and  Ortho- 
pedic Section.  Program:  “Fractures  About  the 
Face”,  Dr.  C.  L.  McDonald;  “Kidney  Injuries”, 
Dr.  J.  B.  Morgan;  “Treatment  of  Certain  Cases 
from  the  Accident  Room”,  Dr.  G.  P.  O’Malley; 
“Cases  Showing  Fracture  Treatment”,  Dr.  G.  I. 
Bauman. 

November  17  — General  Session.  Program: 
“Anemia — Etiology  and  Treatment”,  Dr.  George 
R.  Minot,  Boston. 

November  22 — Obstetrical  and  Gynecological 
Section.  Program:  “A  Short  History  of  Anes- 

thetics and  Analgesics”,  Dr.  J.  J.  Thomas;  “A 
Survey  of  Analgesics  Used  in  the  Obstetrical  De- 
partments of  Maternity  and  City  Hospitals”,  Dr. 
A.  E.  Bennett;  discussion  opened  by  Dr.  J.  L. 
Reycraft;  “The  Use  of  Pento-Barbital  In  Ob- 
stetrics at  St.  Ann’s  Hospital  (Preliminary  Re- 
port of  500  Cases)”,  Dr.  M.  Laven,  Dr.  M.  F. 
Yeip,  and  Dr.  A.  W.  Lakner;  discussion  opened 
by  J.  R.  Thompson. 

Lake  County  Medical  Society  and  the  North- 
eastern Ohio  Dental  Society  held  a joint  meeting 
October  25  at  the  Parmly  Hotel,  Painesville.  Dr. 
Allen  Moritz,  Cleveland,  discussed  “Death  Due  to 
Heart  Disease”.  The  address  was  illustrated  with 
lantern  slides.  Dr.  G.  O.  Hedlund,  Painesville, 
assisted  Dr.  Moritz  in  the  demonstration.  Dr.  E. 
E.  Ecker,  Cleveland,  explained  the  results  of  his 
research  work  with  phenyl  mercuric  nitrate  and 
enumerated  the  various  conditions  for  which  the 
new  antiseptic,  fungicide  and  germicide  may  be 
used. — Bulletin. 

Lorain  County  Medical  Society  met  in  regular 
session  November  14  at  Elyria.  Dr.  Frank  A. 
Lawrence,  Elyria,  presented  a paper  on  “Infan- 
tile Paralysis”.  A summary  of  the  annual  meet- 
ing of  the  State  Association  at  Akron  was  given 
by  Dr.  S.  V.  Burley,  Lorain,  and  Dr.  A.  S.  Mc- 
Kitrick  reviewed  the  program  presented  at  the 


recent  Chicago  meeting  of  the  American  College 
of  Surgeons.  Dr.  J.  P.  Rankin  reported  on  the 
Cleveland  Meeting  of  the  Interstate  Post  Grad- 
uate Assembly. — Bulletin. 

Sixth  District 

Mahoning  County  Medical  Society  at  its  regu- 
lar meeting  October  26  at  the  Youngstown  Club 
was  addressed  by  Dr.  Wilbert  C.  Davison,  dean 
of  Duke  University  School  of  Medicine,  and  Dr. 
Charles  Doan,  Columbus.  Dr.  Davison  discussed 
“Intestinal  Diseases  of  Childhood”,  and  Dr.  Doan 
presented  the  first  lecture  of  the  seven-lecture 
course  on  “Haematology”  he  is  giving  in  Youngs- 
town under  the  auspices  of  the  society. 

At  its  regular  meeting  on  November  28,  the 
society  was  addressed  by  Dr.  Allan  Brown,  asso- 
ciate professor  of  medicine,  Toronto. — Bulletin. 

Portage  County  Medical  Society  at  its  meeting 
on  November  2 at  the  residence  of  Dr.  A.  O. 
DeWeese,  Kent,  was  addressed  by  Dr.  James  J. 
Joelson,  Cleveland,  on  “Organic  Obstruction  of 
the  Prostate  Gland”.  The  paper  was  illustrated 
with  lantern  slides  and  was  discussed  by  Dr.  B. 
II.  Nichols  of  Ravenna  and  Cleveland. — Bulletin. 

Stark  County  Medical  Society  met  in  regular 
session  November  14  at  the  Elks  Club,  Canton. 
The  guest  speaker  was  Dr.  Max  M.  Zinninger, 
Cincinnati,  who  discussed  the  subject  “The  Sur- 
gical Treatment  of  Acute  Abdominal  Emergency”. 
A buffet  supper  was  served  following  the  pro- 
gram.—Bulletin. 

Summit  County  Medical  Society  was  addressed 
by  Dr.  Charles  A.  Doan,  Columbus,  at  its  meeting 
on  November  7 at  the  Mayflower  Hotel,  Akron. 
Dr.  Doan  discussed  “The  Role  of  the  White  Cell 
in  Disease”. — Bulletin. 

Seventh  District 

Belmont  County  Medical  Society,  the  Belmont 
County  Dental  Society  and  the  Belmont  County 
Pharmaceutical  Society  held  a joint  meeting  No- 
vember 2 at  the  Presbyterian  Church,  Bellaire. 
The  following  program  was  presented:  “Present 
Nutrition  and  Future  Health”,  Dr.  W.  Miles  Gar- 
rison; “Dental  Nutrition”,  J.  W.  Nesbitt,  D.D.S., 
and  “Unemployment  As  it  Affects  the  Druggist”, 
R.  W.  Duvall.  A chicken  dinner  was  served  fol- 
lowing the  meeting. — Bulletin. 

Jefferson  County  Medical  Society  met  on  Octo- 
ber 26  at  the  Ohio  Valley  Hospital.  The  ques- 
tion of  payment  of  physicians  for  services  to  the 
indigent  was  discussed. — News  Clipping. 

Tuscarawas  County  Medical  Society  held  its 
monthly  meeting  November  9 at  New  Philadel- 
phia. The  guest  speakers  were  Dr.  G.  T.  Hard- 
ing, Jr.,  and  Dr.  G.  T.  Harding,  III,  of  Colum- 
bus. They  discussed  “Present  Day  Conceptions 
of  Mental  Disease,  With  Illustrative  Case  His- 
tories”. 

At  its  meeting  October  12  at  Dennison,  the 


792 


The  Ohio  State  Medical  Journal 


December,  1933 


society  was  addressed  by  Dr.  R.  D.  Schirack,  Can- 
ton, on  “Rickets”. — Bulletin. 

Eighth  District 

Eighth  District  Medical  Society,  composed  of 
members  of  the  county  societies  of  the  Eighth 
Councilor  District,  held  its  annual  meeting  No- 
vember 1 at  the  Cambridge  Country  Club.  About 
80  physicians  and  guests  were  present.  A tur- 
key dinner  was  served  at  noon.  The  meeting  was 
opened  by  an  address  of  welcome  by  Dr.  C.  C. 
Headley,  president  of  the  Guernsey  County  Med- 
ical Society,  who  introduced  Dr.  B.  A.  Souders, 
president  of  the  Eighth  District  Society.  The 
principal  address  was  made  by  Dr.  Geo.  Edw. 
Follansbee,  Cleveland,  chairman  of  the  Judicial 
Council  of  the  American  Medical  Association,  who 
spoke  on  “Is  Medicine  a Profession  or  a Trade?” 
Dr.  Follansbee  discussed  many  of  the  social  and 
economic  problems  confronting  the  profession.  A 
report  on  the  recent  annual  meeting  of  the  State 
Association  at  Akron  was  presented  by  Dr.  Rob- 
ert Martin,  Zanesville,  and  Dr.  E.  R.  Brush, 
Zanesville,  councilor  of  the  Eigth  District,  dis- 
cussed organization  questions.  The  arrange- 
ments for  the  meeting  were  made  by  Dr.  Souders, 
Dr.  Paul  Huth,  Dr.  J.  W.  Camp,  Dr.  O.  R.  Jones 
and  Dr.  G.  F.  Swan. — News  Clipping 

Fairfield  County  Medical  Society  was  enter- 
tained on  October  10  at  the  home  of  Dr.  and  Mrs. 
E.  B.  Roller.  The  guest  speaker  was  Dr.  S.  J. 
Goodman,  Columbus,  who  presented  a paper  on 
“The  Toxemias  of  Pregnancy”. — News  Clipping. 

Guernsey  County  Medical  Society  at  its  meet- 
ing October  5 at  the  Romance  Restaurant,  Cam- 
bridge, was  addressed  by  Dr.  Frank  J.  Lacken- 
sen,  Quaker  City,  on  “Anemias”. — News  Clipping. 

Licking  County  Medical  Society  met  in  regular 
session  October  27,  at  the  Warden  Hotel,  Newark. 
Following  a dinner,  the  society  was  addressed  by 
Dr.  Charles  Hartsook,  Cleveland,  on  “Gastro-In- 
testinal  Diseases”.  At  the  business  meeting  the 
question  of  payment  of  physicians  for  services  to 
the  indigent  was  discussed. — News  Clipping. 

Perry  County  Medical  Society  met  in  regular 
session  October  16  at  the  Park  Hotel,  New  Lex- 
ington. Medical  relief  to  the  indigent  was  dis- 
cussed. Mrs.  George  Sheeran,  county  relief  di- 
rector, was  present  and  explained  the  state  and 
federal  regulations  governing  the  expenditure  of 
funds  for  medical  care. — News  Clipping. 

Washington  County  Medical  Society  held  its 
regular  monthly  meeting  November  8 at  the 
Marietta  Memorial  Hospital.  The  program  con- 
sisted of  a showing  of  a four-reel  motion  picture 
relative  to  “The  Forceps  Operation”  taken  at  the 
Chicago  Lying-In  Hospital.- — Bulletin. 

Ninth  District 

Scioto  County — The  Hempstead  Academy  of 
Medicine  was  addressed  on  November  13  by  Dr. 
Paul  Charlton,  Columbus.  Dr.  Charlton  discussed 


“Considerations  of  the  Stomach”.  A buffet  sup- 
per was  served  following  the  meeting. — Bulletin. 

Tenth  District 

COLUMBUS  ACADEMY  OF  MEDICINE 

(George  J.  Heer,  M.D.,  Secretary) 

November  6 — General  Session.  Program:  “A 

Consideration  of  the  Common  Cold”,  Dr.  C.  C. 
Sherburne. 

November  13 — General  Session.  Program: 
“The  Problem  of  Tuberculosis”,  Dr.  J.  Arthur 
Meyers,  chief  of  staff,  Lymanhurst  Medical  Staff, 
Minneapolis. 

November  20 — Clinic  at  Children’s  Hospital. 

November  27 — General  Practitioners’  Section. 
Program:  “Radiology  and  Diagnosis  from  the 

Standpoint  of  the  General  Practitioner”,  Dr.  W. 
H.  Miller;  discussion  by  Dr.  P.  L.  Cordray,  Dr. 
L.  N.  Jentgen  and  Dr.  Bruce  Lindsey. 

Crawford  County  Medical  Society  in  regular 
session  November  6 at  the  Bueyrus  City  Hospital 
was  addressed  by  Dr.  E.  H.  Baxter,  Columbus, 
on  “Problems  of  the  Newborn  and  Infancy”. — 
Bulletin. 

Ross  County  Medical  Society  met  October  5 at 
Chillcothe  with  Dr.  Fred  Fletcher,  Columbus,  as 
the  guest  speaker.  Dr.  Fletcher  spoke  on  “Some 
Gynecological  Problems”.- — News  Clipping. 


New  Books  Received 

The  1933  Year  Book  of  General  Medicine, 
edited  by  George  F.  Dick,  M.  D.;  Lawrason 
Brown,  M.D. ; George  R.  Minot,  M.D.;  William 
B.  Casto,  M.D.;  William  D.  Stroud,  M.D.,  and 
George  B.  Eusterman,  M.D.,  and  one  of  a volume 
of  10  Practical  Medicine  year  books;  published  by 
The  Year  Book  Publishers,  Inc.,  304  South  Dear- 
born Street,  Chicago. 

Fetal,  Newborn  and  Maternal  Morbidity  and 
Mortality,  report  of  a sub-committee  of  the  Com- 
mittee on  Prenatal  and  Maternal  Care  of  the 
White  House  Conference  on  Child  Health  and 
Protection;  D.  Appleton-Century  Company;  price, 
$3.00. 

4|i  yi  yi 

A number  of  Ohio  physicians  attended  the 
recent  two-weeks  post-graduate  course  for  gen- 
eral practitioners  given  by  the  University  of  Buf- 
falo, School  of  Medicine.  Among  those  who  at- 
tended were:  Dr.  Joseph  R.  McDaniel,  East 

Fultonham;  Dr.  Orrin  C.  McDowell,  Orrville; 
Dr.  H.  C.  Mundhenk,  Brookville;  Dr.  Clarence  E. 
Northrup,  McConnelsville ; Dr.  H.  C.  O’Roark, 
Portsmouth,  and  Dr.  Samuel  H.  Williamson, 
Hamilton. 

y*  yi  yi 

— Dr.  Edward  E.  Smith,  Franklin  County  coro- 
ner, has  been  elected  president  of  the  Columbus 
Board  of  Health. 


nciaia 


Constructed  Letters  In  Contacting  His  Patients^ 
Especially  Those  Delinquent  in  the 
Payment  of  Bills 

By  G.  C.  Driver,  Cleveland,  Ohio 


The  four  fundamentals  productive  of  an  intel- 
ligent letter,  I should  say,  are: 

Appearance 

Approach 

Appeal 

Action 

First  of  all  let  us  realize  that  the  letter  is  a 
substitute  for  a verbal  conversation.  It  has  been 
said  over  and  over  that  in  business  communica- 
tions the  major  thought  is  to  sell  something, 
either  an  idea  or  a commodity.  Anything  to  be 
cordially  received  or  acceptable  must  be  first 
pleasing  to  the  eye.  Anything  that  is  awkward  or 
ugly  is  displeasing  and  distasteful.  Although 
there  may  be  real  merit  involved,  you  handicap  it 
by  clothing  it  shabbily. 

This  leads  us  to  the  appearance  of  the  letter. 
If  you  use  good  quality  of  paper,  with  a dignified 


The  accompanying  article  by  Mr.  Driver,  credit 
manager  of  The  May  Company,  Cleveland,  is  an- 
other of  a series  being  published  in  The  Journal  on 
business  and  legal  questions  of  particular  interest 
and  importance  to  members  of  the  medical  profession 
and  their  secretaries.  The  papers  reproduced  in  part 
in  the  series  comprised  a course  in  business  adminis- 
tration presented  by  the  Academy  of  Medicine  of 
Cleveland  in  conjunction  with  the  Cleveland  Retail 
Credit  Men’s  Company  and  are  being  published  with 
their  consent  and  through  their  courtesy.  Because  of 
space  limitations  in  The  Journal,  it  has  been  found 
necessary  in  some  instances  to  abstract  parts  of  the 
presentations  made  by  the  lecturers,  but  this  has  been 
done  in  such  a way  that  the  meaning,  effect  and  much 
of  the  value  of  each  have  been  retained. — The  Com- 
mittee on  Publication. 


business  inscription  thereon,  and  if  the  letter  is 
neatly  typed  and  properly  spaced,  it  certainly  is 
more  welcome  to  the  addressee  than  if  carelessly 
or  sloppily  written  on  inferior  stationery  with  a 
repulsive,  blatant  letterhead.  If  you  are  invited 
by  your  friends  to  some  social  function,  you  are 
careful  to  see  that  your  person  is  well  groomed 
and  that  your  dress  is  entirely  suitable  for  the 
occasion.  If  you  called  in  overalls  you  might  be 
more  comfortable,  but  you  simply  would  not  “fit 
in”  with  the  occasion.  This  may  be  a rather  crude 
thought,  but  a letter  to  be  carefully  read  and 
digested,  should  be  well  clothed.  Otherwise  it  is 
routed  almost  automatically  to  the  waste  basket. 

PROPER  APPROACH 

You,  ladies  and  gentlemen,  know  that  nearly 
everybody  these  days  is  deluged  with  letters  of  all 
kinds  and  characters,  and  a large  percentage  of 


them  are  either  carelessly  read  or  not  read  at  all. 
I am  endeavoring  to  stress  the  necessity  that 
your  message  be  greeted  with  a welcome  rather 
than  by  the  opposite — '“what's  this?  we  don’t  need 
any,  anyway!”  Whether  we  have  in  mind  a ser- 
vice or  a commodity,  or  whether  we  are  trying  to 
collect  an  account,  there  is  always  the  urge  for 
salesmanship,  and  your  contact,  as  now  discussed 
by  letter  must  start  with  the  proper  approach. 

A very  happy  condition  would  exist  if  we  knew 
the  taste  and  temperament  of  our  customer, 
present  or  potential.  It  is  highly  desirable  to  talk 
to  the  man  in  his  own  language.  Mentally  you 
have  to  place  yourself  in  the  position  of  the  re- 
cipient and  try  to  analyze  or  visualize'  what  the 
reaction  will  be.  The  same  subject  cannot  be 
presented  in  the  same  stereotyped  way  to  different 
types  of  people  if  the  message  is  to  be  successful. 

The  presumption,  of  course,  is  that  the  writer 
of  the  letter  thoroughly  knows  his  subject  and  is 
fully  sold  himself  or  herself.  Otherwise,  the 
communication  is  wasted,  for  it  must  be  so  worded 
as  to  bring  a responsive  reaction  on  the  part  of 
the  recipient. 

AVOID  THESE  MISTAKES 

Sometimes  attempts  to  be  witty  or  funny  are 
successful  and  there  are  occasions  when  these 
efforts  are  not  only  valueless  but  actually  dis- 
pleasing. It  should  also  be  borne  in  mind,  that  the 
public  is  not  suffering  from  inferiority  complex 
but  is  modern  and  progressive  in  its  ideas  and 
does  not  like  to  be  patronized  even  in  a letter. 

Oft-times  a letter  is  stilted  and  poorly  ex- 
pressed because  the  dictator  is  making  an  extra 
effort  to  write  a good  letter.  There  does  not  seem 
to  be  any  set  formula  for  writing  a letter  that  is 
applicable  to  every  one. 

You  cannot  force  a reply  to  your  letters  by  ex- 
pression of  disappointment,  impatience  or  anger. 

Your  message  or  request  should  be  clear,  con- 
cise, to  the  point,  but  still  be  so  expressed  as  to 
create  interest.  You  can  be  so  brief  as  to  be 
blunt,  and  the  idea  doesn’t  go  over.  On  the  other 
hand  you  can  be  so  long-winded  as  to  smother  out 
the  flame  expressing  the  thought. 

We  should  be  at  ease,  not  on  parade.  Our  let- 
ters should  be  natural.  They  can  be  forceful  and 
yet  soothing;  they  can  be  virile  and  yet  gentle; 
they  can  be  commanding  and  yet  considerate. 
There  is  a saying  which  I think  holds  true,  that 


793 


794 


The  Ohio  State  Medical  Journal 


December,  1933 


you  can  “catch  more  flies  with  sugar  than  vine- 
gar”. 

I have  an  idea  that  you,  being  engaged  in  a 
particular  profession  wherein  there  is  service  and 
not  commodity  to  sell,  rather  feel  that  you  are 
greatly  handicapped  as  compared  with  the  manu- 
facturer or  merchant  who  has  a specific  com- 
modity for  disti’ibution.  Your  thought  is  not  en- 
tirely wrong.  At  least,  you  do  not  suffer  from  re- 
turned goods  evil.  It  behooves  you  to  be  all  the 
more  alert,  and  I might  be  so  bold  as  to  suggest 
you  adopt  more  modern  or  scientific  methods  for 
the  conduct  of  your  affairs. 

EDUCATING  THE  PUBLIC 

We  all  know  that  the  physician  or  the  surgeon 
is  in  a sense  a public  servant  and  a messenger  of 
mercy.  At  the  same  time  he  must,  in  order  to 
maintain,  be  compensated  for  his  services.  He, 
like  all  others,  can  be  classed  as  “a  servant 
worthy  of  his  hire”.  We  hear  all  the  time  through 
the  various  organizations  comprising  the  National 
Retail  Credit  Men’s  Association,  of  the  progress 
that  the  professional  man  is  making  toward  the 
proper  and  businesslike  handling  of  his  affairs. 
More  and  more  is  the  public  being  educated  to 
understand  that  the  doctor  and  the  dentist  and  the 
surgeon  have  a right  to  expect  reasonable  and 
prompt  compensation  for  services  performed.  By 
concerted  effort  and  well-regulated  publicity,  you 
members  of  this  Academy  can  tell  your  patients 
you  expect  to  be  paid  promptly.  If  the  patient  is 
told  that  often  enough  he  will  believe  it.  You 
will  be  paid. 

One  great  trouble  is  that  when  the  professional 
man  comes  to  urging  the  debtor  to  pay,  he  has  in 
mind  the  old  custom  (almost  a tradition)  that  the 
patient  has  through  a long  period  of  time  been 
taught  that  he  has  the  privilege  of  paying  prac- 
tically as  he  pleases.  The  doctor,  fearful  he  may 
lose  the  patient’s  business,  hesitates  to  insist  upon 
the  payment  of  the  account. 

Naturally,  in  writing  a letter  about  an  account, 
you  have  to  bear  in  mind  the  length  of  time  you 
have  been  serving  your  patient  and  maybe  his 
father  and  grandfather;  and  you  have  in  mind 
also  possibly  serving  his  posterity.  But  if  you 
allow  sentiment  and  the  retention  of  good  will  to 
play  too  large  a part  in  your  business,  you  may 
eventually  have  no  business. 

It  is  also  well  in  every  collection  letter  to  use 
“the  iron  arm,  but  the  gloved  hand”. 

BE  SANE  AND  SENSIBLE 

Apply  in  letter  writing  the  same  sane  and 
sensible  methods  used  in  personal  contact.  The 
average  person  realizes  the  necessity  of  meeting 
a business  contract.  Those  who  object,  display  an 
ignorance  of,  or  a wilful  disregard  for,  the  funda- 
mentals of  business.  Very  few  expect  to  get  some- 
thing for  nothing  and  in  the  majority  of  cases  this 


class  can  be  defined  as  intentionally  or  uninten- 
tionally dishonest  and  can  be  easily  detected  by 
making  an  inquiry  of  the  local  Credit  Bureau. 
There  are  many  credit  risks  that  are  not  good. 
But  there  are  comparatively  few  really,  downright 
dishonest  people.  However,  a leopard  never 
changes  his  spots  and  a man  who  is  slow  pay  by 
past  performances  will  not  change  his  established 
practice  simply  because  he  patronizes  you. 

Be  sincere  and  do  not  say  or  write  anything 
that  you  do  not  mean.  If  the  time  has  arrived  for 
“force”  (and  this  is  a much-to-be  avoided  term) 
do  not  write  as  a threat.  If  you  are  convinced 
that  further  appeal  is  a wasted  effort,  then  use 
more  stringent  methods.  But  do  not  say  you  will 
and  then  don’t. 

Can  we  capitalize  on  the  other  fellow’s  idea 
without  being  copy-cats?  I say  “yes”.  In  these 
modern  times  of  considerate  competition  there  is 
no  reason  for  not  having  a free  interchange  of 
business  ideas.  I would  rather  bank  on  the  judg- 
ment of  two  men  than  one.  Conferences  and  con- 
ventions are  held  daily  all  over  this  land  for  the 
sole  purpose  of  betterment  and  improvement.  In 
your  profession  there  is  a constant  and  intensive 
research  which  develops  almost  unbelievable  prog- 
ress and  astounding  help  to  those  in  need.  Can 
there  be  any  reason  why  I should  not  apply  to  the 
conduct  of  my  business,  principles  which  have 
proven  worthy  elsewhere? 

Before  letters  are  dictated,  the  dictator  should 
thoroughly  go  over  the  details  and  master  his  sub- 
ject, get  himself  set,  and  not  try  to  think  out  the 
problems  as  he  dictates. 

BE  SURE  TO  KNOW  THE  FACTS 

All  letters  build  for  good  will  or  the  opposite. 
After  the  message  is  delivered  in  cold  type,  it  is 
too  late  to  undo  any  harm. 

It  is  a good  idea  to  display  genuine  interest  in 
the  other  fellow’s  problems.  A helping  hand  and 
the  appreciation  of  the  customer’s  difficulties  oft- 
times  retain  him  as  a friend  and  develop  him  into 
a profitable  customer. 

It  is  possible  that  the  physician  or  the  surgeon 
at  the  time  of  the  call  or  the  operation,  due  to  the 
physical  and  mental  condition  of  the  patient, 
makes  certain  conciliatory  remarks  or  statements 
to  the  patient  direct  or  to  some  member  of  the 
family  about  the  money  end  of  the  business,  that 
will  handicap  the  collection  of  the  account  at  a 
later  date.  Then  when  a strictly  business  letter 
follows  asking  for  payment  of  a just  debt,  there 
is  the  reaction,  “Well  doctor,  you  told  us  not  to 
worry  and  that  we  could  settle  whenever  we 
please”,  or  some  such  alibi. 

A soft  answer  turneth  away  wrath.  It  has 
been  found  good  judgment  not  to  reply  to  a 
criticizing  or  complaining  letter  in  the  same  vein. 
Rather,  if  necessary,  lay  the  letter  aside  and 
acknowledge  it  later  in  a calm,  deliberate  way, 


December,  1933 


State  News 


795 


being  conciliatory  without  jeopardizing  your  real 
interest. 

Undoubtedly  some  of  the  previous  or  subse- 
quent lecturers  have  or  will  bring  out  the  neces- 
sity for  keeping  a proper  office  record  of  the  cus- 
tomer, giving  his  antecedents,  occupation,  re- 
sponsibility, location,  etc.,  as  well  as  his  paying 
habit.  With  this  in  the  background  you  are  well 
equipped  to  construct  an  intelligent  letter. 

Attempts  at  sarcasm  and  a tone  of  paternalism 
should  be  strictly  avoided.  Likewise  utmost 


caution  should  be  used  where  flattery  is  injected. 
A little  soothing  syrup  may  be  good,  but  too  much 
of  it  is  sickening. 

Every  letter,  regardless  of  how  capable  a 
stenographer  you  may  be  or  have,  should  be  care- 
fully re-read  before  being  signed  and  sent. 

After  all  is  said  and  done,  a really  sincere, 
straight  forward,  businesslike,  honest  expression 
of  your  idea,  couched  in  a polite,  forceful,  gram- 
matical way  is  the  best  way  to  handle  any  matter. 


Ray  C.  Ash  M.D.,  Ashland;  University  of  Illi- 
nois, College  of  Medicine,  1904;  aged  53;  former 
member  of  the  Ohio  State  Medical  Association  and 
the  American  Medical  Association;  died  October 
15  of  chronic  neuritis.  Dr.  Ash  a World  War 
veteran  with  nine  months  overseas  service  had 
practiced  in  Ashland  for  29  years.  He  was  a mem- 
ber of  the  Masonic  and  Modern  Woodmen  lodges 
and  the  Lutheran  Church.  Surviving  are  his 
widow  and  his  mother. 

Samuel  N.  Bausman,  M.D.,  Pleasant  Hill;  Medi- 
cal College  of  Ohio,  Cincinnati,  1890;  aged  73; 
member  of  the  Ohio  State  Medical  Association  and 
a Fellow  of  the  American  Medical  Association ; 
died  November  1 following  a paralytic  stroke. 
Dr.  Bausman  had  practiced  at  Pleasant  Hill  since 
his  graduation  from  medical  school.  He  was  a 
member  of  the  Masonic  and  Odd  Fellows  lodges. 
Surviving  are  three  sisters  and  two  brothers,  Dr. 
Albert  J.  Bausman,  Piqua,  and  Dr.  Charles  Baus- 
man, Bradford. 

Roy  L.  Chambers,  M.D.,  Sardinia;  Ohio  State 
University,  College  of  Medicine,  1909;  aged  48; 
member  of  the  Ohio  State  Medical  Association  and 
a Fellow  of  the  American  Medical  Association ; 
died  October  16  of  heart  disease.  Dr.  Chambers 
had  practiced  in  Sardinia  for  the  past  23  years. 
He  was  an  active  member  of  the  Masonic  Lodge 
and  held  membership  in  the  Grange  and  Modern 
Woodmen,  Odd  Fellows  and  Elks  lodges.  Dr. 
Chambers  was  a member  of  the  Brown  County 
Republican  Executive  Committee  and  was  a for- 
mer coroner.  Surviving  are  his  widow  and  two 
sisters. 

John  W.  Clemmer,  M.D.,  Columbus;  Pulte  Medi- 
cal College,  Cincinnati,  1876;  aged  82;  former 
member  of  the  Ohio  State  Medical  Association 
and  the  American  Medical  Association;  died 
October  21  following  a stroke  of  paralysis.  Dr. 
Clemmer  was  a pioneer  in  public  health  work  in 
Columbus  and  was  the  last  surviving  member  of 


the  first  city  board  of  health  named  in  1903. 
Moving  to  Columbus  from  Piqua  in  1879,  Dr. 
Clemmer  served  as  physician  at  the  State  School 
for  the  Blind  and  later  for  four  years  as  physi- 
cian at  the  Ohio  Penitenttiary.  He  was  for  two 
years  health  director  of  Columbus  and  helped 
draft  some  of  the  regulations  which  are  in  force 
today.  His  widow  and  a half  brother  survive. 

George  H.  Cole,  M.D.,  Conneaut;  Cleveland 
Medical  College,  Homeopathic,  1892;  aged  76;  died 
November  2 of  heart  disease.  Dr.  Cole  had  prac- 
ticed at  Conneaut  since  1893.  Surviving  are  two  ’ 
daughters. 

Ann  Jeanette  Erskine,  M.D.,  Steubenville;  Cleve- 
land University  of  Medicine  and  Surgery,  1894; 
aged  74;  former  member  of  the  Ohio  State  Medi- 
cal Association  and  the  American  Medical  Asso- 
ciation; died  October  31  of  paralysis.  Dr*.  Ers- 
kine had  been  active  in  club,  W.C.T.U.  and  Y.W. 
C.A.  work  and  was  an  active  member  of  tbc 
United  Presbyterian  Church.  Surviving  are  four 
brothers,  one  of  whom  is  Dr.  DeMarr  Erskine, 
Steubenville. 

John  H.  Fritz,  M.D.,  West  Alexandria;  Eclectic 
Medical  College,  Cincinnati,  1881;  aged  82;  died 
October  18.  Dr.  Fritz  was  a native  of  Preble 
County  and  had  practiced  at  New  Madison  and 
West  Alexandria  for  52  years.  He  was  a member 
of  the  Masonic  Lodge.  His  widow  and  two  daugh- 
ters survive  him. 

Mary  A.  Hoehn,  M.D.,  Cincinnati;  Woman’s 
Medical  College,  Cincinnati,  1894;  aged  78;  died 
November  1.  Dr.  Hoehn  had  practiced  in  Cincin- 
nati since  leaving  medical  school.  She  was  an 
active  member  of  the  St.  Clara  Auxiliary,  Knights 
of  St.  John. 

John  Dustin  Howe,  M.D.,  Tiffin;  Toledo  Medical 
College,  1891;  aged  73;  member  of  the  Ohio  State 
Medical  Association  and  a Fellow  of  the  American 
Medical  Association;  died  October  11.  Dr.  Howe, 
a veteran  of  the  Spanish-American  War,  moved  to 


796 


The  Ohio  State  Medical  Journal 


December,  1933 


Tiffin  in  1901  from  Toledo.  He  leaves  his  widow, 
one  step-daughter  and  one  sister. 

Levi  Dungan  Hurd,  M.D.,  Jackson;  Starling 
Medical  College,  Columbus,  1903;  aged  57;  died 
October  29  of  tumor.  Dr.  Hurd  was  a native  of 
Jackson  and  had  practiced  there  since  leaving 
medical  school  except  for  a period  of  two  years 
when  he  practiced  at  Lorain.  Surviving  are  two 
sisters  and  one  brother. 

Edgar  McCormick,  M.D.,  Jackson  Center;  Medi- 
cal College  of  Ohio,  Cincinnati,  1888;  aged  67, 
member  of  the  Ohio  State  Medical  Association  and 
the  American  Medical  Association;  died  Novem- 
ber 5.  Dr.  McCormick  had  practiced  at  Jackson 
Center  for  28  years  having  moved  there  from 
Auglaize  County.  He  is  survived  by  his  widow 
and  two  sons. 

John  F.  McGarvey,  M.D.,  Lorain;  Jefferson 
Medical  College,  Philadelphia;  1883;  aged  76; 
member  of  the  Ohio  State  Medical  Association 
and  a Fellow  of  the  American  Medical  Associa- 
tion; died  November  6 of  heart  disease.  Dr.  Mc- 
Garvey located  in  Lorain  in  1894.  He  was  active 
in  public  health  work  and  in  medical  organization, 
and  was  a past-president  of  the  St.  Joseph’s  Hos- 
pital staff.  Dr.  McGarvey  held  memberships  in 
the  Masonic,  Woodmen  of  the  World  and  For- 
esters lodges  and  the  Congregational  Church. 
Surviving  are  his  widow,  one  son  and  one  brother. 

Noah  Myers,  M.D.,  Springfield;  Medical  College 
of  Ohio,  Cincinnati,  1887;  aged  75;  died  October 
13  of  apoplexy.  Dr.  Myers  was  a native  of  Spring- 
field  and  had  practiced  there  since  graduating 
from  medical  school.  Surviving  are  his  widow, 
two  daughters,  three  sisters  and  two  brothers,  one 
of  whom  is  Dr.  John  E.  Myers,  Springfield. 

William  S.  Phillips,  M.D.,  Bellecenter;  Colum- 
bus Medical  College,  1882;  aged  80;  former  mem- 
ber of  the  Ohio  State  Medical  Association  and  of 
the  American  Medical  Association;  died  October 
26  of  pneumonia.  Dr.  Phillips  located  in  Belle- 
center  in  1882.  He  was  active  in  political  and 
civic  affairs,  having  served  as  mayor  and  council- 
man, and  for  40  years  a member  of  the  board  of 
education.  He  was  active  in  the  United  Presby- 
terian Church,  having  been  an  elder  and  teacher 
of  the  Men’s  Bible  Class  for  many  years.  Dr. 
Phillips  had  served  as  president  of  the  Logan 
County  Medical  Society  and  of  the  Third  District 
Medical  Society.  Surviving  are  his  widow  and 
one  daughter. 

Charles  A.  Rife,  M.D.,  Kyger;  Starling  Medical 
College,  Columbus,  1882;  aged  75;  member  of  the 
Ohio  State  Medical  Association  and  a Fellow  of 
the  American  Medical  Association;  died  October 
29  of  cancer  of  the  mouth.  Dr.  Rife  had  recently 
celebrated  the  50th  anniversary  of  his  entrance 
into  medicine  and  was  honored  at  that  time  with 
a banquet  attended  by  his  professional  colleagues 
and  other  friends.  He  was  a member  of  the 
Knights  of  Pythias  and  Junior  Order  lodges 


Surviving  ax-e  his  widow,  three  daughters,  two 
sons  and  three  brothers. 

John  W.  Sharpe,  M.D.,  Toledo;  Medical  College 
of  Trinity  University,  Toronto,  1878;  aged  73; 
died  October  25.  Dr.  Sharpe  practiced  for  35 
years  at  McClure  before  moving  to  Toledo.  His 
widow,  one  daughter,  one  sister  and  two  brothers 
survive. 

J.  Newell  Sipher,  M.D.,  Medina;  Cleveland  Col- 
lege of  Physicians  and  Surgeons,  1885;  aged  71; 
former  member  of  the  Ohio  State  Medical  Associa- 
tion and  Fellow  of  the  American  Medical  Associa- 
tion; died  October  15  of  heart  disease.  Dr.  Sipher 
practiced  in  Cleveland  until  1916  when  he  moved 
to  Medina.  He  leaves  one  daughter,  two  brothers, 
one  of  whom  is  Dr.  John  A.  Sipher,  Norwalk,  and 
one  sister. 

James  W.  Watts,  M.D.,  Newark;  Medical  Col- 
lege of  Ohio,  Cincinnati,  1880;  aged  78;  died 
October  12.  Dr.  Watts  had  practiced  in  Delaware, 
Vinton  and  Gallia  counties  previous  to  his  retire- 
ment from  active  px-actice.  He  is  survived  by 
three  daughters. 

Matthies  A.  Wagner,  M.D.,  Toledo;  St.  Louis 
University,  School  of  Medicine,  1912;  aged  44; 
former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  Fellow  of  the  Amex*ican  Medical  As- 
sociation; died  October  30  following  an  extended 
illness.  Dr.  Wagner,  a native  of  Sidney,  located 
in  Toledo  in  1924.  He  was  a World  War  veteran 
and  was  a member  of  the  Amei’ican  Legion.  Sur- 
viving are  his  widow,  three  daughters,  one  sister 
and  four  bi’others. 


KNOWN  IN  OHIO 

Charles  W.  Moots,  M.D.,  Mentone,  Calif.,  Medi- 
cal College  of  Ohio,  Cincinnati  1895;  aged  64; 
former  member  of  the  Ohio  State  Medical  Asso- 
ciation and  a Fellow  of  the  American  Medical 
Association;  died  October  14.  Dr.  Moots  was 
fi’om  May,  1915  to  October,  1917,  a member  of  the 
Council  of  the  Ohio  State  Medical  Association, 
representing  the  Fourth  District.  He  was  a native 
of  Bellefontaine.  In  1903,  Dr.  Moots  located  in 
Toledo  where  he  px’acticed  and  taught  att  he 
the  Toledo  Medical  College.  During  the  World 
War  he  served  in  the  navy  as  surgeon-in-chief  of 
the  hospital  ship,  Mercy.  He  was  a past  president 
of  the  Toledo  Academy  of  Medicine  and  was  a 
member  of  the  Amei-ican  College  of  Surgeons  and 
the  American  Association  of  Gynecologists  and 
Obstetricians.  At  the  time  of  his  death  he  was 
inspector  of  the  western  division  of  hospitals  for 
the  American  College  of  Surgeons.  Dr.  Moots  was 
affiliated  with  the  Masonic  Lodge.  His  widow 
survives. 

Frank  Taliaferro,  M.D.,  Ocean  Beach,  Calif., 
Jefferson  Medical  College,  1875;  aged  84;  former 
member  of  the  Ohio  State  Medical  Association; 
died  October  22.  Dr.  Taliaferro  was  a former 
x’esident  of  Carlisle,  Warren  County.  His  widow 
and  one  daughter  survive. 


December,  1933 


State  News 


Exclusively  Engaged 
in  providing 


Thirty -four  Tears 

of 


Tsjfo  Medical  Protective  Company 

of  Fort  Wayne,  Ind. 

Wheaton,  111. 


2NEW5  NOTESs^OHIO 


Cleveland — Dr.  V.  C.  Rowland,  chairman  of  the 
Committee  on  Preventive  Medicine  and  Periodic 
Health  Examinations  of  the  Ohio  State  Medical 
Association,  addressed  the  Lake  County  Tubercu- 
losis and  Health  Association  on  November  2 on 
“Periodic  Health  Examinations”. 

Cleveland — Dr.  J.  L.  Bubis  recently  delivered 
an  address  at  Mt.  Sinai  Hospital,  Chicago,  on 
“Puerperal  Gynecology”  and  addressed  the1  annual 
meeting  of  the  Central  Association  of  Obstetric- 
ians and  Gynecologists  in  Milwaukee  on  “Treat- 
ment of  Spetic  Abortions  and  Their  Complica- 
tions”. 

Cleveland — Dr.  Myron  Metzenbaum  conducted 
a guest  clinic  at  Cook  County  Hospital,  Chicago, 
in  connection  with  the  Clinical  Congress  of  Sur- 
geons, covering  the  subject,  “The  Reduction  of  the 
Dislocated  Lower  End  of  the  Cartilaginous  Nasal 
Septum  in  Children,  Operative  and  Diagnostic”. 

Greentown — Dr.  L.  E.  Anderson,  formerly  of 
Mt.  Hope,  has  moved  his  family  here  and  is  con- 
ducting private  practice  in  the  offices  formerly 
occupied  by  Dr.  L.  E.  Dougherty. 

Columbus — Many  Columbus  physicians  attended 
a recent  meeting  of  the  Columbus  Dental  Society 
to  hear  an  address  by  Dr.  Chalmers  J.  Lyons, 
chief  of  oral  surgery,  University  of  Michigan. 
Following  Dr.  Lyons’  talk,  Dr.  J.  F.  Baldwin  pre- 
sented and  discussed  a case  of  double  ankylosis  of 
the  jaws. 

Cleveland — Dr.  Harold  N.  Cole,  associate  pro- 
fessor of  dermatology  and  syphilology,  Western 
Reserve  University,  School  of  Medicine,  recently 
addressed  the  Oklahoma  City  Clinical  Society. 

Cleveland — Dr.  G.  E.  Harmon,  associate  pro- 
fessor of  hygiene  and  vital  statistics,  Western  Re- 
serve University,  School  of  Medicine,  is  the  new 
chairman  of  the  Section  on  Vital  Statistics,  Amer- 
ican Public  Health  Association. 

Lima — Announcement  has  been  made  of  the 
marriage  of  Miss  Stella  Carr  and  Dr.  Burt  Hib- 
bard, both  of  this  city. 

Bellaire — Dr.  C.  W.  Kirkland  has  been  elected 
president  of  the  Bellaire  Kiwanis  Club. 

Marietta — Dr.  S.  E.  Edwards  and  Dr.  R.  M. 
Meredith  have  opened  a joint  practice  in  new 
quarters  at  326  Third  Street. 

Akron — Announcement  has  been  made  of  the 
marriage  of  Miss  Lena  L.  Zwickel,  Anderson,  In- 
diana, and  Dr.  Cloyd  F.  Wharton  of  this  city. 

Cincinnati — The  National  Research  Council, 
Washington,  D.  C.,  has  granted  a fellowship  in 
surgical  research  to  Dr.  Edward  McGrath  of  the 
surgical  research  department,  University  of  Cin- 
cinnati. Dr.  McGrath  will  use  the  scholarship  to 


continue  his  work  in  the  etiology  of  peripheral 
vascular  diseases  at  the  College  of  Medicine,  Uni- 
veristy  of  Cincinnati. 

Barberton — Dr.  George  R.  Taylor  has  been 
elected  president  of  the  Barberton  Kiwanis  Club. 

Mt.  Vernon — Dr.  Joseph  Landesman,  formerly 
connected  with  the  Toledo  State  Hospital,  has 
joined  the  staff  of  the  Ohio  State  Tuberculosis 
Sanatorium  here  as  assistant  physician. 

Je?iera — Offices  have  been  opened  here  by  Dr. 
Roselle  L.  Biederman,  formerly  of  Bluffton. 

Ashland — The  progress  of  medical  science  was 
discussed  by  Dr.  George  M.  Emery  in  a recent  ad- 
dress before  the  Ashland  Lions  Club. 

Dayton — Dr.  Thomas  L.  Laughlin  has  been 
promoted  from  second  lieutenant  to  first  lieuten- 
ant, Medical  Reserve  Corps. 

Columbus — Dr.  John  Edwin  Brown,  Jr.,  gradu- 
ate of  Harvard  Medical  School,  and  for  the  past 
three  years  connected  with  the  staffs  of  several 
Boston  hospitals,  has  become  an  associate  of  his 
father,  Dr.  John  Edwin  Brown,  of  this  city.  He 
will  specialize  in  diseases  of  infancy  and  child- 
hood. 

Ravenna — Dr.  A.  0.  DeWeese,  head  of  the  stu- 
dent health  service,  Kent  State  College,  has  been 
elected  president  of  the  American  Association  of 
School  Physicians. 

Cincinnati — Alpha  Kappa  Kappa  Fraternity, 
University  of  Cincinnati,  recently  held  a reception 
honoring  Dr.  John  A.  Caldwell,  president-elect  of 
the  Ohio  State  Medical  Association  and  president- 
elect of  the  Cincinnati  Academy  of  Medicine. 

Cincinnati — Officers  of  the  Cincinnati  Social 
Hygiene  Society  recently  elected  are:  President, 
Dr.  William  S.  Keller;  first  vice  president,  Dr. 
Elizabeth  Campbell;  second  vice  president,  Dr.  ET. 
W.  Mitchell,  and  treasurer,  Ralph  Rogan. 

Columbiana — Dr.  C.  W.  Kellogg  has  resumed 
active  practice  following  an  absence  of  two 
months  while  convalescing  from  injuries  received 
in  an  automobile  accident. 

Xe?iia — Dr.  Harold  Ray,  formerly  of  Cedar- 
ville,  has  moved  to  Xenia  and  opened  offices. 

Alliance — The  marriage  of  Mrs.  Nora  V.  Lank- 
ton,  Sydney,  Iowa,  and  Dr.  C.  H.  Ross  of  Alliance 
was  observed  here  recently. 

Cleveland — The  marriage  of  Miss  Maurine 
Simpson  and  Dr.  Louis  E.  Baron  has  been  an- 
nounced. 

Xenia — Dr.  Walter  M.  Simpson,  Dayton,  ad- 
dressed the  Xenia  Kiwanis  Club  recently  on  “Th< 
Lost  Art  of  Conversation”. 

Newton  Falls — Dr.  H.  M.  Mealy  and  his  fam- 
ily have  removed  to  Monroe,  Michigan,  where  Dr. 


798 


December,  1933 


State  News 


799 


THE  NEW  YORK  POLYCLINIC 

MEDICAL  SCHOOL  AND  HOSPITAL 

(ORGANIZED  1881) 

THE  PIONEER  POST-GRADUATE  MEDICAL 
INSTITUTION  IN  AMERICA 


PROCTOLOGY,  GASTRO-ENTEROLOGY 
and  ALLIED  SUBJECTS 


For  Information  Address 

MEDICAL  EXECUTIVE  OFFICER 

345  West  50th  Street  NEW  YORK  CITY 


CLASSIFIED  ADVERTISEMENTS 

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answers.  Forms  close  16th  of  the  month  preceding 
publication. 


Assistance  to  Medical  Writers — Abstracts,  Translations, 
Papers  prepared.  Experience  with  leading  medical  journals. 
Florence  Annan  Carpenter,  413  St.  James  Place,  Chicago, 
Illinois. 


For  Sale — Bausch  and  Lomb  Compound  Microscope,  3 ob- 
jectives, 2 eye  pieces.  Good  as  new.  S.  J.  Brown,  Richwood, 
Ohio. 


For  Rent — Wish  to  communicate  with  doctor  who  desires 
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No  other  periodical  on  the  re- 
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Send  your  subscription  now  ($3.00  per 
year)  to  the  A.M.A.  Offices,  535  North  Dear- 
born Street,  Chicago. 


COOK  COUNTY  GRADUATE 
SCHOOL  OF  MEDICINE 


(In  affiliation  with  COOK  COUNTY  HOSPITAL) 

Announces  Continuous  Courses 

MEDICINE  — General  and  Intensive  Course,  all 
branches.  (Two  Weeks  Intensive  Course 
starting  February  12,  1934.  Attendance 

Limited.) 

PEDIATRICS — Informal  Course — Four  Weeks  Inten- 
sive Course  starting  May  7,  1934.  Attendance 
Limited. 


OBSTETRICS — Informal  Course — Two  Weeks  Inten- 
sive Course. 

GYNECOLOGY — Three  Months  Course — Two  Weeks 
Course — Special  Courses. 

FRACTURES  AND  TRAUMATIC  SURGERY  — In- 
formal Course — Ten  Day  Intensive  Course 
starting  February  26,  1934.  Attendance 

Limited. 

ROENTGENOLOGY  — Special  and  Comprehensive 
Courses. 

CYSTOCOPY — Intensive  Course.  Attendance  Limited. 
UROLOGY — General  Course  Two  Months — Intensive 
Course  two  weeks. 

SURGERY — General  Course  One,  Two,  Three  and  Six 
Months  ; Surgical  Technique  two  weeks  inten- 
sive course — Special  courses. 

General,  Intensive  or  special  course  in  Tuberculosis, 
Orthopaedic  Surgery,  Dermatology  and  Syphilis,  Oph- 
thalmology, Ear,  Nose  and  Throat,  Pathology,  Neur- 
ology, Proctology,  Electrocardiography,  Topographical 
and  Surgical  Anatomy,  Physical  Therapy,  Gastroen- 
terology, Allergy. 

TEACHING  FACULTY 
Attending  Staff  of  Cook  County  Hospital 


Address:  Registrar, 

427  South  Honore  Street,  Chicago,  111. 


800 


The  Ohio  State  Medical  Journal 


December,  1933 


Mealy  will  be  physician  for  the  Newton  Steel 
Company. 

Columbus — Dr.  Howard  M.  Brundage  has  been 
named  a member  of  a medical  executive  committee 
to  aid  in  segregating  prisoners  at  the  U.  S.  Re- 
formatory, Chillicothe. 

Columbus — Announcement  has  been  made  of 
the  marriage  of  Miss  Mary  Poly  and  Dr.  Robert 
Smith,  both  of  Columbus. 

McConnelsville — Dr.  R.  B.  Bainter,  Zanesville, 
addressed  the  local  Rotary  Club  on  his  recent  tou,r 
of  Europe. 

Portsmouth — Dr.  H.  M.  Keil  is  taking  a course 
in  bone  surgery  at  the  New  York  Post  Gradu- 
ate School,  Columbia  University. 

Lima- — Dr.  Edward  B.  Pedlow  has  been  named 
a member  of  the  board  of  trustees  of  the  Lima 
District  Tuberculosis  Hospital. 

Martins  Ferry — An  address  on  Soviet  Russia 
was  made  by  Dr.  R.  H.  Wilson  at  a recent  meet- 
ing of  the  Martins  Ferry  Kiwanis  Club. 

Toledo — Dr.  E.  B.  Gillette  is  the  new  commo- 
dore of  the  Toledo  Yacht  Club. 

Toledo — Dr.  M.  D.  Haag,  president-elect  of  the 
Toledo  Academy  of  Medicine,  is  convalescing 
from  a recent  operation  for  acute  appendicitis. 

Toledo — The  following  marriages  have  been 
announced:  Dr.  L.  I.  Clark  to  Miss  Mae  Rear- 

don of  North  Scituate,  Mass. ; Dr.  A.  B.  Johnson 
to  Miss  Betty  Gruenberg,  and  Dr.  A.  S.  Avery 
to  Miss  Margaret  Crawford. 

Cleveland — A gift  of  $90,000  to  the  Western 
Reserve  University,  School  of  Medicine,  by  the 
Rockefeller  Foundation  has  been  announced  by 
President  R.  E.  Vinson. 

Fort  Recovery — Dr.  L.  Null  Shroder,  a gradu- 
ate of  the  University  of  Cincinnati,  College  of 
Medicine,  has  located  here,  taking  over  the  prac- 
tice of  Dr.  J.  V.  Richardson,  retired. 

Springfield — Announcement  has  been  made  of 
the  marriage  of  Miss  Florence  Barlow,  Urbana, 
and  Dr.  Joseph  Webb,  this  city. 

Zanesville — Dr.  James  E.  McCormick,  who  re- 
cently completed  his  internship  at  Bethesda  Hos- 
pital, has  joined  his  father,  Dr.  G.  W.  McCor- 
mick, in  active  practice. 

Martins  Ferry — Announcement  has  been  made 
of  the  marriage  of  Miss  Elizabeth  McGary,  St. 
Louis,  and  Dr.  Francis  J.  Robben,  this  city. 

Wilmington — Dr.  W.  B.  Yoakley  has  resumed 
active  practice  after  a three  months’  illness. 

Franklin — Dr.  Orville  L.  Layman,  who  recently 
completed  his  internship  at  the  Miami  Valley 
Hospital,  Dayton,  has  opened  offices  here. 

Wooster — Dr.  L.  E.  Seyler,  formerly  of  Lake- 
side Hospital,  Cleveland,  has  opened  offices 
here. 

Mt.  Vernon — Dr.  John  Drake,  formerly  on  the 
staff  at  Mt.  Sinai  Hospital,  Cleveland,  has  moved 
here  and  will  open  offices  for  general  practice. 

Dayton— Dr.  C.  C.  Burton  has  been  appointed 
director  of  surgery  at  the  National  Military 


Home,  succeeding  the  late  Dr.  S.  B.  Woodward. 
Dr.  Burton  formerly  occupied  a similar  post  at 
the  new  veterans’  hospital  at  Lexington,  Ky., 
which  is  now  closed. 

Delaware — Dr.  George  D.  Lowry,  student  phy- 
sician at  Ohio  Wesley  University,  for  the  past 
six  years,  has  resigmed  to  resume  private 
practice. 

Akron — Dr.  Ray  S.  Friedley  has  been  elected 
president  of  the  Akron  Exchange  Club. 

Gallipolis — Dr.  N.  A.  Martin,  formerly  an  in- 
tern at  Flower  Hospital,  Toledo,  has  joined  the 
staff  of  the  Holzer  Hospital,  here. 

Ravenna — Dr.  Iolas  M.  Huffman  has  been  ap- 
pointed local  physician  and  surgeon  for  the  Bal- 
timore & Ohio  Railroad. 

Findlay — Dr.  B.  F.  Mowery,  formerly  of  Bel- 
laire,  has  opened  offices  here  to  specialize  in  eye, 
earn,  nose  and  throat  work. 

Cumber-land — Dr.  S.  S.  Daw,  graduate  of  Ohio 
State  University  College  of  Medicine,  and  a re- 
cent interne  at  the  Allegheny  General  Hospital, 
has  opened  offices  here. 

Middleto'wn — Dr.  E.  M.  Morris  is  taking  post- 
graduate work  at  Berlin,  Vienna  and  Budapest. 

Coshocton — Offices  have  been  opened  here  by 
Dr.  H.  H.  Schwindt,  graduate  of  the  College  of 
Medicine,  Ohio  State  University. 

4|l  4|I 

Specimens  In  Barber  Exams  Should  Go 
To  Private  Labs 

Under  Section  9 of  Senate  Bill  129,  enacted  at 
the  regular  session  of  the  Ohio  General  Assembly 
and  signed  by  the  Governor,  creating  a state  board 
of  barber  examiners  and  regulating  the  business 
of  barbering,  every  person  desiring  to  obtain  a 
license  to  practice  barbering  must  file  with  the 
board  of  barber  examiners  a certificate  from  a 
licensed  physician  stating  that  “after  careful 
clinical  and  laboratory  examination  he  finds  such 
applicant  to  be  not  affected  with  any  contagious, 
infectious  or  communicable  disease”. 

During  the  past  few  weeks,  hundreds  of  ap- 
plicants for  barbering  licenses  have  submitted 
themselves  to  physical  examinations  to  comply 
with  this  provision  of  the  law. 

Contrary  to  the  regulations  of  the  State  De- 
partment of  Health  Laboratory,  some  physicians 
have  been  sending  blood  specimens  to  the  State 
Laboratory  for  examination  instead  of  to  private 
laboratories. 

As  all  physicians  know,  the  State  Laboratory 
is  not  authorized  to  make  blood  examinations  for 
other  than  indigents.  This  is  emphasized  on  the 
face  of  the  card  sent  in  with  specimens. 

Therefore,  unless  an  applicant  for  a barbering 
license  can  be  classified  as  an  indigent,  the  phy- 
sician making  the  physical  examination  should 
have  the  laboratory  examination  made  by  a priv- 
ate laboratory — not  by  the  State  Laboratory. 


December,  1933 


State  News 


801 


Edward  Reinert 

Ph.G.,  M.D. 

247  East  State  Street  Columbus,  Ohio 

Radium  and  Deep  X-Ray  Therapy 
X-Ray  Diagnosis 
Electro  Coagulation 
Grenz  Ray 


Associates 

FRANK  GALLEN,  M.D.,  LEE  A.  HAYS,  M.D.,  1 

Dermatology  Roentgenology 

Tel.  Main  1537  University  5842 


W.  H.  MILLER,  M.  D. 

328  East  State  St.  Columbus,  Ohio 

Office  Telephone,  MAin  3743  Residence,  EVergreen  5644 

•JL'Ug) 

Specializes  in 

Superficial  Malignancy  Electro-Coagulation 

Deep  Malignancy  X-ray  Diagnosis 

High  Voltage  X-ray  Therapy  Portable  X-ray. 

Prompt  and  Full  Report 


802 


The  Ohio  State  Medical  Journal 


December,  1933 


—The  following  appointments  to  the  staff  of 
the  Springfield  City  Hosiptal  for  the  year  ending 
Otcober  1,  1934,  have  been  announced: 

Anaesthesia  department,  Dr.  J.  H.  Riley,  director ; Dr.  E. 

R.  Brubaker  and  Dr.  I.  H.  Boesel. 

Dental  department,  Dr.  E.  G.  Benham,  director ; Dr.  G. 
P.  Fitzgerald,  and  Dr.  N.  C.  Farrell. 

Dermatology  department,  Dr.  A.  A.  Gravey,  director. 
Electrocardiology  department.  Dr.  Clement  L.  Jones, 
director. 

Gynecology  department,  Dr.  E.  Paul  Greenawalt,  director ; 
Dr.  Joseph  Webb,  Dr.  J.  H.  Poulton  and  Dr.  H.  B.  Elliott. 
Neurology  department,  Dr.  A.  Richard  Kent,  director. 
Medicine  department.  Dr.  Clement  L.  Jones,  director;  Dr. 
F.  P.  Anzinger,  Dr.  R.  R.  Richison  and  Dr.  L.  H.  Mendelson. 

Obstetrics  department.  Dr.  C.  S.  Rmasey,  director ; Dr.  A. 
K.  Howell,  DDr.  Roger  Marquart  and  Dr.  W.  D.  Beasley. 
Ophthalmology  department.  Dr.  C.  L.  Minor,  director. 
Oto-Iaryngology  department.  Dr.  J.  E.  Burgman,  director ; 
Dr.  Delos  W.  Hogue,  Dr.  F.  A.  Hartley  and  Dr.  J.  C. 
Easton. 

Orthopedics  department,  Dr.  J.  A.  Link,  director ; and  Dr. 
C.  M.  E.  Finney. 

Out-patient  department.  Dr.  R.  R.  Richison,  director ; Dr. 

F.  A.  Halloran,  Dr.  C.  W.  Hullinger,  Dr.  J.  N.  Hebble, 
Dr.  R.  D.  Arn,  Dr.  S.  E.  Fook,  Dr.  W.  D.  Beasley  and  Dr. 

G.  A.  Allen. 

Pathology  department.  Dr  Charles  B.  Kingry,  director. 
Pediatrics  department.  Dr.  Harris  B.  Martin,  director ; and 
Dr.  H.  H.  Hildred. 

Surgery  department.  Dr.  J.  H.  Rinehart,  director.  Dr.  H. 
A.  McKnight,  Dr.  A.  H.  Potte  and  Dr.  G.  C.  Ullery. 

Urology  department.  Dr.  N.  L.  Burrell,  director,  and  Dr. 

S.  W.  Mulholland. 

X-ray  department.  Dr.  Will  Ultes,  director. 

— The  following  committees  have  been  ap- 
pointed by  Dr.  E.  R.  Brush,  new  chief  of  staff  of 
Bethesda  Hospital,  Zanesville:  Surgery,  Drs.  W. 
A.  Melick,  W.  D.  Coffman  and  R.  D.  Bateman; 
medicine,  Drs.  W.  D.  Coffman,  C.  M.  Rambo  and 
A.  H.  Gorrell;  obstetrics,  Drs.  W.  F.  Sealover,  L. 
E.  Grimes  and  G.  B.  Trout;  records,  Drs.  0.  I. 
Dusthimer,  L.  Lasky  and  J.  W.  McCormick;  train- 
ing school,  Drs.  R.  B.  Bainter,  G.  B.  Trout  and 
S.  P.  Carter;  eye,  ear,  nose  and  throat,  Drs. 
Robert  S.  Martin,  W.  A.  Samuell  and  A.  E.  Wal- 
ters; M-ray  and  laboratory,  Drs.  M.  A.  Loebell, 
and  C.  F.  Sisk;  sanitation  and  hospital  hygiene, 
Drs.  Beatrice  T.  Hagen,  C.  Prouty  and  C.  G. 
Caudy;  autopsy,  Drs.  H.  T.  Glaser  and  W.  L. 
Cruise. 

— Dr.  Henry  J.  John  has  been  appointed  head  of 
the  newly-created  department  of  metabolic  dis- 
eases at  St.  Luke’s  Hospital,  Cleveland. 

— Dr.  C.  D.  Hemmings,  Cleveland,  addressed  the 
staff  of  Mt.  Carmel  Hospital,  Columbus,  relative 
to  advanced  methods  of  handling  obstetrical  cases. 

— Charles  E.  Findlay  has  resigned  as  superin- 
tendent of  the  Springfield  City  Hospital  to  become 
superintendent  of  the  Butterworth  Hospital, 
Grand  Rapids,  Michigan.  The  institution  is  tem- 
porarily in  charge  of  Assistant  Superintendent 
Frank  A.  Crothers. 

— Elyria  Memorial  Hospital  recently  celebrated 
its  125th  anniversary. 


URINE  DARK  FIELD— SPIROCHETA 

BLOOD  BASAL  METABOLISM 

BLOOD  CHEMISTRY  AUTOGENOUS  VACCINES 
SPUTUM  SURGICAL  PATHOLOGY 

FAECES-VACCINES  MEDICO-LEGAL  AUTOPSIES 
EFFUSIONS  X-RAY  DIAGNOSIS 

STOMACH  CONTENTS  ALLERGY 
PREGNANCY  TEST  ELECTROCARDIOGRAPHY 

LABORATORY 

Clinical  and  Pathological 

Established  1904 

Approved  by  the  American  Medical  Asaociattan. 

Columbus,  Ohio  370  E.  Town  Street 


J.  J.  COONS,  BJ3-,  M.D. 

Director 

H.  M.  Brundage,  M.D. 

H.  A.  Banghn,  A.B.,  M.D. 

M.  D.  Godfrey,  M.D. 

Campbell  Taylor,  A.B.,  M.D. 
Rowena  Berger,  A.B. 

Frances  Coup,  A.B. 

Flora  Moone 

PROMPT  SERVICE 

Immediate  Report  on  Frozen  Sections  of  all  Tumors. 


CHAS.  F.  BOWEN,  M.D. 

SPECIALIZES 

in 

Superficial 

Malignancies 

Removal  of 

Foreign  Bodies 

Radium  and 

X-Ray 

Diagnosis  and 
Therapy 


332  E.  State  Street 
COLUMBUS,  OHIO 


December,  1933 


State  News 


803 


Jin  Candjuic  CoTLcUiicrn^ 

QMjcnujoutexL  urilk  (RoItl 


A 


HMCPtmilN 


(SEARLE) 


In  angina  pecioris,  coronary  sclerosis,  and  coronary  thrombosis 
Aminophyllin  (Searle)  not  only  provides  relief  from  the  excruciating 
pain  of  acute  attacks,  but  also  worthwhile  prophylaxis. 


Aminophyllin  (Searle) — theophylline  ethylenediamine — is  a purine 
derivative,  water-soluble,  with  a vasodilating  action  comparable  to 
that  of  the  nitrites,  except  that  its  influence  is  more  prolonged.  It  is 
free  from  the  risk  attending  the  use  of  nitroglycerine. 

The  three  forms  in  which  Aminophyllin  (Searle)  is  available  offer  the 


A monograph  on  the 
rational  drug  treat- 
ment of  cardiac  con- 
ditions associated 
with  pain  will  be 
mailed  to  physicians 
on  request. 


physician  a valuable  armamentarium  for  the  treatment  of  the  condi- 
tions named.  It  is  supplied  in  ampul  forms  for  intramuscular  and 
intravenous  administration,  and  in  tablet  form  for  oral  or  rectal  use. 
Parenteral  administration  is  indicated  when  relief  from  an  acute  attack 
of  pain  is  imperative;  prolonged  oral  administration  of  the  tablets  has 
a tendency  to  ward  off  attacks  and  to  lessen  the  severity  and  fre- 
quency of  such  attacks  as  do  appear. 


Aminophyllin  (Searle)  is  made  in  America  from  American- 
made  ingredients  exclusively,  in  the  laboratories  of 


CHICAGO 


FINE  PHARMACEUTICALS  SINCE  1888 
LOS  ANGELES  KANSAS  CITY 


SPOKANE 


804 


The  Ohio  State  Medical  Journal 


December,  1933 


OFFICIAL  REGISTRIES  FOR  NURSES 

May  we  call  to  the  attention  of  physicians  the  official  registries  maintained  by  the  Ohio 
State  Nurses’  Association  for  the  benefit  of  physicians,  hospitals  and  the  public?  These 
registries  are  operated  not  for  profit  and  are  located  in  the  following  cities: 

Telephone : 

42  Hawthorne  Ave.,  Akron  Fr.  7013 

1316  Mahoning  Bank  Bldg.,  Youngstown  44581 

Prospect  1951 

Cincinnati  Cherry  7127 

Main  7962 
Fulton  7211 
M.  191 
ADams  1569 
559 

The  Ohio  State  Nurses’  Association  also  operates  an  employment  bureau  where  nurses  may  be  secured  for 
physicians’  and  dentists’  offices,  hospitals,  public  health  nursing  organizations,  official  health  organizations,  etc. 

OHIO  STATE  NURSES’  ASSOCIATION,  50  East  Broad  Street,  Columbus,  Ohio 


2157  Euclid  Ave.,  Cleveland 
733  Chamber  of  Comerce  Bldg.. 
2352  Monroe  Street,  Toledo 
871  W.  Riverview  Ave.,  Dayton 
435  E.  Liberty  St.,  Springfield 
Normandie  Hotel,  Columbus 
General  Hospital,  Portsmouth 


PUBLIC  HEALTH  NOTES 


. — Smallpox  has  been  in  a state  of  decline  for 
several  years ; but  there  is  no  reason  to  hope  that 
the  country  is  so  well  vaccinated  that  the  disease 
is  at  or  near  (or  even  on  the  way)  to  the  vanish- 
ing point,  according  to  the  Ohio  Health  News, 
which  adds: 

“The  people  of  the  United  States  are  merely 
mighty  lucky.  In  spite  of  the  very  marked  re- 
duction in  incidence  during  the  last  three  years, 
there  have  been  numerous  foci  of  infection,  in- 
cluding Ohio,  from  which  any  number  of  epidem- 
ics might  easily  have  spread.  They  just  didn’t, 
that’s  all;  and  Ohio,  which  made  10.5  per  cent  of 
the  country’s  smallpox  record  in  1930,  5.8  per 
cent  of  it  in  1931  and  9.1  per  cent  in  1932,  was 
just  a little  luckier  than  the  rest  of  the  country 
that  a really  serious  outbreak  of  the  disease  did 
not  come  to  rebuke  the  people  for  their  neglect  of 
or  opposition  to  the  one  real  safeguard — vaccina- 
tion. 

“It  is  noted  in  a recent  bulletin  of  the  U.  S. 
Public  Health  Service  that  in  1930,  which  was  the 
latest  peak  year  for  the  disease,  there  were  re- 
ported in  the  United  States  48,907  cases  of  small- 
pox (of  which  Ohio  reported  5116)  ; in  1931, 
30,232  (Ohio  1767);  and  in  1932,  11,168  (Ohio 
1017).  The  number  of  cases  of  smallpox  reported 
for  1932  was  27.8  per  cent  of  the  average  for  the 
preceding  four  years  in  the  United  States;  but  in 
Ohio  the  1932  total,  which  was  the  lowest  in  the 
history  of  the  State’s  epidemiological  records,  was 
39.3  per  cent  of  the  preceding  four-year  average. 

“The  number  of  cases  of  smallpox  reported 
nationally  for  the  first  13  weeks  of  1933  was 
2413  (of  which  Ohio  reported  157,  or  6.5  per 
cent) , compared  with  5280  during  the  same  period 
in  1931  and  12,835  cases  in  1930.  No  other  dis- 
ease which  is  reported  to  the  Public  Health  Ser- 
vice, says  the  bulletin,  shows  such  notable  reduc- 
tion in  incidence  during  the  period  covered. 


“The  real  point  of  interest  in  these  figures  for 
Ohioans  is  the  fact  that  whereas  Ohio  is  2 per 
cent  of  the  number  of  states,  with  approxi- 
mately 7 per  cent  of  the  population,  it  has  for 
several  years  furnished  approximately  8 per  cent 
of  the  country’s  smallpox  record.  The  time  to 
vaccinate,  as  an  essentially  conservation  measure, 
is  NOW!” 

— Henrietta  Luessing,  St.  Mary  High  School, 
Cincinnati,  was  Ohio  winner  in  the  Fifth  An- 
nual Gorgas  Memorial  Contest  and  will  compete 
with  the  other  state  winners  for  the  national 
award. 

— Dr.  Seward  Harris,  Lisbon,  has  been  ap- 
pointed health  commissioner  of  Columbiana 
County,  to  fill  out  the  unexpired  term  of  the  late 
Dr.  T.  T.  Church. 

— Dr.  John  B.  McClure  has  been  reappointed 
health  commissioner  of  Marietta. 

4|I  yi 

Funds  for  the  reimbursement  of  health  districts 
within  the  state,  for  a portion  of  the  salaries  of 
health  commissioners,  public  health  nurses  and 
clerks,  to  be  borne  from  state  funds,  may  not  be 
withheld  for  the  reason  that  the  county  of  which 
the  health  district  is  a part  is  indebted  to  the 
state,  according  to  an  opinion  rendered  recently 
by  Attorney  General  John  W.  Bricker. 


— The  following  new  internes  have  taken  up 
their  duties  at  St.  Elizabeth  Hospital,  Dayton: 
William  Hartlage,  Joseph  Prince,  John  Meyers, 
Arch  HarVey,  Lawrence  Reichard,  Arthur  Mc- 
Donald, and  Wallace  Miller. 

yi 

More  than  300  physicians  have  registered  for 
the  Post  Graduate  Course  on  “Diseases  of  the 
Gastro-Intestinal  Tract”  being  sponsored  by  the 
Cleveland  Academy  of  Medicine. 


December,  1933 


State  News 


805 


Every  baby  is  a special  baby. 
Every  baby  is,  therefore,  an  in- 
dividual feeding  problem  which 
your  own  prescription 
alone  can  solve.  Your 
own  formula— based  on 
the  condition  of  the  in- 
fant-one that  takes  into 
consideration  the  baby’s 


digestive  ability  as  well  as  its 
most  urgent  needs  is  the  best  as- 
surance of  success  in  infant  feed- 
ing. KLIM  is  a safe, 
pure,  uniform  milk, 
easily  digested  and  assim- 
ilated and  readily  adapt- 
able to  your  prescrip- 
tions. 


AUTHORITY:  “As  the  doctor  says,  the 

multiplication  of  complicated  foods  through 
the  interests  which  push  them  for  commercial 
reasons  is  out  of  proportion  to  their  value. 
For  the  general  practitioner  to  adapt  the  for- 
mula to  abnormal  conditions  from  a printed 
card  is  difficult.  Since  the  compound  is  fixed, 


it  is  impossible  to  vary  the  amount  of  a sin- 
gle ingredient  without  varying  the  amount  of 
all  the  other  contained  ingredients  by  the  use 
of  either  dilution  or  concentration.  Scientific 
medication  with  "shot-gun”  prescriptions  is 
no  more  impossible  than  scientific  feeding 
with  “shot-gun”  proprietary  infant  foods.” 


(DR.  HENRY  E.  Irish,  discussion  of  Dennett’s  paper:  “The  Teaching 
of  Infant  Feeding,”  Arch.  Pediat.,  Vol.  XLVIII,  No.  4,  April,  1931) 


PRESCRIBE 

SAFE,  PURE  WHOLE  MILK  IN  POWDERED  FORM.... 


Samples  and  literature  on  request 


THE  BORDEN  COMPANY,  DEPT.  KM-108,  205  EAST  42ND  STREET,  NEW  YORK,  N.  Y. 


808 


The  Ohio  State  Medical  Journal 


December,  1933 


OHIO  state  medical  association 

£6  Jt  Jt 


STANDING  COMMITTEES 
(Constitutional) 

PUBLIC  POLICY 

C.  W.  Stone,  Chairman,  (1935) Cleveland 

J.  H.  J.  Upham,  (1934) . Columbus 

John  B.  Alcorn,  (1936) Columbus 

C.  L.  Cummer,  (ex-officio) Cleveland 

John  A.  Caldwell,  (ex-officio) Cincinnati 

PUBLICATION 

Andrews  Rogers,  Chairman,  (1934) 

Columbus 

Gilbert  Micklethwaite,  (1935)  .Portsmouth 
A.  B.  Denison,  (1936) Cleveland 

MEDICAL  DEFENSE 

J.  E.  Tuckerman,  Chairman,  (1934) 

Cleveland 

F.  P.  Anzinger,  (1935) Springfield 

W.  H.  Snyder,  (1936) Toledo 

MEDICAL  EDUCATION  AND  HOSPITALS 
Ben  R.  McClellan,  Chairman,  (1934)  ..Xenia 

R.  H.  Birge,  (1935) Cleveland 

John  F.  Wright,  (1936) Toledo 

MEDICAL  ECONOMICS 
J.  Craig  Bowman,  Chairman,  (1936) 

Upper  Sandusky 

A.  B.  Brower,  (1934) Dayton 

E.  0.  Smith,  (1935) Cincinnati 


SPECIAL  COMMITTEES 

JUDICIAL 

H.  M.  Platter,  Chairman Columbus 

John  A.  Caldwell Cincinnati 

I.  P.  Seiler Piketon 

PREVENTIVE  MEDICINE  AND  PERIODIC 
HEALTH  EXAMINATIONS 

V.  C.  Rowland,  Chairman Cleveland 

C.  W.  Burhans Cleveland 

Jonathan  Forman  Columbus 

Beatrice  T.  Hagen Zanesville 

R.  R.  Hendershott Tiffin 

A.  J.  Skeel Cleveland 

C.  I.  Stephen Ansonia 

MILITARY  AND  VETERANS’  AFFAIRS 

Louis  Feid,  Jr.,  Chairman Cincinnati 

John  A.  Sipher Norwalk 

A.  J.  McCracken Belief ontaine 

COUNCIL  COMMITTEES 

AUDITING  AND  APPROPRIATIONS 

B.  J.  Hein,  Chairman Toledo 

H.  V.  Paryzek Cleveland 

S.  J.  Goodman Columbus 

PROGRAM  1934  ANNUAL  MEETING 

H.  V.  Paryzek,  Chairman Cleveland 

John  A.  Caldwell Cincinnati 

H.  M.  Platter Columbus 

ARRANGEMENTS  1934  ANNUAL  MEETING 

S.  J.  Goodman,  Chairman Columbus 

E.  R.  Brush Zanesville 

E.  M.  Huston .Dayton 


Cecil  Striker  .. 


SECTION  OFFICERS  FOR  1933-1934 

MEDICINE 


.Chairman 


700  Provident  Bank  Bldg.,  Cincinnati 

H.  W.  Gauchat Secretary 

615  First  National  Bank  Bldg.,  Canton 
SURGERY 

Norris  Gillette  Chairman 

320  Michigan  St.,  Toledo 

Verne  A.  Dodd Secretary 


327  East  State  St.,  Columbus 

OBSTETRICS  AND  PEDIATRICS 
John  Toomey  Chairman 

City  Hospital,  Cleveland 

J.  K.  Hoerner 


400  Fidelity  Building,  Dayton 


.Secretary 


EYE,  EAR,  NOSE  AND  THROAT 
Ivor  G.  Clark Chairman 

188  East  State  St.,  Columbus 

Orville  J.  Walker Secretary 

Home  Savings  and  Loan  Bldg.,  Youngstown 
NERVOUS  AND  MENTAL  DISEASES 
Henry  C.  Schumacher Chairman 


2525  Euclid  Ave., 

C.  C.  Kirk.. 


Cleveland 


.Secretary 


Orient,  Ohio 

PUBLIC  HEALTH  AND  PREVENTIVE  MEDICINE 
R.  H.  Markwith Chairman 

Court  House  Annex,  Akron 

P.  A.  Davis Secretary 

1004  E.  Market  St.,  Akron 


Delegates  and  Alternates  to  American  Medical  Association 


DELEGATES 


Wells  Teachnor,  Sr.,  (1984). 

Ben  R.  McClellan,  (1934) 

E.  R.  Brush,  (1934) 

C.  W.  Stone,  (1934) 

J.  P.  DeWitt,  (1936) 

C.  E.  Kiely,  (1935) 

C.  W.  Waggoner,  (1936) 


..Toledo 


ALTERNATES 


Xenia 

-Zanesville 

A.  Howard  Smith,  (1934) 

Marietta 

Cleveland 

..Cincinnati 

L.  H.  Schriver.  (1935)..  ...  

...Cincinnati 

Charles  Lukens,  (1935) 


.Toledo 


1934  ANNUAL  MEETING  NEXT  AUTUMN 


^OHIOf  STATE 

medical  Journal 

WA^A^A^A^A^A^WyA^A^AVAVA^AVA^AVA^AVA^A^ATA^AVA^AV' 


OWNED  AND  PUBLISHED  MONTHLY  BY 

THE  OHIO  STATE  MEDICAL  ASSOCIATION 

AS  A MEDIUM  OF  SERVICE  TO  ITS  MEMBERS 


INDEX  TO  VOLUME  XXIX 

The  Ohio  State  Medical  Journal 
January--- December,  1933 


January  Pages 

February  “ 

March  

April  

May  “ 

June  


July  

August  

September  

October  

November  

December  


U 


it 


it 


1 

to 

72 

73 

to 

144 

145 

to 

208 

209 

to 

272 

273 

to 

336 

337 

to 

400 

401 

to 

464 

465 

to 

528 

529 

to 

600 

601 

to 

672 

673 

to 

736 

737 

to 

808 

SUPPLEMENT  TO  DECEMBER,  1933,  VOL.  XXIX. 


ORIGINAL  CONTRIBUTIONS 


Abscess,  Subdural ; Its  Relation  to  Sterile  Purulent 


Leptomeningitis.  (W.  James  Gardner) _.  235 

Acute  Abdomen,  Management  of  the ; with  Special  Ref- 
erence to  the  Use  of  Spinal  Anaesthesia.  (R.  C. 
Austin  and  H.  H.  Wagner).... 176 

Abdominal  Surgery  in  Children  (Norris  W.  Gillette) 23 


Intussusception,  Acute  and  Chronic,  (Charles  W.  Mayo)  . 693 

Jaundice,  Familial  Hemolytic ; Clinical  Study  of  Case 
before  and  After  Splenectomy.  (Donald  M.  Glover 
and  Warren  C.  Fargo) 428 

Lead  Poisoning  Followed  by  Diffuse  Vascular  Disease. 

(Z.  T.  Wirtschafter) 771 


Abdominal  Tumors  and  Their  Differentiation  ; A Radio- 
logical Study  of,  (Samuel  Brown) 424 

Adenoma  of  Thyroid,  Calcification  of  (J.  F.  Beachler  and 

G.  A.  Woodhouse)... 311 


Leptomeningitis,  Purulent,  Subdural  Abscess  in  Relation 

to  Sterile.  (W.  James  Gardner) 235 

Liver  Extract  Therapy,  Intravenous,  in  Pernicious 

Anemia.  (Warren  Payne  and  H.  H.  Brittingham)  ...  553 


Allergy,  Migraine-Like  Headaches  Due  to  (Jonathan 

Forman)  ^ 28 

Anemia,  Nutritional  (Ernest  Scott  and  C.  J.  Delor) 165 

Anemia,  Clinical  Consideration  of  Secondary  (George  I. 

Nelson)  1 232 

Anemia,  Intravenous  Liver  Extract  Therapy  in  Per- 
nicious (Warren  Payne  and  H.  H.  Brittingham) 553 


Lymphadenopathy,  Cervical  (B.  K.  Wiseman)  364 

Mastoiditis.  Bone  and  Joint  Complications  in,  (Samuel 

S.  Quittner  and  Rudolph  E.  Reich) 764 

Medicine  in  Retrospect  and  Prospect;  A Resume  of  Medi- 
cal Accomplishment  as  Reviewed  at  the  Beginning 
of  the  New  Year,  1933,  (Charles  A.  Doan) 297 

Medicine  and  Genetics.  (Laurence  H.  Snyder) 705 


Anemia,  Pernicious ; Spinal  Cord  Changes  in  (C.  E. 

Kiely)  761 

Antitoxin,  Therapeutic  Values  in  Treatment  of  Scarlet 

Fever.  (F.  E.  Stevenson) 421 

Anus,  Imperforate  (George  M.  Curtis  and  F.  E.  Kredel)  . 183 

Bismuth,  Oral,  in  the  Treatment  of  Syphilis.  (Reed  O. 

Brigham)  556 

Bone  and  Joint  Complications  in  Mastoiditis  (Samuel  S. 

Quittner  and  Rudolph  E.  Reich) 764 

Cataract,  The  Intra-Capsular  Operation  of  ; A Survey  of 

Fifty  Years’  Experience.  (J.  W.  Wright)  41 

Catarrhalis,  Pneumococcic  Meningitis  Combined  with 

Streptococcus  and  Diplococcus,  (S.  H.  Ashmun) 243 

Cervical  Lymphadenopathy.  (B.  K.  Wiseman) — — 364 

Children,  Abdominal  Surgery  in,  (Norris  W.  Gillette)  — 23 

Colitis,  Observations  in  Ulcerative ; with  Illustrative 

Cases.  (V.  C.  Rowland) 629 

Dermatological  Hints  for  Elimination  of  Occupational 

Skin  Diseases.  (Karl  G.  Zwick)  111 

Disability,  Estimation  of  ; from  an  Orthopedic  Standpoint. 

(Walter  G.  Stern) 170 

Diverticulum,  Meckel’s,  in  a Hernia  Sac  (Littre’s  Hernia) 

(S.  C.  Lind) 549 

Encephalitides,  The  (H.  D.  McIntyre) 239 

Encephalitis,  Chronic,  Associated  with  Gall  Bladder  In- 
fection. (S.  R.  Salzman) — 767 

Eosinoplilia,  75  Per  Cent.  (A.  Cowan) 633 

Eye,  Pathological  States  of  the  Nervous  System  and  the 

(A.  R.  Vonderahe)  105 

Ear  and  Throat  Problems  from  a Pediatric  Standpoint. 

(C.  W.  Wyckoff)  757 

Gall  Bladder  Disease.  A Plea  for  Early  Diagnosis  and 

Surgical  Treatment  of  Acute,  (Max  M.  Zinninger)... . 229 

Gall  Bladdder  Infection.  Chronic  Encephalitis  Associated 

with,  (S.  R.  Salzman) 767 

Gas  Gangrene  as  a Complication  of  Pregnancy.  (Charles 

W.  Pavey  and  H.  L.  Reinhart)  551 

Genetics  and  Medicine.  (Laurence  H.  Snyder).. 705 

Head  Injuries ; A Consideration  of  the  Late  Effects  of, 

(H.  E.  LeFever)  493 

Hay  Fever  Treatment;  the  Continuous  Method.  (Karl 

D.  Figley)  — . 360 

Headaches  Due  to  Allergy.  Migraine-like,  (Jonathan 

Forman)  28 

Health  Education,  Adult  (Robert  Lockhart)  436 

Health  Administration,  The  Economic  Status  of  Public, 

(Harry  G.  Southard) 695 

Health  Examinations,  Preventive  Medicine  and  Periodic, 

(V.  C.  Rowland)  117 

Heart  Failure,  Congestive ; A Report  of  Thirty-Seven 

Cases.  (Bernard  A.  Schwartz) 308 

Heart,  Penetrating  Wound  of  ; with  Successful  Removal 

of  Foreign  Body.  (B.  J.  Dreiling) 698 

Hemorrhage,  Pathologic.  (Russel  L.  Haden)  487 

Hernia  Littre’s ; A Meckel’s  Diverticulum  in  a Hernia 

Sac.  (S.  C.  Lind) 549 

Imperforate  Anus.  (George  M.  Curtis  and  F.  E.  Kredel)  183 
Injuries,  A Consideration  of  the  Late  Effects  of  Head, 

(H.  E.  LeFever)  : 493 

Intracranial  Injuries,  Modern  Treatment  of  Fractures  of 

the  Skull  and,  (E.  R.  and  Roy  D.  Arn) 293 


Meningitis,  Pneumococcic,  Combined  with  Streptococcus 

and  Diplococcus  Catarrhalis.  (S.  H.  Ashmun) 243 

Nervous  System  and  the  Eye,  Pathological  States  of  the 

(A.  R.  Vonderahe) 105 

Nutritional  Anemia.  (Ernest  Scott  and  C.  J.  Delor) 165 

Obstetrics;  A Survey  of  1253  Consecutive  Deliveries.  (C. 

T.  Hemmings) 97 

Occipito-Posterior  Positions,  Management  of  (George  A. 

Palmer)  ! 496 

Orthopaedic  Standpoint,  Estimation  of  Disability  from  an 

(Walter  G.  Stern) 170 

Ophthalmic  Manifestations  of  Otic  Disease.  (M.  F. 

McCarthy)  31 

Paralysis,  Graphic  Methods  of  Evaluating  Remissions  in 

General  (Richard  E.  Stout) — _i 179 


Paralysis,  General,  and  the  Malarial  Treatment.  (Fred 

L.  Rhodes)  700 

Pathologic  Hemorrhage.  (Russel  L.  Haden)  487 

Pediatrics,  Throat  and  Ear  Problems  from  the  Stand- 
point of  (Wyckoff,  C.  W.) 757 

Pregnancy,  Gas  Gangrene  as  a Complication  of  (Charles 

W.  Pavey  and  H.  L.  Reinhart) 551 

Prostate,  Transurethral  Resection  of  the  (Wm.  E. 

Lower  and  Wm.  J.  Engel) 357 


jScarlet  Fever  Antitoxin,  Therapeutic  Values  of  (F.  E. 
Stevenson)  — 

Skin  Diseases,  Occupational ; Dermatologic  Hints  for 
their  Elimination.  (Karl  G.  Zwick) 


Sphenoidal  Sinus  Infection,  Practical  Considerations  of 
(Harris  H.  Vail)  — 

Spinal  Anaesthesia.  Management  of  the  Acute  Abdomen 
with  Special  Reference  to  the  Use  of  (Robert  C. 
Austin  and  H.  H.  Wagner)  - - 


Spinal  Cord  Changes  in  Pernicious  Anemia.  (C.  E. 
Kiely)  - - — 

Splenectomy.  Clinical  Study  of  a Case  of  Familial  Hem- 
olytic jaundice,  Before  and  After  (Donald  M.  Glover 
and  Warren  C.  Fargo)  — 


Syphilis.  Oral  Bismuth  in  the  Treatment  of  (Reed  O. 

Brigham)  — 

Thrombosis  of  the  Inferior  Vena  Cava  and  Extensive 
Skin  Necrosis.  (W.  H.  Bunn) — - 


Thyroid,  Calcification  of  Adenoma  of  the  (J. 
and  G.  A.  Woodhouse) — — 


F.  Beachler 
311 


Tularemia;  A Summary  of  Recent  Researches,  with  a 
Consideration  of  103  Dayton  Cases.  (Walter  M. 

Simpson)  - 

Tumors,  Abdominal,  and  their  Differentiation.  A Rad- 
iological Study  of  (Samuel  Brown) 

Ulcerative  Colitis  with  Illustrative  Cases.  Observations 

in  (V.  C.  Rowland). — 

Vaccine  Therapy.  (Stanley  E.  Dorst)  --- 


Vascular  Disease.  Lead  Poisoning  Followed  by  (Z.  T. 

Wirtschafter)  — - - ‘ 

Visual  Acuity,  Determination  of  the  (Paul  G.  Moore)  367 


Undulant  Fever.  Preliminary  Note  on  Treatment  of, 
with  Detoxified  Vaccine  and  with  Antiserum.  (Al- 
fred E.  O’Neil) - — 


43S 


AUTHORS  TO  CONTRIBUTIONS 


Andrews,  W.  B.  (Kent) 

Arn,  E.  R.  (Dayton)  

Arn,  Roy  D.  (Springfield) 

Ashmun,  S.  H.  (Dayton) 

Austin,  Robert  C.  (Dayton) 

Beachler,  J.  F.  (Piqua) 

Brigham,  Reed  O.  (Toledo) 

Brittingham,  H.  H.  (Cleveland) 

Brown,  Samuel  (Cincinnati) 

Bunn,  W.  H.  (Youngstown) :. 

Cowan,  A.  (Cleveland) 

Cummer,  C.  L.  (Cleveland) 586;  625;  709; 

Curtis,  George  M.  (Columbus) 

Delor,  C.  J.  (Columbus) 

Doan,  Charles  A.  (Columbus) 

Dorst,  Stanley  E.  (Cincinnati) 

Dreiling,  B.  J.  (Youngstown) 

Engle,  Wm.  J.  (Cleveland) ... 

Fargo,  Warren  C.  (Cleveland) 

Figley,  Karl  D.  (Toledo) 

Forman,  Jonathan  (Columbus). 

Gardner,  W.  James  (Cleveland)  

Gillette,  Norris  W.  (Toledo)  

Glover,  Donald  M.  (Cleveland) i. 

Haden,  Russel  L.  (Cleveland)  

Hemmings,  C.  T.  (Cleveland)  

Kiely,  C.  E.  (Cincinnati). 

Kredel,  F.  E.  (Chicago)  

LeFever,  H.  E.  (Columbus) 

Lind,  S.  C.  (Cleveland) 

Lockhart,  Robert  (Cleveland)  

Lower,  Wm.  E.  (Cleveland) - -. 

Mayo,  Charles  W.  (Rochester,  Minn.)  

McCarthy,  M.  F.  (Cincinnati) 

McIntyre,  H.  D.  (Cincinnati) 

Moore,  Paul  G.  (Cleveland) 

Nelson,  George  I.  (Columbus)  

O’Neil,  Alfred  E.  (Cincinnati)  

Palmer,  George  A.  (Akron) 

Pavey,  Charles  W.  (Columbus) 

Payne,  Warren  (Cleveland) 

Platter,  H.  M.  (Columbus) 43,  123,  186,  247,  315, 

440,  508,  586, 

Quittner,  Samuel  S.  (Cleveland) 

Reich,  Rudolph  E.  (Cleveland) 

Reinhart,  H.  L.  (Columbus) 

Rhodes,  Fred  L.  (Massillon) 

Rowland,  V.  C.  (Cleveland) . 117, 

Salzman,  S.  R.  (Toledo)  

Schwartz,  Bernard  A.  (Cincinnati) — 

Scott,  Ernest  (Columbus) 

Simpson,  Walter  M.  (Dayton)  

Snyder,  Laurence  H.  (Columbus)..— 

Southard,  Harry  G.  (Columbus) 

Stern,  Walter  G.  (Cleveland)  __ 

Stevenson,  F.  E.  (Cincinnati)  _ 

Stout,  Richard  E.  (Cleveland) 

Vail,  Harris  H.  (Cincinnati) 

Vonderahe,  A.  R.  (Cincinnati)...: 

Wagner,  H.  H.  (Dayton) 

Wirtschafter,  Z.  T.  (Cleveland)  

Wiseman,  B.  K.  (Columbus) 

Woodhouse,  G.  A.  (Pleasant  Hill)  

Wright,  J.  V/.  (Columbus) 

Wyckoff,  C.  W.  (Cleveland) 

Zinninger,  Max  M.  (Cincinnati) 

Zwick,  Karl  G.  (Cincinnati) 


ORGANIZATION— O.  S.  M.  A. 

Annual  Meeting — - 

1933  Annual  Meeting  Plans  Considered  at  Council 
Meeting,  44 ; Annual  Meeting  Plans  Progress,  91 ; 
Akron  Ready  for  Annual  Meeting,  162  ; Hotel  Reser- 
vations Should  Be  Made  Immediately  for  Coming 
Annual  Meeting  in  Akron,  187 ; 447  ; 506 ; Medical 
Golfers  Already  Feel  the  Golf  Itch  for  Coming  An- 
nual Tournament,  199 : Annual  Meeting  Postponed, 
225 ; Annual  Meeting  Dates,  289 ; 353 ; Problems  of 
the  1933  Annual  Meeting,  374 ; Medical  Golfers  to 


Contest  in  Akron  September  6,  the  Day  Preceding 
Annual  Meeting,  380  ; 444  ; Annual  Meeting  Interest 
Gains  in  Momentum,  417 ; Akron  Committees  Busy 
Completing  Arrangements  for  Entertaining  State 
Association,  445 ; This  Year’s  Annual  Meeting  an 
Important  Event,  481  ; Eighty-Seventh  Annual 
Meeting  Program,  499  ; Special  and  Attractive  Fea- 
tures are  Being  Planned  for  Annual  Meeting,  507  ; 
Annual  Meeting  Details  Completed  at  July  Council 
Meeting,  509 ; Annual  Reports  in  September  Issue, 

545  ; High  Spots  of  Program  and  Entertainment  Fea- 
tures of  Akron  Meeting,  587  ; Special  Announce- 
ments, 588 ; The  Spirit  of  Leadership  at  Annual 
Meeting,  617 ; Successful  Annual  Meeting  Held 
Innumerable  Attractions  for  Those  in  Attendance, 

650  ; Annual  Organization  Luncheon  Addressed  by 
Dr.  Follansbee,  655 ; Splendid  Attendance  at  87th 
Annual  Meeting,  657  ; Thirteenth  Annual  Golf  Tour- 
nament at  Akron  on  September  6,  660  ; Preliminary 
Plans  for  1934  Annual  Meeting— 776 


Annual  Address — 

A Glance  at  Our  Balance  Sheet ; Annual  Address  of 
the  Retiring  President,  H.  M.  Platter,  M.D.,  621  ; 
The  Educational  Functions  of  the  State  Medical  As- 


oUL  Id  UUI 1 , lllu  Uq  UX  ul  xa.UUXv.oo  ul  LIlc  lilLUIUlilj,  JL  1 Col 

dent,  C.  L.  Cummer,  M.D 625 

Committees,  Annual  Reports — 

Public  Policy  — 557 

Medical  Economics  .563 

Publication  — 568 

Medical  Defense  — 570 

Medical  Education  and  Hospitals 573 

Preventive  Medicine  and  Periodic  Health  Examina- 
tions   576 

Auditing  and  Appropriations 578 

Military  and  Veterans’  Affair’s 580 

Councilors  : — __  583 

Report  of  House  of  Delegates  Committee  on  Annual 

Reports . . . — . — 640 

Committee  Appointments,  (See  House  of  Delegates), 

644  ; Council  Minutes 778 


Council — • 

Numerous  Important  Policy  and  Org-anization  Prob- 
lems Considered  by  the  Council  at  Its  Last  Meeting 
for  1932  ; Preparations  Made  for  1933,  44  ; Prepara- 
tion for  Emergency  to  Meet  Problems  Confronting  the 
Profession  and  Medical  Organization  Provided  by 
Council  at  March  Meeting,  248  ; Annual  Meeting, 
Workmen’s  Compensation  Problems,  Legislation,  and 
Other  Important  Matters  Considered  at  May  Council 
Meeting,  374  ; Annual  Meeting  Details  Completed  and 
Consideration  Given  to  Other  Important  Subjects  at 
July  Council  Meeting,  509 : Annual  Reports  of  the 
Councilors,  583 ; Council  Meeting  Minutes  During 
87th  Annual  Meeting  of  the  Ohio  State  Medical  As- 
sociation,  647  ; Preliminary  Plans  for  1934  Annual 
Meeting,  Committee  Appointments,  Problems  of  Med- 
ical  Care,  Hospital  Group  Payment  Plans,  and  Nu- 
merous Other  Vital  Questions  Considered  by  Council . 776 


County  Societies  and  Academies  of  Medicine — 

News  Notes  from  County  Societies  and  Academies, 

58;  132;  190;  258;  321;  390  ; 454;  522;  598  ; 668, 

719  : ....  789 


Columbus  Academy  of  Medicine  Resolutions  on  Ad- 
vertising  of  Physicians,  228 ; Program  for  Post- 
Graduate  Day  of  Mahoning  County  Society,  246 ; 
Cleveland  Academy  Inaugurates  Plan  to  ’’Rate”  Pa- 
tients Who  Are  Unable  to  Provide  Full  Medical  Pay- 
ment, 450 ; District  Meeting  Postponed,  590  ; Tiffin 
Host  to  Northwestern  Ohio  Medical  Gathering,  723  ; 
Society  Annual  Elections,  775;  Union  Medical  Assn...  760 


District  Societies — (See  County  Societies) 


Meetings,  Annual — (See  Annual  Meetings;  Associations) 


Organization — 

Harmonious  Coordination  is  Necessary,  22 ; Organ- 
ized Medicine  and  Public  Health  Workers  Must  Co- 
operate, 52 ; Local  Leadership  in  Medical  Societies, 

91 ; Younger  Members’  Interest  in  Organization,  291  : 
Team  Work  Vital  Now,  356  ; Membership  Fortifi- 
cation, 483 ; Procedure  on  Social  Problems,  484  ; 
Urgent  Reasons  for  Early  Payment  of  1934  Dues, 

689  ; 1934  Membership  Dues  Should  Be  Paid  Prompt- 
ly, 753  ; Society  Annual  Elections 755 


388 

293 

293 

243 

176 

311 

556 

553 

424 

485 

633 

775 

183 

165 

297 

93 

698 

357 

428 

360 

28 

235 

23 

428 

487 

97 

761 

183 

493 

549 

436 

357 

693 

31 

239 

367 

232 

438 

496 

551 

553 

373 

621 

764 

764 

551 

700 

629 

767 

308 

165 

35 

705 

695 

170 

421 

179 

432 

105 

176 

771 

364 

311 

41 

757 

229 

111 


GENERAL 


Accidents — 

Infection  Following  Slight  Injuries  Takes  Big  Toll, 

96 ; Home  is  Scene  of  Numerous  Injuries,  Survey 
Shows,  104 ; Legislation  Provides  Reimbursement  to 
Some  Hospitals  for  Services  to  Indigents  in  Auto 
Accidents  722 

Advertising — 

Resolutions  on  Advertising  Adopted  by  Columbus 
Academy,  228 ; Exaggeration  in  Advertising  and 
Labeling  Many  Food  Products,  318 ; Classified  Ad- 
vertisements, 68  ; 204  ; 262  ; 398  ; 460  ; 526  ; 596  ; 662  ; 

732  799 

Alcohol — (See  Medicinal  Liquors) 

American  Medical  Association — 

Interesting  Decision  by  Judicial  Council,  A.M.A., 

Sets  a Precedent  in  Regard  to  Types  of  Contract 
Practice,  188 ; Ohio  to  Have  Prominent  Part  in 
A.M.A.  Annual  Meeting  in  Milwaukee,  381 ; A.M.A. 
Meeting  in  Cleveland  in  1934  ; 417  ; 548 ; Ohio’s  Par- 
ticipation in  A.M.A.  Meeting,  510  ; 512  ; Council  Con- 
sideration of  Joint  Meeting  of  Ohio  State  Medical 
Association  with  A.M.A.  in  Cleveland,  1934 649 

Associations — 

Officers  Elected  by  Federation  of  Public  Health  Offi- 
cials, 53 ; Northern  Tri-State  Program,  104 ; 238  ; 
Pathologists  Hold  Annual  Meeting,  187 ; Annual 
Meeting  of  Cleveland  Medical  Library  Association, 

231 ; Ohio  Eclectic  Medical  Association  Meeting, 

328 ; Northern  Tri-State  Meeting  Featured  by  At- 
tractive and  Instructive  Program,  382 ; Postgradu- 
ate and  Alumni  Day  in  Cincinnati,  June  9,  389; 

Six  Ohio  Physicians  Scheduled  to  Address  Inter- 
State  Assembly,  590  ; Northwestern  Ohio  Medical 
Meeting,  Tiffin,  October  3 662 


Attorney  General  Opinions — (See  also  Court  Decisions) 

Medical  Board  Ruling  on  Nurse  Applicants  Approved 
by  Attorney  General,  199 ; Opinion  on  Tuberculin 
Test  is  Given  by  Attorney  General,  327  ; Legal  Opin- 
ion on  Membership  on  District  Board  of  Health, 

382 : Federal  Laws  and  Regulations  on  Medicinal 
Liquor  Now  Apply  in  Ohio  ; Attorney  General  Holds 
Ohio  Law  Removed  Quantitative  Limitation,  514 ; 
County  Liable  for  Medical  Care  Rendered  in  Rabies 
Cases,  590  ; County  Home  Physicians  Must  Furnish 
Medicine  According  to  Attorney  General  Opinion. 

594  ; Hospital  Group  Payment  Plans  Proposed  by  the 
Cleveland  Hospital  Council — Attorney  General  Is- 
sues Ruling,  714 ; Ruling  on  Contract  of  Employ- 
ment by  Boards  of  Health,  717 ; Jurisdiction  of 
Health  Officers,  722 ; Osteopath  Ineligible  as  Medi- 
cal Witness  in  Lunacy  Proceedings 723 


Auditing  and  Appropriations — 

Report  and  Recommendations  to  Council  for  1933, 
46  ; Special  Council  Committee,  248 ; Annual  Report 
of  Committee,  Including  Report  of  the  Treasurer  and 


the  Annual  Audit s 578 

Books  Received — 

New  Books,  27  ; 42  ; 231 ; 310  ; 334  ; 372  ; 427  ; 498  ; 

708 ; 783  792 

Budget — 


Report  and  Recommendations  of  the  Auditing  and 
Appropriations  Committee  for  the  year  1933,  46  ; 
Health  and  Welfare  Budgets  for  1933-34  Biennium 
Submitted  to  Legislature 128 

Clinics — 

Plan  for  Control  Over  Medical  and  Dispensary  Serv- 
ice Adopted  in  Cincinnati,  376  ; Program  for  Clinics 
During  Annual  Meeting  in  Akron,  445 589 

Collections — 

Some  Practical  Suggestions  for  Collecting  Medical 
Fees,  Particularly  Applicable  to  Smaller  Cities  and 
Towns,  by  W.  B.  Andrews,  M.D.,  388;  Cleveland 
Academy  Inaugurates  Plan  to  “Rate”  Patients  Who 
Ai-e  Unable  to  Provide  Full  Medical  Payment,  450  ; 

Ohio  Supreme  Court  Establishes  Principle  that  Hus- 
band Not  Necessarily  Liable  for  Necessities — Medi- 
cal Service — Furnished  Wife,  452 ; Hospital  Group 
Payment  Plan  Proposed  by  the  Cleveland  Hospital 
Council ; Attorney  General  Issues  Ruling,  714  ; Medi- 
cal Fees  and  Collections,  756;  Physician  Should  Make 
Use  of  Business-Like  and  Well-Constructed  Letters 


in  Contacting  His  Patients,  Especially  Those  Delin- 
quent in  the  Payment  of  Bills,  by  G.  C.  Driver, 
Cleveland  - 793 


Colleges,  Medical — 

University  of  Cincinnati  College  of  Medicine  News, 

42.;  Centennial  Celebration  of  the  College  of  Medi- 
cine, Ohio  State  University - 726 

Constitution  and  By-Laws — 

Proposed  Amendments  Submitted  to  Council  by  Mont- 
gomery County,  45 ; Constitutional  Questions  Dis- 
cussed by  Council,  248 510 

Contract  Practice — 

Interesting  Decision  by  Judicial  Council,  A.M.A., 

Sets  a Precedent  in  Regard  to  Types  of  Contract 
Practice  188 

Cost  of  Medical  Care — 

Socialization  of  Medicine  Advocated  in  Majority  Re- 
port of  Committee  on  the  Costs  of  Medical  Care, 

19  ; Official  Statement  Issued  by  the  Council  on  the 
Report  of  the  Committtee  on  the  Costs  of  Medical 
Care,  45 ; 48 ; Business  Viewpoint  on  Medical  Cost 
Report,  92 ; Discussions,  Council  Meetings,  248 ; 
Caustic  Critic  and  Wise-Cracker  Extraordinary  Dis- 
sects Costs  of  Medical  Care  Report  and  Social  Phases 
of  Medical  Service,  251 ; One  Phase  of  Education 691 

Court  Decisions— 

Supreme  Court  Decision  Strengthens  Law  Enforce- 
ment in  Prosecution  of  Violators  of  Medical  Prac- 
tice Act,  130  ; Degree  of  Skill  Required  by  Doctors 
Interpreted  by  Court,  163 ; Ownership  of  X-Ray 
Plates,  Liability  of  Physicians  to  Family  of  Patient, 
Municipal  Hospital  Responsibilities  and  Other  Medi- 
cal-Legal Questions  in  Recent  Court  Decisions,  200  ; 

Ohio  Supreme  Court  Establishes  Principle  that  Hus- 
band Not  Necessarily  Liable  for  Necessities — Medical 
Service — Furnished  Wife,  452  ; Court  Ruling  on  Fee 
Splitting,  692  ; Court  Decision  on  Injunction  Against 


Illegal  Practice 726 

Cult  School,  A High-Sounding  Title  for 195 

Deaths  in  Ohio — 

63;  131;  195;  262  ; 325  ; 396  ; 456;  518;  593;  665; 

724  795 

Dentists — 

Dental  Education  Started  in  Ohio  as  an  Early  Spe- 
cialty of  Medicine 204 

Diabetes — 


Death  Rate  Increase  Attributed  to  Better  Diagnosis..  330 
Economics — * 

Saving  for  Sickness,  92  ; History  in  the  Making,  225  ; 
Constitutional  Reconstruction.  226  ; Variations  in 
Social  Theory,  354  ; Participation  in  Social  Problems, 

355 ; Redoubled  Interest  and  Effoi’t  Necessary,  419  ; 
Ethical  and  Economic  Questions,  618  ; Modern  Social 
Program,  689;  Education  in  Economics, . 690  : Medical 
Fees  and  Collections,  756;  Economic  Planning 756 

Ethics — 

Privileges  and  Principles  of  the  Profession,  227 ; 
Code  of  Conduct  Still  Fundamental,  546  ; Ethical  and 
Economic  Questions,  618  ; Ethics  and  Economics  Dis- 
cussed by  Dr.  Follansbee  at  the  Annual  Organization 
Luncheon  Held  in  Akron,  655  ; Court  Ruling  on  Fee 


Splitting  692 

Expert  Testimony — 

Osteopath  Ineligible  as  Medical  Witness  in  Lunacy 
Proceedings  723 

Federal  Legislation — (See  Government;  Legislation) 

Federal  “Economy  Measure”  May  Result  in  Equitable 
Adjustment  of  Benefits  to  Military  Veterans 254 


Fees — 

Acute  and  Serious  Problems  in  Workmen’s  Com- 
pensation ; State  Association  Presents  Recommenda- 
tions for  Procedure  and  Opposes  Fee  Schedule  Re- 
duction, 377  ; Workmen’s  Compensation  Problems  of 
Administration,  Finance  and  Reduct'on  of  Medical 
and  Surgical  Fee  Schedule,  441  ; Medical  Fees  and 
Collections  756 


Foods — 

Exaggeration  in  Advertising  and  Labeling  Many 
Food  Products,  318 ; Drastic  Revision  of  Food  and 
Drug  Act  Proposed 427 

General  Assembly — 

Important  Legislative  Issues  Affecting  Public  Health 
and  Medical  Practice  Anticipated  in  90th  General 
Assembly,  17  ; Vital  Problems  Confront  the  Legis- 
lature, 89 ; The  Ohio  Legislative  Situation,  161  ; 
Hectic  and  Colorful  Session  of  Ohio  Legislature 


Established  Various  “Records”  but  It  Properly  Re- 
frained from  Damaging  Present  Health  and  Medical 
Statutes  - - 447 

Goiter,  American  Society  for  Study  of 760 

Government — (See  also  Legislation) 

Unwarranted  Governmental  Competition,  164  ; His- 
tory in  the  Making,  225  ; Constitutional  Reconstruc- 
tion   226 

Health — (See  Ohio  State  Department  of  Health;  Public 
Health) 

Hospitals — 


Municipal  Hospital  Responsibilities,  200  ; Group  Plans 
for  Hospital  Service,  227  ; Hospital  Insurance  Pro- 
posals, 354  ; A Unique  Plan  of  Group  Medical  Care, 

356  ; Plan  for  Control  Over  Med  cal  and  Dispensary 
Service  Adopted  in  Cincinnati,  376  ; Qualifications  for 
Hospital  Superintendent,  383  ; Some  Examples  of 
Unfair  Competition,  483  ; Annual  Report  of  the  Com- 
mittee on  Medical  Education  and  Hospitals,  573  ; 
Hospital  Insurance,  620  ; Hospital  Group  Payment" 
Plans  Proposed  by  the  Cleveland  Hospital  Council  — 
Attorney  General  Issues  Ruling,  714  ; Legislature 
Provides  Reimbursement  to  Some  Hospitals  for  Ser- 
vices to  Indigents  Injured  in  Auto  Accidents,  722  ; 
Hospital  Group  Insurance  Plans — Report  and  Reso- 
lutions ..  777 

Hospital  News  Notes  197  ; 255  ; 329  ; 385  ; 460  ; 730  ; 802 

House  of  Delegates — 

Official  Proceedings,  Annual  Meeting,  Akron,  1933  _ 636 

Hygiene — (See  Mental  Hygiene) 

Income  Tax — (See  Taxation) 

Indigents — (See  Poor  Relief) 

Industrial  Commission  of  Ohio — (See  Workmen’s  Com- 
pensation) 

Injuries — (See  Accidents) 

Insurance — (See  also  State  Medicine) 

Hospital  Insurance  Proposals,  354  ; Medical  Socialism, 

620  ; Hospital  Insurance,  620  ; Warning  Against 
Rackets,  692.  Insurance  Coverage,  755.  Hospital 
Group  Insurance  Payment  Plans - 777 

Laws — (See  Legislation) 

Legal  Opinions — (See  Court  Decisions) 

Legislation — (See  Government) 

Important  Legislative  Issues  Anticipated  in  90th  Gen- 
eral Assembly,  17  ; 46  ; Vital  Problems  Confront  the 
Legislature,  89  ; The  Ohio  Legislative  Situation,  161  ; 
Legislation  and  Machinery  in  Ohio  for  “Relief” 
During  Remainder  of  1932-33  Biennium,  257  ; Legis- 
lative Problems  are  Still  Serious,  289  ; Drastic  Re- 
vision of  Food  and  Drug  Act  Proposed,  427  ; Record- 
Making  Legislative  Session  Comes  to  an  End,  513 ; 
County  Home  Rule  Amendment  Up  to  the  Voters  ..  628 

Licensure — (See  Ohio  State  Medical  Board) 

Malpractice — (See  Medical  Defense) 

Medical  Defense — 

Report  to  Council  on  Conferences  with  State  Bar 
Association  re  Unauthorized  Practice  of  Law,  45 ; 
Degree  of  Skill  by  Doctors  Interpreted  by  Court, 

163 ; Liability  of  Physicians  to  Family  of  Patient, 


200  ; Annual  Report  of  Committee  570 

Medical  Economics — (See  Economics) 

Annual  Report  of  Committee  on 563 

Medical  Education — 


Dental  Education  Started  in  Ohio  as  an  Early  Spe- 
cialty in  Medicine,  204  ; Annual  Report  of  The  Com- 
mittee on  Medical  Education  and  Hospitals,  573  ; 


Education  in  Economics,  690 ; One  Phase  of  Edu- 
cation   691 

Medicine Medical  Profession 

Unwarranted  Governmental  Competition,  164 ; Lia- 
bility of  Physician  to  Family  of  Patient,  200  ; Privi- 
leges and  Principles  of  the  Profession,  227  ; Caustic 
Critic  and  Wise-Cracker  Extraordinary  Dissects 
Cost  of  Medical  Care  Report  and  Social  Phases  of 
Medical  Service,  251  ; Shall  Medicine  Avoid  Com- 
mercial Chaos,  290  ; An  Interesting  Lay  View  on 
State  Medicine,  292 ; Variations  in  Social  Theory, 

354  ; Participation  in  Social  Problems,  355  ; A Unique 
Plan  of  Group  Medical  Care  (Detroit  Plan),  356; 
Medicine, — Science,  Art  or  Religion,  418  ; Health 
Work  and  Private  Practice,  419  ; Vital  Factor  of 
Human  Nature,  481  ; Some  Examples  of  Unfair 
Competition,  483  ; Code  of  Conduct  Still  Funda- 
mental, 546 ; Participation  in  Public  Affairs,  547 ; 
Lessons  Learned  From  Adversity,  548  ; National  Re- 
covery Administration  Interpretation  Affecting  the 
Medical  Profession,  575 ; County  Home  Physicians 
Must  Furnish  Medicine  According  to  Attorney  Gen- 
eral Opinion,  594  ; Problems  of  Collectivism  691 

Medicinal  Liquor — 

Radical  Changes  in  Near  Future  in  Federal  and  State 
Regulations  on  Prescribing,  319  ; Medicinal  Liquor 
Prescription  Question  Subject  to  Court  Interpretation 
Between  Ohio  and  Federal  Statutes.  380  : Medicinal 
Liquor  Prescriptions,  482  ; Federal  Laws  and  Regu- 
lations on  Medicinal  Liquor  Now  Apply  in  Ohio; 
Attorney  General  Holds  Ohio  Law  Removed  Quan- 
titative Limitation 514 

Meetings — (See  Associations;  County  Societies;  Annual 
Meetings) 

Membership — (See  Organization) 

Communication  to  Council  re  Action  of  a County 
Society  in  Suspending  Membership,  45  ; 249 ; 778  ; 
Membership  Fortification,  483  ; Urgent  Reasons  for 
Early  Payment  of  1934  Dues,  689  ; 1934  Membership 
Dues  Should  Be  Paid  Promptly 753 

Mental  Hygiene — 

Mental  Health  of  Nation  Affected  by  Depression, 

264 ; Report  of  Election  of  Officers,  Ohio  Mental 
Hygiene  Association  387 

Military  Committee — 

Annual  Report  of  the  Committee  on  Military  and 
Veterans’  Affairs,  580  ; Military  Course  for  Reserve 
Officers  590 

Mortality  and  Morbidity  Statistics — (See  Vital  Statistics) 


National  Recovery  Administration — 

Interpretation  Affecting  the  Medical  Profession,  576  ; 

N.  R.  A.  Provisions  Discussed  by  Council 648 

News  Notes — 

News  Notes  of  Ohio,  66  ; 127  ; 142  ; 196  ; 266  ; 328  ; 

384  ; 458  ; 596  ; 729 798 

Nostrums  and  Quackery — 

“Miracle  Man  of  1932”  and  His  Subsidiary  Shoe 


Stock,  7(5  ; Newspaper  Publicity  re  Telescopic  Spec- 
tacles for  Blind,  310 ; Sale  of  Theronoid  Belt  En- 
joined, 453  ; Imposter  Nabbed  in  Columbus  ..  723 

Nurses — 

A Large  Proportion  of  Nurses,  Outnumbering  Physi- 
cians, Are  in  Public  Health  and  Institutional  Serv- 
ice, 184  ; Medical  Board  Ruling  on  Nurse  Applicants 
Approved  by  Attorney  General,  199  ; Steps  Taken  to 
Meet  Over-Production  and  Unemployment  Among 
Graduate  Nurses,  201  ; Communication  to  Council 
from  State  Nurses’  Association  re  Employment  of 
Registered  Nurses,  648 ; Interesting  Comparative 
Data  on  Nursing  Education  Has  Just  Been  An- 
nounced for  Ohio 718 

Occupational  Diseases — (See  Workmen’s  Compensation) 

Ohio  Commission  for  the  Blind,  Members  Appointed  to  727 

Ohio  State  Department  of  Health — (See  Public  Health) 

Changes  in  Staff  Heads,  42  ; Important  Public  Health 
Questions  Discussed  at  Well-Attended  Conference  of 
Commissioners  and  Public  Health  Nurses,  51  ; 
Health  Department  Orders  Requiring  Adequate  Sew- 
age Disposal  Upheld  by  Court,  129 ; Year  1932 
Healthful  One  for  Ohioans,  State  Report  Shows. 

256  ; Legal  Opinion  on  Membership  on  District  Board 
of  Health,  382  ; Specimens  to  State  Laboratory  Can 


Be  Sent  at  Lower  Postage  Rates  if  Rules  Are  Ob- 
served, 383 ; Annual  Health  Commissioners’  Confer- 
ence, October  19  and  20,  659  ; Attorney  General 
Ruling  re  Employment  by  Boards  of  Health,  717 ; 
Jurisdiction  of  Health  Officers,  722  ; Fourteenth  An- 
nual Conference  of  Health  Commissioners,  723  ; 784  ; 
Cooperation  with  Public  Health  Administration 754 

Ohio  State  Medical  Board — 

Mid-Winter  Examinations  Taken  by  44  Medical  Stu- 
dents and  953  Nurses ; Medical  Examination  -Ques- 
tions, 57  ; Supreme  Court  Decision  Strengthens  Law 
Enforcement  in  Prosecution  of  Violators  of  Medical 
Practice  Act,  130;  Thirty  _ New  Physicians  Licensed 
in  Ohio,  140  Medical  Board  Ruling  on  Nurse  Ap- 
plicants Approved  by  Attorney  General,  199  ; Physi- 
cians Licensed  Through  Reciprocity,  202  ; Next  Medi- 
cal Exams,  June  6-9,  334  ; Resolution  of  Federation 
of  State  Medical  Boards  re  Admission  to  Practice, 

334  ; Mid-Summer  Medical  Board  Examinations 
Taken  by  348  Applicants ; Questions  Asked  Medical 
Graduates,  451  ; Licenses  to  Practice  Medicine  and 
Surgery  in  Ohio  Issued  to  237  at  July  Meeting, 

518 ; Licensed  to  Practice  in  Ohio  Through  Reci- 


procity, 592  ; Medical  Exams,  December  6,  7,  8 732 

Osteopathy — 

Osteopath  Ineligible  as  Medical  Witness  in  Lunacy 
Proceedings  723 


Poor  Relief — 

Legislation  and  Machinery  in  Ohio  for  “Relief” 
During  Remainder  of  1932-33  Biennium,  257  ; Pai*- 
ticipation  in  Social  Problems,  355 ; Problems  of 
Medical  and  Hospital  Care  of  the  Indigent  Sick, 

510  ; Problems  of  “Relief”  to  the  Indigent  and  Un- 
employed Including  Local  Phases  of  Medical  Care, 

516 ; Problems  of  the  Indigent  Sick,  648  ; Medical 
Care  to  Indigents  and  Needy  Unemployed  and  Com- 
pensation to  Physicians  is  Legal  Duty  of  Federal, 
State  and  Local  Governments,  663 ; Problems  and 
Developments  in  Plans  for  Medical  Care  to  the  Needy 
Unemployed  Through  Federal  Funds,  with  Emphasis 
on  Local  Activity  in  Addition  to  Local  Legal  Re- 
sponsibility, 710 ; Problems  of  Medical  Care  to  the 
Needy  Unemployed,  776  ; Council  of  State  Medical 
Association  Requests  Changes  in  Administrative 
Procedure  for  Medical  Care  of  the  Needy  Unem- 
ployed   - 780 

Periodic  Health  Examinations — 

Annual  Report  of  the  Committee  on  Preventive  Medi- 
cine and  Periodic  Health  Examinations,  576 ; Com- 
mittee Appointments  for  1934 779 

Practice,  Medical — (See  Medicine;  Medical  Profession) 

President — 

Annual  Address  of  the  Retiring  President,  H.  M. 
Platter,  M.D.,  621 ; Inaugural  Address  of  the  In- 


coming President,  C.  L.  Cummer,  M.D 625 

President’s  Page,  43  ; 123 ; 186  ; 247  ; 315  ; 373  ; 440  ; 

508 ; 586  709 

Probst,  C.  0„  M.  D.  Tribute  to  Late, _ 713 

Publication  Committee — 

Annual  Report  of  Committee  on 568 


Public  Health — (See  also  Ohio  State  Department  of 
Health) 

Miscellaneous  Public  Health  Projects  Summarized 
and  Discussed  at  Annual  Health  Commissioners’ 
Conference,  52 ; Undulant  Fever  Now  Listed  as 
Major  Public  Health  Problem,  324 ; Health  Work 
and  Private  Practice,  419  ; Concerning  Public  Health 
Administration,  546  ; Participation  in  Public  Affairs, 

547  ; Some  Problems  of  Health  Education,  619  ; The 
Economic  Status  of  Public  Health  Administration, 

695  ; Cooperation  with  Public  Health  Administration  . 754 

Public  Health  Notes,  201 ; 268  ; 332 ; 386  ; 460  ; 

727  804 

Public  Policy — (See  Legislation;  Government;  Eco- 
nomics) 

Committee’s  Report  to  Council,  250  ; Annual  Report ..  557 
Quackery — (See  Nostrums) 


Rabies,  County  Liable  for  Medical  Care  Rendered 690 

Reciprocity — New  Physicians  Licensed  in  Ohio  Through, 

202  ; 592  _ 766 

Reports,  Annual — (See  Committees) 

Annual  Reports  in  September  Issue,  645  ; House  of 
Delegates  Committee  Report  on  Annual  Reports 640 


Resolutions — (See  Council  Minutes;  House  of  Delegates’ 
Minutes) 

Sewage  Disposal — 

Health  Department  Orders  Requiring  Adequate  Sew- 
age Disposal  Upheld  by  Court 129 

Social  Service — (See  Economics) 

Socialism — (See  State  Medicine  and  Economics) 

Socrates  Asklepian— 

Discourse  on  Higher  Learning,  185 ; Discourse  on 


the  Debunkment  of  Healing 371 

State  Institutions — 

Health  and  Welfare  Budgets  for  1933-34  Biennium 

Submitted  to  Legislature 128 

Housing  Conditions  at  Many  State  Institutions 
“Shocking”  Report  by  Legislators  Declares 387 


State  Medicine — 

Socialization  of  Medicine  Advocated  in  Majority  Re- 
port of  National  Committee  on  the  Costs  of  Medical 
Care,  19 ; Shall  Medicine  Avoid  Commercial  Chaos, 

290  ; An  Interesting  Lay  View  on  State  Medicine, 

292  ; Medical  Systems  in  Austria  Are  Described  by 
American  Physician,  376  ; Is  State  Medicine  Neces- 
sary, 482 ; Medical  Socialism 620 

Taxation — 

Taxability  of  Electrical  Energy,  70  ; Federal  Income 
Tax  Returns  Must  be  Made  Before  March  15 ; Pro- 
cedures Physicians  Should  Follow  Outlined  and 
Changes  in  Rates  and  Regulations  Analyzed,  124 ; 
State  Personal  Property  Tax  Returns,  127  ; What  to 
Do  If  Unable  to  Pay  Your  Federal  Income  Tax 329 

Theronoid  Belt  Sale  Enjoined - 453 

Tuberculosis — 

Opinion  on  Tuberculin  Test  is  Given  by  Attorney 
General,  327  ; Tributes  to  Late  Dr.  Probst  Read  at 
T.  B.  Conference 713 

Undulant  Fever- — 

Now  Listed  as  Major  Public  Health  Problem 324 

United  States  Public  Health  Service — (See  Public  Health) 
Statistical  Study  in  Cases  of  Influenza  and  Pneu- 

United  States  Veterans’  Bureau — 

Unwarranted  Governmental  Competition,  164 ; Fed- 
eral “Economy  Measure”  May  Result  in  Equitable 
Adjustment  of  Benefits  to  Military  Veterans,  254 ; 
Government’s  Administrative  Policy  on  Veterans’ 
Benefits,  316  ; Annual  Report  of  the  State  Associa- 
tion Committee  on  Military  and  Veterans’  Affairs, 

580  ; Present  Policy  on  Veterans’  Benefits 690 

Vital  Statistics — 

Year  1932  Healthful  One  for  Ohioans,  State  Report 
Shows,  256  ; Decrease  Shown  in  Birth  and  Infant 
Mortality  Rates  in  United  States  During  Year,  1931, 

270 ; Need  for  Standard  Statistics,  420 ; Depression 
Accelerating  Decline  in  Nation’s  Birth  Rate,  439  ; 
United  States  Birth  and  Infant  Mortality  Rates 
Show  Decline  During  Year  1932,  462;  Nation’s  Mor- 


tality Rate  in  1932  is  Lowest  Ever  Recorded 725 

Welfare,  Department  of — (See  State  Institutions) 

Health  and  Welfare  Budgets  for  1933-34  Biennium 
Submitted  to  Legislature 128 


Workmen’s  Compensation — 

Problems  of  Workmen’s  Compensation  Discussed  at 
Council  Meeting,  44 ; Infection  Following  Slight  In- 
juries Takes  Big  Toll,  96  ; Court  Decision  on  Limita- 
tion for  Reopening  Cases,  200  ; Decrease  Noted  in  Oc- 
cupational disease  Claims  During  1932,  314 ; Work- 
men’s Compensation  Developments,  374 : Acute  and 
Serious  Problem  in  Workmen’s  Compensation  ; State 
Association  Presents  Recommendations  for  Proced- 
ure and  Opposes  Fee  Schedule  Reduction,  377  ; 
Workmen’s  Compensation  Problems  of  Administra- 
tion, Finance  and  Reduction  of  Medical  and  Surgical 
Fee  Schedule,  Subject  of  Report  by  Committee  of 
the  Ohio  State  Medical  Association,  441 ; Workmen's 
Compensation  Developments,  509  ; Ohio  Senate  Com- 
mittee to  Investigate  Workmen’s  Compensation  Ad- 
ministration, 626  ; New  Member  of  State  Industrial 
Commission,  526  ; Workmen’s  Compensation  Devel- 
opments Following  Audit  of  Funds  and  Increase  in 
Premiums  Assessed  Against  Employers,  591 ; Work- 
men’s Compensation  Problems,  647  ; Report  of  Bu- 
reau of  Occupational  Diseases,  State  Department  of 
Health,  727  ; Workmen’s  Compensation  Problems 777 

X-Ray— 

X-Ray  Service  with  Industrial  Commission,  44 ; 778 ; 
Ownership  of  X-Ray  Plates 200 


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